For the third straight year, we have prepared a roundup of the year's most important developments in biomedicine. And for the third year running, we found ourselves wondering whether there is an adequate way to select the papers that can genuinely lay claim to the designation of key advances of the year. Is it really fair to choose the discovery of axonal abnormalities in Alzheimer disease over the use of factor VII to treat hemorrhagic stroke? Or to pick the successful delivery of babies born from transplanted ovaries over the extension of lifespan achieved by overexpressing catalase in mitochondria? Unfortunately, but not unexpectedly, objectivity is a precious commodity when trying to answer questions like these, and you may find that your favorite paper of 2005 didn't make the roundup. But we hope that you'll realize that we can devote only so many pages to this roundup, and must leave out some contributions that deserve recognition.

Choosing the key political and social events that shaped biomedicine in 2005 wasn't as taxing as identifying the top papers. This is perhaps because the prominence of science in the mind of the average person is arguably at an all-time high. Biomedicine is everywhere—from the temple to the media to the politician's desk. It is in chat rooms, in blogs, even in podcasts.

In the US, for example, stem cells are a political issue for almost every race for public office; if a candidate finds herself on the wrong side of the debate, it might make the difference between victory and defeat. On a global scale, the threat of a flu pandemic has become standard fodder for the evening news. The high visibility of newly approved drugs, courtesy of direct-to-consumer advertising, is matched only by the parallel rise in concerns about their efficacy and safety. And this year Charles Darwin had to face trial once more, meeting his latest foe—intelligent design.

Reflecting on these stories, the case of stem cells is particularly fascinating, and it will certainly give us more to talk about in 2006. The excitement—or what some might call hype—about their potential to cure disease gained momentum in 2005, and crystallized in the creation of a number of stem cell research centers in America, Europe and Asia. But despite this worldwide enthusiasm, the visions of countries like South Korea and the US about how to realize the potential of stem cells continue to be as diametrically opposed as their positions on the planet. While in the US scientific evidence has taken a back seat to political ideology, in South Korea fresh allegations of ethical breaches indicate that boundaries could also be pushed a bit too far in the other direction. Paradoxically, therapeutic advances using stem cells in animal models were rather limited in 2005. Will the promise of stem cells be as difficult to fulfill as the potential of gene therapy has been? The settlement last January in the case of Jesse Gelsinger, who died in a gene therapy clinical trial, reminds us that caution is well advised when expecting fast and striking results. But as Eric Topol predicts in our roundup, the flurry of uninterpretable stem cell trials in 2006 will not be stopped.

Bird flu will also be a topic of conversation next year. Although numerous experts have voiced their concerns about the danger of avian flu for years, preparedness for a potential pandemic only started to pick up speed in 2005. Ironically, despite the impromptu efforts to get ready, welcomed by many but dismissed by others as 'too little, too late', we will only know whether we're truly prepared if and when a pandemic breaks out. And as is the case too often, the needs of developing countries may fall through the cracks, leaving their inhabitants in a particularly vulnerable position. The silver lining of this story is that the increased awareness about the need to optimize vaccine production will finally move us away from the currently used egg-yolk technology and closer to recombinant DNA techniques.

In addition to this increased awareness, there were some other positive developments for biomedicine in 2005—the unrelenting benefaction of the Bill & Melinda Gates Foundation, the generosity of several pharmaceutical companies that donated or gave away the rights to some of their drugs and Europe's efforts to boost up science across the continent are a few examples. But the truth is that the overall balance for 2005 cannot be called positive. And if we don't want to go as far as calling it negative, there's always the option to call 2005 an interesting year, in which case there may be something to the claim that 'May you live in interesting times' is an ancient Chinese curse. Oddly enough, the Chinese disown this phrase, putting forward a proverb truly of their own: 'It's better to be a dog in a peaceful time than a man in a chaotic period'. This year was fortunately not that bad. We can only hope that 2006 won't get to be too 'interesting'.