Smoking ban in Scotland has greater impact than expected

In a recent issue of the New England Journal of Medicine, Mackay et al. (N Engl J Med 2010, 363:1139-1145) follow up on the outcome of a 2006 smoking ban in enclosed public places in Scotland. The law was enacted to protect workers exposed to occupational smoke, such as bar workers. To examine evidence for a wider impact, data from the Scottish Morbidity Record (SMR) was pulled for asthma-attributed hospital admissions for infants and children up to 14 years.

Banning smoking in public places has been shown to reduce acute myocardial infarction deaths and hospitalizations as well as decrease hospital admissions because of respiratory conditions, but there have been no studies on how the bans affect asthma in children.

In Scotland, prior to the 2006 ban, there was an increasing trend in admissions for childhood asthma symptoms. After the ban, Mackay et al. report a significant reduction in asthma-related admissions by 13%. They discuss previous studies that have reported significant reduction in respiratory symptoms of workers exposed to occupational smoke as well – even if they are smokers.

Of particular interest, Mackay et al. discuss concerns among Scottish public health officials that the ban would cause increased smoking in the home. In fact, studies had found that voluntary smoking bans in the home increased after the legislation based on objective findings of salivary cotinine in children from those homes.

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The Lancet focuses on asthma

To coincide with the European Respiratory Society meeting in Barcelona, which starts on September 18th, The Lancet's September 4 issue highlights asthma in four review articles. The articles cover areas of asthma care in vulnerable populations, areas that are in desperate need of attention as the incidence rises and patients with asthma are living longer.

Gibson et al. (Lancet 2010, Vol 376:803-813) discuss the complexity and lack of research on management of elderly patients with asthma, noting that their age and comorbidities exclude them from most clinical trials. Bush and Saglani (Lancet 2010, Vol. 376:814-825) hit the other age-related knowledge gap; that is, pediatric asthma patients, especially those with severe, refractory asthma. They comment that this population faces the same obstacles to clinical research that elderly patients with asthma have. Moreover, clinical trials in this age group are needed to understand medical needs in young children.

Busse et al. (Lancet 2010, Vol 376:826-834) discuss the need for better understanding of the mechanisms by which respiratory viruses increase risk of asthma as well as increase susceptibility asthma exacerbation in order to more effectively manage and prevent asthma. Finally, Lambrecht and Hammad (Lancet 2010, Vol. 376:835-843) review the state of knowledge about dendritic cells and their collusion with airway epithelium that results in allergic sensitization and asthma.

Tell us what you think. Please feel free to post your own comments and/or predictions below. Topics and articles that you think would be of interest in our NBOP section and/or this blog can be sent to the JACI Editorial Office at jaci@njhealth.org.

NIH Director responds to stem cell research injunction

Francis S. Collins, M.D., Ph.D., Director, National Institutes of Health, released a statement two days after a controversial injunction on stem cell research was issued by the US District Court of the District of Columbia. Dr. Collins stated that “(t)he recent court ruling that halted the federal funding of human embryonic stem cell research could cause irreparable damage and delay potential breakthroughs to improve care for people living with serious diseases and conditions such as spinal cord injury, diabetes, or Parkinson’s disease. The injunction threatens to stop progress in one of the most encouraging areas of biomedical research, just as scientists are gaining momentum—and squander the investment we have already made.” (For the complete statement go to: http://www.nih.gov/about/director/08262010statement_stemcellinjunction.htm.)

The preliminary injunction ordering the temporary halt of all government funding of stem cell research is based on the case Sherley vs. Sebelius. The suit is brought by Christian groups to challenge President Obama’s reversal of the Bush administration’s increased restrictions on NIH funding of stem cell research under the Dickey-Wicker Amendment

The Dickey-Wicker Amendment prohibits federal funding for “(1) the creation of a human embryo or embryos for research purposes; or (2) research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death greater than that allowed for research on fetuses in utero under” applicable federal regulations.

President Bush’s executive order in 2001 permitted funding induced pluripotential stem cell (iPSC) research, but prohibited federal funding for research on embryonic stem cells (ESCs) that were created after the date of the policy statement. Interestingly, federal funding remained available for research on ESCs that were created by private researchers prior to his policy statement.

Two physicians, Drs. James Sherley, of the Boston Biomedical Research Institute, and Theresa Deisher, of Ave Maria Biotechnology Company, are co-plaintiffs with Nightlight Christian Adoptions and the Christian Medical Association. Ave Maria Biomedical Research Institute is a Seattle-based firm co-founded by Dr. Deisher to establish ethical alternatives to embryonic stem cell research.

Tell us what you think. Please feel free to post your comments below. Topics and articles that you think would be of interest in our NBOP section and/or this blog can be sent to the JACI Editorial Office at jaci@njhealth.org.