Kidney Drugs Hampered By High Blood Phosphate Levels

High blood phosphate levels can set chronic kidney disease (CKD) patients on a rapid path to kidney failure, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). To make matters worse, phosphate appears to interfere with the effectiveness of important kidney medications.

The kidneys of patients with CKD cannot efficiently get rid of wastes such as excess phosphate in the blood. As a result, the kidneys become overloaded with phosphate. Carmine Zoccali, MD (CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Italy) and his colleagues wondered how this phosphate overload affects the kidneys of patients with CKD. They also wondered whether phosphate overload alters the effects of ramipril, a drug prescribed to slow the progression of kidney disease. (The use of ramipril and other drugs in its class represents the current standard of care for patients with CKD.)

The researchers studied health information from 331 CKD patients, dividing patients into four groups based on their phosphate levels.

Among the major findings:

– Even though their blood phosphate was still normal or near normal, patients in the two highest phosphate groups progressed more quickly to serious kidney dysfunction or kidney failure than patients with lower phosphate levels.

– Higher phosphate levels blunted ramipril’s benefits.

These results suggest that phosphate levels can predict which CKD patients are in serious trouble of developing kidney failure. They also show that high phosphate levels block the beneficial effects of important kidney medications.

Future studies should test whether reducing phosphate improves kidney health and optimizes patients’ medications. “Our study opens the exciting possibility that reducing phosphate, either by diet or drug treatment, may enhance CKD patients’ response to certain drugs,” said Dr. Zoccali. “If our findings are replicated in a new clinical trial, interventions aimed at reducing phosphate will be a relevant step forward in the fight against these dangerous kidney diseases,” he added.

Source: American Society of Nephrology (ASN)

Women Who Sleep Badly In More Danger Than Men

Researchers at Duke University Medical Center say they may have figured out why poor sleep does more harm to cardiovascular health in women than in men.

Their study, appearing online in the journal Brain, Behavior and Immunity, found that poor sleep is associated with greater psychological distress and higher levels of biomarkers associated with elevated risk of heart disease and type 2 diabetes. They also found that these associations are significantly stronger in women than in men.

“This is the first empirical evidence that supports what we have observed about the role of gender and its effects upon sleep and health,” says Edward Suarez, an associate professor in the department of psychiatry and behavioral sciences at Duke and the lead author of the study. “The study suggests that poor sleep – measured by the total amount of sleep, the degree of awakening during the night, and most importantly, how long it takes to get to sleep – may have more serious health consequences for women than for men.”

Suarez says that while women are twice as likely as men to report problems with sleep, most sleep studies in the past have focused on men, a phenomenon that has been slowly changing in recent years.

Researchers studied 210 apparently healthy, middle-aged men and women without any history of sleep disorders. None smoked or took any medications on a daily basis and investigators excluded any women who were on hormone therapy, which has been shown in some studies to alter sleep patterns in some women.

Using a standardized sleep quality questionnaire, participants rated various dimensions of their sleep during the previous month. Additional measures assessed the extent of any depression, anger, hostility and perceived social support from friends and family.

Blood samples taken from the volunteers were measured for levels of biomarkers associated with increased risk of heart disease and diabetes, including insulin and glucose levels, fibrinogen (a clotting factor) and two inflammatory proteins, interleukin-6 and C-reactive protein.

The researchers found that about 40 percent of the men and the women were classified as poor sleepers, defined as having frequent problems falling asleep, taking 30 or more minutes to fall asleep or awakening frequently during the night. But while their sleep quality ratings were similar, men and women had dramatically different risk profiles.

“We found that for women, poor sleep is strongly associated with high levels of psychological distress, and greater feelings of hostility, depression and anger. In contrast, these feelings were not associated with the same degree of sleep disruption in men,” says Suarez.

Women who reported higher degree of sleep disruption also had higher levels of all the biomarkers tested. For women, poor sleep was associated with higher levels of C-reactive protein and interleukin-6, measures of inflammation that have been associated with increased risk of heart disease, and higher levels of insulin. The results were so dramatic that of those women considered poor sleepers, 33 per cent had C-reactive protein levels associated with high risk of heart disease, says Suarez.

“Interestingly, it appears that it’s not so much the overall poor sleep quality that was associated with greater risk, but rather the length of time it takes a person to fall asleep that takes the highest toll,” says Suarez. “Women who reported taking a half an hour or more to fall asleep showed the worst risk profile.”

The study was supported by a grant from the National Institutes of Health.

Suarez says he’s planning further studies to understand the complex relationship between health risk and poor sleep in men and women. He believes that the gender differences may be due, in part, to variation in the activity of a number of naturally occurring substances in the body, such as tryptophan, an amino acid; serotonin, a neurotransmitter; and melatonin, a neurohormone. “All of these substances are known to affect mood, sleep, onset of sleep, inflammation and insulin resistance,” he says.

“Good sleep is related to good health. More research needs to be done to define gender-linked responses to poor sleep, including the role that sex hormones play over a lifetime and how sleep needs and responses change from childhood to maturity,” says Suarez.


Source: Michelle Gailiun

Duke University Medical Center

Grant For Rice’s Global Health Program Renewed By HHMI

The Howard Hughes Medical Institute (HHMI) today awarded a $1.2 million, four-year grant to continue Rice University’s successful undergraduate global health program Beyond Traditional Borders (BTB).

BTB, which began with a $2.2 million HHMI grant in 2006, challenges students to come up with practical solutions to real-world problems in the developing world. The program has captured the imagination of Rice’s students; more than 10 percent of the university’s undergraduates have taken a BTB class since 2006, and several dozen students have traveled to developing nations to test their designs in local clinics.

“Our program aims to open students’ eyes to the challenges of global health and to help them use the tools of science and engineering to design solutions that are affordable, effective and culturally appropriate,” said BTB creator Rebecca Richards-Kortum, Rice’s Stanley C. Moore Professor of Bioengineering. “HHMI’s continued support will allow us to expand our undergraduate and K-12 initiatives.”

The technologies BTB students have created include:
A low-cost fluorescence microscope that makes malaria and tuberculosis diagnosis easier.
A “lab-in-a-backpack” full of diagnostic tools – including a microscope, centrifuge and rapid tests – that nurses in the developing world can use to accurately determine what is making a patient sick.
A tiny clip that pharmacists can attach to a syringe to help parents and other caregivers deliver the proper dose of medicine to children.

BTB students take global health courses and work in teams to solve challenging health problems. In their first BTB class, students get an introduction to biomedical engineering and design a simple solution to a real-world global health problem. From there, they can enroll for a global health minor – which includes four additional BTB classes and two related electives – and tackle progressively more difficult design problems.

The new HHMI grant will allow Rice to expand BTB to a national scale. BTB’s annual outreach workshop for high school teachers plans to recruit the best science and engineering teachers from across the country. Rice will also invite students from other universities and from high schools whose teachers were trained in the K-12 workshop to participate in an international health-technologies design conference and competition.

“I’m excited about the opportunity for students nationwide to be a vital part of the process of designing a new technology and seeing the impact that it has,” Richards-Kortum said. “I think we’re creating a generation of students who can design solutions to important global health problems.”

Rice is one of 50 research universities in 30 states and the District of Columbia that are receiving a total of $70 million from HHMI to strengthen undergraduate and precollege science education nationwide.

Jade Boyd
Rice University

Osiris Therapeutics Completes Enrollment Of Stem Cell Trial For The Treatment Of Heart Attacks

Osiris Therapeutics, Inc. (NASDAQ: OSIR), announced that it has successfully completed enrollment in a Phase 2 clinical trial evaluating Prochymal (remestemcel-L), an adult mesenchymal stem cell therapy, in patients experiencing their first heart attack. The double-blind, placebo-controlled trial enrolled a total of 220 patients from 33 leading clinical centers in the United States and Canada.

“We appreciate the participation of our outstanding team of clinicians and would like to offer our special thanks to the patients who are taking part in this exciting trial,” said Lode Debrabandere, Ph.D., Senior Vice President of Therapeutics at Osiris. “We look forward to following their progress and collecting high quality data on the safety and efficacy of Prochymal in this significant indication.”

In 2009, Osiris completed a Phase 1 double-blind, placebo-controlled study in 53 patients that demonstrated the safety of Prochymal in cardiac patients suffering from their first heart attack. Additionally, treatment with Prochymal significantly improved cardiac function, patient global assessment and reduced cardiac arrhythmias (irregular heartbeat) when compared to placebo.

About the Phase 2 Acute Myocardial Infarction Trial

The Phase 2 double-blind, placebo-controlled trial will evaluate the safety and efficacy of Prochymal in conjunction with standard of care in improving heart function in patients who experienced their first heart attack. The trial is being conducted at leading institutions and academic research centers in the United States and Canada. The focus is on patients who have suffered a severe myocardial infarction. To be classified as severe, the patient’s left ventricular ejection fraction, or LVEF, must have been between 20% and 45% at baseline. LVEF, which reflects the fraction of blood pumped out of a ventricle with each heart beat, is a common measurement of overall heart function and typically declines after a heart attack. Patients were randomized to either Prochymal or placebo at 1:1. Efficacy endpoints determined from cardiac MRI include end systolic volume, LVEF and the ability of Prochymal to preserve functional heart tissue and limit scar formation following a heart attack. In addition, functional and quality of life assessments will be performed.


Osiris Therapeutics, Inc.

Global AIDS Alliance Thanks Congress For Increasing Funding For AIDS, TB And Malaria Programs

Today the Global AIDS
Alliance thanked the US Congress for agreeing to a major increase in funds
to combat AIDS, tuberculosis and malaria in Africa and other regions for
fiscal year 2007. Congress will increase funding by $1.3 billion, for a
total of $4.5 billion. This will raise the U.S. contribution to the Global
Fund to Fight AIDS, Tuberculosis and Malaria, a cost-effective
international partnership, to $724 million.

Congress has recognized that global disease is a true emergency in
which bold US leadership can be truly effective. The AIDS epidemic is still
spreading, with 4.3 million new infections this past year. Extremely drug-
resistant TB is a major new threat, especially in southern Africa. Malaria
is a major killer of children and a contributing factor in the spread of

Dr. Paul Zeitz, Executive Director of the Global AIDS Alliance, made
the following statement:

“This funding increase will save millions of lives and provide urgently
needed care and support for millions of orphaned and vulnerable children.
We thank all members of Congress responsible for this funding increase, in
particular Senate Majority Whip Richard Durbin (D-IL), Senator Patrick
Leahy (D-VT), Senator Robert Byrd (D-WV), Speaker Nancy Pelosi (D-CA),
Representative David Obey (D-WI), House Majority Leader Steny Hoyer (D-MD),
and Representative Barbara Lee (D-CA). These legislators are putting the US
on the right side of history by fully backing the fight against disease.
This is exactly the kind of bold leadership we need in the US Congress.

“With the increase for the Global Fund, the US is much better placed to
go to other countries and urge them to increase their contributions to the
Fund. We will need Germany, Japan and others to now reciprocate by upping
their contributions; otherwise the global goal of universal access to
AIDS-related services by 2010 will remain out of reach.

“A new, extremely dangerous form of TB has emerged, and much more US
funding will be required to combat it, and quickly. Extremely
drug-resistant tuberculosis (XDR-TB) threatens to undermine much of our
progress in fighting HIV/AIDS. The emergency is so great that the Congress
should use the upcoming Supplemental Budget for 2007 to channel $300
million to address this disease threat.

“A wide range of humanitarian, student and religious groups worked
together to urge Congress to provide the funding agreed to this week.
People across the United States also appealed to Congress to provide this
funding, and Congress responded with vision and leadership.

“Increases are also urgently needed for other global poverty programs,
as well as the response to AIDS in the United States, and we hope Congress
provides these as a part of the FY 2008 appropriations process.”

Global AIDS Alliance

FDA Gives TCA Cellular Therapy Green Light To Proceed With First ALS Adult Stem Cell Trial Using Patient’s Own Stem Cells

TCA Cellular Therapy, LLC (TCA-CT) announced that the U.S. Food and Drug Administration (FDA) has approved its adult stem cell protocol to conduct Phase I clinical trials to treat Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease).

This is the second FDA-approved protocol for the treatment of ALS using stem cells in the country; and the first using adult stem cells from the same patient. The aim of the Phase I study will assess safety.

ALS afflicts approximately 30,000 Americans. More people die of ALS than Huntington’s disease; and the fatalities nearly equal Multiple Sclerosis. The life expectancy of a patient diagnosed with ALS is two to five years.

“I hope that our trial, along with the combined efforts of scientists and patients, will pave the way to breaking the chains of this devastating disease,” stated Gabriel Lasala, M.D., president and CEO of TCA Cellular Therapy.

About the Trial

Under the scientific guidance of cellular biologist, Jose J. Minguell, Ph.D., the adult stem cells will be taken from the patient’s bone marrow in a simple outpatient procedure. The cells will then be processed in TCA-CT’s GMP laboratory and administered to the patient by spinal tap in one of TCA-CT’s facilities.

Recruitment for trial patients will commence in the next few weeks. The company anticipates moving into Phase II within a year.

TCA Cellular Therapy

Dusting Up Vehicle Emissions

Queensland University of Technology (QUT) researchers have identified a silver lining in the cloud of red dust that enveloped much of eastern Australia two years ago.

Research fellow Dr Rohan Jayaratne from QUT’s International Laboratory for Air Quality and Health (ILAQH) said that data, from what is believed to be the first air quality test undertaken during an Australian dust storm, showed that large dust particles swept up the smaller, potentially fatal ultrafine particles caused by everyday vehicle emissions.

Air quality tests taken during the September 2009 dust storm showed that Brisbane’s most harmful ultrafine particle pollution from vehicle emissions, which contain 250 well-known carcinogens, almost disappeared as the eerie orange haze settled over the city.

Dr Jayaratne’s team, led by ILAQH director Professor Lidia Morawska, said the dramatic shift in air quality was the result of a process of polydisperse coagulation whereby smaller particles, such as diesel emissions, diffuse on to the surface of larger particles, such as dust.

“We have seen this happen in the laboratory but never in an environment like this, given the very specific conditions,” he said.

“One of the reasons vehicle emissions are so scary is that the ultrafine particles are able to penetrate deeper into the lungs, in the alveoli, whereas larger particles such as dust tend to get trapped in the upper-respiratory system. Asthma is often caused by larger particles, but the finer particles are associated with long-term health issues such as cardiovascular mortality.”

The threshold for the process of polydisperse coagulation usually occurs when large dust particles reach concentrations of “a couple of hundred” micrograms per cubic metre.

On a typical day in an urban area, such as Brisbane, the dust concentration is about 50 micrograms.

However, at the peak of the dust storm in the Brisbane CBD at noon on September 23, 2009, the measured concentration shot up to 6000 micrograms per cubic metre, causing the vehicle emission particles to almost disappear.

The QUT findings were recently reported in the internationally reputed journal Atmospheric Environment.

Dr Jayaratne said he also investigated causes of severe Australian dust storms in order to predict future occurrences and believes we may see a similarly severe storm this year if dry conditions continue.

“We found dust storms in Australia usually occur after flood events, similar to what Brisbane experienced in January,” he said.

“Sediment is carried along inland rivers and settles as fine alluvial dust on the desert floor.

“If these conditions are followed by a prolonged dry season, which we have had, and the heavy winds that are characteristic in September and October, then there is every chance we will see another dust storm similar to the one we experienced in 2009.”

ASH Compares Critics Of Link Between Smoking Bans And Dramatic Heart Attack Reductions AIDS Dissidents WHo Deny Link Between HIV And AIDS

Action on Smoking and Health (UK) has, in a published (peer-reviewed) article, compared those who question the link between smoking bans and dramatic reductions in heart attacks with dissidents who deny the link between the HIV virus and AIDS.

And, in a separate article published in another journal, a different set of anti-smoking advocates (Pascal Diethelm and Martin McKee) have compared those who question the link between passive smoking and heart disease/lung cancer with those who deny the existence of the Holocaust.

In the commentary, I discuss the implications of these articles, concluding that the tobacco control movement has now become a religion. It is based solely on ideology, not science. And worse still, there is a McCarthyist-like nature to the movement, where those who question any of its doctrines are attacked, discredited, and blacklisted out of further discourse on the issue.

The commentary appears this morning in its entirety on my tobacco policy blog.

Excerpt from the commentary:

In an article published this month online ahead of print in the journal Expert Review of Pharmacoeconomics and Outcomes Research, Martin Dockrell – policy and campaigns manager for Action on Smoking and Health in London (ASH-UK) – argues that those who have questioned the causal relationship between smoking bans and dramatic, immediate reductions in heart attacks are comparable to dissidents who deny the causal link between the HIV virus and AIDS (see: Dockrell M. Eye and heart at mortal war: coronaries and controversy in a smoke-free Scotland. Expert Review of Pharmacoeconomics and Outcomes Research 2009).

Dockrell argues that the Pell et al. study, which reported a 17% decline in acute coronary syndrome cases during the first year following the implementation of a smoking ban in Scotland, is conclusive evidence of a causal relationship between the smoking ban and a dramatic and immediate decline in acute cardiac events. He further argues that anyone who disagrees with this conclusion is a denialist, similar to the AIDS denialists, and that such opinion is an orchestrated artifact of tobacco industry lobbying, rather than sincere scientific criticism of the study conclusions.

Specifically, Dockrell argues that: “Organized groups who seek to deny and discredit this work are comparable in nature and intent, but not in origin, to the self-styled AIDS dissidents who continue to deny the causal link between HIV and AIDS and offer a comparable threat to an evidence-based health policy.”

Moreover, Dockrell asserts that this dissidence is not pure: it is the result of orchestration by the tobacco industry: “While AIDS dissidence was largely an indigenous phenomenon, tobacco dissidence is the carefully conceived creature of tobacco industry lobbyists.”

Readers should keep in mind that I am in fact a major dissenter, as I have criticized the Pell et al. study (critique 1 ; critique 2 ; critique 3; critique 4 ; critique 5 ;hcritique 6) and in fact have reported follow-up data which I believe demonstrate that the conclusion from that study was wrong. I have challenged anti-smoking groups to publicize the follow-up data which show that the decline in cardiac events during the first-year after Scotland’s smoking ban was followed by an increase in cardiac events during the second year, thus disproving Pell et al.’s conclusion (post 1 ; post 2 ).

I take it this means that Dockrell is calling me a denialist and comparing me to AIDS dissidents who still deny that HIV causes AIDS. I also take it to mean that Dockrell is accusing me of being in the pocket of the tobacco companies and acting at their beck and call and presumably -their payments.

In fact, ASH-UK appears to make precisely such an accusation when it states in its press release to accompany the article: “A number of studies have been published recently showing a decline in admissions to hospital for heart attack following the implementation of smokefree laws in various countries. Many of these studies, including one on the impact of the Scottish smoking ban have also been the subject of criticism by so-called “dissidents” who claim that the research is nothing more than ‘junk’ science. In a recently published review ASH’s Director of Policy and Research, Martin Dockrell, looks behind the scenes to see what has prompted this criticism and to what extent it is justified. The analysis finds parallels with those who were in denial about the causes of AIDS long after the scientific debate was over. … We found an unholy alliance of conspiracy theorists, tobacco industry lobbyists and journalists impatient for a good story.”

Dockrell is particularly critical of Michael Blastland, who wrote a commentary published by BBC News on November 14, 2007 which presented data showing that the actual decline in heart attacks in all of Scotland in the year following the smoking ban was similar to that observed in the three years preceding the ban, and that a dramatic decline in heart attacks occurred in 2000, in the absence of a smoking ban. Based on these findings, Blastland questioned the validity of the study’s conclusion that the smoking ban was causally related to a 17% decline in acute cardiac events.

Dockrell argues in the article that Blastland is a denialist and conspiracy theorist and concludes that his criticism has been carefully conceived and orchestrated by the tobacco industry: “While AIDS dissidence was largely an indigenous phenomenon, tobacco dissidence is the carefully conceived creature of tobacco industry lobbyists.”

The Rest of the Story

This article demonstrates the religious-like and McCarthyist-like nature of the modern-day anti-smoking movement. If you do not subscribe to the accepted dogma of the movement, even when there is legitimate scientific evidence that brings that dogma into question, you are a dissident and a denialist — on no firmer ground than those who deny that AIDS is caused by the HIV virus. Moreover, you are not expressing a sincere opinion, but are in the pocket of the tobacco industry, part of an orchestrated industry campaign.

The absurdity of the article is evident in its implication that I – a strong anti-smoking advocate – am a denialist who is being orchestrated by the tobacco companies to disseminate conspiracy theories – since I myself have been a vocal critic of the conclusions of these heart attack/smoking ban studies.

Someone who has argued that secondhand smoke kills over 50,000 Americans each year and whose testimony about the tobacco industry’s deception of the public contributed towards a $145 billion verdict against the companies is hardly someone who fits the description of being a denialist who is waving around conspiracy theories under orchestration by Big Tobacco.

To be sure, historically the tobacco industry has orchestrated campaigns to undermine the public’s appreciation of the recognized hazards of active smoking and secondhand smoke exposure. If you want to read about that history, you need go only so far as to read my testimony in the Engle tobacco case, which initially resulted in a $145 billion verdict against the tobacco companies. It is also true that a number of supposedly independent scientists who have challenged the link between smoking or secondhand smoke and disease have been funded by the industry and have been part of a campaign orchestrated by the industry.

However, the criticism of the research linking smoking bans with a causal effect on acute cardiac events is largely a different story. First, the nature of the evidence is very different. While there is abundant evidence linking smoking and disease and one would have to be a denialist to argue that smoking is not harmful, the research being used to conclude that smoking bans result in huge, immediate declines in heart attacks is very weak. These conclusions are based on time trend analyses, often without a control group, they cannot adequately determine whether observed changes reflect random variation, secular trends, or a real effect of the smoking ban, and thus causal conclusions from these studies are very shaky.

I will not take the time here to explain all the methodologic weaknesses of these studies, but interested readers will find an extensive set of commentaries on my blog which critique this literature.

Perhaps the most important fact to point out here is that studies which have used national, population-based data for all of Scotland have failed to find a 17% decline in heart attacks in Scotland in the year after the smoking ban, and actually found that heart attacks increased in the second year after the ban, thus negating the earlier decline. Overall, there was little change in heart attack admissions in all of Scotland from before the smoking ban to two years after the ban.

As Christopher Snowdon explained: “Much was made of an apparent reduction in the number of patients being diagnosed with the life-threatening heart condition after the smoking ban came into effect in 2006, including a study published in the New England Journal of Medicine which claimed that the ban had caused emergency ACS [acute coronary syndrome] admissions to fall by 17%. However, official statistics show that the decline in hospitals admissions for acute coronary syndrome has been greatly exaggerated. The real decline in the first year of the smoking ban was just 7.2% – not 17% – and the rate then rose by 7.8% in the second year, cancelling out the earlier drop.”

“In the last 12 months before Scotland enacted its smoking ban (April 05 to March 06) there were 16,199 admissions for acute coronary syndrome. In the second year of the smoking ban (April 07 to March 08) there were 16,212 admissions, slightly more than there had been before the legislation was enacted.” …

“Hospital admissions for acute coronary syndrome have been declining in Scotland for many years. The new data show that the well-publicised fall in admissions following Scotland’s smoke-free legislation was in line with the existing downward trend and was significantly less steep than has previously been claimed.” … “If the 2006-07 decline had really been the result of the smoke-free legislation, it would be expected for rates to remain low in subsequent years. The fact that Scottish hospitals have seen an unusually sharp rise – despite the smoking ban being rigorously enforced – suggests that whatever lay behind the 2006-07 dip, it was not the smoking ban.”

Despite the accusation that Blastland is part of some tobacco-industry orchestrated campaign and that he nothing more than a denialist, Dockrell presents no evidence that either of these is the case. First, he fails to present any evidence showing that Blastland is being paid by Big Tobacco or that he has had any alliance, association, or communication with tobacco companies over his commentaries. Reading other articles Blastland, it appears that he is in fact not particularly focused on tobacco, but that he writes in general about many areas in which he believes that statistics have been inaccurately used to draw policy-relevant conclusions.

Second, Dockrell fails to present any evidence to suggest that Blastland’s critiques of the smoking ban studies are anything other than legitimate scientific opinions. In fact, I find Blastland’s commentary to be quite compelling and from a scientific standpoint, on much more solid ground than the Pell et al. article which was published in the New England Journal of Medicine.

The problem with the Pell et al. study is that its conclusion is based on a comparison of apples to oranges. In order to compare the change in heart attacks in Scotland from 2006-2007 to the trend in heart attacks during the preceding ten-year period, one needs to use the same data source to compare these trends. In the Pell et al. article, the researchers use one source of data to estimate the change in heart attacks from 2006-2007 (observed changes in admissions for nine hospitals representing a portion of the country) and a different source of data to estimate the trend in heart attacks from 1996-2006 (national data from the Scottish National Health Service).

A critical basis for the article’s conclusion is that the year-to-year decline in heart attacks in Scotland never exceeded 10%, while the researchers found a 17% decline in heart attacks during the year following the smoking ban. However, the relevant question is not what the national health service data show, but what changes in heart attack admissions would have been found using the same methods employed by the researchers to count heart attack admissions for 2006-2007. What would the annual changes have been using the same 9 hospitals and using the same method of counting heart attack admissions?

In contrast, Blastland presents a consistent data source for hospital admissions throughout all of Scotland for a long period of time: 1998-2007. The graph he presents illustrates that there is no visible change in heart attacks in Scotland in 2006-2007. In fact, the graph shows that the rate of decline in heart attacks in Scotland remained exactly the same as it was prior to the smoking ban.

In addition, the graph shows that there was a substantial decline in heart attacks from 1999-2000 which occurred in the absence of a smoking ban, illustrating that the magnitude of decline in heart attacks in 2006-2007 is actually less than the random variation and secular trends in heart attacks that were observed in Scotland in prior years.

Thus, rather than being denialism, Blastland’s criticism of the study is well-founded. Whether he is correct or not, there are absolutely no grounds to dismiss his criticism as being denialism, conspiracy theory, or tobacco industry propaganda being delivered by a paid hack, all of which are implied by Dockrell in his article and press release.

Action on Smoking and Health (UK) evidently views the anti-smoking movement as a religion. Any challenge to the doctrines of the religion amounts to heresy. Scientific discourse is not allowed. You have to accept everything anti-smoking researchers claim with blind faith.

ASH-UK would have the tobacco control movement turn into non-critical automatons, who merely accept, on blind faith, any research which is favorable to the cause. Science would no longer play a role. It would, in fact, become a religion rather than a science-based public health movement.

Moreover, Dockrell’s article illustrates the McCarthyist nature of the modern day anti-smoking movement. If you challenge the doctrines of the movement, not only are you viewed as a denialist, but you are automatically attacked as being a Big Tobacco hack. In other words, without any evidence, you are publicly maligned in an attempt to permanently discredit you and blacklist you from any further participation in public discourse.

Dockrell has accused Michael Blastland of being a tobacco industry hack who is not expressing his sincere scientific criticism, but instead is being orchestrated by the tobacco industry to spout out conspiracy theories. This is not only arguably defamation, but it is essentially McCarthyism. It is an attempt to permanently malign Blastland’s reputation and remove him from public discourse. And all of this solely because of the nature, not the quality, of his scientific argument.

Lest readers think that this article from ASH-UK is simply an isolated example, consider that just last week, the European Journal of Public Health published an article in which two other anti-smoking advocates – Pascal Diethelm and Martin McKee – accused all those who do not accept the causal relationship between secondhand smoke and lung cancer/heart disease as being denialists comparable to those who deny the existence of the Holocaust.

Diethelm and McKee argue that the paper by Drs. James Enstrom and Geoffrey Kabat – a meta-analysis which failed to find evidence of a causal relationship between secondhand smoke and lung cancer or heart disease – and its use by various groups is comparable to Holocaust denial.

There are many reputable scientists who have challenged the conclusion that secondhand smoke causes heart disease and lung cancer. While I disagree with their interpretation of the scientific evidence, I would never suggest that their opposing opinion is denialism and that it is comparable to Holocaust denial.

Once again, Diethelm and McKee view the anti-smoking movement as a religion. You have to accept the claims on blind faith and if you don’t, you are guilty of heresy. Even worse, you will be publicly attacked and have your character maligned in an attempt to silence you by blacklisting you out of public discourse on the issue.

The rest of the story is that the anti-smoking movement is quickly losing its science base. It is becoming a religious-like, McCarthyist-like movement which attacks and attempts to blacklist anyone who doesn’t accept the doctrines of the movement. Its personal attacks are on character, not on science, and are doled out based not on the quality of science in the opposing arguments, but the position that the dissenter has taken.

The most important implication of today’s story is that this shift in the movement is now evident not only in the informal statements of the anti-smoking groups, but in the peer-reviewed, published literature. Tobacco control as a religion, rather than as a science-based field of public health practice, is now becoming formally institutionalized.

Michael Siegel, MD, MPH
Associate Chair of Academics
Social and Behavioral Sciences Department
Boston University School of Public Health
801 Massachusetts Avenue, 3rd Floor
Boston, MA 02118

Development Of Resistance-Detecting Field Kit Funded By ВЈ1.1m Grant

Liverpool School of Tropical Medicine (LSTM) has been awarded a ВЈ1.1m grant by the US National Institutes of Health to lead a five year project to develop a Field Applicable Screening Tool (FAST) kit to detect resistance to public health insecticides in mosquitoes.

The two principal methods for control of malaria in sub-Saharan Africa are the use of insecticide-treated bednets (ITNs) and indoor residual spraying (IRS) of insecticides. Scientists at LSTM, the Centers for Disease Control and Prevention in the US, Ghana’s Biotechnology and Nuclear Agricultural Research Institute and Uganda’s National Livestock Resources Research Institute will be working in partnership to identify genes that render malaria-carrying mosquitoes resistant to a range of insecticides that are used for IRS and ITN. At present information on underlying resistance mechanisms of the two most important mosquito species is very limited.

Based upon this knowledge, a rapid and cost-effective DNA-based screening kit will be designed, tested and rolled out for use by control programme staff in the regions of sub-Saharan Africa where malaria and filariasis, a disabling and disfiguring condition also spread by mosquitoes, is endemic. The new screening tools will provide information vital for predicting the success of IRS and ITN programmes.

Project leader Dr Martin Donnelly, Senior Lecturer in Vector Biology at LSTM said: “Malaria control in Africa is reliant upon the use of insecticides against mosquitoes. Therefore if the mosquitoes develop high levels of resistance to these insecticides the public health impact could be devastating. We are proposing to develop DNA-based tests which are sensitive enough to detect resistance when it is at a low level and thereby enable control programme staff to take action to reduce the build up of resistance.”

The rollout of FAST kits will be facilitated in collaboration with existing programmes run by IVCC, TDR (a World Health Organisation programme for research and training in tropical diseases) and PMI (US President’s Malaria Initiative).

Billy Dean

Liverpool School of Tropical Medicine

National Achievement Award Presented To Boxing Champ, UK

A Rochdale man who transformed his life after the death of his fiancГ©, depression and serious illness and now helps underprivileged children has been recognised with a national award.

30 year old Marcus Dean has been named Fitness First New You Achiever of the Year 2008 in the prestigious awards for his amazing story and desire to help others.

In 2003 Marcus’ fiancГ© died leaving him to care for their three year old daughter. His grief led to a downward spiral involving drink, over eating, depression and the onset of two serious stomach problems.

He lost his job, his confidence, his self esteem and felt unable to look after his daughter.

But a visit to Fitness First set Marcus on the road to recovery and a new life as a successful boxer.

“I knew where Fitness First was because it was next to a takeaway I used to visit,” said Marcus who was an unfit 18 stone when he began his transformation in 2006. “I joined the Get Results programme, teamed up with personal trainer Dean Whamby and haven’t looked back.”

He said Fitness First had given him a new lease of life and within weeks of beginning his training Marcus had taken up boxing – winning his first fight and becoming the 2007 East Lancashire Champion.

“I’d always wanted to box and I’m now also working with youngsters to help them channel their energies into boxing,” he said.

Judges in the New You Achievement Awards said Marcus has shown tremendous courage and commitment to turn his life around and become a great role model for his daughter and other young people.

He won the Sport category in the awards for his boxing success together with the overall award пїЅпїЅ” and a holiday of a lifetime for him and his family.

An overjoyed Marcus said that he owed Fitness First everything. “Fitness First has given me stability, I have made so many new friends, my health is great and I love helping others.”

Marcus was one of 15 finalists in the Fitness First New You Achievement Awards and judges described his story as truly inspirational.

“Marcus is exactly what these awards set out to recognise,” said Fitness First’s managing director John Gamble. “All of the finalists had amazing stories but Marcus stood out for overcoming so many hurdles and now using his experience to help so many other people.”

Awards were also presented to Alison Grant from Dundee who shed more than 11 stone to win the Shape category, to Paul Silcock from Halifax who had two major heart attacks and fought back to fitness to win the Health Award.

The Fitness category was won by 38 year old Jacqui Goodwin from Middlesborough who has transformed her life as an overweight mother of four to become a marathon runner while personal trainer Dean Whitfield won the Staff award for his amazing fightback from near death after a car crash to become a personal trainer with Fitness First.

Pictured: Sport category – from left to right – Dean Wharmby Marcus’ personal trainer at the Rochdale club, Marcus Dean and Dr Hilary Jones Fitness First medical advisor

Marcus wins – from left to right, Dean Wharmby, Marcus and Dr Hilary


Fitness First is the largest privately owned health club group in the world with over 550 Fitness First clubs worldwide reaching over 1.7 million members. In the UK alone there are 172 Fitness First clubs with over 465,000 members. Log on to www.fitnessfirst for more information and to find a club.

Fitness First is a member of the Fitness Industry Association (F.I.A), the industry trade body which represents both private and public organisations that are involved in the fitness industry, visit fia.

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