Michael Fitzpatrick

Salmeterol in nocturnal asthma: a double blind, placebo controlled trial of a long acting inhaled beta 2 agonist.

OBJECTIVE--To determine whether inhaled salmeterol, a new long acting inhaled beta adrenergic agonist, reduces nocturnal bronchoconstriction and improves sleep quality in patients with nocturnal asthma. DESIGN--Randomised, double blind, placebo controlled crossover study. SETTING--Hospital outpatient clinics in Edinburgh. SUBJECTS--Twenty clinically stable patients (13 women, seven men) with nocturnal asthma, median age 39 (range 18-60) years. INTERVENTIONS--Salmeterol 50 micrograms and 100 micrograms and placebo taken each morning and evening by metered dose inhaler. Rescue salbutamol inhalers were provided throughout the run in and study periods. MAIN OUTCOME MEASURES--Improvement in nocturnal asthma as measured by peak expiratory flow rates and change in sleep quality as measured by electroencephalography. RESULTS--Salmeterol improved the lowest overnight peak flow rate at both 50 micrograms (difference in median values (95% confidence interval for difference in medians) 69 (18 to 88) l/min) and 100 micrograms (72 (23 to 61) l/min) doses twice daily. While taking salmeterol 50 micrograms twice daily patients had an objective improvement in sleep quality, spending less time awake or in light sleep (-9 (-4 to -44) min) and more time in stage 4 sleep (26 (6-34) min). CONCLUSIONS--Salmeterol is an effective long acting inhaled bronchodilator for patients with nocturnal asthma and at a dose of 50 micrograms twice daily improves objective sleep quality.

From hero to zero

Andrew Wakefield was once the media’s darling—but a new study unravels why they turned against him. Michael Fitzpatrick reports

Should psychiatric hospitals completely ban smoking

A “smoking culture” leads to disproportionate harm among people with serious mental health problems, argue Deborah Arnott and Simon Wessely. But Michael Fitzpatrick thinks it unethical to deprive patients of autonomy and impose treatment

Evidence of Harm. Mercury in Vaccines and the Autism Epidemic: Medical Controversy

W hen Andrew Wakefield, the former Royal Free Hospital researcher who launched the scare about a link between the measles, mumps, and rubella (MMR) vaccine and autism in Britain, claimed that he had learnt everything he knew about autism from parents, this sounded merely disingenuous. In David Kirbys case, unfortunately, it appears to be true: he seems to take at face value every claim made by campaigning parents in the United States who believe that vaccines containing the mercury based preservative thiomersal caused their children to become autistic. ![][1] David Kirby St Martins Press,

Routinely asking women about domestic violence: Ill considered professional interference in personal relationships will prove damaging

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The Rise and Fall of Modern Medicine

C38.95, pp 480 ISBN 0 312 32644 0 www.stmartins.com/ Rating:![Graphic][2] ![Graphic][3] ![Graphic][4] ![Graphic][5] But parents may not be reliable guides. Kirby faithfully records one mothers account of how she brought her son from the United States to see Dr Wakefield at the Royal Free Hospital, which she described as an “old stone building, soot-coloured and depressing,” located “on Grays Inn Road in central London,” a site abandoned by the Royal Free some 30 years ago for a modernist tower block in Hampstead. Further descriptions of “halls filled with the … [1]: /embed/graphic-1.gif [2]: /embed/inline-graphic-1.gif [3]: /embed/inline-graphic-2.gif [4]: /embed/inline-graphic-3.gif [5]: /embed/inline-graphic-4.gif

George and Sam

EDITOR—The notion that, because some social problem has effects on health, this justifies medical intervention aiming to tackle it has acquired a growing influence on medical practice. The result is that medicine is stretched beyond its sphere of competence as social problems are …

Are ribbon campaigns making us loopy

James Le Fanu is a general practitioner and medical journalist well known during the 1990s for his exposures of the follies and pretensions of the drive to regulate lifestyle in the cause of promoting public health. In 1999 he raised the polemical stakes in this magisterial survey of modern medicine. Le Fanu boldly insists that “much current medical advice is quackery,” and recommends “the simple expedient of closing down most university departments of epidemiology,” which “could both extinguish this endlessly fertile source of anxiety-mongering while simultaneously releasing funds for …

Salmeterol in nocturnal asthma: Authors' reply

Having seen a newspaper excerpt from Charlotte Moores account of her autistic sons, some parents wrote to complain that she had neglected the “grittier realities” of life as a single parent caring for children with autism. In fact, the book reveals a household smeared with excrement, olive oil, and ketchup, and details all manner of bizarre behaviours. What seems to have rankled is that Moore describes her family in a positive and often humorous way, and that she does not seem to feel sorry for herself. ![][1] Charlotte Moore … [1]: /embed/graphic-1.gif

The Greatest Benefit to Mankind

At the start of ovarian cancer awareness month, a general practitioner claims that disease awareness increases anxiety—and newspaper and magazine circulations—much more than it increases diagnosis “And finally, today is colorectal cancer awareness day so heres our health correspondent—wearing the campaigns distinctive melaena-coloured ribbon—to tell us about a new ‘do-it-yourself’ colonoscopy technique.” Perhaps not this week, but it can only be a matter of time before every day of the year is allocated to some disease or disorder and every news bulletin concludes with an awareness raising feature. But when does public enlightenment become morbid preoccupation? Are we in danger of becoming so obsessed with the threat of disease that our quality of life is diminished? ![][1] Powerful forces drive campaigns to increase public recognition of disease. Doctors seeking to raise the profile of their specialty or special interest sponsor voluntary organisations to attract funds and promote research. For politicians worried about their loss of influence and respect, health … [1]: /embed/graphic-1.gif