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Perils of asthma research in vulnerable groups
Editorial
Penguin
Stigmatisation of problem-drug users
For the report on stigmatisation see http://www. ukdpc.org.uk/reports.shtml For more on Recovery Month see http://www.recoverymonth.gov
William S Burroughs II, the American Beat Generation author, published Junkie: Confessions of an Unredeemed Drug Addict in 1953 about life dependent on heroin (some editions use Junky). Junk was a slang term for heroin, possibly from users being seen as the “junk of society”, an early use of a stigmatising phrase. 60 years on, stigmatising labels for drug users remain topical, according to a report last week by the UK Drug Policy Commission, Sinning and sinned against: the stigmatisation of problem drug users. The Commission used a definition of problem drug use as injecting drug use or long duration or regular use of opioids, cocaine, or amphetamines. The Commission rather stumbled with this definition, because it wants to see the drug as the problem not the user. Use of the powerful connecting hyphen would have solved their dilemma: problem-drug user. They excluded “recreational” drugs, such as alcohol, cannabis, and ecstasy, but acknowledged that users of those drugs carry different stigmatising labels. “Stigmatisation matters”, says the Commission. “We feel stigma exquisitely because we are fundamentally social in
our make-up.” They conclude that problem-drug users are so strongly stigmatised that their ability to escape addiction is compromised in treatment, housing, and employment. Because of such stigma, the Commission feels, problem-drug users find it hard to be seen as blameless, like those with mental illness or disability. The vote-catching rhetoric of “war on drugs” or “tough on drugs” means politicians and policy makers are simply paying lip service to the compassionate “road to recovery” as a goal for society, says the Commission, which wants politicians and policy makers to think more carefully about such rhetoric. As a start, the Commission also calls for the public, health professionals, and particularly the media to be educated about the effects of stigmatising drug users. A good example was set by California Governor Arnold Schwarzenegger in his support of Recovery Month. Perhaps determined to not call a rose by any other name, Burroughs’ second book was entitled Queer—he would probably have written wryly about today’s concerns about stigmatising labels. ■ The Lancet
Science Photo Library
Perils of asthma research in vulnerable groups
See Review pages 803 and 814
744
To coincide with the annual European Respiratory Society meeting, in Barcelona, on Sept 18–22, The Lancet today focuses on asthma and respiratory diseases. WHO estimates that asthma affects 300 million people worldwide, and vulnerable groups—particularly children and elderly people—can be especially difficult to treat. Two Reviews in this issue focus on these groups, for which asthma is associated with substantial morbidity and mortality, and is characterised by scarce data from research. With an ageing population, the prevalence of asthma in elderly people will soar in the next few years; yet diagnosis is often overlooked because of comorbidity, underreporting of symptoms, insufficient use of lung-function testing, and overlap with chronic obstructive pulmonary disease. Peter Gibson and colleagues explore these issues and take an integrated approach to the understanding and management of asthma in this age group. Research into new treatments is needed for progress to be made; however, patients older than 65 years are often not eligible
for inclusion in clinical trials because of age restriction, substantial comorbidity, or smoking history. Thus clinicians treating elderly people are unable to know the extent to which results from trials apply to their patients. At the other end of the age spectrum, Andrew Bush and Sejal Saglani focus on the management of severe paediatric asthma that is unresponsive to treatment. For these patients there are similar barriers to high-quality research as for the barriers faced by elderly patients: most of the data on which to base therapy options are from trials of children with less severe forms of asthma or adults. Furthermore, severe asthma is often misdiagnosed and adherence to treatment is poor. Although asthma is one of the most enigmatic chronic diseases, evidence for new treatments in vulnerable populations is scarce and is compounded by the exclusion of such groups from randomised trials. 2010 has been declared the Year of the Lung. To live up to this title, more research is needed that focuses specifically on these difficult-to-treat patients. ■ The Lancet www.thelancet.com Vol 376 September 4, 2010
Penguin
Stigmatisation of problem-drug users
For the report on stigmatisation see http://www. ukdpc.org.uk/reports.shtml For more on Recovery Month see http://www.recoverymonth.gov
William S Burroughs II, the American Beat Generation author, published Junkie: Confessions of an Unredeemed Drug Addict in 1953 about life dependent on heroin (some editions use Junky). Junk was a slang term for heroin, possibly from users being seen as the “junk of society”, an early use of a stigmatising phrase. 60 years on, stigmatising labels for drug users remain topical, according to a report last week by the UK Drug Policy Commission, Sinning and sinned against: the stigmatisation of problem drug users. The Commission used a definition of problem drug use as injecting drug use or long duration or regular use of opioids, cocaine, or amphetamines. The Commission rather stumbled with this definition, because it wants to see the drug as the problem not the user. Use of the powerful connecting hyphen would have solved their dilemma: problem-drug user. They excluded “recreational” drugs, such as alcohol, cannabis, and ecstasy, but acknowledged that users of those drugs carry different stigmatising labels. “Stigmatisation matters”, says the Commission. “We feel stigma exquisitely because we are fundamentally social in
our make-up.” They conclude that problem-drug users are so strongly stigmatised that their ability to escape addiction is compromised in treatment, housing, and employment. Because of such stigma, the Commission feels, problem-drug users find it hard to be seen as blameless, like those with mental illness or disability. The vote-catching rhetoric of “war on drugs” or “tough on drugs” means politicians and policy makers are simply paying lip service to the compassionate “road to recovery” as a goal for society, says the Commission, which wants politicians and policy makers to think more carefully about such rhetoric. As a start, the Commission also calls for the public, health professionals, and particularly the media to be educated about the effects of stigmatising drug users. A good example was set by California Governor Arnold Schwarzenegger in his support of Recovery Month. Perhaps determined to not call a rose by any other name, Burroughs’ second book was entitled Queer—he would probably have written wryly about today’s concerns about stigmatising labels. ■ The Lancet
Science Photo Library
Perils of asthma research in vulnerable groups
See Review pages 803 and 814
744
To coincide with the annual European Respiratory Society meeting, in Barcelona, on Sept 18–22, The Lancet today focuses on asthma and respiratory diseases. WHO estimates that asthma affects 300 million people worldwide, and vulnerable groups—particularly children and elderly people—can be especially difficult to treat. Two Reviews in this issue focus on these groups, for which asthma is associated with substantial morbidity and mortality, and is characterised by scarce data from research. With an ageing population, the prevalence of asthma in elderly people will soar in the next few years; yet diagnosis is often overlooked because of comorbidity, underreporting of symptoms, insufficient use of lung-function testing, and overlap with chronic obstructive pulmonary disease. Peter Gibson and colleagues explore these issues and take an integrated approach to the understanding and management of asthma in this age group. Research into new treatments is needed for progress to be made; however, patients older than 65 years are often not eligible
for inclusion in clinical trials because of age restriction, substantial comorbidity, or smoking history. Thus clinicians treating elderly people are unable to know the extent to which results from trials apply to their patients. At the other end of the age spectrum, Andrew Bush and Sejal Saglani focus on the management of severe paediatric asthma that is unresponsive to treatment. For these patients there are similar barriers to high-quality research as for the barriers faced by elderly patients: most of the data on which to base therapy options are from trials of children with less severe forms of asthma or adults. Furthermore, severe asthma is often misdiagnosed and adherence to treatment is poor. Although asthma is one of the most enigmatic chronic diseases, evidence for new treatments in vulnerable populations is scarce and is compounded by the exclusion of such groups from randomised trials. 2010 has been declared the Year of the Lung. To live up to this title, more research is needed that focuses specifically on these difficult-to-treat patients. ■ The Lancet www.thelancet.com Vol 376 September 4, 2010