This week in the BMJ
Volume 328, Number 7446, Issue of 24 Apr 2004Do public smoking bans reduce heart attacks?
Do public smoking bans reduce heart attacks?
Banning smoking from public places may decrease the risk of having a myocardial infarction. In a study from the United States, Sargent and colleagues (p 977) analysed admissions for acute myocardial infarction to the only hospital serving Helena, Montana, where tobacco smoking in public and workplaces was banned between June and December 2002. During the six months of the smoking ban, admissions of people living outside Helena increased, but admissions of people living in Helena were significantly reduced. The reduction was not sustained after the law was suspended. Even if these results are plausible, say Pechacek and Babb (p 980) in an accompanying commentary, the small size of the study and the lack of data on exposure are limitations.
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Living with people who smoke is risky
Mortality is increased by around 15% in people who have never smoked but live with a smoker. Hill and colleagues (p 988) retrospectively examined mortality in two cohorts of New Zealand adults who never smoked, contributing a total of about 19 000 deaths and 2 million person years of observation. Never smokers with domestic exposure to secondhand smoke had consistently higher mortality than those living in non-smoking households. These findings add to the weight of evidence for the adverse health effects of passive smoking, say the authors, and highlight the need to protect the public from exposure to other people's tobacco smoke.
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"Normal" levels of aminotransferase don't rule out liver disease
High normal levels of serum aminotransferase concentration may be a warning of liver disease. Kim and colleagues (p 983) followed up more than 142 000 people in Korea for eight years. Even within the normal range of aminotransferase concentration (35-40 IU/l), men with concentrations of 20-29 IU/l and anyone with concentrations of 30-39 IU/l had a significantly higher risk of dying from liver disease than people with concentrations < 20 IU/l. People with high normal aminotransferase activity may need to be observed and further investigated for liver diseases, say the authors, and normal limits may need to be lowered in some populations.
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Topical capsaicin may be a useful adjunct in chronic pain...
Capsaicin is better than placebo for treating neuropathic and musculoskeletal pain. Analysing data from nine trials including more than 1000 patients, Mason and colleagues (p 991) found that the number needed to treat for patients with neuropathic pain was six for benefit eight weeks after treatment with capsaicin, and eight for patients with musculoskeletal pain after four weeks of treatment. A third of treated patients experienced local adverse effects. The authors conclude that, although topical capsaicin has moderate to poor efficacy, it may be useful for a small number of patients who are unresponsive to, or intolerant of, other treatment.
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... and salicylate works better in acute pain
Topical rubefacients containing salicylate may be efficacious in acute pain, but less so in chronic arthritic and rheumatic pain. Mason and colleagues (p 995) analysed available data from randomised placebo controlled trials including 182 patients with acute pain and 429 patients with chronic pain. The trials suggest that rubefacients containing salicylates work better than placebo, but the information available is limited and of poor quality. Analgesic creams and ointments may be useful for treating some acute and chronic pain, comments Tramèr (p 998), but none are universally efficacious.
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