© 2004 American Thoracic Society
Rebuttal from Dr. MacklemIt appears that Dr. Lenfant is describing achievements of research supported by the Division of Lung Diseases (DLD) of the NHLBI since 1972, whereas I limited my comments to the period since 1987 when he and Suzanne Hurd wrote their editorials (1, 2) announcing a new funding policy for the DLD and promising that it would impact on the clinical practice of respiratory medicine. Thus he refers to research over a 20- to 25-year period "that slashed the toll of neonatal respiratory disease syndrome from 270 deaths/100,000 live births in 1972 to approximately 20 deaths/100,000 in 2000." But by 1987 the mortality rate was only 84/100,000 live births (3), a reduction of 69% since 1972; 74% of the total decrease in mortality rates occurred before Drs. Lenfant's and Hurd's editorials. This reduction was almost entirely due to improved methods of mechanical ventilation and the administration of corticosteroids.Dr. Lenfant describes the promises for future therapy in asthma resulting from cytokine research and gene mutation/drug interactions. Everyone assumes that cytokine-induced airway inflammation in asthma leads to excessive bronchoconstriction; but shouldn't we entertain the possibility that inflammation is caused and perpetuated by repeated episodes of excessive bronchoconstriction? In any event, Dr. Lenfant supports my argument: we are still waiting for what was promised. So does the article by Rees quoted by Lenfant (4). The major thrust of that article is that new and effective therapies in dermatology have not arisen from cell and molecular biology but from more traditional areas of scientific endeavor. I like Dr. Lenfant's analogy to the offspring of a marriage, but I would argue that the mother is still pregnant with possibilities; the gestational period is too long; and that unless labor is induced in the near future there is a serious danger of stillbirth. REFERENCES
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