Major Benefits of Reducing Air Pollution

Air pollution has for many years been a major public health problem that doesn’t receive much attention despite its significant effects on the population. It has been estimated that the majority of people in the world are regularly breathing unclean air.

Reductions in air pollution yielded fast and dramatic impacts on health-outcomes, as well as decreases in all-cause morbidity, according to findings in “Health Benefits of Air Pollution Reduction,” new research published in the American Thoracic Society’s journal, Annals of the American Thoracic Society.

The study by the Environmental Committee of the Forum of International Respiratory Societies (FIRS) reviewed interventions that have reduced air pollution at its source. It looked for outcomes and time to achieve those outcomes in several settings, finding that the improvements in health were striking. Starting at week one of a ban on smoking in Ireland, for example, there was a 13 percent drop in all-cause mortality, a 26 percent reduction in ischemic heart disease, a 32 percent reduction in stroke, and a 38 percent reduction in chronic obstructive pulmonary disease (COPD). Interestingly, the greatest benefits in that case occurred among non-smokers.

“We knew there were benefits from pollution control, but the magnitude and relatively short time duration to accomplish them were impressive,” said lead author of the report, Dean Schraufnagel, MD, ATSF. “Our findings indicate almost immediate and substantial effects on health outcomes followed reduced exposure to air pollution. It’s critical that governments adopt and enforce WHO guidelines for air pollution immediately.”

In the United States, a 13-month closure of a steel mill in Utah resulted in reducing hospitalizations for pneumonia, pleurisy, bronchitis and asthma by half. School absenteeism decreased by 40 percent, and daily mortality fell by 16 percent for every 100 ?g/m3 PM10 (a pollutant) decrease. Women who were pregnant during the mill closing were less likely to have premature births.

A 17-day “transportation strategy,” in Atlanta, Georgia during the 1996 Olympic Games involved closing parts of the city to help athletes make it to their events on time, but also greatly decreased air pollution. In the following four weeks, children’s visits for asthma to clinics dropped by more than 40 percent and trips to emergency departments by 11 percent. Hospitalizations for asthma decreased by 19 percent. Similarly, when China imposed factory and travel restrictions for the Beijing Olympics, lung function improved within two months, with fewer asthma-related physician visits and less cardiovascular mortality.

In addition to city-wide polices, reducing air pollution within the home also led to health benefits. In Nigeria, families who had clean cook stoves that reduced indoor air pollution during a nine-month pregnancy term saw higher birthweights, greater gestational age at delivery, and less perinatal mortality.

The report also examines the impact of environmental policies economically. It highlights that 25 years after enactment of the Clean Air Act, the U.S. EPA estimated that the health benefits exceeded the cost by 32:1, saving 2 trillion dollars, and has been heralded as one of the most effective public health policies of all time in the United States. Emissions of the major pollutants (particulate matter [PM], sulfur oxides, nitrogen oxides, carbon monoxide, volatile organic compounds, and lead) were reduced by 73 percent between 1990 and 2015 while the U.S. gross domestic product grew by more than 250 percent.

Given these findings, Dr. Schraufnagel has hope. “Air pollution is largely an avoidable health risk that affects everyone. Urban growth, expanding industrialization, global warming, and new knowledge of the harm of air pollution raise the degree of urgency for pollution control and stress the consequences of inaction,” he says. “Fortunately, reducing air pollution can result in prompt and substantial health gains. Sweeping policies affecting a whole country can reduce all-cause mortality within weeks. Local programs, such as reducing traffic, have also promptly improved many health measures.”

Abortion Reversal — The Dangerous Practice You’ve Probably Never Heard Of

In the United States, many more laws have been implemented that restrict or ban a woman’s ability to have an abortion. Abortion reversal is a new technique that hasn’t undergone much medical testing since the one test on it showed significant harm to the women.

Several states now require women who seek medication abortions to be provided with dubious information that the procedure could be stopped, allowing a pregnancy to continue.

But when researchers attempted to carry out a legitimate study of whether these “abortion reversal” treatments were effective and safe, they had to stop almost immediately – because some of the women who participated in the study experienced dangerous hemorrhaging that sent them to the hospital.

By passing these abortion reversal laws, “states are encouraging women to participate in an unmonitored experiment,” Creinin said.

Creinin and his colleagues detailed their concerns in a commentary in the journal Contraception, and they will publish their study in January’s edition of Obstetrics and Gynecology.

Medication abortions, which are used up to 10 weeks into a pregnancy, consist of taking two pills in sequence. The first pill in the regimen, mifepristone, loosens the pregnancy’s attachment to the uterus. The second pill, misoprostol, forces the uterus to contract to push out the pregnancy. The pills must be taken consecutively to complete the abortion, and there’s a chance the pregnancy will continue if the second pill is not taken.

A total of 862,320 abortions were provided in clinical settings in 2017, according to the Guttmacher Institute, about 39 percent of which were medication abortions. Research has shown that using these drugs is a safe way to end a pregnancy.

Some antiabortion activists and legislators claim that not taking the second pill, or giving a woman high doses of the hormone progesterone after taking mifepristone, can help stop, or “reverse,” a medical abortion.

The American College of Obstetricians and Gynecologists firmly states that “claims regarding abortion ‘reversal’ treatment are not based on science and do not meet clinical standards” and say the purported studies that underpin these antiabortion arguments lack scientific rigor and ethics.

Despite this, the claims made in these discredited studies have worked their way to antiabortion lawmakers, who in turn have put them into abortion reversal legislation that was signed by governors in North Dakota, Idaho, Utah, South Dakota, Kentucky, NebraskaOklahoma and Arkansas. The laws are currently blocked or enjoined in Oklahoma and North Dakota.

Because reliable research on these treatments is nonexistent, earlier this year, Creinin and his colleagues designed a legitimate double-blind, placebo-controlled, randomized trial that aimed to observe 40 volunteers who had already elected to have a surgical abortion.

Their goal was to see if giving progesterone to women who took the first pill in the prescribed regimen would effectively and safely halt an abortion.

After the women took the first pill in the abortion protocol, mifepristone, rather than take the second pill, misoprostol, they were either given a placebo or a dose of progesterone.

Researchers only enrolled 12 women before they had to stop the study.

Bleeding is normal during a medication abortion. But three of the women who enrolled in the UC-Davis study experienced far more serious bleeding than anyone could have anticipated when the second pill was not administered.

One woman “was so scared she called an ambulance,” while another woman startled by the amount of blood “called 911 and crawled into her bathtub”, Creinin said. A third woman who went to the emergency room needed a transfusion. One of the women had received a placebo, while two others had taken the progesterone.

Creinin and his colleagues halted the study as soon as it became clear that they could not proceed safely.

“I feel really horrible that I couldn’t finish the study. I feel really horrible that the women … had to go through all this,” Creinin said. Because the study ended prematurely, the researchers could not establish any evidence that progesterone was an effective way to stop a medication abortion.

“What the results do show, though, is that there’s a very significant safety signal” when it comes to disrupting the approved medication abortion protocol, Creinin said.

In their upcoming paper in Obstetrics and Gynecology, the researchers warn that “patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.”

Medical experts are so concerned about abortion reversal laws that the American Medical Association joined a lawsuit against North Dakota’s abortion reversal law, which was blocked by a federal judge in September.

The North Dakota abortion reversal law, signed by Gov. Doug Burgum (R) in March, instructed health-care providers to tell a woman “that it may be possible to reverse the effects of an abortion-inducing drug if she changes her mind, but time is of the essence” and to provide a woman with literature on how to do this. The law fails to specify what that literature would include, or what such a treatment might entail.

In 2019, 27% of Denmark’s Power Was from Wind

A model of clean energy that other countries should take note of.

COPENHAGEN, Jan 2 (Reuters) – Denmark sourced almost half its electricity consumption from wind power last year, a new record boosted by steep cost reductions and improved offshore technology.

Wind accounted for 47% of Denmark’s power usage in 2019, the country’s grid operator Energinet said on Thursday citing preliminary data, up from 41% in 2018 and topping the previous record of 43% in 2017.

European countries are global leaders in utilising wind power but Denmark is far in front of nearest rival Ireland, which sourced 28% of its power from wind in 2018 according to data from industry group WindEurope.

Across the European Union, wind accounted for 14% of consumption last year, the group says.

The higher proportion of wind energy in Denmark last year was partly due to Vattenfall starting operations at the Horns Rev 3 offshore wind farm in the North Sea in August.

The share of power from wind turbines at sea increased to 18% last year from 14% in 2018, Energinet said. Onshore wind accounted for 29% last year.

The International Energy Agency (IEA) said in October that while power generated from wind turbines at sea only accounts for 0.3% of today’s global electricity generation, capacity is set to increase 15-fold over the next two decades.

Denmark aims to reduce greenhouse gas emissions by 70% by 2030, with a new climate law passed late last year targeting an increase in the share of electricity sourced from renewable power to 100%.

Denmark, home to wind turbine giant Vestas and the world’s largest developer of offshore wind Orsted, has favourable wind conditions and began investing heavily in wind power in the 1970s.

Orwell’s 1984 — Too Real in the 2010s

The interpretation of Orwell’s 1984 that I have is that the mere possibility that people may be being watched by a powerful, corrupt state changes behavior in a way that has significant implications across society. It’s been found in research that people change their behavior when they know they are being watched.

There’s no poking holes in the Party’s control, no loose thread for any opposition to pull. If there is a Resistance, it vanishes halfway through. The book is designed to make The Party and its machinery of oppression look entirely infallible. You accept, like the protagonist Winston Smith, that it can never be overthrown. This isn’t The Hunger Games. There is no cartoonish YA villain like President Snow for a defiant Katniss Everdeen to topple. Even Margaret Atwood, in The Handmaid’s Tale, destroyed Gilead in a far-future postscript.

But 1984? So far as we know, it’s boots on human faces all the way down.

How come? The Party doesn’t get its power from spying on its citizens, or turning them into snitches, or punishing sex crimes. All were presented as mere tools of the state. How did it come to wield that control in the first place?

Orwell, aka Eric Blair, a socialist freedom fighter and a repentant former colonial officer who had a lifelong fascination with language and politics, knew that no control could be total until you colonized people’s heads too. A state like his could only exist with loud, constant, and obvious lies.

To be a totalitarian, he knew from his contemporary totalitarians, you had to seize control of truth itself. You had to redefine truth as “whatever we say it is.” You had to falsify memories and photos and rewrite documents. Your people could be aware that all this was going on, so long as they kept that awareness to themselves and carried on (which is what doublethink is all about).

The upshot is, Winston Smith is gaslit to hell and back. He spends the entire novel wondering exactly what the truth is. Is it even 1984? He isn’t sure. Does Big Brother actually physically exist somewhere in Oceania, or is he just a symbol? ¯\_(ツ)_/¯

Winston is what passes for well-educated in his world; he still remembers the name “Shakespeare.” He’s smart enough not to believe the obvious propaganda accepted by the vast majority, but it doesn’t matter. The novel is about him being worn down, metaphorically and physically, until he’s just too tired and jaded to hold back the tide of screaming nonsense.

Don’t call him Winston Smith. Call him Mr. 2019. Because it’s looking increasingly like we live in Oceania. That fictional state was basically the British Isles, North America, and South America. Now the leaders of the largest countries in each of those regions — Boris Johnson, Donald Trump, Jair Bolsonaro — are men who have learned to flood the zone with obvious lies, because their opponents simply don’t have the time or energy to deal them all.

As we enter 2020, all three of them look increasingly, sickeningly, like they’re going to get away with it. They are protected by Party members who will endure any humiliation to trumpet loyalty to the Great Leader (big shout-out once again to Sen. Lindsay Graham) and by a media environment that actively enables political lies (thanks, Facebook).

All the Winston Smiths of our world can see what the score really is. It doesn’t seem to make any difference. But hey, at least we’re all finally aware of the most important line in 1984, which is now also its most quote-tweeted: “The party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”

In the decades following its 1949 publication, the message of 1984 became corrupted. Popular culture reduced it to a single slogan — Big Brother is Watching You — and those with only a vague memory of studying the book in school thought the surveillance state was the main thing Orwell was warning against.

That was certainly where we were at in 2013, when Edward Snowden released his treasure trove of documents that proved the vast scale of NSA spying programs. “George Orwell warned us of the danger of this kind of information,” Snowden told UK TV viewers in his “alternate Christmas message” that year. “The types of collection in [1984] — microphones and video cameras, TVs that watch us — are nothing compared to what we have available today.”

Which was true, but also beside the point. Orwell doesn’t actually claim the surveillance system in Oceania is all that strong. It would have strained credulity to have a Party that watched all of its members all of the time. It sounded like a bad science fiction plot. (In China, where the growing state systems of facial recognition and social media post ranking make NSA programs look like amateur hour, it no longer does).

In 1984, the only time we definitively know a telescreen is watching Winston is when he’s doing morning exercise and a female instructor calls him out for not pushing hard enough. Here in the real future, people pay Peloton $2200 plus $40 a month for the same basic setup.

It isn’t that Big Brother is watching — that too is another Party lie. It’s that he may be watching, just as knowing there may be a speed camera around the next bend keeps your mph in line. Against that possibility, citizens can still rebel. For much of the book, Winston and Julia are able to escape all cameras, out in the post-atomic countryside. Avoiding surveillance doesn’t matter. What causes their capture is the fact that they fell for a lie (the “Brotherhood,” a fake Resistance operation run by the Inner Party member O’Brien).

We are invited to consider whether we too are falling for The Party’s lies. The book-within-a-book that explains the shape of Winston’s world turns out to be written by O’Brien, the master liar. The rocket bombs dropping on London are dropped by the Party. All the in-universe truth the reader has to go on is Winston’s word, and by the end — as he is tortured into genuinely seeing O’Brien hold up three fingers instead of two, then thinks he hears news of a final victory in the endless war — even that isn’t reliable.

By the end of this decade, even words like “Orwell” and “Orwellian” had become ambivalent. I realized this in 2017 when my wife, knowing my love of the book, had bought me a cap that said “Make Orwell Fiction Again.” I loved it until I found it had been made in a state that voted for Trump, by a company with a line of libertarian merch. We saw the cap as a riposte to the MAGA mentality, but it was also possible to see it as a reinforcement: Make Orwell fiction again by helping Trump fight Deep State surveillance, man!

If there is hope for Oceania in the coming decade, it may come from uniting people under the banner of all that 1984 warns against — starting with the bare-faced lies that Orwell was most concerned about. The lies that social media gatekeepers have taken way too long to notice, if they notice them at all.

If we can’t agree on basic facts of science and history, we’re lost. But if we the people can do that, there’s no surveillance system or endless war or sexcrime we can’t dismantle. “Freedom is the freedom to say that two plus two makes four,” Winston wrote in his diary. “If that is granted, all else follows.”

By remaining skeptical about all we read, but still reading widely and clawing our way back to a world of truths that are as simple and as objective as math, we can prove that we finally learned Orwell’s lesson. And we can make 1984 merely a masterpiece of fictional worldbuilding again.

Study: Facts Misremembered to Fit Personal Biases

Reality is sometimes very unpleasant to see, but there are clearly problems in people choosing to cloud their clear views of reality.

A recent study by Ohio State researchers found that people tend to misremember information to match commonly-held beliefs.

If you’re looking for who’s responsible for all the misinformation out there, you might want to take a peek in the mirror.

OK, OK, it’s not all your fault.

Although external sources of misinformation like “fake news” and purposeful disinformation campaigns draw a lot of attention today, recent research at Ohio State University indicates we might misremember information all on our own.

In a recent study, Ohio State researchers found that when given accurate statistics on a controversial issue, people tended to misremember numbers to match their own beliefs. Then, when researchers gave study participants accurate information and asked them to convey it to others, the information grew more and more different as it was passed from person to person.

“What our research would suggest is there’s a lot of focus on external sources of misinformation, but we also have to pay attention to these internal sources,” said Jason Coronel, an assistant professor of communication at Ohio State.

For the study, participants were given factual numerical information about four societal issues. Based on pre-tests, researchers found that the numbers for two of the societal issues matched many people’s understanding of the matter. But for the other two issues, the numbers didn’t fit with their understanding.

For the numbers that were inconsistent with how people view the issue, participants were more likely to remember the numbers incorrectly, in a way that matched their probable biases.

For example, researchers presented participants with information showing there were 12.8 million Mexican immigrants in the United States in 2007, and fewer — 11.7 million — in 2014. When participants were then given a memory test, they were more likely to remember the statistics incorrectly, in a way that agreed with many people’s understanding that the number of Mexican immigrants would be higher in 2014 than 2007.

In a second portion of the study, researchers examined how memory distortions can be spread among social circles as individuals share the misinformation they created. Mimicking a game of “telephone,” researchers presented a participant with accurate numbers about a societal issue.

For example, the participant was asked to write down the numbers of Mexican immigrants in 2007 and 2014 from memory. The numbers from the first person were then given to a second person, and the process was repeated to a third person.

Researchers found that as the retellings increased from person to person, the information transformed to be more consistent with people’s understanding of the issue rather than the factual numbers.

It’s one thing to believe information yourself without fact-checking it first, said Shannon Poulsen, a doctoral student at Ohio State who conducted the study with Coronel and fellow doctoral student Matthew Sweitzer. But the second portion of the study shows the danger of then sharing inaccurate information with others, she said.

“Now the issue is not just you … now you’re sharing information,” Poulsen said.

Then, you can become part of the bigger problem, Coronel said.

“If you don’t scrutinize on what you’re remembering and you decide to talk about it and pass it on to another person, you just turned into an external source of misinformation,” Coronel said.

It may be a bit unsettling to think you can’t trust your own brain, but researchers hope the study leads to better understanding about how we remember things and encourages healthy scrutiny and skepticism.

“It can be a little bit scary,” Poulsen said. “But if it’s enough to increase … a little bit of skepticism to a point where people can be accurate, that’s great.”

People tend to think of their memories as simply a video recording device, taking in everything and repeating it back when they need it, Coronel said. But lots of research in psychology indicates memory doesn’t work that way.

Instead, think of memory as a jigsaw puzzle, he said — sometimes you’re missing some pieces, or you’ve got pieces from multiple boxes dumped on the same table.

Unjust Voter Purges in Georgia and Wisconsin Will Likely Contribute to the Tipping of the 2020 Election

America masquerades as a democracy. As shown with articles such as the one below, at best, it is a country with some functioning but flawed democratic structures. The idea that rescinding someone’s eligibility to vote based on them not voting in some past elections is an absurd assault on voting rights, but that’s what’s being done by the Republican party in these instances in the swing states of Georgia and Wisconsin.

Republicans are intensifying efforts to aggressively purge the voter rolls in Wisconsin and Georgia before the 2020 elections, potentially giving their party a crucial advantage by shrinking the electorate in two key swing states.

On Friday, a state judge in Wisconsin ruled that the state could begin canceling the registrations of 234,000 voters—7 percent of the electorate—who did not respond to a mailing from election officials. The Wisconsin Elections Commission, a bipartisan group overseeing state elections, had planned to wait until 2021 to remove voters it believes have moved to a new address. But in response to a lawsuit from a conservative group, the Wisconsin Institute for Law & Liberty, Judge Paul Malloy, a Republican appointee, said those voters could be purged 30 days after failing to respond to a mailing seeking to confirm their address.

Republicans are intensifying efforts to aggressively purge the voter rolls in Wisconsin and Georgia before the 2020 elections, potentially giving their party a crucial advantage by shrinking the electorate in two key swing states.

On Friday, a state judge in Wisconsin ruled that the state could begin canceling the registrations of 234,000 voters—7 percent of the electorate—who did not respond to a mailing from election officials. The Wisconsin Elections Commission, a bipartisan group overseeing state elections, had planned to wait until 2021 to remove voters it believes have moved to a new address. But in response to a lawsuit from a conservative group, the Wisconsin Institute for Law & Liberty, Judge Paul Malloy, a Republican appointee, said those voters could be purged 30 days after failing to respond to a mailing seeking to confirm their address.

On Monday night, Georgia Secretary of State Brad Raffensperger removed 309,000 voters from the rolls—4 percent of the electorate—whose registrations were labeled inactive, including more than a hundred thousand who were purged because they had not voted in a certain number of previous elections.

These numbers are large enough to swing close elections. Donald Trump carried Wisconsin by 22,000 votes; the number of soon-to-be purged voters is more than 10 times his margin of victory. Democrat Stacey Abrams failed to qualify for a runoff against Brian Kemp in the 2018 governor’s race by 21,000 votes; the number of purged voters in Georgia is 14 times that.

These purges appear to disproportionately affect Democratic-leaning constituencies, including voters of color, students, and low-income people who tend to move more often. In Wisconsin, 55 percent of those on the purge list come from municipalities where Hillary Clinton defeated Trump in 2016. Nine of the 10 areas with the highest concentration of voters slated to be purged voted for Clinton. Milwaukee and Madison, the state’s two most Democratic areas, account for 14 percent of the state’s registered voters but 23 percent of those on the purge list, according to the Milwaukee Journal Sentinel.

For the past decade, Republican election officials and conservative groups have sought to expand the use of voter purges. They were aided in 2018 by a Supreme Court decision allowing states to remove people who had not voted in two or three previous elections, a move voting rights group said turned the right to vote into a “use it or lose it” privilege.

Both Wisconsin and Georgia have a recent history of inaccurate voter purges based on faulty data. In 2017, Wisconsin sought to remove 340,000 voters who the state government said had filed a change of address with the post office or registered their cars at an address other than the voter registration address. But at least 7 percent of the people on the list had not moved and should not have been on the purge list, according to the League of Women Voters of Wisconsin. Milwaukee removed 44,000 voters but later reinstated nearly half of them, who remained eligible to vote. The state’s new purge list “likely once again contains a substantial amount of unreliable and demonstrably inaccurate information,” according to a legal brief filed by the Wisconsin League of Women Voters. (Because Wisconsin has Election Day registration, purged voters can re-register at the polls, but they need to bring proof of address and a valid ID.)

“If our experience is anything like it was back in 2017-2018, where we lost thousands of voters, we’re afraid that history will repeat itself,” says Neil Albrecht, the executive director of Milwaukee’s Election Commission. “This will lead to people distrusting election administration in Wisconsin. If people feel like a system is rigged, it has a pretty profound impact on whether or not they feel it’s even worthwhile to participate in an election.”

Georgia purged 1.4 million people from 2012 to 2018. That included a purge of more than half a million people in the summer of 2017, the largest in state history. Seventy thousand people purged for having not voted in previous elections re-registered to vote in the 2018 election, and 65 percent of them re-registered in the same county, according to American Public Media, suggesting that they should not have been purged in the first place. Voters living in areas that went for Abrams over Kemp were more likely to be purged.

Earlier this year, the state of Ohio released a list of 235,000 voters slated to be purged. It turned out that 40,000 people shouldn’t have been on it. That included the head of the Ohio League of Women Voters, who had voted in three elections in the past year but nonetheless found herself labeled an inactive voter.

The same sort of problems appear to be resurfacing in the latest round of purging in Wisconsin and Georgia, with eligible voters wrongly targeted for removal.

Clinical Trial on Lupus Shows Significant Promise on Better Treating It

Lupus is surprisingly prevalent and is in many respects a uniquely terrible disorder, and this experimental trial shows statistically significant results in treating it. The long-term side effects of using this new medicine (anifrolumab) on lupus patients aren’t known, but the progress on lupus is still important.

Lupus is a potentially fatal autoimmune disorder that impacts roughly 5 million people worldwide, and yet it still has no known cause or cure.

Today, most treatments come with a whole bunch of adverse side effects, and given how little we know, finding new avenues for medicine has proved extremely difficult.

In the past six decades, only one drug for lupus has been approved by the United States Food and Drug Association and it’s still unavailable to many. Now, an international three-year clinical trial offers the first real hope for patients in half a century.

The Phase 3 trial, called TULIP-2, tested a drug called anifrolumab on a randomised selection of 180 people with lupus, giving them 300 mg every four weeks for 48 weeks.

Compared to the placebo, which was given to a further 182 participants who also had lupus, the authors say anifrolumab produced a statistically significant and clinically-meaningful reduction in the disease.

After 52 weeks, not only only did this drug reduce autoimmune activity in the relevant organs of many of the treated patients, it also reduced the rate of flare-ups – which include fever, painful joints, fatigue and rashes – and lessened the need for steroids.

“There is now a strong body of evidence demonstrating the benefit of anifrolumab, and we look forward to bringing this potential new medicine to patients with systemic lupus erythematosus as soon as possible,” says Mene Pangalos, the executive vice president of BioPharmaceutical R&D.

Even when no virus infection can be found, recent studies show the vast majority of lupus patients produce excess Type 1 interferon, which is an immune protein linked to the development of white blood cells.

Previous attempts to block this protein have failed, but anifrolumab blocks the receptors for this protein instead and not the molecule itself.

Another clinical trial that tested this drug, called TULIP-1, couldn’t support any particular benefits based on its specific method, although there were signs that it might help improve the health of certain organs.

The smaller second trial has now explored this second outcome further – known as the British Isles Lupus Assessment Group–based Composite Lupus Assessment (BICLA) – and the results look much more promising.

Unlike TULIP-1, TULIP-2 showed benefits on both the BICLA and SRI index.

“Measurement of treatment response in [systemic lupus erythematosus] has been very problematic and this represents a kind of second breakthrough of this trial,” says rheumatologist and lead researcher Eric Morand from Monash University.

It’s still unclear why TULIP-1 and TULIP-2 produced different results, especially since they were nearly identical. But an accompanying editorial explains they might have differed because various elements of lupus were weighted differently. One of the assessments, for example, only captures partial responses while another only captures complete responses.

“Therefore, the effect of a drug on particular disease features may produce superior results with one end point and not another,” the editorial reads.

So far, three clinical trials in total have tested anifrolumab, and the results for five of the six outcomes favoured the drug over the placebo. Given the desperate need for treatment, many in the lupus community are urging regulators to consider trials that allow greater flexibility in defining success.

“For example,” the authors of the editorial write, “perhaps a benefit with respect to just one of two end points — the SRI or the BCLA — needs to be observed to declare a drug effective in this complex disease.”

This could accelerate drug development until we know better what response measures and biomarkers are most useful when trialling lupus medication.

More research is needed for anifrolumab before we can say for sure whether its benefits outweigh its side-effects in the long run. Some patients taking the drug were more at risk of bronchitis and upper respiratory infection and the risks beyond 52 weeks are still unclear.

“As clinicians we need new medicines for this complex and difficult-to-treat disease,” says Morand.

“These exciting results from the TULIP 2 trial demonstrate that, by targeting the type I interferon receptor, anifrolumab reduced disease activity in patients with systemic lupus erythematosus.”

The study was published in NEJM.