r REVEIVED FOBACCA) Manufacturers Association 1 6 MAR 19cl- A. J. NELIVES -5.=F S'vV'-- SAG. Tell: G1"---;7? -;:-.J-T'-2.3^^.7.-.'5 CHve Tunter Exe=::ve Dua--n :--d=" ALL'S Dr. Andrew Nelmes, March 15 1994 Gallaher Tobacco Limited, Members Hill, Brooklands Road, Weybridge, Surrey, KT13 OQU. C-~r 4A,~J~P~ , Herewith some correspondence which has passed between me and the National Asthma Campaign Director. Ms Lefts answers the first question I had, namely the one about the source of her research comments, but she does not answer anything else I asked. You can do with this correspondence what you will in terms of copying it to your colleagues if you wish. Best regards, A P CLIVE TURNER. U-. X-- BATCo document for Legal Services : Health Canada 19 October 1999 ---0001 NATIONAL ASTHMA CAMPAIGN gcrting),otir brradi back C Turner Esa Tobacco Manufacturers Association Glen House Stag Place LONDON SWIE 5AG 10th March 1994 Dear Mr Turner Thank you for your letter 2nd March. The study to which I referred in my letter in The Times was carried out by Dr John Britton at Nottingham University and was funded by the National Asthma Campaign together with the British Lung Foundation, and published at the Britis ' h Thoracic Society meeting in Dublin in July 1993. Dr Britton and his colleagues investigated a number of factors which had all been implicated in the aetiology on wheezing in childhood - low birth weight, premature birth, low maternal age, and cessation of breast feeding - and found that all these effects were shown to be interrelated, and in particular to be confounded by maternal smoking during pregnancy and in early childhood. They estimated the relative independent importance of these effects and the occurrence of wheezing up to 16 in 15,712 subjects from a British national birth cohort of children born in one week of April 1970, and followed up at ages 5, 10, 16. They found accumulative reported prevalence of wheezing up to 16 of over 30%. After adjustment for maternal smoking in pregnancy and birth weight, there was no additional significant effect of social index, maternal age or breast feeding, indicating that the only variegate in association with these variables arose from confounding by maternal smoking. They concluded that these data demonstrated that maternal smoking in pregnancy and low birth weight are the major independent predictors of childhood wheezing. Maternal smoking is, of course, well known to be closely associated with low birth weight. Yours sincerely Melinda Letts Director Un CD don.zrit)n ro suppon ,ttr work M rcsicardi, c4cation ayia* --d"ice CID Telephone 071 Z26 2260 Helpline 0345 01 02 03 Facsimile 071 704 0740 Reagis,zered OfSce: Providence House Providence Place London Ni ONT ~auo~ -- TNI ~;--ess z' ~-es-ce- --e :i! KCM L~1~ V St MAI', e'Z:nf --e Q! 61c., S-r Pete, cc. Vel-ca ~s BATCo document for Legal Services : Health Canada 19 October 1999 T(BIACIA) Manufacturers Association GlenHouse. Stag Place, Lcndm V;'IE ERG. Tel: 071-328 Z'iA71-213 73E'~,,djrect)/0aK-559.122 (motHe). Fax- 071-630961" Clive Tumer Envitive Dirpctor. Indusu y Mau Ms Melinda Letts, Director, National Asthma Campaign, Providence House, Providence Place, London, N.1. &.119. Wtsq I note your letter in the March I 'Times' and from it I see you assert that "smoking by a mother during pregnancy is now known significantly to increase the risk of the child developing asthma!. May I ask if this assertion is drawn from the recent study on the Isle of Wight which reported a highly significant effect on the development of asthma at two years? If so, would it not have been even-handed to include the comment that the same study, (within which It was mooted a longer follow-up study should be conducted), suggested that smoking by a pregnant mother 'Imay just be an irritant effect on the children's airways and may not lead to permanent bronchial hyperactivity"? Many would reasonably argue that this can scarcely be considered proof, but simply statistical association. And in this study several other significant effects were reported, including positive family history, male sex, and season of birth. Yet you refer in your Times letter to the "only one proven culprit - smoking by a mother during pregnancy", which statement, although you do also mention the genetic factor and occupational asthma, could be regarded as a little biased and less than objective, don't you feel? Ln C:) co BATCo document for Legal Services : Health Canada 19 October 1999 it is also interesting to note that some researchers claim that diet is the main cause of the increasing incidence of asthma, and I enclose an extract from GP News, which I daresay you have probably seen already. I recognise that your letter was primarily concerned with traffic and pollution and the concomitant effects for asthma sufferers, but would ft not have been reasonable and relevant, since you mentioned smoking, also to refer to the dietary aspect, given Its apparent Importance? Yours sincerely, CLIVE TURNER. ul CD C) Co t BATCo document for Legal Services : Health Canada 19 October 1999 FACSIMILE From A j Nelmes To Clive Turner Date 2nd March1994 Total Number of Pages (including Cover Sheet) 2 0 Letts letter to the Times You asked me about the data on maternal smoking and asthma to which Melinda Letts, in her letter to the editor, refers. There is a recent UK study, conducted on the Isle of Wight, which reported a highly significant effect on the development of asthma at 2 years. The authors su-est, and I quote "this may be an irritant effect on the children's airways and may not lead to permanent bronchial hyperactivity". A longer follow-up study to clarify the effect has been mooted. This does not sound to me like proof but merely statistical association. In the same study other significant effects were reported, including positive family history, male sex and season of birth. Its interesting to note that some researchers claim that diet is the main cause of the increasing incidence of asthma. A note to that effect published in GP News is attached. If you want me to obtain the paper on which the article was based, I can do so tomorrow. A J Nelmes Research & Development Division Gallaher Ltd Brooklands Rd Weybridge KT13 OOU Facsimile (0932) 857089 Telephone (0932) 859777 Ext 2191 BATCo document for Legal Services : Health Canada 19 October 1999