A homeopathic remedy for early COPD.

“Let’s Diagnose COPD Early!” was the title of an editorial written by the late great Doctor Tom Petty over 35 years ago. Towards the end of his editorial, promoting the widespread use of office spirometry to detect COPD, he stated, “It must be honestly admitted that studies to establish the value of early or so-called preventive therapy are yet to be established.” The U.S. National Heart Lung and Blood Institute and the American Thoracic Society then held a workshop on screening programs for early diagnosis of airway obstruction to discuss the “rapidly developing confusion about pathophysiologic abnormalities associated with early airway obstruction.” The eminent group of respiratory scientists at the 1973 workshop included Doctors Nicholas Anthonisen, Margaret Becklake, Sonia Buist, Reuben Cherniack, Charles Fletcher, Claude Lenfant, Peter Macklem, Solbert Permutt, and others. They concluded that “a mass screening program for early detection of chronic bronchitis and emphysema should not be undertaken at this time” . because “these diseases have a long course and currently available treatment is at best no more than palliative.” Very little has changed since then, except that many large studies have proven conclusively that COPD inhalers do not improve the course of the disease in smokers. However, because of financial imperatives, during the past decade, much more has been written about this topic than is known. The editorial review “New horizons in early stage COPD” in this issue by Marc Decramer and colleagues, resulting from a meeting sponsored by Boehringer and Pfizer, is no exception. The manufacturers and distributors of COPD inhalers are diligently working to expand their 5 billion Euro per year worldwide market. They are generously funding medical education companies (MECs) to hold meetings at luxurious resorts for key opinion leaders to discuss the value of early detection and treatment of mild COPD. The MECs then pay skilled medical writers to produce reviews and editorials which promote this concept as “Early detection and management of COPD guidelines from the National COPD Awareness Panel”. Some experts worry about the ethics of these marketing methods, even when professional medical societies are involved. Even after 35 years, there is no consensus definition of “early” COPD. Decramer and colleagues suggest that mild