Unjust Laws and Illegal Norms

Due to a variety of circumstances, lawmakers occasionally create laws whose aims are perceived as outright unjust by the majority of the people. In other situations, the law may utilize improper means for the pursuit of a just goal. In all such cases, lawmaking processes generate rules that do not reflect the values of the underlying population. In these cases individuals may face legal commands or prohibitions that conflict with their sense of justice or fairness. Individuals can oppose unjust laws through protest. Social opposition to unjust laws may trigger social norms that can have countervailing effects on legal intervention. The dynamic effects of these phenomena are the object of this paper

Bronchial thermoplasty: long-term safety and effectiveness in patients with severe persistent asthma

Background: Bronchial thermoplasty (BT) has previously been shown to improve asthma control out to 2 years in patients with severe persistent asthma.<p></p> Objective: We sought to assess the effectiveness and safety of BT in asthmatic patients 5 years after therapy.<p></p> Methods: BT-treated subjects from the Asthma Intervention Research 2 trial (ClinicalTrials.govNCT01350414) were evaluated annually for 5 years to assess the long-term safety of BT and the durability of its treatment effect. Outcomes assessed after BT included severe exacerbations, adverse events, health care use, spirometric data, and high-resolution computed tomographic scans.<p></p> Results: One hundred sixty-two (85.3%) of 190 BT-treated subjects from the Asthma Intervention Research 2 trial completed 5 years of follow-up. The proportion of subjects experiencing severe exacerbations and emergency department (ED) visits and the rates of events in each of years 1 to 5 remained low and were less than those observed in the 12 months before BT treatment (average 5-year reduction in proportions: 44% for exacerbations and 78% for ED visits). Respiratory adverse events and respiratory-related hospitalizations remained unchanged in years 2 through 5 compared with the first year after BT. Prebronchodilator FEV1 values remained stable between years 1 and 5 after BT, despite a 18% reduction in average daily inhaled corticosteroid dose. High-resolution computed tomographic scans from baseline to 5 years after BT showed no structural abnormalities that could be attributed to BT.<p></p> Conclusions: These data demonstrate the 5-year durability of the benefits of BT with regard to both asthma control (based on maintained reduction in severe exacerbations and ED visits for respiratory symptoms) and safety. BT has become an important addition to our treatment armamentarium and should be considered for patients with severe persistent asthma who remain symptomatic despite taking inhaled corticosteroids and long-acting β2-agonists.<p></p&gt