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Medical Forum / Diseases and Disorders / Asthma / August 2004Asthma research on the wrong trail
Joy wrote on "Breath holding and asthma" "Whatever. I view it as immaterial. No one wants to spend their lives taking meds, or in breathing exercises. They just want what everyone else has - the ability to breath without thinking about it. Again, the best HOPE of figuring this all out rests with the people who are looking at the CAUSES of asthma. Clearly there is more than one." But can you honestly say, judging from your experience with human nature, that research might not be barking up the wrong tree? Could not the mystery behind asthma be due to a misunderstanding? Dr. Rolf Hubmayr (Am J Respir Crit Care Med Vol 165. pp 16471653, 2002) complains of the critical care community's tunnel vision (on ventilating patients). Specifically, ongoing asthma research is largely concentrated on molecular and cellular biology. This might be due to a logical fallacy as follows: 1 Symptomatic treatment with drugs is presently paramount in asthma treatment. 2 Therefore such drugs provide a strong lead to a cause of asthma being at the molecular or cellular level. However, since symptomatic and causal treatment may bear no relation to each other, this hypothesis seems too weak in comparison with theories that there is some self-limiting factor like carbon dioxide accumulating (Buteyko, has been disproved) or inspiratory muscles adapting to cope with increased load in asthma (implied by Weiner, Chest 1992, 1357-61, http://www.findarticles.com/p/articles/mi_m0984/is_n5_v102/ai_12940162/pg_1). Then, it could follow that asthma drugs might tend to torpedo such adaptation, while being paradoxically acclaimed as beneficial. As witnessed by the activities of ethics commissions giving permission to test asthma and other drugs, there is the principle that probands (those taking part in such tests) should not be denied an effective treatment. It would not be permissible to stop probands from taking any (normally needed) effective medication in the sham treatment (placebo or control) group, while the other group took the new medication to be tested. This principle should apparently override the principle of free enterprise that drug companies are allowed to fully focus their activities on drug development. They should, as a moral duty, have control groups in asthma research using breathing methods and if such methods are not adequately tested so far then such testing (which is unfortunately comparatively expensive)should be funded. Regards, Richard Friedel > Joy wrote on "Breath holding and asthma" > [quoted text clipped - 17 lines] > molecular and cellular biology. This might be due to a logical fallacy > as follows: I don't see that treatment for asthma with drugs has anything to due with the reason they are looking at cell biology. I was told that doctors have to hit everyone with a shotgun approach right now because they don't know specifically what will work for an individual person. You know, how some drugs work without side effects for one person while the next is left not only without relief, but with unbareable side effects. Understanding the genetics will allow them to more accurately prescribe the drug which has been shown to help people with that genetic makeup. We are all just so different, it isn't like A single drug is likely to work well for everyone. > 1 Symptomatic treatment with drugs is presently paramount in asthma > treatment. [quoted text clipped - 8 lines] > adapting to cope with increased load in asthma (implied by Weiner, > Chest 1992, 1357-61, http://www.findarticles.com/p/articles/mi_m0984/is_n5_v102/ai_12940162/pg_1). > Then, it could follow that asthma drugs might tend to torpedo such > adaptation, while being paradoxically acclaimed as beneficial. [quoted text clipped - 6 lines] > (placebo or control) group, while the other group took the new > medication to be tested. I am not certain what you are implying. I have never heard of a company who in testing would tell you to deny yourself your asthma meds. They may deny you their really great, or not so great, not yet marketed product. I have a chemistry friend in California whose company was testing a new drug for Lupus which was so successful that the company gave everyone a chance to try the drug before the trial ended. So some companies do take care of the participants. I have also heard of studies which don't complete (time wise) because the results were so significant, the researchers no longer needed to test. How, other than testing, do you propose they get this information about efficacy? Side effects? > This principle should apparently override the principle of free > enterprise that drug companies are allowed to fully focus their [quoted text clipped - 3 lines] > unfortunately comparatively expensive)should be funded. Regards, > Richard Friedel Why breathing methods? The is no innate reason to pick breathing methods. Why not try the Doe approach or the cow dung. Which breathing method? You could go nuts as a researcher trying to appease all you guys. Joy > I am not certain what you are implying. I have never heard of a company who > in testing would tell you to deny yourself your asthma meds. They may deny > you their really great, or not so great, not yet marketed product. ..... Yes, probands (persons in a clinical test) in the control or sham treatment group, could not be prevented from taking satisfactory state of the art meds. Such denial would be prevented by the relevant ethics commission. However you could, I think; easily extend this moral duty to considering other treatments. If, as you seem to consider a repulsive thought (:- o any non-drug treatment has a good status, then probands normally using it could be considered as a control group as well, whereas the other group would be treated with the new drug. The logic may not be accepted by all, but there is the danger of drug companies specializing too much on comparing drugs with each other and so simply small timing. As we all know, medicine as the art of healing cannot be commercialized, or at any rate, not to an unlimited extent. On the distinction between breathing techniques and obviously lunatic fringe stuff (doe and cow dung), see Weiner as a leading authority on asthma (Chest 1992 1357-61). "In addition, circumstantial evidence exists to suggest that the inspiratory muscles may suffer damage during an acute asthmatic attack that may lead to acute respiratory failure." He states that his muscle training and his interpretation of asthma as being largely a muscular condition to be treated by breathing, is a valuable method and perspective. His method or at any rate other breathing methods (counting to slow respiration rate, pursed lips breathing) curb attacks. Therefore, it could be plausibly argued, the optimum state of the art treatment given to asthmatic probands in a control group getting should not be limited to drugs. Likewise, it would be no good finding some asthmatics normally undergoing substandard treatment and using them as probands, even if some ethics commission allowed it. I do know that many (as a sort of silent majority) think that breathing techniques have next to no effect on asthma and that this would seem to be almost axiomatic and sort of common sense, but the competently researched SIMT stuff seems to provide a proof that this is not so. Regards, Richard Friedel > > I am not certain what you are implying. I have never heard of a company who > > in testing would tell you to deny yourself your asthma meds. They may deny [quoted text clipped - 4 lines] > of the art meds. Such denial would be prevented by the relevant ethics > commission. > However you could, I think; easily extend this moral duty to > considering other treatments. If, as you seem to consider a repulsive [quoted text clipped - 5 lines] > small timing. As we all know, medicine as the art of healing cannot be > commercialized, or at any rate, not to an unlimited extent. I don't feel that there is a moral duty of a drug company to test your ideas out for free. They make profits from the production of drugs - that is the reason for their existance. Furthermore, they may so confuse the picture by letting the control group do something that is not a control, their results would be invalidated. Wasted test. No new product. It will never happen. > On the distinction between breathing techniques and obviously lunatic > fringe stuff (doe and cow dung), see Weiner as a leading authority on [quoted text clipped - 3 lines] > inspiratory muscles may suffer damage during an acute asthmatic attack > that may lead to acute respiratory failure." That is an exception and those people whose asthma is so severe they experience disabling attacks would never make it into the test. No researcher likes having someone die on them. Now I know that people with COPD are particularly incouraged to use breathing devices, particularly after a heart attack. > He states that his muscle training and his interpretation of asthma > as being largely a muscular condition to be treated by breathing, is a [quoted text clipped - 13 lines] > competently researched SIMT stuff seems to provide a proof that this > is not so. Regards, Richard Friedel I disagree. I think that the majority think that SIMT stuff has no effect. The army tried that in WWI and you may not have noticed, but almost no one uses it anymore. They must find the asthma meds more satisfactory. People use what works. I did see a report out of Britain that said the number of asthmatics who had tried alternative treatments was pretty small - 6%. That would vary culture to culture I suspect. But that coincides with the report Dr Enright quoted that 80% of asthmatics are satisfactorily controlled by asthma meds. Those who are doing fine are not out there looking for answers. So I expect nothing much will come of any altmed treatment. Joy >> Specifically, ongoing asthma research is largely concentrated on > molecular and cellular biology. Post links to your sources that state this, please. > As witnessed by the activities of ethics commissions giving permission > to test asthma and other drugs, there is the principle that probands [quoted text clipped - 11 lines] > unfortunately comparatively expensive)should be funded. Regards, > Richard Friedel According to you, Richard, breathing exercises will solve all their asthma problems, and since all participants would have to do the breathing exercises, this would really skew the study. (said, tongue in cheek) You have no understanding of what clicinal trials are about. I'd stop now if I were you. |
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