Keywords: Clinician-patient interaction, communication, relationship, patient empowerment, participatory medicine.
Citation: Kraleti S, Jarrett D. Book review: A Cure for Asthma? What Your Doctor Isn’t Telling You — And Why. J Participat Med. 2014 Jun 25; 6:e10.
Published: June 25, 2014.
Competing Interests: The authors have declared that no competing interests exist.
In 1991, a group of primary care practice partners completed a study of 365 patients with acute respiratory illness caused by Chlamydia pneumoniae. One of their most remarkable conclusions was that C. pneumoniae infection was associated with adult-onset asthma. The conclusion: Clear up the infection, and the asthma is cured.
David L. Hahn MD, MS, the current director of Wisconsin Research and Education Network, was the leader of the study. Almost a quarter of a century later, he continues to challenge the conventional wisdom about the causes and treatments of asthma by describing the treatment protocol he has used successfully on some of his patients – namely a course of antibiotics, particularly azithromycin.
His frustration at the lack of response to his theories is palpable. Dr. Hahn rightly points out that the case reports he offers are “the weakest form of scientific evidence and can be misleading,” but he presents a compelling argument for the need for open minds and additional research. Along the way, he paints an unpleasant picture of some physicians who lack insight into the devastation that asthma can wreak in the lives of patients, along with a perceived resistance to change in light of hopeful evidence that a complete rethinking of asthma treatment is necessary.
A patient named Jim, for example, recounts his fury when a doctor “casually” told him he had asthma and gave him an inhaler. A patient named Steve was disheartened to find that the only response that he could elicit from physicians was to “take these drugs for the rest of your life and hope for the best.”
In Jim’s case, he rapidly transformed from a healthy, productive man into a wheezing, exhausted wreck who frequented emergency rooms in a desperate struggle to breathe, seeing physicians who had basically nothing new to offer. After consultations with Dr. Hahn and others, Jim embarked on what ended up as a 14-week course of antibiotics. Slowly he began to improve. Within a year, he was cured. Fifteen years later, he is still asthma free.
The author offers several similar cases in painful detail (perhaps too much detail), including that of a child whose worried parents asked their pediatrician about antibiotic treatment, only to find that the he was not only unwilling to discuss the possibility but also was offended that the parents had suggested it. The resistance of physicians and researchers to the mere idea of antibiotic treatment for asthma is a refrain in this book.
Part Two, Evidence, and Part Three, Challenges, are perhaps of most interest to physicians. They include discussion of the connection between infection, inflammation, and asthma, along with criticism of how lab-based research is conducted and how dogmatic thinking has stifled innovation in asthma treatment. Part Four, Solutions, summarizes his beliefs and provides his recommendations for treatment protocols based on his hypothesis. His description of guidelines for future research on asthma is fascinating to read and provides a good blueprint for valuable asthma research.
Overall, the author recounts extensive research and quotes several interesting and valid articles on the topic. He indicates that the attitude of providers is the biggest barrier to change in practice of asthma management. (One of the case stories involves a cured asthma sufferer whose physician not only refused to believe the patient was cured, but refused to consider antibiotic treatment for his own asthma!) The book is intriguing and might tempt many physicians to attempt a replication of Dr. Hahn’s antibiotic treatment.
Although several of Dr. Hahn’s patients were cured from asthma, about 50% did not respond to the antibiotic course. This reflects the current dilemma of many providers in treating their asthma patients. Could there be multiple unrelated etiologies resulting in a common pathology? There is a definite gap in the existing information of etiology, pathology, diagnosis and management of asthma that warrants further research as recommended by Dr. Hahn.
Dr. Hahn states in his book that more than half of the patients treated by traditional methods for asthma are not adequately controlled. On the other hand, he reports an almost equal percentage of patients being cured with his method. This is a remarkable achievement indeed and a ray of hope to physicians who are aware of the gaps in the current guidelines for asthma management.
- Hahn DL. A Cure for Asthma? What Your Doctor Isn’t Telling You — And Why. Durham, NC: People’s Pharmacy Press; 2013. ↩
Copyright: © 2014 Shashank Kraleti and Diane Jarrett. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.