Personal Health - A Breathing Technique Offers Help for People With Asthma - NYTimes.com
November 3, 2009
Personal Health
A Breathing Technique Offers Help for People With Asthma
By JANE E. BRODY
I don’t often write about alternative remedies for serious medical conditions. Most have little more than anecdotal support, and few have been found effective in well-designed clinical trials. Such trials randomly assign patients to one of two or more treatments and, wherever possible, assess the results without telling either the patients or evaluators who received which treatment.
Now, however, in describing an alternative treatment for asthma that does not yet have top clinical ratings in this country (although it is taught in Russian medical schools and covered by insurance in Australia), I am going beyond my usually stringent research criteria for three reasons:
¶The treatment, a breathing technique discovered half a century ago, is harmless if practiced as directed with a well-trained therapist.
¶It has the potential to improve the health and quality of life of many people with asthma, while saving health care dollars.
¶I’ve seen it work miraculously well for a friend who had little choice but to stop using the steroid medications that were keeping him alive.
My friend, David Wiebe, 58, of Woodstock, N.Y., is a well-known maker of violins and cellos, with a 48-year history of severe asthma that was treated with bronchodilators and steroids for two decades. Ten years ago, Mr. Wiebe noticed gradually worsening vision problems, eventually diagnosed as a form of macular degeneration caused by the steroids. Two leading retina specialists told him to stop using the drugs if he wanted to preserve his sight.
He did, and endured several terrifying trips to the emergency room when asthma attacks raged out of control and forced him to resume steroids temporarily to stay alive.
Nothing else he tried seemed to work. “After having a really poor couple of years with significantly reduced quality of life and performance at work,” he told me, “I was ready to give up my eyesight and go back on steroids just so I could breathe better.”
Treatment From the ’50s
Then, last spring, someone told him about the Buteyko method, a shallow-breathing technique developed in 1952 by a Russian doctor, Konstantin Buteyko. Mr. Wiebe watched a video demonstration on YouTube and mimicked the instructions shown.
“I could actually feel my airways relax and open,” he recalled. “This was impressive. Two of the participants on the video were basically incapacitated by their asthma and on disability leave from their jobs. They each admitted that keeping up with the exercises was difficult but said they had been able to cut back on their medications by about 75 percent and their quality of life was gradually returning.”
A further search uncovered the Buteyko Center USA in his hometown, newly established as the official North American representative of the Buteyko Clinic in Moscow.
“When I came to the center, I was without hope,” Mr. Wiebe said. “I was using my rescue inhaler 20 or more times in a 24-hour period. If I was exposed to any kind of irritant or allergen, I could easily get a reaction that jeopardized my existence and forced me to go back on steroids to save my life. I was a mess.”
But three months later, after a series of lessons and refresher sessions in shallow breathing, he said, “I am using less than one puff of the inhaler each day — no drugs, just breathing exercises.”
Mr. Wiebe doesn’t claim to be cured, though he believes this could eventually happen if he remains diligent about the exercises. But he said: “My quality of life has improved beyond my expectations. It’s very exciting and amazing. More people should know about this.”
Ordinarily, during an asthma attack, people panic and breathe quickly and as deeply as they can, blowing off more and more carbon dioxide. Breathing rate is controlled not by the amount of oxygen in the blood but by the amount of carbon dioxide, the gas that regulates the acid-base level of the blood.
Dr. Buteyko concluded that hyperventilation — breathing too fast and too deeply — could be the underlying cause of asthma, making it worse by lowering the level of carbon dioxide in the blood so much that the airways constrict to conserve it.
This technique may seem counterintuitive: when short of breath or overly stressed, instead of taking a deep breath, the Buteyko method instructs people to breathe shallowly and slowly through the nose, breaking the vicious cycle of rapid, gasping breaths, airway constriction and increased wheezing.
The shallow breathing aspect intrigued me because I had discovered its benefits during my daily lap swims. I noticed that swimmers who had to stop to catch their breath after a few lengths of the pool were taking deep breaths every other stroke, whereas I take in small puffs of air after several strokes and can go indefinitely without becoming winded.
The Buteyko practitioners in Woodstock, Sasha and Thomas Yakovlev-Fredricksen, were trained in Moscow by Dr. Andrey Novozhilov, a Buteyko disciple. Their treatment involves two courses of five sessions each: one in breathing technique and the other in lifestyle management. The breathing exercises gradually enable clients to lengthen the time between breaths. Mr. Wiebe, for example, can now take a breath after more than 10 seconds instead of just 2 while at rest.
Responses May Vary
His board-certified pulmonologist, Dr. Marie C. Lingat, told me: “Based on objective data, his breathing has improved since April even without steroids. The goal now is to make sure he maintains the improvement. The Buteyko method works for him, but that doesn’t mean everyone who has asthma would respond in the same way.”
In an interview, Mrs. Yakovlev-Fredricksen said: “People don’t realize that too much air can be harmful to health. Almost every asthmatic breathes through his mouth and takes deep, forceful inhalations that trigger a bronchospasm,” the hallmark of asthma.
“We teach them to inhale through the nose, even when they speak and when they sleep, so they don’t lose too much carbon dioxide,” she added.
At the Woodstock center, clients are also taught how to deal with stress and how to exercise without hyperventilating and to avoid foods that in some people can provoke an asthma attack.
The practitioners emphasize that Buteyko clients are never told to stop their medications, though in controlled clinical trials in Australia and elsewhere, most have been able to reduce their dependence on drugs significantly. The various trials, including a British study of 384 patients, have found that, on average, those who are diligent about practicing Buteyko breathing can expect a 90 percent reduction in the use of rescue inhalers and a 50 percent reduction in the need for steroids within three to six months.
The British Thoracic Society has given the technique a “B” rating, meaning that positive results of the trials are likely to have come from the Buteyko method and not some other factor. Now, perhaps, it is time for the pharmaceutically supported American medical community to explore this nondrug technique as well.
Monday, November 16, 2009
Book Review - 'What the Dog Saw - And Other Adventures,' by Malcolm Gladwell - Review - NYTimes.com
Book Review - 'What the Dog Saw - And Other Adventures,' by Malcolm Gladwell - Review - NYTimes.com Read and digest
November 15, 2009
Malcolm Gladwell, Eclectic Detective
By STEVEN PINKER
Skip to next paragraph
WHAT THE DOG SAW
And Other Adventures
By Malcolm Gladwell
410 pp. Little, Brown & Company. $27.99
Have you ever wondered why there are so many kinds of mustard but only one kind of ketchup? Or what Cézanne did before painting his first significant works in his 50s? Have you hungered for the story behind the Veg-O-Matic, star of the frenetic late-night TV ads? Or wanted to know where Led Zeppelin got the riff in “Whole Lotta Love”?
Neither had I, until I began this collection by the indefatigably curious journalist Malcolm Gladwell. The familiar jacket design, with its tiny graphic on a spare background, reminds us that Gladwell has become a brand. He is the author of the mega-best sellers “The Tipping Point,” “Blink” and “Outliers”; a popular speaker on the Dilbert circuit; and a prolific contributor to The New Yorker, where the 19 articles in “What the Dog Saw” were originally published. This volume includes prequels to those books and other examples of Gladwell’s stock in trade: counterintuitive findings from little-known experts.
A third of the essays are portraits of “minor geniuses” — impassioned oddballs loosely connected to cultural trends. We meet the feuding clan of speed-talking pitchmen who gave us the Pocket Fisherman, Hair in a Can, and other it-slices!-it-dices! contraptions. There is the woman who came up with the slogan “Does she or doesn’t she?” and made hair coloring (and, Gladwell suggests, self-invention) respectable to millions of American women. The investor Nassim Taleb explains how markets can be blindsided by improbable but consequential events. A gourmet ketchup entrepreneur provides Gladwell the opportunity to explain the psychology of taste and to recount the history of condiments.
Another third are on the hazards of statistical prediction, especially when it comes to spectacular failures like Enron, 9/11, the fatal flight of John F. Kennedy Jr., the explosion of the space shuttle Challenger, the persistence of homelessness and the unsuccessful targeting of Scud missile launchers during the Persian Gulf war of 1991. For each debacle, Gladwell tries to single out a fallacy of reasoning behind it, such as that more information is always better, that pictures offer certainty, that events are distributed in a bell curve around typical cases, that clues available in hindsight should have been obvious before the fact and that the risk of failure in a complex system can be reduced to zero.
The final third are also about augury, this time about individuals rather than events. Why, he asks, is it so hard to prognosticate the performance of artists, teachers, quarterbacks, executives, serial killers and breeds of dogs?
The themes of the collection are a good way to characterize Gladwell himself: a minor genius who unwittingly demonstrates the hazards of statistical reasoning and who occasionally blunders into spectacular failures.
Gladwell is a writer of many gifts. His nose for the untold back story will have readers repeatedly muttering, “Gee, that’s interesting!” He avoids shopworn topics, easy moralization and conventional wisdom, encouraging his readers to think again and think different. His prose is transparent, with lucid explanations and a sense that we are chatting with the experts ourselves. Some chapters are masterpieces in the art of the essay. I particularly liked “Something Borrowed,” a moving examination of the elusive line between artistic influence and plagiarism, and “Dangerous Minds,” a suspenseful tale of criminal profiling that shows how self-anointed experts can delude their clients and themselves with elastic predictions.
An eclectic essayist is necessarily a dilettante, which is not in itself a bad thing. But Gladwell frequently holds forth about statistics and psychology, and his lack of technical grounding in these subjects can be jarring. He provides misleading definitions of “homology,” “saggital plane” and “power law” and quotes an expert speaking about an “igon value” (that’s eigenvalue, a basic concept in linear algebra). In the spirit of Gladwell, who likes to give portentous names to his aperçus, I will call this the Igon Value Problem: when a writer’s education on a topic consists in interviewing an expert, he is apt to offer generalizations that are banal, obtuse or flat wrong.
The banalities come from a gimmick that can be called the Straw We. First Gladwell disarmingly includes himself and the reader in a dubious consensus — for example, that “we” believe that jailing an executive will end corporate malfeasance, or that geniuses are invariably self-made prodigies or that eliminating a risk can make a system 100 percent safe. He then knocks it down with an ambiguous observation, such as that “risks are not easily manageable, accidents are not easily preventable.” As a generic statement, this is true but trite: of course many things can go wrong in a complex system, and of course people sometimes trade off safety for cost and convenience (we don’t drive to work wearing crash helmets in Mack trucks at 10 miles per hour). But as a more substantive claim that accident investigations are meaningless “rituals of reassurance” with no effect on safety, or that people have a “fundamental tendency to compensate for lower risks in one area by taking greater risks in another,” it is demonstrably false.
The problem with Gladwell’s generalizations about prediction is that he never zeroes in on the essence of a statistical problem and instead overinterprets some of its trappings. For example, in many cases of uncertainty, a decision maker has to act on an observation that may be either a signal from a target or noise from a distractor (a blip on a screen may be a missile or static; a blob on an X-ray may be a tumor or a harmless thickening). Improving the ability of your detection technology to discriminate signals from noise is always a good thing, because it lowers the chance you’ll mistake a target for a distractor or vice versa. But given the technology you have, there is an optimal threshold for a decision, which depends on the relative costs of missing a target and issuing a false alarm. By failing to identify this trade-off, Gladwell bamboozles his readers with pseudoparadoxes about the limitations of pictures and the downside of precise information.
Another example of an inherent trade-off in decision-making is the one that pits the accuracy of predictive information against the cost and complexity of acquiring it. Gladwell notes that I.Q. scores, teaching certificates and performance in college athletics are imperfect predictors of professional success. This sets up a “we” who is “used to dealing with prediction problems by going back and looking for better predictors.” Instead, Gladwell argues, “teaching should be open to anyone with a pulse and a college degree — and teachers should be judged after they have started their jobs, not before.”
But this “solution” misses the whole point of assessment, which is not clairvoyance but cost-effectiveness. To hire teachers indiscriminately and judge them on the job is an example of “going back and looking for better predictors”: the first year of a career is being used to predict the remainder. It’s simply the predictor that’s most expensive (in dollars and poorly taught students) along the accuracy-cost trade-off. Nor does the absurdity of this solution for professional athletics (should every college quarterback play in the N.F.L.?) give Gladwell doubts about his misleading analogy between hiring teachers (where the goal is to weed out the bottom 15 percent) and drafting quarterbacks (where the goal is to discover the sliver of a percentage point at the top).
The common thread in Gladwell’s writing is a kind of populism, which seeks to undermine the ideals of talent, intelligence and analytical prowess in favor of luck, opportunity, experience and intuition. For an apolitical writer like Gladwell, this has the advantage of appealing both to the Horatio Alger right and to the egalitarian left. Unfortunately he wildly overstates his empirical case. It is simply not true that a quarterback’s rank in the draft is uncorrelated with his success in the pros, that cognitive skills don’t predict a teacher’s effectiveness, that intelligence scores are poorly related to job performance or (the major claim in “Outliers”) that above a minimum I.Q. of 120, higher intelligence does not bring greater intellectual achievements.
The reasoning in “Outliers,” which consists of cherry-picked anecdotes, post-hoc sophistry and false dichotomies, had me gnawing on my Kindle. Fortunately for “What the Dog Saw,” the essay format is a better showcase for Gladwell’s talents, because the constraints of length and editors yield a higher ratio of fact to fancy. Readers have much to learn from Gladwell the journalist and essayist. But when it comes to Gladwell the social scientist, they should watch out for those igon values.
Steven Pinker is Harvard College professor of psychology at Harvard University. His most recent book is “The Stuff of Thought.”
November 15, 2009
Malcolm Gladwell, Eclectic Detective
By STEVEN PINKER
Skip to next paragraph
WHAT THE DOG SAW
And Other Adventures
By Malcolm Gladwell
410 pp. Little, Brown & Company. $27.99
Have you ever wondered why there are so many kinds of mustard but only one kind of ketchup? Or what Cézanne did before painting his first significant works in his 50s? Have you hungered for the story behind the Veg-O-Matic, star of the frenetic late-night TV ads? Or wanted to know where Led Zeppelin got the riff in “Whole Lotta Love”?
Neither had I, until I began this collection by the indefatigably curious journalist Malcolm Gladwell. The familiar jacket design, with its tiny graphic on a spare background, reminds us that Gladwell has become a brand. He is the author of the mega-best sellers “The Tipping Point,” “Blink” and “Outliers”; a popular speaker on the Dilbert circuit; and a prolific contributor to The New Yorker, where the 19 articles in “What the Dog Saw” were originally published. This volume includes prequels to those books and other examples of Gladwell’s stock in trade: counterintuitive findings from little-known experts.
A third of the essays are portraits of “minor geniuses” — impassioned oddballs loosely connected to cultural trends. We meet the feuding clan of speed-talking pitchmen who gave us the Pocket Fisherman, Hair in a Can, and other it-slices!-it-dices! contraptions. There is the woman who came up with the slogan “Does she or doesn’t she?” and made hair coloring (and, Gladwell suggests, self-invention) respectable to millions of American women. The investor Nassim Taleb explains how markets can be blindsided by improbable but consequential events. A gourmet ketchup entrepreneur provides Gladwell the opportunity to explain the psychology of taste and to recount the history of condiments.
Another third are on the hazards of statistical prediction, especially when it comes to spectacular failures like Enron, 9/11, the fatal flight of John F. Kennedy Jr., the explosion of the space shuttle Challenger, the persistence of homelessness and the unsuccessful targeting of Scud missile launchers during the Persian Gulf war of 1991. For each debacle, Gladwell tries to single out a fallacy of reasoning behind it, such as that more information is always better, that pictures offer certainty, that events are distributed in a bell curve around typical cases, that clues available in hindsight should have been obvious before the fact and that the risk of failure in a complex system can be reduced to zero.
The final third are also about augury, this time about individuals rather than events. Why, he asks, is it so hard to prognosticate the performance of artists, teachers, quarterbacks, executives, serial killers and breeds of dogs?
The themes of the collection are a good way to characterize Gladwell himself: a minor genius who unwittingly demonstrates the hazards of statistical reasoning and who occasionally blunders into spectacular failures.
Gladwell is a writer of many gifts. His nose for the untold back story will have readers repeatedly muttering, “Gee, that’s interesting!” He avoids shopworn topics, easy moralization and conventional wisdom, encouraging his readers to think again and think different. His prose is transparent, with lucid explanations and a sense that we are chatting with the experts ourselves. Some chapters are masterpieces in the art of the essay. I particularly liked “Something Borrowed,” a moving examination of the elusive line between artistic influence and plagiarism, and “Dangerous Minds,” a suspenseful tale of criminal profiling that shows how self-anointed experts can delude their clients and themselves with elastic predictions.
An eclectic essayist is necessarily a dilettante, which is not in itself a bad thing. But Gladwell frequently holds forth about statistics and psychology, and his lack of technical grounding in these subjects can be jarring. He provides misleading definitions of “homology,” “saggital plane” and “power law” and quotes an expert speaking about an “igon value” (that’s eigenvalue, a basic concept in linear algebra). In the spirit of Gladwell, who likes to give portentous names to his aperçus, I will call this the Igon Value Problem: when a writer’s education on a topic consists in interviewing an expert, he is apt to offer generalizations that are banal, obtuse or flat wrong.
The banalities come from a gimmick that can be called the Straw We. First Gladwell disarmingly includes himself and the reader in a dubious consensus — for example, that “we” believe that jailing an executive will end corporate malfeasance, or that geniuses are invariably self-made prodigies or that eliminating a risk can make a system 100 percent safe. He then knocks it down with an ambiguous observation, such as that “risks are not easily manageable, accidents are not easily preventable.” As a generic statement, this is true but trite: of course many things can go wrong in a complex system, and of course people sometimes trade off safety for cost and convenience (we don’t drive to work wearing crash helmets in Mack trucks at 10 miles per hour). But as a more substantive claim that accident investigations are meaningless “rituals of reassurance” with no effect on safety, or that people have a “fundamental tendency to compensate for lower risks in one area by taking greater risks in another,” it is demonstrably false.
The problem with Gladwell’s generalizations about prediction is that he never zeroes in on the essence of a statistical problem and instead overinterprets some of its trappings. For example, in many cases of uncertainty, a decision maker has to act on an observation that may be either a signal from a target or noise from a distractor (a blip on a screen may be a missile or static; a blob on an X-ray may be a tumor or a harmless thickening). Improving the ability of your detection technology to discriminate signals from noise is always a good thing, because it lowers the chance you’ll mistake a target for a distractor or vice versa. But given the technology you have, there is an optimal threshold for a decision, which depends on the relative costs of missing a target and issuing a false alarm. By failing to identify this trade-off, Gladwell bamboozles his readers with pseudoparadoxes about the limitations of pictures and the downside of precise information.
Another example of an inherent trade-off in decision-making is the one that pits the accuracy of predictive information against the cost and complexity of acquiring it. Gladwell notes that I.Q. scores, teaching certificates and performance in college athletics are imperfect predictors of professional success. This sets up a “we” who is “used to dealing with prediction problems by going back and looking for better predictors.” Instead, Gladwell argues, “teaching should be open to anyone with a pulse and a college degree — and teachers should be judged after they have started their jobs, not before.”
But this “solution” misses the whole point of assessment, which is not clairvoyance but cost-effectiveness. To hire teachers indiscriminately and judge them on the job is an example of “going back and looking for better predictors”: the first year of a career is being used to predict the remainder. It’s simply the predictor that’s most expensive (in dollars and poorly taught students) along the accuracy-cost trade-off. Nor does the absurdity of this solution for professional athletics (should every college quarterback play in the N.F.L.?) give Gladwell doubts about his misleading analogy between hiring teachers (where the goal is to weed out the bottom 15 percent) and drafting quarterbacks (where the goal is to discover the sliver of a percentage point at the top).
The common thread in Gladwell’s writing is a kind of populism, which seeks to undermine the ideals of talent, intelligence and analytical prowess in favor of luck, opportunity, experience and intuition. For an apolitical writer like Gladwell, this has the advantage of appealing both to the Horatio Alger right and to the egalitarian left. Unfortunately he wildly overstates his empirical case. It is simply not true that a quarterback’s rank in the draft is uncorrelated with his success in the pros, that cognitive skills don’t predict a teacher’s effectiveness, that intelligence scores are poorly related to job performance or (the major claim in “Outliers”) that above a minimum I.Q. of 120, higher intelligence does not bring greater intellectual achievements.
The reasoning in “Outliers,” which consists of cherry-picked anecdotes, post-hoc sophistry and false dichotomies, had me gnawing on my Kindle. Fortunately for “What the Dog Saw,” the essay format is a better showcase for Gladwell’s talents, because the constraints of length and editors yield a higher ratio of fact to fancy. Readers have much to learn from Gladwell the journalist and essayist. But when it comes to Gladwell the social scientist, they should watch out for those igon values.
Steven Pinker is Harvard College professor of psychology at Harvard University. His most recent book is “The Stuff of Thought.”
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