By Dr. Larry Chiaramonte
In our book, I tell a story about trying to promote asthma care in a Brooklyn neighborhood. We asked an African-American board-certified allergist to talk to a group in the community. “To my dismay she began by talking not about our new scientific treatments, but about folk treatments from Africa and the American South, how grandmothers could replace doctors in a pinch, and how people would use cat’s milk to treat asthma. She now had the attention of the people in a way I never could, and began to convince them to start with the scientific treatments. The distance from the folk remedies to the modern treatment was not as great as I thought, but it took the right messenger to lead them across the bridge.”
I have a great deal of respect for custom in treating chronic ailments. In the first place, both the diseases and the treatments have been around far longer than such modern breakthrough medications as inhaled corticosteroids (ICS), and to the extent that they could provide at least some relief from what the philosopher Seneca called “rehearsal for death” they were very important. The Chinese ancients were on to something when they used ma huang for asthma because it contains ephedra, aka ephedrine, a powerful and dangerous drug. One current website devoted to herbal remedies warns: “Long-term or overuse [of ma huang] causes heavy sweating and weakens the body. May also raise blood pressure, do not use if patient has insomnia, spontaneous sweating, high blood pressure, or cardiac arrhythmias.” News buffs will know that pseudo ephedrine is a precursor to crystal meth.
Still, onward and upward. ICS and bronchodilators, which work only in the lungs where they are needed, are a big improvement on the oral steroids and other drugs previously in use, and which were, in their time, a big advance on what came before.
In “Westernized” countries the biggest obstacle to better asthma control is getting people to take the new drugs as prescribed, as I never stop saying on this website. Nevertheless it still comes as a shock to read about what happens in other cultures. India’s medical system is so advanced that many Americans fly there for surgery to save money, but each year, thousands of Indian asthmatics gather on a date chosen by astrologers to swallow live sardines smeared with herbs, provided free of charge, and follow up with a strict diet. I must say—this one baffles me a bit. It’s “only” 170 years old, and I wonder how people feel during the treatment and the ensuing diet, although placebos do make people feel better temporarily. Modern treatments are well known in India, but they cost money, as Western patients know all too well. So does fixing the environmental factors that contribute to the epidemic, and as the economy continues to Westernize, they will undoubtedly get worse before they get better.