What's scientific and what's not?
peter kolb
I had another rude letter from one of the anti-Buteyko camp about two
weeks ago. Unfortunately it hasn't materialised on a.s.a.b. yet,
although I understand it was posted.
I'd like to address the issue of what is scientific and what isn't.
We keep hearing these noises about how Buteyko is supposed to be
unscientific while contemporary asthma therapy is.
The problem is that the people telling us this obviously have no
scientific background themselves. One of them even told me that he
was'nt interested at all and does not wish to be informed. Well,
that's OK. We certainly don't want to ram Buteyko down anyone's
throat. That's why we started our own news group. But if they really
don't want to be informed they should'nt be passing comment on it
either. It's hardly scientific to present a commentary which is
neither informed nor based on any personal experience. The worst of
it is they then claim to represent scientific thought!
Now, I have a bachelor's degree in Engineering Science and a Masters
in Medical Science and would therefore, by any standard, be considered
qualified to comment on this subject. We Biomedical Engineers are
specifically trained to understand measurement processes in medicine.
Our jobs invariably involve advising on measurement processes and
techniques as well as designing equipment and procedures to effect
these measurements.
I reckon every practicing biomedical engineer will have come across
countless incidents of poor measurement practices. My first
experience came while I was still a student. We had to dissect out
the gastrocnemius muscle from a pithed frog, tie it to the needle on a
kymograph and then get it to contract with an electrical impulse. For
decades frogs have been killed for students to learn about the
contraction phase, the relaxation phase and the physiological reason
for the overshoot in a simple muscle twitch. Well, with my
engineering background it didn't take me long to work out that by
applying a broad band impulsive force to the needle, we could get an
identical "muscle twitch", complete with overshoot and ringing. In
other words, the frequency response of the equipment was inadequate to
measure the muscle response. Thousands of medical students would have
learnt an incorrect lesson from what appeared, on the face of it, to
be a scientific experiment.
The point I want to make is that Medicine is portrayed as being
scientific when often it isn't. Physiological parameters can be very
difficult to measure and often need a careful understanding of physics
to interpret correctly.
Well respected respiratory physician and adviser to the asthma
foundations, Dr. Mitchell, who was co-author of an unpublished article
on the Brisbane trials, conceded that the results in terms of the
reduction in bronchodilators experienced by the Buteyko group was a
good outcome. Dr Simon Bowler said the same. However, Dr. Mitchell
clearly said that he cannot support Buteyko therapy because it made no
difference to "the objective measures of asthma".
As a Scientist I have a great deal of difficulty with accepting Prof.
Mitchell's position as being scientifically sound. There is no such
thing as an objective measure of asthma in the same way as there is no
such thing as an objective measure of a headache.
In the first place, I have never seen either FEV1 or Peak flow
rationalised as being scientific measures of airway resistance. They
provide at best some sort of crude indication only of large airway
resistance. You only need to look at the basic physics to understand
why. To find a resistance of a tube you need to know the flow rate
through the tube as well as the pressure producing that flow rate.
Neither peak flow measures nor FEV1 take this pressure into account.
The pressure is just assumed to be "normal!?"
Since the airways consist of a complex network of series and parallel
tubes of different bores, a large percentage of which may be
completely blocked, just exactly how meaningful are the figures that
come out of this exercise anyway? There are, after all, no two
measuring techniques which agree with each other, so you can't even
check one against the other.
Finally, a measurement technique should not interfere (or change) the
parameter that is being measured. Thermometers can be used, for
example, to measure the temperature of water in a bath tub, but not in
a thimble, because the thermometer itself would change the temperature
of the water in the thimble.
So too, both peak flow and FEV1 are unacceptable measures of asthma
from the point of view of Buteyko's theory (which we're trying to
prove or disprove), because the manoeuvre requires inhaling and
rapidly expelling large quantities of air, flushing out CO2 and
therefore affecting the bronchioles according to the theory. In other
words, the measurement process is changing the resistance it's trying
to measure. This is very basic measurement physics and absolutely
excludes these procedures from being used as a reliable scientific
measure of asthma in a Buteyko experiment.
So what is left?
Well, we don't have any trouble determining the effectiveness of
analgesics, say, such as aspirin for curing headaches, even though
there is no such thing as an objective measure of pain. If the same
standards were applied to these drugs as is applied to Buteyko's drug
free treatment, then all analgesics would have to be taken off the
market, because you can't prove that they work using an "objective"
measure.
Now what happened at the Brisbane trials was that the experiment was
to resolve not only whether or not Buteyko was effective in asthma
treatment (hence the Placebo Group), but also to see if the theory
could be verified. This was an ambitious goal, indeed, given that they
didn't even know what they were looking for. And having not found
what they didn't know they were looking for they decided that the
theory was not yet proven and that although the treatment was shown to
be effective, they should not proceed with recommending the therapy.
What they did not do was to disprove the theory. Just because you
can't find the needle in the haystack doesn't mean that it isn't
there. Proving the theory should never have been part of the clinical
trials. However, since the treatment is based on the theory and the
treatment works so spectacularly well, you'd have to have some pretty
powerful arguments to dispute the theory! I have'nt seen any.
Buteyko's treatment is based on sound physiological principles. It
makes sense, and the treatment is stunningly successful even though it
relies on 100% patient compliance. This kind of treatment which
addresses the root cause of a diseases is very much more "scientific"
than is the traditional treatment. How can a treatment which is not
based on an understanding of the cause of a diseases but only on
symptomatic relief, be considered to be scientific?
Fianlly a comment to Paul. Yes, Paul, they did find a normal group in
the hospital population with a high minute volume. But what you don't
understand is how extraordinarily difficult it is to make accurate
physiological measurements. It's not like taking out a tape measure
and measuring the length of a table. It's more like finding the length
of an amoeba.
Peter Kolb
BIOMEDICAL ENGINEER
pk...@wt.com.au
Robert Stark
peter kolb <pk...@wt.com.au> wrote in article
<5o4d5e$v2j$1...@kurica.wt.com.au>...
Excellent comments Peter, I just wanted to add two points:
a) The normal group wasn't randomised - infact if you look at them they
were all from a highly selective group of people- hospital workers whereas
the Buteyko group and Control group were randomised. These people could be
overweight - which could increase the MV. How can you possibly compare a
randomised group with a non-randomised group? The interesting thing was
that the normal group had a normal level of CO2 whereas both the control
and Buteyko group had a level that wasn't normal (32mmHG).
b) The point of the trials as defined by the protocol was to see if
Buteyko could reduce symptoms, could it reduce bronchodilators and further
more could it reduce steriods. Not to assess why or how the Buteyko works.
The results show Buteyko reduced bronchodilators and symptoms by 90%,
steriods by over a quarter, thus achieving the aims of the trial.
I also think it will be a good idea to post the alternative view of the
trial written by physiotherapist Tess Graham. I think it gives a greater
insight into the trial results.
I will do that sometime next week after I have finished exams.
I'd also be interested on your opinion that Buteyko is beneficial for
hyperventilation syndrome and not asthma? Seeing this the latest argument
to surface, yet I haven't heard this from any asthma foundations,
respiratory specialists or doctors.
Regards
Robert Stark
http://www.buteyko.co.nz/
email me if you want to
join our mailing list
Dave Malcolm
In the trial results that I read the objective of the trial was stated
as being to test the effectiveness of Buteyko as compared to standard
physiotherapy exercises in treating asthma. This is only from
memory...is it correct?
Dave
Robert Stark
Dave Malcolm <ma...@ihug.co.nz> wrote in article
<33AF5E...@ihug.co.nz>...
The protocol for the study established two aims:-
(i) To determine the efficacy of the Buteyko Method in controlling airway
obstruction and the symptoms of asthma and in reducing the need of
bronchodilators in patients with asthma.
(ii) To determine the efficacy of the Buteyko Method in reducing the need
for inhaled and systemic corticosteroid and cromoglycate therapy in these
patients.
Robert
http://www.buteyko.co.nz