In lieu of an abstract, here is a brief excerpt of the content:Asthma:Strangling the Caged Bird (Something Like a Prayer)Imani Perry (bio)Yet do a marvel at this curious thing; To make a poet black and bid him sing!– Countee CullenI know why the caged bird sings, ah me,When his wing is bruised and his bosom sore,—When he beats his bars and he would be free;It is not a carol of joy or glee,But a prayer that he sends from his (...) heart's deep core,But a plea, that upward to Heaven he flings—I know why the caged bird sings!– Paul Laurence DunbarAsthma is an inflammation of the airways. But that word in a Black American life is an associative one. It is emergency room visits, "treatments," and jackleg care. It is death's door. It is the vague feeling that something in the bedroom walls, school corridors, cells, coming up from the pavement, is eking away at your life. We speak of it knowingly and frequently."How is your asthma?" When Dr. Bird asked me that question, I was alarmed. I'd forgotten I had ever received the diagnosis. But there it was in my chart. There are so many words about me housed in that digital file. I expect there's more than I could guess. The chart itself is a testament to access. Not everybody has the protective surveillance of a chart or an ID, much less medical insurance. Mine is far more crowded than I'd prefer.The conditions of my life and body have made it such that I could forget my own asthma. But I think about asthma all the time, because it has snaked through my family and friends and communities. I have written, more than once, that the most powerful statement that hip hop leaves us with is this: An art form made by generations ravaged by environmental racism is defiantly profound because it depends upon the mastery of breath. Breath control is as much its hallmark as rhyming. Snatching oneself from the gates of a breath-thieving hell, with a heavy bass line, is its testimony. [End Page 213]Have you ever gasped for air? You grab at it and get almost nothing. Flail. You are rendered indeliberate. Panic is the only option in that moment. Invisible hands crush your windpipe but never touching a bone. (After this, how could you not believe in ghosts?) When you get out of it, relief spreads over you. It is euphoric at first. Then trauma settles and you ritually hold your breath and neck muscles, hypervigilant for the next time though praying against it.Black people have the highest rates of asthma in the United States. Black women are most likely to die of the disease. I am not a scientist so I can speculate about this terrible fact freely. I think it is because Black women's roles require a tamping down of suffering in the service of labor for others. Private keening and public fortitude. There is poison in our post-coloniality of being.That said, the post-coloniality of being doesn't belong alone to those with colonized and Jim Crowed histories. It is a shared though wildly unequal condition. The post-coloniality of being characterizes this epoch, post- ages of revolution and decolonization and social transformation, in which we (the big we, not the freedom-fighter we) against all better dreams, remain committed to being suffocated. And as the climate crisis shows its face, we have to admit that everybody's breath is shallowing. Everyone's body is being invaded by the ethic of accumulation, to a greater or lesser extent. And that "lesser" promise is the worst kind of seduction. Air purifiers and green detergents are nothing but stop-gap measures in a world bent on its own destruction.I could say, we, Black women, are like canaries in the coal mine. But the metaphor hits too close to home. It is too true a thing to attach it to the glibness of literary figurative language. Our airways are literally closing in. In the Black South, to be "strangled" doesn't require someone's hands around your throat. It is used the... (shrink)

Moshe ben Maimon, or Moses Maimonides (1135-1204), remains one of the most celebrated rabbis in this history of Judaism; his numerous writings include philosophical and medical treatises in Arabic, two of history's most important works on Jewish law, and, most notably, efforts to reconcile Aristotelian philosophy with biblical teaching. The _Complete Medical Works_, edited by Gerrit Bos of the Martin-Buber-Institut fur Judaistik at the University of Cologne, collects the entirety of Maimonides's medical writings. Notwithstanding its title, _On Asthma_ is in (...) fact a complete regimen of health, designed for the needs of a high-ranking patient whose identity is not stated. In true Galenic fashion, Maimonides stresses that a healthy lifestyle and diet are the most important preventative measures against chronic illness such as asthma. Good and bad foods are described in detail, and many recipes for beneficial dishes and drugs are included, with Maimonides adapting Galenic regimens to the needs of his Muslim patient. (shrink)

Death of a normal volunteer highlights problems with research review and protection of subjectsHealthy volunteer dies in asthma studyOn July 19, after investigating the death of a previously healthy volunteer, the United States Office for Human Research Protections suspended nearly all federally funded medical research involving human subjects at Johns Hopkins University. The death has been described as “particularly disturbing” because 24 year old Ellen Roche was a healthy volunteer who had nothing to gain by taking part in the (...) study.1 Her death has revived debate about the adequacy of oversight of medical research that followed the death of 18 year old Jesse Gelsinger who volunteered for a gene therapy experiment.Ellen Roche was a 24 year old technician from the Johns Hopkins Asthma and Allergy Centre who volunteered to take part in a study designed to provoke a mild asthma attack in order to help doctors discover the reflex that protects the lungs of healthy people against asthma attacks. After inhaling hexamethonium, a medication used for treating high blood pressure in the 1950s and 60s, Ms Roche became ill. She developed a cough and her condition worsened over the next week until she was put on a ventilator. With her lung tissue breaking down, blood pressure falling and her kidneys beginning to fail, nothing could be done to save her.2 She died on June 2, about a month after entering the study.The Office for Human Research Protections investigated the circumstances of Ms Roche's death and accused the Hopkins Institutional Review Board of failing to take proper precautions. It also evaluated the human subject protection system at Hopkins. The OHRP found that prior to approving the study, Hopkins researcher …. (shrink)

The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (...) (65%) achieved quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. (shrink)

Historians of modern medicine often divide their subject into two parts, separated by the bacteriological revolution of the late nineteenth century, when medicine supposedly became 'scientific' for the first time. The history of medical geography - to say nothing of other subjects - calls this common view into question. At least in the United States, students of medical geography, arguably the pre-eminent medical science in an age dominated by miasmatic theories of disease, readily adapted to the discovery of germs. And (...) although bacteriology quickly eclipsed medical geography in the world of medicine, place remained an important consideration in treating asthma (and allergies generally) throughout the post-bacteriological period. (shrink)

This chapter examines four ethical issues raised by clinical asthma research involving children subjects: (1) to what extent are clinical asthma trials designed as placebo-controlled trials as opposed to active-drug controlled trials?; (2) do placebo-controlled trials in a condition like asthma place the research subjects at increased risk of harm?; (3) are the new guidelines promoting increased access of children to research changing the enrollment pattern of children in research?; and (4) are the new guidelines achieving their (...) goal of garnering useful information about medication safety, efficacy, and dosing for children as a class? It is argued that children are a vulnerable population in clinical research and need additional protection. This means that the former recommendations of the National Commission to perform research first on animals, second on adults, and only then on children should be maintained. It also means that when children are involved, highest scientific and ethical standards must be maintained. (shrink)

Previous research reported about high comorbidity between asthma and neurodevelopmental disorders. Recently, asthma was associated also with executive functions poorness. The current study aimed to investigate the verbal and visual memory performances among fifteen asthmatic kindergarten children compared to the performances of other fifteen healthy kindergarten children. The results showed that the asthmatic group revealed poor performances in the immediate short term verbal memory and the verbal working memory tests but not in the verbal learning test as it (...) was compared to the healthy group. In addition, the asthmatic group revealed poor performances in the visual memory tasks compared to the healthy group. The results were explained in light of the assumption that poor executive functions might be interfere the process of managing the attentional resources which are needed through the process of memory encoding and retrieval. (shrink)

Executive functions measures of 27 asthmatic children, with general learning difficulties, were tested by using the Wisconsin card sorting test (WCST), and were compared to the performances of 30 non-asthmatic children with general learning difficulties. The results revealed that the asthmatic group has poor performance through all the WCST psychometric parameters and especially the perseverative errors one. The results were discussed in light of the postulation that poor executive functions could be associated with the learning difficulties of asthmatic children. Neurophysiological (...) framework has been suggested to explain the etiology of poor executive functions among children with moderate into severe asthma. (shrink)

Sharing Experiences of Illness and Effectiveness of Asthma Therapy in Children This research deals with relationships between openness and opportunities to share asthma experiences between an ill child and close family, and effectiveness of medical therapy of asthma. Subjects were 58 children, between the age of 12-14, from the allergic outpatient clinic with a diagnosed bronchial asthma and under pharmacological therapy. Each child answered questions on frequency and satisfaction with talking with parents, or other close family (...) members, on his or her experiences related to asthma. A doctor conducting the therapy was asked to evaluate results of therapy, and intensity of the asthma, for each child. The data support the hypotheses that degree of sharing own asthma-related experiences with close persons correlates positively with effectiveness of therapy. This effect appears stronger among children with more severe asthma. (shrink)

BackgroundKnowledge development depends on an unbiased representation of the available evidence. Selective citation may distort this representation. Recently, some controversy emerged regarding the possible impact of swimming on childhood asthma, raising the question about the role of selective citation in this field. Our objective was to assess the occurrence and determinants of selective citation in scientific publications on the relationship between swimming in chlorinated pools and childhood asthma.MethodsWe identified scientific journal articles on this relationship via a systematic literature (...) search. The following factors were taken into account: study outcome (authors’ conclusion, data-based conclusion), other content-related article characteristics (article type, sample size, research quality, specificity), content-unrelated article characteristics (language, publication title, funding source, number of authors, number of affiliations, number of references, journal impact factor), author characteristics (gender, country, affiliation), and citation characteristics (time to citation, authority, self-citation). To assess the impact of these factors on citation, we performed a series of univariate and adjusted random-effects logistic regressions, with potential citation path as unit of analysis.ResultsThirty-six articles were identified in this network, consisting of 570 potential citation paths of which 191 (34%) were realized. There was strong evidence that articles with at least one author in common, cited each other more often than articles that had no common authors (odds ratio (OR) 5.2, 95% confidence interval (CI) 3.1–8.8). Similarly, the chance of being cited was higher for articles that were empirical rather than narrative (OR 4.2, CI 2.6–6.7), that reported a large sample size (OR 5.8, CI 2.9–11.6), and that were written by authors with a high authority within the network (OR 4.1, CI 2.1–8.0). Further, there was some evidence for citation bias: articles that confirmed the relation between swimming and asthma were cited more often (OR 1.8, CI 1.1–2.9), but this finding was not robust.ConclusionsThere is clear evidence of selective citation in this research field, but the evidence for citation bias is not very strong. (shrink)

The issue of aftercare for participants in clinical research was explored in the context of an asthma drug trial. Although there may be financial constraints and practical difficulties with implementation, the results show that it may be feasible for clinical investigators and commercial sponsors to take on some limited responsibility for the medical care of research subjects after clinical trials. However, the ethical implications for this practice remain unclear. On the one hand, society may have a moral obligation to (...) compensate and reward some of its members who assume the risk of research subjects for the benefit of society as a whole. On the other hand, the promise of aftercare may provide an inducement to volunteers which, under certain conditions may be considered morally wrong and scientifically unsound. (shrink)

Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best (...) available evidence informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)

Through the early twentieth century, asthmatics were advised to move to a more suitable climate, or to vacation in one during their worst season. In the late nineteenth century, physicians sought to quantify the ideal temperature, humidity, altitude, and pollen count to help travellers to select a suitable place, but these investigations led some physicians to question contradictions between expected and actual conditions. Given that even the best climate was not perfect at all times, and that many patients could not (...) afford to travel or relocate, a group of physicians-who came to be known as allergists-sought ways to adapt their patients to any climate through changes in their indoor environments and treatments to manage their symptoms. Their approach included changes in household design, furnishings, and cleaning techniques, especially a strict avoidance of dust, which could carry feathers, animal hair, skin debris, pollen, moulds, and an unknown 'dust' allergen. Air filtering and air conditioning were also promoted as ways to protect asthmatics and hay fever sufferers. These modifications of patients and their microenvironments signalled both a move away from climactic approaches to asthma and toward the sanitary, modernist home of the twentieth century. (shrink)

Through the early twentieth century, asthmatics were advised to move to a more suitable climate, or to vacation in one during their worst season. In the late nineteenth century, physicians sought to quantify the ideal temperature, humidity, altitude, and pollen count to help travellers to select a suitable place, but these investigations led some physicians to question contradictions between expected and actual conditions. Given that even the best climate was not perfect at all times, and that many patients could not (...) afford to travel or relocate, a group of physicians—who came to be known as allergists—sought ways to adapt their patients to any climate through changes in their indoor environments and treatments to manage their symptoms. Their approach included changes in household design, furnishings, and cleaning techniques, especially a strict avoidance of dust, which could carry feathers, animal hair, skin debris, pollen, moulds, and an unknown ‘dust’ allergen. Air filtering and air conditioning were also promoted as ways to protect asthmatics and hay fever sufferers. These modifications of patients and their microenvironments signalled both a move away from climactic approaches to asthma and toward the sanitary, modernist home of the twentieth century. (shrink)

Within the sociology of sport, phenomenologically-inspired perspectives on sensory embodiment have emerged in recent years. This corpus includes investigations into the senses in water-based sports such as scuba diving (Merchant, 2011), performance swimming (Allen-Collinson et al., 2021 ; McNarry et al., 2021) and in land-based sports such as distance running (Allen-Collinson et al., 2018, 2021 ; Allen-Collinson & Jackman, 2021), and cycling (Hammer, 2015 ; Spinney, 2006). In this article, I draw upon phenomenological sociology (Allen-Collinson, 2009) and ‘sensory work’, to (...) investigate the experience of asthma in sports participants. Currently, despite the prevalence of asthma globally, there remains a lack of in-depth research on actual experiences of coping with asthma and ‘breathing battles’ in sporting contexts. Here, I draw on data from two linked research projects: a collaborative autoethnography and an interview-based study, which generated findings that highlighted sensory aspects relating to the lived experience of asthma and sporting embodiment. (shrink)

Effective clinical practice in a hospital needs current knowledge together with the skills and right attitude; these should be applied continuously. Failure of this system can be due to ignorance or arrogance. We attempted to correct these deficiencies by formulating a set of policies which were enforced from 1962 to 1983. The policies related to the following: intensive care (including asthma, nutrition and organ donation), drug prescribing and resuscitation. We believe that these rules improved patient care and the standards (...) of training; the prescribing policy also saved money. (shrink)

Numerous and diverse reports indicate the efficacy of shamanic plant adjuncts (e.g., iboga, ayahuasca, psilocybin) for the care and treatment of addiction, post-traumatic stress disorder, cancer, cluster headaches, and depression. This article reports on a first-person healing of lifelong asthma and atopic dermatitis in the shamanic context of the contemporary Peruvian Amazon and the sometimes digital ontology of online communities. The article suggests that emerging language, concepts, and data drawn from the sciences of plant signaling and behavior regarding “plant (...) intelligence” provide a useful heuristic framework for comprehending and actualizing the healing potentials of visionary plant “entheogens” (Wasson 1971) as represented both through first-person experience and online reports. Together with the paradigms and practices of plant signaling, biosemiotics provides a robust and coherent map for contextualizing the often reported experience of plant communication with ayahuasca and other entheogenic plants. The archetype of the “plant teachers” (called Doctores in the upper Amazon) is explored as a means for organizing and interacting with this data within an epistemology of the “hallucination/perception continuum (Fischer 1975). “Ecodelic” is offered as a new linguistic interface alongside “entheogen” (Wasson 1971). (shrink)

Barbados is a center of international genetic research premised on race. Drawing on ethnographic fieldwork following Johns Hopkins studies carried out in Barbados, this article explores this travel for research. This biomedical science relies on a conflicting significance of Barbados: as a site of suffering, due to the disparities of disease, and, conversely, a site of ease, playing on desires and pleasures of escaping too much asceticism in biomedicine. For the American researchers, Barbados becomes a locus of desire to ethically (...) address the African diaspora without the quandaries of accusations and recriminations experienced in carrying out such work in urban America. The concept of cathartic science is used to describe an endeavor that creates a controlled space to know and act on some perceived sufferer without risk of being complicit in the suffering. These medical migrations of researchers to Barbados are paralleled by Bajan families participating in the American studies as a kind of proxy medical migration to the US, bitterly reflecting on the care available to them at home. This article explores the motives of this mutual travel, as a biomedicalized Barbados becomes a spectral figure for patients and researchers fraught with race, injustice, and desire. The article extends the concept of cathartic science from genomics of race to medical anthropology to foreground the desires and anxieties of any science of suffering. (shrink)

In recent years there has been substantial support for heart rate variability biofeedback (HRVB) as a treatment for a variety of disorders and for performance enhancement ( Gevirtz, 2013 ). Since conditions as widely varied as asthma and depression seem to respond to this form of cardiorespiratory feedback training, the issue of possible mechanisms becomes more salient. The most supported possible mechanism is the strengthening of homeostasis in the baroreceptor ( Vaschillo et al., 2002 ; Lehrer et al., 2003 (...) ). Recently, the effect on the vagal afferent pathway to the frontal cortical areas has been proposed. In this article, we review these and other possible mechanisms that might explain the positive effects of HRVB. (shrink)

The problem of collecting, analyzing and evaluating evidence on adverse drug reactions (ADRs) is an example of the more general class of epistemological problems related to scientific inference and prediction, as well as a central problem of the health-care practice. Philosophical discussions have critically analysed the methodological pitfalls and epistemological implications of evidence assessment in medicine, however they have mainly focused on evidence of treatment efficacy. Most of this work is devoted to statistical methods of causal inference with a special (...) attention to the privileged role assigned to randomized controlled trials in Evidence Based Medicine. Regardless of whether the RCT’s privilege holds for efficacy assessment, it is nevertheless important to make a distinction between causal inference of intended and unintended effects, in that the unknowns at stake are heterogonous in the two contexts. This point has been emphasized by epidemiologists in the last decade. Their main focus is methodological, and regards the fact that bias and confounding do not affect studies on intended and unintended effects in the same way. However, deeper concerns ground the intuition for such a distinction; these are related to the constraints which we impose on evidence and their epistemological justification. My thesis is that such constraints ought to be understood to be different in the case of evidence for risk vs. benefit assessment. I present the recent debate on the causal association between acetaminophen and asthma in order to illustrate the point at issue. (shrink)

Institutional Review Board decisions hinge on the availability and interpretation of information. This is demonstrated by the following well-known historical example. In 2001, 24-year-old Ellen Roche died from respiratory distress and organ failure as a result of her participation in a study at Johns Hopkins Asthma and Allergy Center. The non-therapeutic physiological study, “Mechanisms of Deep Inspiration-Induced Airway Relaxation,” was designed to examine airway hyperresponsiveness in healthy individuals in order to better understand the pathophysiology of asthma. Participants inhaled (...) hexamethonium, a chemical ganglionic blocker that was not FDA-approved for use as specified in the experimental protocol. Risks of inhaling hexamethonium, including lung damage, had been reported in the 1950s and ‘60s. An investigation conducted after Roche's death determined that the study's principal investigator had failed to adequately search the medical literature; the protocol submitted for IRB review cited articles indexed in online literature databases that went back only as far as the 1970s. (shrink)

Research involving minors has been the subject of much ethical debate. The growing number of longitudinal, pediatric studies that involve genetic research present even more complex challenges to ensure appropriate protection of children and families as research participants. Long-term studies with a genetic component involve collection, retention and use of biological samples and personal information over many years. Cohort studies may be established to study specific conditions (e.g. autism, asthma) or may have a broad aim to research a range (...) of factors that influence the health and development of children. Studies are increasingly intended to serve as research platforms by providing access to data and biological samples to researchers over many years. (shrink)

After the horrors of the Holocaust and its connections to eugenics were revealed to the world, many post‐war population geneticists sought to establish rhetorical distance from the Nazi's state‐led campaigns, without abandoning their belief that actively shaping the population's genetics would produce a prosperous society. While many advancements in equity have come, well‐intentioned geneticists continue to struggle to distance themselves from those weaponizing genetic data. Herein, we outline the practices which often prevent modern population genetics from ridding itself of the (...) ghost of genetic determinism. These include the interlocking practices of: agnostically noting “genes matter” without detailing the degree or context of importance; using examples or explanations which can be ambiguously interpreted; using flawed data to assert that medical advances require genetic insights; homogenizing the environment in ways that ignore, rather than account for, deleterious exposures; insisting that populations be mathematically segregated prior to performing their analysis; then, when predictable harms arise, using lack of intent to harm as an excuse to refuse to change standard practices or to accept responsibility. Finally, discrete recommendations for improvements are presented. Unlike denouncements of overt eugenics, it is controversial to argue that those working on the genetics of diseases like asthma may unwittingly echo the eugenicists of the past. However, the consistency of associations between modern population genetics and historic eugenics demand mechanistic evaluation. (shrink)

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to (...) rely on measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy. (shrink)