Two weeks ago, Michael Cichorski was working for a drug company with annual sales of more than $50 billion. As marketing manager for asthma medications at Glaxo, he promoted drugs such as the top-selling Ventolin to doctors and the public
With 2 million Australians diagnosed as asthmatic, and many on life-long medication, asthma drugs are a massive $300 million annual market, dominated by GlaxoSmithKline. For three years, Cichorski was arguably Australia's biggest promoter of these medications. And he was committed both professionally and personally. Not only was he marketing the drugs, he was also taking them, having had asthma since he was seven.
But the salesman lost the faith. Last week, he defected from the drug industry for a new career in asthma, this time teaching simple breathing techniques. His conversion followed his fears of dependence on the very products he was selling.
"I was taking more and more medications - both the puffers for relief and the steroids used for prevention, but if I stopped them, the asthma came back," he told the The Australian Financial Review. "I was concerned I was building a life-long dependency on very potent medications."
Working inside a global pharmaceutical company, Cichorski had easy access to the large body of scientific literature. “I had no concern about the effectiveness of the drugs but, reading the literature, I became more and more worried about side effects, particularly with long-term usage," he said.
Two years ago, while still marketing Glaxo's asthma brands, he accepted a challenge from a practitioner of the little- known Buteyko breathing technique. Despite being initially sceptical, after just five sessions learning to control his breathing, he was able to dramatically reduce his reliever medications. Within six months, he had stopped using steroids as well. And now? "I am asthma free and drug free," he says.
Anecdotes like this might sound convincing but are worth little scientifically. As it happens, though, there is a small but growing body of scientific evidence that a range of breathing methods, such as Buteyko and yoga classes, can help. But even though early results have been promising, there have been no large trials to date, and simple non-drug options remain on the margins of Australian medicine.
Asked whether the closeness between doctors and drug companies has retarded the progress of breathing methods in Australia, senior asthma specialist Dr. Michael Abramson told the AFR: "That's a difficult question. Certainly, the drug industry provides more infrastructure for trialling drugs."
Abramson recently published results from a small trial of the breathing methods conducted at Mortash University in Melbourne. “We found it very hard to attract any funding for our study of Buteyko," he says, adding that the Monash trial was done without any external funding, relying almost entirely on the hard work of an individual student, Ashley Opat.
That trial found asthmatics who learned breathing exercises from a video were able to reduce their use of reliever medications by 60 per cent and significantly improve their quality of life - as compared with a control group who watched a nature video.
Several years earlier, a small study run at the Mater Hospital inBrisbane found people doing Buteyko classes were able to reduce their use of reliever puffers by more than 90 per cent. Drug use in the control group remained virtually unchanged. Neither trial reported any adverse effects.
If breathing classes like this were more widely adopted, and results anything like those achieved in Melbourne and Brisbane were replicated, the $80 million sales of- Ventolin-style puffers would clearly be in trouble.
Interestingly, despite reductions in medication use and improvements in quality of life, patients showed no improvement on the standard lung function tests in either trial. Associate professor at Monash University, Michael Abramson, says the fact that people didn't show any change on the standard tests is probably less important than the fact that they improved their quality of life. "We think there is evidence they got better," he says.
Abramson' s openness indicates a shift in attitudes within medical science, which treated breathing techniques with extreme scepticism just a decade ago.
Proponents argue that the medical establishment has been far too slow to study the breathing method. The chief executive of the Buteyko Institute, Paul O'Connell, says: "In Australia, much of the funding for asthma research comes from the manufacturers of asthma medications.
“Those companies have no interest in a technique which doesn't involve medications - and, in fact, progressively takes people off them. The influence they have over decision makers in governmentand health organisations has prohibited non-drug therapy receiving serious attention."
According to O'Connell, this is one reason he and others recently set up the Buteyko Institute, which is now seeking funding for more trials.
The chairman of the National Asthma Council, Dr Ron Tomlins, rejects criticism that decision makers are too close to industry.
While conceding his organisation relies on drug companies for a substantial portion of its funding, he says there are strict guidelines guaranteeing independence. He adds that the Federal Government made a significant contribution to the NAC's work in the Budget this year.
Because most of the trials done so far have been small, there is still uncertainty about whether breathing classes can help, how much they can help and who they can help. A recent systematic review of all the scientific evidence, published by the highly respected international Cochrane Collaboration, concluded: "No reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice." However, the authors of the Cochrane review strongly supported more research.
As it happens, a very large trial involving 600 people is under way in Scotland. While early non-peer-reviewed results from Scotland again show dramatic reductions in drug use, final results are a number of years away.
Most asthma specialists do not yet endorse the method, but it's estimated that more than 10,000 Australians have already tried the breathing techniques - commonly taught in five short sessions for a fee of about $600.
Throughout the classes people learn to hold their breath, breathe through their nose, and breath less - in line with the Buteyko belief that asthma symptoms are largely due to over-breathing.
Every night last, week at an RSL club in the Melbourne suburb of Glen Waverley, a small group gathered for breathing classes. Among the group is seven-year-old Christine, whose parents told the AFR they were trying the exercises because of concerns that Christine was already being prescribed large doses of medications.
Under the watchful eyes of Paul O'Connell, tiny Christine was walked through her exercises by new recruit Michael Cichorski, the formerdrug company manager who has just graduated as a practitioner in the Buteyko Institute method.
So keen is the former Glaxo manager that he has just refurbished his suburban home, transforming it into a working clinic. Despite his obvious vested interest, Cichorski is not shy about his passion for the new enterprise. - "It can reverse a life-long dependency on medication," he says.
Asked to explain his defection from. drug promoter to born-again breathing practitioner, he simply says, “'My interest-has shifted" - largely because of his own health concerns about drug dependency.
Like his colleagues, he cautions that breathing classes are not a "cure" for asthma and people should not throw away their medications, insisting instead that reductions should be achieved in consultation with a doctor.
While loath to make any critical comments about his former industry, Cichorski calmly observes that educational bodies such as the National Asthma Council should be free of all company funding, in order to boost objectivity and credibility. For its part, Glaxo declined to comment on either the former manager or breathing classes.
While Western medicine may have been slow to rigorously investigate breathing techniques such as yoga classes and Buteyko, the tide may be turning. In May this year, researchers writing in the prestigious British Medical Journal suggested many problems put down to asthma may in fact be caused by abnormal breathing patterns.
Doctors from the University of Leicester argued in the BMJ that a large minority of asthma patients might be experiencing -avoidable harm, "because of inappropriate diagnosis and ineffective treatment”.
They concluded that many people treated for asthma "may be helped by simple non- pharmacological interventions".
While other researchers have challenged that view, there are growing concerns that too many people are taking asthma meditations they may not really need.
Global sales of asthma puffers are clearly making a healthy contribution to Glaxo's $17 billion pre-tax profits and are of obvious benefit to the company shareholders.
What is not so clear is whether the benefits are also flowing to all of those taking the drugs.