The great physicist Max Planck has a famous line that most scientific change does not happen because existing scientists change their views, but rather because they die and the next generation is able to think about things differently:
“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it”
I was reminded of this concept while working on a new Beyond Journal Club podcast about a clinical trial on asthma.
Asthma is an incredibly common disease - we all know someone who has asthma and uses an inhaler from time to time.
One of the things that interesting about asthma is that even though it’s incredibly common and can be a source of major symptoms, it doesn’t kill people very often.
And since most doctors have seen asthma so commonly and we feel comfortable that the majority of patients are going to do ok, we often prescribe the wrong treatment: a rescue inhaler with albuterol.
This is a podcast on the MANDALA trial, which is latest in a long line of clinical trials telling us that an albuterol rescue inhaler by itself is the wrong asthma treatment for most patients with asthma.
Albuterol alone as a rescue treatment just treats symptoms in the moment but doesn’t alter the trajectory of the inflammation in asthma
There’s evidence from quite a few clinical trials that a combination inhaler that combines albuterol with a drug that reduces inflammation is better than just giving people albuterol alone.
In other words: lots of doctors who have been treating asthma for years (myself included) have been doing it wrong!
In this podcast, we go through some of the history of asthma treatment and discuss how our understanding of the disease has changed over time.
We had the chance to interview Dr. Jeffrey Drazen, former editor-in-chief of the New England Journal of Medicine, who is one of the world experts on asthma management.
Dr. Drazen makes a couple of appearances in the podcast to discuss the evolving paradigm of asthma management.
You can review the show notes and even read a transcript of the podcast here.
Here’s a graphic of some of the key trials that have established practice in this area:
I hope you enjoy!
