A DOCTOR CHALLENGES TRADITION

An hour or two with Dr Alexander James is enough to discover where the conflict - and the communications gap - with some of his orthodox colleagues lie.

The 90-year-old doctor, who graduated from Moscow University in 1910 and again from Sydney University in 1945, is adamant that his drugless treatment of asthma needs no further proof, and he brooks no arguments to the contrary. Moreover, he insists that he achieves 100 percent cure of asthma cases.

Indignant and embittered at years of orthodox scepticism about his treatment he is totally impatient with the proposition that it requires more scientific evaluation. Doctors from the National Health and Medical Research Council and from the NSW Health Department have already had a good look at his methods, he complains. In any case his results speak for themselves. He cures people with asthma while other doctors fail.

"They have plenty of time to study my method." he says. "My method is so simple. There are no secrets and no drugs. I have something. They have nothing. They only humiliate."

It is hard to press a question through the torrent of richly accented words, turbulent with reproach for the cold-shouldering he feels he has received from the medical establishment. Several doctors, including a number in Wollongong, now do admit that some part, if not the whole, of the James system does relieve many cases of asthma. Several doctors refer patients to him, reflecting, at least, their confidence that he does no harm and may well do good. But even these doctors are conditioned by the whole of their training to expect that any new treatment should be validated by certain fairly rigid conventions of testing.

Dr James insists that he has met all requirements in a series of seven letters to the "Medical Journal of Australia," which he regards as a full account of his methods.

The secretary of the south-eastern local association of the Australian Medical Association, Dr David Hillyar, wishing Dr James well in the proposed clinic, puts the demurrer of those who look for more formal proofs: "Everywhere in the world the standard method of getting new treatments accepted is to publish a controlled trial of the method, showing successes and failures in a statistically acceptable form, with an attempt at short and long term follow-up of the patients. Dr James undoubtedly has benefited some very, very sick people. This makes it even more a pity his results have not been collated and scientifically published."

Says another Wollongong doctor, "Even a retrospective study of Dr James' results, through contacting several hundred of his former patients, would be valuable."

The most controversial aspect of Dr James' treatment is his vibration therapy, intended to stimulate the autonomic nerves (activating involuntary functions) concerned in breathing. No doctor to whom I spoke could see any physiological grounds for assuming that vibrotherapy did influence these nerves.

The profession generally also feels that Dr James is straining credulity by claiming to cure every case of asthma. "No treatment is 100 per cent effective," one doctor said. "Even if he cured 70 per cent it would be truly remarkable."

Dr James' stance of infallibility, which does not worry his patients, prompts his colleagues to question how he defines a case of asthma. Doctors who say they have seen patients he has failed to cure, claim that he defines these cases as bronchitis. "In diagnosing bronchitis he does not to my knowledge use x-rays, respiratory studies or cultures of sputum." one doctor told me.

The father in question, a Wollongong general practitioner, says that his 10-year-old daughter was an asthmatic cripple, dependent upon injections of adrenalin and other drugs, before she went to Dr James two years ago. "The results were so dramatic that you just couldn't dismiss them as hocus-pocus," he says.

He does not regard his daughter as cured, but he respects Dr James for making her so much better and enabling her to live without drugs. "There are no such things as cures in medicine," he says. "I just think Dr James' treatment is better than anyone else has come up with. His physical methods are excellent, particularly with children." Dr James' attitude to his patients also plays a part in his success against asthma, this doctor believes. "Even if you are taking out a gall bladder," he says, "it helps a lot if you can give the patient confidence, understanding and sympathy." His daughter is so grateful to Dr James that she intends to emulate him when she grows up by becoming a paediatrician and treating asthmatic children. Her father has sent a telegram to the NSW Minister of Health, Mr A H Jago, congratulating him on his decision to establish a clinic at Wollongong Hospital to assess Dr James' methods.

An asthma specialist from another State who visited Dr James at Wollongong also found a lot of good in the way he treats asthma. The specialist has adopted a similar system of breathing exercises and physiotherapy in his own children's clinic and is pleased with the results. With his modified James approach he has been able to take children off drugs or reduce their dosage.

Another specialist, a Wollongong physician who has referred several patients to Dr James, believes that his methods are extremely simple, but very effective. He attributes his ability to relieve asthma partly to getting patients to use their lungs properly and partly to his unconscious psychological impact on people needing relief.

"Modern textbooks hardly mention breathing exercises for asthma." the physician says. "All the thinking has been on drugs. Dr James also radiates tremendous confidence in his methods, whereas the medical profession as a whole is defeatist about asthma."

The proposed clinic offers the chance of deciding Dr James' role in the field. At this stage, however, no-one in Wollongong seems to know how the clinic will work. Who will staff the clinic with Dr James? Will any of the hospital's honorary doctors be asked to work there? If so, will they be asked to cease using drugs, even if this goes against their principles? These are some of the questions awaiting answer.

The medical superintendent of the hospital, Dr Ian Dixon, says he has asked the NSW Hospitals Commission to clarify how it wants the clinic to operate.

About all he knows so far is that it will be supervised by an expert committee of representatives of Sydney University, the University of NSW, the NSW Department of Health and the NSW Branch of the AMA.

All the chairman of the hospital's honorary board is saying is that the board has stated that it has no objection to the clinic being established in the hospital. He does add that the board agreed with the Hospitals Commission that suddenly withdrawing drugs from asthma patients might be dangerous. But the board had informed the commission that, to its knowledge, Dr James was at present withdrawing steroid drugs slowly.

Let the last word come from Dr Hillyar of the south-eastern local association: "There never has been any suggestion that any member of the medical profession wishes to isolate or boycott Dr James."