It’s been more than a decade since I first submitted a piece to Partisan Review — it was a review of Sidney Hook’s letters — and received a typed note from William Phillips, the journal’s co-founder and longtime editor, telling me that, with some minor changes, he’d print it. I was overjoyed, partly because any acceptance is welcome but especially because it came from the one little magazine I most admired. Being accepted into Partisan Review — “PR” to initiates — meant, in a real way, being accepted into a family.
The family was, of course, the famous Family of New York Intellectuals that first coalesced around PR in the 1930s and continues to occupy an outsize place in America’s imagination nearly 70 years later. It was a noisy, contentious family of writers and critics, most of them Jewish, all of them freethinkers. They began as leftists, but most moved steadily rightward over the decades, and in the course of their journey they helped shape America’s ideas of itself and the life of the mind in a way that few others can claim. By the time I first entered, PR’s salad days were long over, the founding group having dispersed and other journals having captured the high ground. Still, being accepted into its circle meant, in a way, having a small claim to immortality.
Imagine my shock, then, when I cachet of AIDS or SARS, but it is one of the most common diseases in the world, having afflicted notables ranging from comedian Steve Allen to Benjamin Ward, New York’s first black police commissioner. In the last two decades, asthma rates have skyrocketed in urban areas around the world, doubling in some cases. An ongoing Harlem Hospital Center study, for example, has found initial results suggesting that one in four children in Harlem suffer from asthma — a rate four times higher than the national average of 6%. Environmentalists and anti-tobacco advocates claim the phenomenon is the result of pollution and smoking. But Rabinowitz, a 40-year-old Montreal native, is skeptical for now. Data proving that either pollution or smoking actually causes asthma, rather than simply aggravating it, are, well, hazy.
“The jury’s still out when it comes to environment and asthma,” said Rabinowitz, a rising star in the world of respiratory diseases. You won’t find any anti-smoking signs or clean-air sloganeering on the walls of Rabinowitz’s office at National Jewish. Definitive proof that either pollutant actually causes asthma may be impossible right now, he says. But that doesn’t mean that other questions, more manageable but still crucial, can’t be answered in the meantime.
“I see kids whose parents swear that when it’s a red-alert pollution day their kids get worse. I want to know whether that’s valid,” Rabinowitz said. Just last month, at a meeting of the American Academy of Allergy, Asthma & Immunology, he released data showing that smokers who restricted their habit to areas outside the house reduced their children’s exposure to smoke by 30%. That can make a critical, life-saving difference.
Government statistics show that asthma directly causes some 5,000 deaths per year. The cost in lives limited and dreams dashed is many times higher. The search for solutions is centered right here at National Jewish and its asthma research team. Over the last three years, through groundbreaking research with the asthmatic students at the hospital’s Kunsberg School — most of whom are black — team member Rabinowitz has come up with some important clues, especially about the relationships between parents’ smoking and children’s asthma.
Among other things, Rabinowitz has recently presented data suggesting that children in homes where the parents smoked were more affected than other children by daily fluctuations in at-home cigarette smoke and urban pollution. Those results filled in an important gap in data on the so-called “dose response” — the scientific relationship that explains how increasing or decreasing smoke at home affects children qualitatively. Rabinowitz calls the dose response the “holy grail,” because without it, pinning down the connections between smoking, pollution and asthma will be impossible.
If there is a medical team that should be finding a “holy grail” of asthma care, it is at the National Jewish Medical and Research Center. The nation’s leading center for research on respiratory diseases, National Jewish was founded in 1899 by Jewish philanthropists in New York as the National Jewish Hospital for Consumptives, a sanitarium for garment workers, most of them Jewish, suffering from tuberculosis. The disease was a workplace hazard caused by cotton fibers in the air of sweatshops and had reached epidemic proportions among the Jewish immigrants who were crowded into New York’s Lower East Side. Over the years, as Jews moved out of the sweatshops, and as garment industry workplace conditions improved, the hospital expanded its mission to include a broad range of respiratory, immune and allergic diseases.
At the center’s affiliated Kunsberg School, which sits on the hospital grounds and serves students from all over Denver, students with respiratory ailments can exercise in the pool, gym or outside, and two on-site nurses provide treatment and teach the children how to deal with their condition. Nearly all of the school’s 70 students suffer from asthma; a handful face cystic fibrosis or heart disease.
Rabinowitz’s interest in asthma began two decades ago. After growing up in an Orthodox family in Montreal and attending medical school at hometown McGill University, he went to New York City to do his residency in pediatrics at Yeshiva University’s Albert Einstein Medical Center in the Bronx. He says he was not quite prepared for the rush of poor, inner-city kids that confronted him — nor for the enormous proportion who suffered from asthma. One patient he saw repeatedly in the emergency room, a young black girl, would be wheezing audibly each time she arrived.
“I would be working at 2 a.m. and she would come in. It’s like she was breathing through a straw. Once you saw her you just wanted to put her on a ventilator,” he said. “That was one of the things that stayed with me.”
He also found a personal reason to research asthma during his training: During his rotation for pulmonology, he recalled with a laugh, a breathing test alerted him to his own minor case of asthma. “I was supposed to be the control, and I ended up failing the test,” he said.
One reason that it remains impossible to name smoking or pollution as culprits, says Rabinowitz, is that so many factors are at play. Theories about the current spike in urban asthma point to factors ranging from mold to cockroach droppings to bad health care. But the field needs better data: Previous studies looking at urban asthma have used centralized sensors at schools or in downtown areas and tried to correlate daily environmental readings with spikes in asthma. Rabinowitz is improving the research by using personal monitoring devices to track children’s exposure to bad air. These two-pound monitors, which resemble soft lunch boxes, allow Rabinowitz to measure the exact daily exposure that kids receive from pollution, mold and cigarette smoke — what he calls “the Pig Pen effect,” after the Peanuts comic-strip character. Students wear the monitors for six-day stretches several times each year, and on-board computers and filters calculate the personal pollution for each student.
Rabinowitz says he thrives off the “instant gratification” that healing children provides. “It would be very frustrating for me to work with old people, because once you solve one problem another one comes up,” he said. “Kids get better. That’s why I like working with kids.”
Rabinowitz’s goofy smile and battered black leather jacket — he eschews the white doctor’s coat — probably help him, he says, to relate to the kids he sees at biweekly clinics. One question his patients invariably ask, he says, is about the black yarmulke he wears. “Kids will ask that question right away,” he said.
He and his wife Rachel, a radiation oncologist, attend East Denver Orthodox Synagogue. Three children — Avi, 8, Yoni, 6, and Suzanne, 2 — round out the family. Thankfully, he says, there’s no sign of asthma in the children so far.
“We don’t talk about medicine when we get home,” Rabinowitz said, adding that three kids and two medical jobs make it tricky to balance his family’s time. “I really look forward to Shabbat.”
As the next step in the research, Rabinowitz’s team will begin installing air filters in the homes of some of the school’s families. He is also planning programs in some homes to encourage parents to quit smoking. Then his team will study how those changes affect individual students’ exposure and, consequentially, their health. The results will be widely watched.
Asked if asthma is a less thrilling area of medicine than higher-profile areas such as AIDS or cancer, Rabinowitz just laughed. “But we see [asthma] so often. That’s why I can’t think of a disease more exciting.”