By Henry Ehrlich
By complete coincidence, the letters column of the New York Times Monday morning contained this snippet of W.H. Auden that he read in his 1946 Harvard commencement address:
“Thou shalt not sit
With statisticians nor commit
A social science.”
I was glad to see it because I wrestled all weekend with how to respond to an article that showed up last week by Princeton sociologist Miranda R. Waggoner called “Parsing the peanut panic: The social life of a contested food allergy epidemic”*. The piece raised a bit of ire in the food allergy circles I monitor. A few Moms wished on the author a measure of the ill fortune visited on Time Magazine writer Joel Stein a few years ago. Having written a piece that began “Your kid doesn’t have an allergy to nuts. Your kid has a parent who needs to feel special” Stein blamed the epidemic on overreporting, then found out the hard way when his own son suffered anaphylaxis to tree nuts. Waggoner’s piece reads like a sequel, or it would if you can penetrate the dust-dry jargon and lengthy locutions. “I argue that the peanut allergy epidemic was co-constructed through interactions between experts, publics, biomedical categories, and institutions, while social reactions to the putative epidemic expanded the sphere of surveillance and awareness of peanut allergy risk.” The alliteration in the headline was an uncharacteristic flourish.
This piece wasn’t all bad. In its own way it pointed to some of the same problems we complain about around here: how hard it is to figure out how many people have food allergies for example because the term is misunderstood and that more people self-report allergies than actually have them; that people are encouraged by their doctors to avoid more foods than they are seriously allergic to. We have complained about specious research being sensationalized by shallow reporters. But whether the actual numbers are lower than the putative numbers or not, a lot of people are seriously allergic. There are about 75 million Americans under the age of 17. If only one percent of them have peanut allergies that’s still 750,000 kids, and there are tens of thousands of emergency room visits every year. Body counts aren’t the only measure of danger—there was the usual comparison to lightning strikes in the article, but I must point out that we do take our Little Leaguers with their aluminum bats off the field when the clouds start to gather. Besides, and Auden would surely concur given his opinion of statisticians indicated above, even if your child is one in a hundred who has a life threatening food allergy, it’s still 100% of that kid. Each child does deserve some special consideration by the people around them if not the full court press. (We support food-free classrooms but not peanut-free schools.)
Still, I was irked by the idea that the allergy epidemic was somehow a function of these “co-constructors”, who include scientists who have written for this website, and founders of the organizations that have sprung up around the issue. “More than a story of panicked parents and sensationalist media, peanut allergy discourse was co-constructed by multiple actors and institutions over time, with a range of social consequences.” Is she implying a connection with the term “co-conspirators” here? What makes these people any more self-interested than any other affinity group like, say, social scientists, who also, I might add, like to publish their research and use it to raise money? Are they somehow on a par with the legions of academic researchers who lined their pockets with money from the Tobacco Institute? (I notice that the author had support from the NIH, as have all reputable food-allergy researchers.)
But there’s another problem in this way of thinking, and that’s detaching a big, visible, “minority” health issue from any larger context. My friend and fellow New Yorker–and our contributor—Susan Weissman reminded me that in the early days of the HIV/AIDS epidemic, patients were marginalized. We both remember the joke: “The worst thing about AIDS is having to tell your parents that you’re Haitian.” With the disease apparently confined to the fringes of American society, President Ronald Reagan studiously ignored the rising threat. Yet, the continual pressure from activists undoubtedly led in time to the recognition that this was a catastrophe, and eventually, George W. Bush made AIDS prevention and treatment in Africa a signature foreign policy program.
There’s a bigger picture here, too. In February we cited Australian allergist Dr. Susan Prescott who has brilliantly placed allergies within the context of a global pandemic of “inflammatory non-communicable diseases.” She wrote: “[A]s the most common and earliest-onset NCD, the epidemic of allergic diseases points to specific vulnerability of the developing immune system to modern environmental change… The innate immune system provides a clear example of this convergence, with evidence that physical activity, nutrition, pollutants, and the microbiome all influence systemic inflammation through Toll-like receptor pathways (notably Toll-like receptor 4), with downstream effects on the risk of insulin resistance, obesity, cardiovascular risk, immune diseases, and even mood and behavior.”
To the extent that the “co-constructors” have succeeded in drawing attention and resources to the study of food allergies, they may have given us new impetus in understanding the functioning of the immune system and possible new approaches to therapy for a range of immune-system-related conditions (more on this in coming months). They have also provided ammunition for those who argue for a concerted effort to fix the spectrum of environmental problems described by Dr. Prescott. The challenge is to develop the political consensus to do something about it.
*M.R. Waggoner , Social Science & Medicine 90 (2013) 49-55
Photograph by voiceseducation.org