You probably know in regards to the rise in peanut allergies in children. Peanut allergies in American children greater than tripled between 1997 and 2008 after doctors advised pregnant and breastfeeding women to avoid eating peanuts and fogeys not to provide them to their children under 3 years old. This advice was based on a 2000 suggestion from the American Academy of Pediatrics.
You may bear in mind that this suggestion, which followed similar recommendations within the UK, turned out to be completely unsuitable and that lots of these allergies actually arose from avoiding peanuts.
This shouldn’t have been surprising, because the suggestion violated a basic principle of immunology: early exposure to foreign molecules results in the event of resistance. In Israel, where babies are commonly fed peanuts, peanut allergies are rare. Moreover, not less than considered one of the studies on which the British suggestion was based showed the alternative of what the suggestion claimed.
As early as 1998, British pediatric allergist and immunologist Dr. Gideon Lack questioned the rules, saying they were “not evidence-based.” But for years, many doctors rejected Lack's findings and even called his studies, wherein he gave babies peanut butter at an early age, unethical.
When I first reported on peanut allergies in 2006, doctors were expressing a wide selection of theories, while the “hygiene hypothesis,” which states that overly sterile environments can trigger allergic reactions, was gaining traction. Yet when my second child was born that very same 12 months, my pediatrician's suggestion was very clear: “No peanuts.”
It wasn't until 2008, when Lack and his colleagues published a study showing that babies who ate peanuts were less prone to develop allergies, that the AAP released a report acknowledging that there was a “lack of evidence” to support its advice regarding pregnant women. However, it stopped wanting advising parents to provide babies peanuts as a preventative measure. In 2017, after one other compelling study by Lack, the AAP finally reversed its original position entirely and now advises parents to provide their children peanuts early on.
But by that point, 1000’s of fogeys who had diligently followed the instructions of medical authorities had actually caused their children to grow to be allergic to peanuts.
The cost of consistency
This preventable tragedy is considered one of several cases wherein medical authorities have endured of their erroneous positions despite evidence on the contrary. Dr. Marty Makary, a surgeon and professor on the Johns Hopkins School of Medicine, examines this in his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for our Health.
Rather than remaining open to dissent, Makary says, the medical career often bands together and leans toward established practice, consensus, and groupthink. (Makary admits to having done this himself.)
In such an environment, an initial opinion can quickly grow to be dogma, especially if the skilled group is committed to an idea.
“There was an internal policy that all AAP recommendations had to be uniform,” a member of the committee that issued the unique peanut guidelines told Makary. “This was an old dogma that was perpetuated.” In other words, Makary writes, “protecting the institution was more important than showing the public alternative viewpoints.”
The causes of this repeated error are just like those of other medical errors described in Makary's book.
In 1983, just before the AIDS crisis began, the American Red Cross, the American Association of Blood Banks, and the Council of Community Blood Centers rejected a suggestion from a senior expert on the Centers for Disease Control and Prevention to limit blood donations from people at high risk for AIDS. Instead, they issued a joint statement insisting that “there is no clear evidence that AIDS is transmitted by blood or blood products.” The fundamental concern was that Americans would not trust the blood supply or donate blood if the security of the provision was questioned.
As with the peanut advice, the reversal got here much later. It took years for blood banks to start screening donors, and it was not until 1988 that the FDA required all blood banks to check for HIV antibodies. In the meantime, half of all American hemophiliacs and lots of others became infected with HIV through blood transfusions, leading to over 4,000 deaths.
In the case of hormone alternative therapy, thousands and thousands of girls have used hormone alternative therapy to ease the symptoms of menopause and reduce the danger of bone fractures, heart attacks, and even Alzheimer's disease in later years. Yet in 2002, women were told in no uncertain terms that taking estrogen and progesterone to treat menopausal symptoms increased their risk of breast cancer. The underlying suggestion was based on a single study, although years later the lead creator of that study admitted to Makary that it showed no statistically significant difference in cancer rates between women who took hormone alternative therapy and people who took a placebo.
Like peanuts, early dissenters were ignored, ridiculed, and faced skilled consequences. It can be years before the rules were corrected. In the meantime, thousands and thousands of girls suffered hormone therapy withdrawal symptoms and were unable to reap the health advantages of hormone alternative therapy.
Unscientific method
While these errors are appalling, what’s much more disturbing is the continued causes of those errors. Medical journals and conferences routinely reject presentations and articles that challenge the traditional wisdom, even when that wisdom is predicated on poor data. For political or practical reasons, consensus is usually favored over dissenting opinions.
With trust in science dwindling, conspiracy theories and misinformation growing, and anti-vaccine figures like Robert Kennedy Jr. setting an illusory example, this will likely not look like the perfect time to criticize the medical career. But a dose of healthy skepticism will be the healthiest attitude when information seems contradictory, whether it's a few decades-old practice or newer, fashionable procedures like tongue-tie surgery.
When it involves medical certainty within the face of dissenting opinions, it is helpful to recall the case of Ignaz Semmelweis. Semmelweis was the Hungarian physician who, in 1847, proposed that doctors should wash their hands before delivering babies to cut back the danger of “childbed fever,” now often called postnatal infection. For making the offensive claim that doctors' hands might one way or the other be unclean, Semmelweis was denounced by the medical community and later lost his job. His life led to an asylum on the age of 47, and in a very gruesome way. He died there of sepsis, the very disease he had fought so hard against as a physician.
Pamela Paul is a columnist for the New York Times.
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