Perhaps not intentional, but incompetence bordering on malpractice. Peanut avoidance never met evidence-based medicine standards. Even when faced with contrary scientific evidence, pediatricians doubled down on a failed guideline and caused further harm.
No, Aumann's theorem proves a much more limited thing. For one thing, it assumes agents have a common prior, which is a very strong assumption not present in most cases where people "agree to disagree".
When the disagreement starts from foundational subjective disagreements, such as what constitutes malpractice or intent or incompetence, etc, the theorem has nothing to say, and it is perfectly reasonable to say that you "agree to disagree".
What are we disagreeing about? Are you claiming that issuing public health and dietary guidelines without a clear basis in evidence-based medicine is not incompetence?
I discussed that article with an old-timer here in New England told me that a slightly less extreme version worked for him: letting goats eat the massive growth of poison ivy on his land, then drinking the goat milk for a few weeks or months.
There is increasingly more evidence that skin contact before oral ingestion (and in particular on wounds or eczema) increases allergies, and consuming the allergen orally whilst avoiding skin contact reduces it.
It’s even being used in people with allergies to reduce, and sometimes even overcome the allergies completely!
My anecdote. My wife ate PB&J sandwiches all through pregnancy and when breastfeeding. Still, my son was diagnosed with a peanut allergy as an infant, before he was even old enough to really munch on a Bamba.
Also "We have no peanut allergies in Africa"... come on. Maybe it is less prevalent, but what nonsensical quote to include in an article.
It's my experience that Americans, through peanut butter, also eat more peanuts in general than other cultures. Most other places I've been to only have limited snacking or cooking with peanuts and don't really eat any peanut butter (if it's even available in stores, which it often isn't unless there's an "American Food" section).
FYI, I was told by an allergist that things cooked in peanut oil don't tend to have a similar impact as other peanut products I think because the high temperature breaks down whatever it is that causes the allergy.
Here in India we cook with peanut oil, use peanuts as a flavour base in cooking, add peanuts to a variety of sweet and savoury snacks, and snack on roasted peanuts every day in the winter. I'm typing this just having finished munching on some sand-roasted peanuts.
FYI, I was told by an allergist that things cooked in peanut oil don't tend to have a similar impact as other peanut products (I think) because the high temperature breaks down whatever it is that causes the allergy.
Knowing how people in the US are, this article could be published everywhere, on billboards, even tattooed on Doctors foreheads. The damage is done.
Pregnant people and young kids will still avoid peanuts and nuts like the plague, no matter what health officials say. So, this will continue to get worse.
Not sure about “people in the US” being more prone to this than others (maybe! I have no idea) but I have noticed that these kinds of things seem very slow to go away once they’re in the zeitgeist, short of massive public awareness campaigns (which we used to do quite a bit, but hardly do anymore)
"When modern medicine issues recommendations based on good scientific studies, it shines. Conversely, when doctors rule by opinion and edict, we have an embarrassing track record. Unfortunately, medical dogma may be more prevalent today than in the past because intolerance for different opinions is on the rise, in medicine as throughout society."
"medical dogma may be more prevalent today than in the past because intolerance for different opinions is on the rise, in medicine as throughout society."
I think a large part of that is perceived liability. Remember when Covid19 first hit, there was a doctor claiming an early treatment prevented his cases from getting bad. That one sticks with me not because I think he was right, but because the response was "That's not an FDA approved treatment for this." It wasn't just him, but others as well. The problem is there was NO approved treatment for it. To me it looked like doctors being afraid they'd get blamed for doing anything off the beaten path, so much that they were afraid even when there was no path. Such is the world we live in...
So much of the bad advice that was eventually proven wrong was exactly that: advice that seemed to make sense based on our understanding of biological processes, but was never actually tested.
Stuff like the bad advice about avoiding eggs because they are high in cholesterol (turns out for the vast majority of people can eat eggs without negatively impacting blood cholesterol), stress causes ulcers (it was just believed that the stomach was too acidic to allow bacterial growth, until someone really looked), etc. The interesting thing is how strongly the existing "medical establishment" dug in when they had no actual studies to back them up.
Exposure (or lack of) is certainly a huge factor here, but I'm wondering whether some of the variance in peanut allergy between different parts of the world is driven by HLA groups—which are strongly associated with ethnicity and geographic location.
If you got your HLA genes from a great-grandparent who hailed from Scandinavia, are you more likely to develop a peanut allergy than someone whose HLA genes can be traced back to West Africa?
I'm also curious about the way that many (if not most?) kids seem to suffer less severe peanut allergies as they get older, or even grow out of them entirely... because I've heard similar things about bee sting allergies. Not sure if it's a similar mechanism at play.
I am also unconvinced we know the real reason for increased peanut allergies. I still tend to believe the eczema and skin cream theory.
No one in my family except my son has peanut allergies. He did have severe eczema and we diligently applied all kinds of skin creams. It was only later I learned eczema means a breakdown of the skin blood barrier. Maybe this led to exposure to allergens in the air or even in the creams that led to him developing peanut allergy?
The eczema connection is interesting! I do wonder about the cause and effect, though—it may not be that eczema (or creams to treat it) cause peanut allergies so much as that both stem from the same root cause. Eczema is an autoimmune response, after all!
ETA: Not sure if you know this already, but most people who have eczema also have asthma (and vice versa). Might be something to keep an eye on :)
I'm growing against the idea that we actually have this understood. As someone that presented allergies at the age of several months, it feels somewhat suspicious to think I just needed to be exposed earlier in life.
I am open to the idea that people avoid exposure with more zeal than is needed. A lot of that comes from the desire to be doing something active to protect your kids. Such that it is understandable, even if it could be counter productive.
I am also still heavily disposed to think that there were many other contaminants that we were exposed to than at any other time in history. Trans fats, as my easy example, were terrible and only stopped being used relatively recently. That and second hand smoke. Which, wow.
> As someone that presented allergies at the age of several months, it feels somewhat suspicious to think I just needed to be exposed earlier in life.
Mothers who avoided peanuts during pregnancy had babies with higher rates of peanut allergies. There is no guarantee because the human immune system is complex, but the trend is clear.
Fair, if you are criticizing me for just being a gripe. I welcome more data, so I am decidedly not trying to say we should toss this. We also exposed our kids to peanuts at an early age, so I am generally aligned with the new guidance.
I'm largely tilting at the windmill of "tone" in a lot of these stories. It sounds like a solved thing far moreso than I am comfortable with.
I am also interested in details. Did the parents that avoided peanuts actively choose a common replacement?
I'm also curious if this generalizes well to other allergies. In particular, knowing that consumption of peanuts is also an extremely American thing, what are the common major allergies in other nations and do they have the same trends?
>Deaths from peanut allergies are real, and living with the problem can be terrifying. Compounding the tragedy is knowing that America’s epidemic of peanut allergies is a largely avoidable consequence of our policy of peanut abstinence.
We keep getting these articles based on 2 peanut studies that specifically only included Jewish children from Israel and England, the ones in Israel had the peanuts early, and the ones in England did not. One study being under 100 children, and one over 1000. Based on these studies Australia changed their recommendations and the number of people introducing their children to peanuts before the age of 1 went from 26% to 85% by 2018. This had _no_ effect on allergy rates to peanuts. They still remain the same.
As an aside, my wife is allergic to peanuts, we have no peanuts in our house, and our kids didn't try peanuts until after the age of 7. None of them have peanut allergies.
This is somewhat reassuring. We have the same problem with our children (they have not tried the allergen because we cannot even accidentally get it into our home) except with sesame, which is an equally annoying thing to be mortally allergic to!
We are in DIRE fucking need of prominent, loud, and substantial public funding for reproducibility studies, and regulations around reporting on scientific discoveries/studies. There are so many of these communities of folks who have completely gone off the map regarding some aspect of science, and a sufficient amount of research on your part will lead back to 1 or 2 studies by one doctor who had an axe to grind or money to make, and it's since spawned an utter juggernaut of misinformation and fraud.
I am amazed you are being downvoted for advocating increased funding for reproduceable studies.
The Replication crisis is real, and can be avoided if more effort is put in not to discover something new, but instead to verifying the old information we base new questions/studies on.
> I am amazed you are being downvoted for advocating increased funding for reproduceable studies.
I'm not. There are a large contingent of people on here who scream socialism/communism anytime you suggest the government do anything, even when it's demonstrably addressing an existing crisis that's skullfucking our society.
They'll probably downvote this one too because they really don't like when people point out their "objective" and "rational" thinking is neither of those things.
To be fair to anyone so motivated: the word "public" wasn't necessary to the comment. Loud, substantial private funding for such an endeavor would presumably solve the problem just as well.
(They also might be thinking that "regulations around reporting" pose a substantial free speech issue.)
One would counter that if private money was at all interested in resolving this problem they may have done so at any time in the last 3 decades, which is only the most severe the crisis has been, not it's full duration.
One would also counter that regulations regarding the accuracy of speech existed in 1987 and were by most accounts, pretty effective at keeping news informative and balanced, as opposed to after those regulations were retired and we got politics being covered like sports and the political divide becoming larger and larger as time goes on because making people angry and scared of the Other is pretty profitable, while getting them balanced, informed coverage is both more expensive and not as appealing to the consumer.
I think you presume too much of private entities, which would always put their financial interest first (lead gasoline science studies come to mind, tobacco/cancer obfuscation... etc)... you can't trust a private company not to act in its own financial interests, that's not how they work.
At least with a public entity, you should be able to publicly audit what's happening, and with public funding to answer to, the public's interests and the proposed entity's financial security are aligned properly.
> We are in DIRE fucking need of prominent, loud, and substantial public funding for reproducibility studies, and regulations around reporting on scientific discoveries/studies.
there's got to be a market for someone to create a new journal that only accepts/publishes research that has been independently reproduced at least a few times and has an actually meaningful peer review process and standards. It could serve as a repository for research that we can actually put some measure of faith in because right now companies can just pay for research with whatever results they want to see in a headline, and there's basically no accountability for scientists that put out garbage research.
Everyone seems to agree that "publish or perish" is a problem, but as long as people are forced to constantly put something out there it'd be nice to see more effort put into validating/invalidating prior research. It'd be better than just adding to the pile of never-replicated garbage that nobody can trust but everyone goes on to cite anyway.
> there's got to be a market for someone to create a new journal that only accepts/publishes research that has been independently reproduced at least a few times and has an actually meaningful peer review process and standards.
I doubt it. All the incentives for all parties are in the exact opposite direction:
- A journal gains readership based on how many studies it can publish. If it barely publishes any, no one will buy it. Would you buy a magazine that didn't publish anything?
- The doctors and their backers in turn wouldn't give a shit if they got declined by this theoretical journal. They get declined all the time for far less legitimate reasons, most of the time submitting to as many journals as they can, since they will be declined by the majority.
- The journal itself if it's too choosy and lacks the existing brand recognition is incentivized to publish anything it can, which is why most startup journals are even worse than the existing (bad) ones.
Similar things happen when looking at treenut allergies. I have a child allergic to a whole lot of them, even though our first incident requiring medical intervention occurred before age 1.
I have no problem believing that severe allergies weren't all being undiagnosed in the past, but we are way too quick to believe studies that match priors, even if there's evidence that the intervention's effects are, at best overblown.
Science is hard, life sciences doubly so. We need to be far more comfortable with wide error bars than we are.
Can you cite your stats? This study[1] by the Murdoch Children's Research Institute in Australia says there was a 16% reduction in peanut allergies in 2018–2019 after the guideline changes compared to a decade earlier.
This 2024 Australian program[2] for introducing babies to peanuts early is inspired by this 2022 US report[3] about a 22% remission rate in babies who were introduced to peanut powder compared to 2% who received the placebo.
In this case, the conclusion doesn't even quite support the hypothesis. The level of increase in prevalence from a generation ago is greater than the level of claimed reduction from early exposure today.
It's very possible that early exposure is beneficial. It makes sense to me. However, that does not explain why peanut allergies are so much higher now than a century ago. The under-diagnosis hypothesis does not make sense either, since the reactions are so severe.
Something is leading to exploding allergies. I can list other hypotheses, at least as strong, including:
- Travel and genetics (we co-evolve to local environments; the US is mostly immigrant)
- Parasites / hygiene hypothesis
- Environmental changes / new industrial-age pollutants
And, of course, there are things we don't know about and combination effects.
Footnote: Peanuts are native to South America. When the Spanish came, or they were introduced to Europe, we didn't see mass anaphylaxis either, at least as far as I know.
More people are exposed to peanuts today than they were 100 years ago.
What do you think about the possibility that this is similar to rates of other diseases "rising", where really it may be an artifact of access to new populations?
Peanuts were plentiful 100 years ago, and certainly 50 years ago when allergy rates were much lower.
There are also striking geographic differences in allergy rates as well between the US and less developed countries (even within genetically identical populations).
Anecdotally, I also know a bunch of people who developed allergies (not peanut / treenut, but seasonal) a few years after they moved to the US.
It looks like there's something environmental going on. I just don't know what yet.
My youngest has been the ER three times due to ingesting peanuts, including once when the local Costco was sampling granola bars that contained peanuts. There was no posted allergy warning.
A couple of minutes after the staff realized what had happened, a Costco employee hastily scribbled a peanut warning sign with a Sharpie and taped it to the sample station.
Another time we had to administer an Epipen at a Mexican restaurant after she ate a cheese enchilada. Turns out their red sauce contained peanut butter.
This is going to sound accusatory but it's quite obvious a granola bar can contain nuts. I can understand the Mexican restaurant scenario but one trip to the ER should have you questioning EVERY food source that is not within your control. You cant expect food safety if you don't verify yourself.
We did learn to question everything eventually, and today she's vigilant about reading all ingredients.
Just recently I gave her a chocolate wafer from Italy that had peanuts in it, which I would have never assumed based on the taste. Thankfully she read the ingredients. Ouch!
the facts in the article do not justify the headline. 'early exposure resulted in an 86% reduction in peanut allergies by the time the child reached age 5', it summarizes one study. 'Jewish children in Israel had one-tenth the rate of peanut allergies compared with Jewish children in the U.K.,' it summarizes another. but a 6× or 10× smaller peanut allergy epidemic would still be a peanut allergy epidemic. something else is going on
if no cameroonian children have a peanut allergy, could it be that 0.6% of them are born with a peanut allergy but die undiagnosed in infancy?
Ugh, we're going through the cycle of the author of the book going around spreading his little tidbits in all the main sites/podcasts (I heard him on Econtalk).
For us rest-of-the-worlders - note that Peanut allergy is not an invention - there is a small minority of people with peanut allergies, even after exposure to peanuts as infants. However, there is a larger subset of people who developed peanut allergy in the US through full avoidance of peanuts, so that when later in life they came into contact with them, it started an IgE-mediated cascade (according to the model, on the second exposure to peanuts) that could've been avoided had their body been habituated to peanuts earlier in life.
The real thing to learn here is how suggestions become dogma in human society. "We don't know what's causing allergy, maybe just avoid it?" becomes "We [some formal group of pediatric allergologists] suggest to avoid peanuts" becomes "Our guideline is to avoid peanuts".
The point of Evidence-Based Medicine is exactly to avoid this, but note that this is the standard affairs in anything else in life. Iterative improvement is built on doing something until it stops working/starts harming and then doing something else. It's just magnified where human life is concerned - Military, Aviation, Medicine, etc.
Just like in Aviation - the best solution is process - to admit mistakes and force changes and improvements without knee-jerk opprobrium and litigation (here it's obvious that no medical association should suggest something extreme if there's no evidence for it one way or the other, duh) - but creating sensationalist headlines demonizing a group just makes sure that future mistakes will continue to be covered up.
I've had a mixed experience with medical professionals and prevailing medical advice. Through my fathers stroke, my mothers heart attack, both of them being diagnosed with some form of diabetes and/or blood pressure just to be prescribed some meds that make it worse (looking at u metropolol) - time and again we have had to filter their advice through common sense and our own experience. Both my parents are managing their lifestyle and diets, and taking smaller or no doses of the meds the docs are prescribing them with glee it seems.
On nut allergies, we have a tradition in India where pregnant and breast feeding women are given every single type of nut over a period of time in a particular sequence. There is something called panjiri that is an amalgam of nuts and ghee, the idea being to provide sustenance to a pregnant mother and then after birth slowly introducing different nuts (and other foods) into the diet over a period of days/weeks. This stuff has been honed over a period of generations.
Nut allergies are fairly uncommon in India. This isn't some silver bullet thing, but just another piece of evidence not to just listen to medical professionals blindly.
All medical advice is inevitably biased by who doctor's see - not who they don't see. Pediatricians encountered peanut allergies, so they took action - cardiac patients appear with high blood pressure, so action is taken.
Advice appropriate for individuals entering a hospital for emergency care is likely inaccurate for the general population. Human anatomy is so immensely complex that it's unlikely that a recommendation based on averages will have positive outcomes for most individuals unless the effect size is extremely large. Bus accidents are still bad for everyone's health.
Pediatric allergy and atopic diseases in general is a mess an only slowly getting better. There's strong correlation between early eczema and food allergies, and now mild but convincing evidence it could even be causal. That eczema (and atopic disease in general) is strongly linked with microbiome and exposure to beneficial bacteria, especially in the first few days and weeks of life. This is also associated with malnutrition, diabetes, obesity, colic, and other symptoms we generally only treat symptomatically and in a silo. Yet for structural reasons, most pediatricians will at best tell you that early probiotics is a placebo. Top pediatricians in the know though will enthusiastically support targeted probiotics. Hell, the whole country of Bangledesh has a successful probiotic program -- https://www.science.org/doi/10.1126/scitranslmed.abk1107. It's amazing how much of common pediatric wisdom in the 80s/90s (clean newborn after birth, eat mushy prepared foods, enriched formula feeding, clean environments, avoid allergens, etc) are now seen as really harmful.
Our pediatrician strongly encouraged us to introduce nuts young. It was not just about developing finance tolerance, it's that the reaction would be less severe when you are younger and your immune system is less developed.
Also, death from anaphylactic shock is much, much, much rarer than I was led to believe. Only a few dozen cases a year, and the majority had compounding health issue (like asthma or heart problems). The anecdotes about people almost dying are just that.
Aside: One issue that you'll come across for allergy tests is that they are pretty much useless. It's been a while, but if I recall correctly, the false positive rate is ~10% and the false negative rate is ~45%. This is for both the skin prick and the IgG (IgE?) tests. If you run those numbers through the standard Bayesian analysis, you'll conclude that you pretty much get no information from these tests.
But, really, go out and make sure they don't have some new test these days and figure out what those false positive and false negative rates are.
Essentially, you're at the mercy of the allergists and the luck here. Make sure to find a good MD for help.
I'm not buying this pseudo-scientific nonsense. Allergies have to do with the immune system, but you cannot be "immunized" against an allergy.
Someone genetically predisposed to a peanut allergy cannot have that problem thwarted by early exposure.
Allergies grow worse with exposure, as the substance which triggers the allergy is memorized by the immune system. This is sensitization.
The second problem with the claim is that nobody actually does what the article describes: avoid giving kids peanut butter until they are 3. The modern protocol is that peanut butter is cautiously introduced in a tiny amount to a weaning infant. If that looks okay, they get more until it either looks obvious that they are fine, or else that they are not.
The third problem is that even if people doggedly followed this three year rule, it has not been enough time for that to be imprinted on the human genome, so that we have more prevalence of peanut allergy now in our DNA.
All we have today is better awareness. That's why there is more of everything, not just peanut allergies.
I wonder, do the believers in this hypothesis also think this would work for industrial irritants? If we just expose infants to epoxy resins, they will later able to work in a fiberglass shop without any problems?
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[ 1.4 ms ] story [ 3604 ms ] threadhttps://peterattiamd.com/martymakary3/
https://en.m.wikipedia.org/wiki/Aumann's_agreement_theorem
When the disagreement starts from foundational subjective disagreements, such as what constitutes malpractice or intent or incompetence, etc, the theorem has nothing to say, and it is perfectly reasonable to say that you "agree to disagree".
Not everyone is going to be reasonable about everything.
Including their own definitions of "agreeing" or "reasonable".
I tried turning off uBlock, still no luck getting it to work correctly.
https://news.ycombinator.com/item?id=40399224
I discussed that article with an old-timer here in New England told me that a slightly less extreme version worked for him: letting goats eat the massive growth of poison ivy on his land, then drinking the goat milk for a few weeks or months.
There is increasingly more evidence that skin contact before oral ingestion (and in particular on wounds or eczema) increases allergies, and consuming the allergen orally whilst avoiding skin contact reduces it.
It’s even being used in people with allergies to reduce, and sometimes even overcome the allergies completely!
Data labeling is important ;-)
Also "We have no peanut allergies in Africa"... come on. Maybe it is less prevalent, but what nonsensical quote to include in an article.
It's my experience that Americans, through peanut butter, also eat more peanuts in general than other cultures. Most other places I've been to only have limited snacking or cooking with peanuts and don't really eat any peanut butter (if it's even available in stores, which it often isn't unless there's an "American Food" section).
How would you classify cultures that use peanut oil in cooking? That may not be "eating", but it is exposure.
* https://en.wikipedia.org/wiki/Peanut_oil
Pregnant people and young kids will still avoid peanuts and nuts like the plague, no matter what health officials say. So, this will continue to get worse.
"When modern medicine issues recommendations based on good scientific studies, it shines. Conversely, when doctors rule by opinion and edict, we have an embarrassing track record. Unfortunately, medical dogma may be more prevalent today than in the past because intolerance for different opinions is on the rise, in medicine as throughout society."
I think a large part of that is perceived liability. Remember when Covid19 first hit, there was a doctor claiming an early treatment prevented his cases from getting bad. That one sticks with me not because I think he was right, but because the response was "That's not an FDA approved treatment for this." It wasn't just him, but others as well. The problem is there was NO approved treatment for it. To me it looked like doctors being afraid they'd get blamed for doing anything off the beaten path, so much that they were afraid even when there was no path. Such is the world we live in...
Stuff like the bad advice about avoiding eggs because they are high in cholesterol (turns out for the vast majority of people can eat eggs without negatively impacting blood cholesterol), stress causes ulcers (it was just believed that the stomach was too acidic to allow bacterial growth, until someone really looked), etc. The interesting thing is how strongly the existing "medical establishment" dug in when they had no actual studies to back them up.
If you got your HLA genes from a great-grandparent who hailed from Scandinavia, are you more likely to develop a peanut allergy than someone whose HLA genes can be traced back to West Africa?
I'm also curious about the way that many (if not most?) kids seem to suffer less severe peanut allergies as they get older, or even grow out of them entirely... because I've heard similar things about bee sting allergies. Not sure if it's a similar mechanism at play.
No one in my family except my son has peanut allergies. He did have severe eczema and we diligently applied all kinds of skin creams. It was only later I learned eczema means a breakdown of the skin blood barrier. Maybe this led to exposure to allergens in the air or even in the creams that led to him developing peanut allergy?
https://www.independent.co.uk/life-style/health-and-families...
A lot of creams have colloidal oatmeal which seems safe.
https://www.medicalnewstoday.com/articles/oatmeal-bath-for-e...
I would avoid anything with nut oils.
https://www.allergycompanions.com/blog/skincare-that-can-con...
ETA: Not sure if you know this already, but most people who have eczema also have asthma (and vice versa). Might be something to keep an eye on :)
I am open to the idea that people avoid exposure with more zeal than is needed. A lot of that comes from the desire to be doing something active to protect your kids. Such that it is understandable, even if it could be counter productive.
I am also still heavily disposed to think that there were many other contaminants that we were exposed to than at any other time in history. Trans fats, as my easy example, were terrible and only stopped being used relatively recently. That and second hand smoke. Which, wow.
Mothers who avoided peanuts during pregnancy had babies with higher rates of peanut allergies. There is no guarantee because the human immune system is complex, but the trend is clear.
I'm largely tilting at the windmill of "tone" in a lot of these stories. It sounds like a solved thing far moreso than I am comfortable with.
I am also interested in details. Did the parents that avoided peanuts actively choose a common replacement?
I'm also curious if this generalizes well to other allergies. In particular, knowing that consumption of peanuts is also an extremely American thing, what are the common major allergies in other nations and do they have the same trends?
We keep getting these articles based on 2 peanut studies that specifically only included Jewish children from Israel and England, the ones in Israel had the peanuts early, and the ones in England did not. One study being under 100 children, and one over 1000. Based on these studies Australia changed their recommendations and the number of people introducing their children to peanuts before the age of 1 went from 26% to 85% by 2018. This had _no_ effect on allergy rates to peanuts. They still remain the same.
As an aside, my wife is allergic to peanuts, we have no peanuts in our house, and our kids didn't try peanuts until after the age of 7. None of them have peanut allergies.
The Replication crisis is real, and can be avoided if more effort is put in not to discover something new, but instead to verifying the old information we base new questions/studies on.
I'm not. There are a large contingent of people on here who scream socialism/communism anytime you suggest the government do anything, even when it's demonstrably addressing an existing crisis that's skullfucking our society.
They'll probably downvote this one too because they really don't like when people point out their "objective" and "rational" thinking is neither of those things.
(They also might be thinking that "regulations around reporting" pose a substantial free speech issue.)
One would also counter that regulations regarding the accuracy of speech existed in 1987 and were by most accounts, pretty effective at keeping news informative and balanced, as opposed to after those regulations were retired and we got politics being covered like sports and the political divide becoming larger and larger as time goes on because making people angry and scared of the Other is pretty profitable, while getting them balanced, informed coverage is both more expensive and not as appealing to the consumer.
At least with a public entity, you should be able to publicly audit what's happening, and with public funding to answer to, the public's interests and the proposed entity's financial security are aligned properly.
in an ideal world...
there's got to be a market for someone to create a new journal that only accepts/publishes research that has been independently reproduced at least a few times and has an actually meaningful peer review process and standards. It could serve as a repository for research that we can actually put some measure of faith in because right now companies can just pay for research with whatever results they want to see in a headline, and there's basically no accountability for scientists that put out garbage research.
Everyone seems to agree that "publish or perish" is a problem, but as long as people are forced to constantly put something out there it'd be nice to see more effort put into validating/invalidating prior research. It'd be better than just adding to the pile of never-replicated garbage that nobody can trust but everyone goes on to cite anyway.
I doubt it. All the incentives for all parties are in the exact opposite direction:
- A journal gains readership based on how many studies it can publish. If it barely publishes any, no one will buy it. Would you buy a magazine that didn't publish anything?
- The doctors and their backers in turn wouldn't give a shit if they got declined by this theoretical journal. They get declined all the time for far less legitimate reasons, most of the time submitting to as many journals as they can, since they will be declined by the majority.
- The journal itself if it's too choosy and lacks the existing brand recognition is incentivized to publish anything it can, which is why most startup journals are even worse than the existing (bad) ones.
I have no problem believing that severe allergies weren't all being undiagnosed in the past, but we are way too quick to believe studies that match priors, even if there's evidence that the intervention's effects are, at best overblown.
Science is hard, life sciences doubly so. We need to be far more comfortable with wide error bars than we are.
This 2024 Australian program[2] for introducing babies to peanuts early is inspired by this 2022 US report[3] about a 22% remission rate in babies who were introduced to peanut powder compared to 2% who received the placebo.
1. https://www.mcri.edu.au/news-stories/decrease-peanut-allergy...
2. https://www.theguardian.com/australia-news/article/2024/aug/...
3. https://www.nih.gov/news-events/nih-research-matters/oral-im...
It's very possible that early exposure is beneficial. It makes sense to me. However, that does not explain why peanut allergies are so much higher now than a century ago. The under-diagnosis hypothesis does not make sense either, since the reactions are so severe.
Something is leading to exploding allergies. I can list other hypotheses, at least as strong, including:
- Travel and genetics (we co-evolve to local environments; the US is mostly immigrant)
- Parasites / hygiene hypothesis
- Environmental changes / new industrial-age pollutants
And, of course, there are things we don't know about and combination effects.
Footnote: Peanuts are native to South America. When the Spanish came, or they were introduced to Europe, we didn't see mass anaphylaxis either, at least as far as I know.
What do you think about the possibility that this is similar to rates of other diseases "rising", where really it may be an artifact of access to new populations?
There are also striking geographic differences in allergy rates as well between the US and less developed countries (even within genetically identical populations).
Anecdotally, I also know a bunch of people who developed allergies (not peanut / treenut, but seasonal) a few years after they moved to the US.
It looks like there's something environmental going on. I just don't know what yet.
A couple of minutes after the staff realized what had happened, a Costco employee hastily scribbled a peanut warning sign with a Sharpie and taped it to the sample station.
Another time we had to administer an Epipen at a Mexican restaurant after she ate a cheese enchilada. Turns out their red sauce contained peanut butter.
This is going to sound accusatory but it's quite obvious a granola bar can contain nuts. I can understand the Mexican restaurant scenario but one trip to the ER should have you questioning EVERY food source that is not within your control. You cant expect food safety if you don't verify yourself.
Just recently I gave her a chocolate wafer from Italy that had peanuts in it, which I would have never assumed based on the taste. Thankfully she read the ingredients. Ouch!
if no cameroonian children have a peanut allergy, could it be that 0.6% of them are born with a peanut allergy but die undiagnosed in infancy?
For us rest-of-the-worlders - note that Peanut allergy is not an invention - there is a small minority of people with peanut allergies, even after exposure to peanuts as infants. However, there is a larger subset of people who developed peanut allergy in the US through full avoidance of peanuts, so that when later in life they came into contact with them, it started an IgE-mediated cascade (according to the model, on the second exposure to peanuts) that could've been avoided had their body been habituated to peanuts earlier in life.
The real thing to learn here is how suggestions become dogma in human society. "We don't know what's causing allergy, maybe just avoid it?" becomes "We [some formal group of pediatric allergologists] suggest to avoid peanuts" becomes "Our guideline is to avoid peanuts".
The point of Evidence-Based Medicine is exactly to avoid this, but note that this is the standard affairs in anything else in life. Iterative improvement is built on doing something until it stops working/starts harming and then doing something else. It's just magnified where human life is concerned - Military, Aviation, Medicine, etc.
Just like in Aviation - the best solution is process - to admit mistakes and force changes and improvements without knee-jerk opprobrium and litigation (here it's obvious that no medical association should suggest something extreme if there's no evidence for it one way or the other, duh) - but creating sensationalist headlines demonizing a group just makes sure that future mistakes will continue to be covered up.
On nut allergies, we have a tradition in India where pregnant and breast feeding women are given every single type of nut over a period of time in a particular sequence. There is something called panjiri that is an amalgam of nuts and ghee, the idea being to provide sustenance to a pregnant mother and then after birth slowly introducing different nuts (and other foods) into the diet over a period of days/weeks. This stuff has been honed over a period of generations.
Nut allergies are fairly uncommon in India. This isn't some silver bullet thing, but just another piece of evidence not to just listen to medical professionals blindly.
Advice appropriate for individuals entering a hospital for emergency care is likely inaccurate for the general population. Human anatomy is so immensely complex that it's unlikely that a recommendation based on averages will have positive outcomes for most individuals unless the effect size is extremely large. Bus accidents are still bad for everyone's health.
Also, death from anaphylactic shock is much, much, much rarer than I was led to believe. Only a few dozen cases a year, and the majority had compounding health issue (like asthma or heart problems). The anecdotes about people almost dying are just that.
But, really, go out and make sure they don't have some new test these days and figure out what those false positive and false negative rates are.
Essentially, you're at the mercy of the allergists and the luck here. Make sure to find a good MD for help.
Someone genetically predisposed to a peanut allergy cannot have that problem thwarted by early exposure.
Allergies grow worse with exposure, as the substance which triggers the allergy is memorized by the immune system. This is sensitization.
The second problem with the claim is that nobody actually does what the article describes: avoid giving kids peanut butter until they are 3. The modern protocol is that peanut butter is cautiously introduced in a tiny amount to a weaning infant. If that looks okay, they get more until it either looks obvious that they are fine, or else that they are not.
The third problem is that even if people doggedly followed this three year rule, it has not been enough time for that to be imprinted on the human genome, so that we have more prevalence of peanut allergy now in our DNA.
All we have today is better awareness. That's why there is more of everything, not just peanut allergies.
I wonder, do the believers in this hypothesis also think this would work for industrial irritants? If we just expose infants to epoxy resins, they will later able to work in a fiberglass shop without any problems?