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News You Can Use--Peanut Allergies:

A new study of Jewish children in Israel and the UK suggests that early exposure to peanuts significantly reduces the risk of peanut allergy. What the article describing the study doesn't say is that most Israeli infants are introduced to a peanut snack called "Bamba" as one of their first foods. We started giving Natalie Bamba at around eight months, contrary to our doctors' recommendations. My wife said at the time, "I don't care what the doctors here say. Where is the evidence that peanut allergies are caused by early exposure to peanuts? [There is none, just a theory.] We all ate Bamba as babies in Israel growing up, and I never even heard of peanut allergies until I moved to the U.S."

MCM (mail):
I'm unclear on why the doctor would make sure a recommendation in the first place?

But the principle you're describing makes perfect sense; the human body needs exposure to an allergen to learn to cope with it. Evidently the ability to adapt declines with age.
11.11.2008 12:36am
Freddy Hill:
I had never heard of peanut alergy nor of peanut butter until I moved to the US. It seemed to me then that American children ate inordinate amounts of peanuts before they could even walk. Until I read this I would have assumed that peanut allergy had to do with too many peanuts, not too few. Live and learn...

PS. I one of the many that enjoy your intense political posts, but I confess that once in a while I welcome some lightly salted peanuts!
11.11.2008 12:44am
Adina (mail):
Kids who are put in day care at an early age have a significantly reduced risk of having Hodgkin's Lymphoma (even controlling for other factors). It's good to get all the snotty-nose diseases, and to get them early.
11.11.2008 12:53am
Bruce:
Allergies are either caused by too much exposure to the allergen too early, or too little too late. Or by something else entirely. We now return you to your regularly scheduled programming, already in progress.
11.11.2008 1:01am
Glenn W. Bowen (mail):
Thetis, my mother, held me by the heel and dipped me in peanut butter.
11.11.2008 2:10am
einhverfr (mail) (www):
IANA Physician....

My sister developed a cows milk allergy when she was probably started on cows milk too early. Like it or not, infants do develop allergies faster than the rest of us.

However, even given that, I don't see why life-long food allergies should develop during the toddler years. Food allergies themselves are somewhat weird in that one's body is supposed to suppress them (think about it-- otherwise we would eventually be allergic to everything we eat). Hence food allergies can sometimes point to other problems (candidiasis, for example). Often in these cases, if the underlying condition is properly treated, the allergy will disappear.

What I havent seen is any reason to think that toddlers who develop allergies due to being exposed to food too early retain these allergies very long. My sister, for example, had to be taken off of cows milk for a year or so, and after that had no more problems with it (even after trying it again).
11.11.2008 2:46am
Splunge:
I wouldn't worry about allergies, you git, I'd worry about aflatoxins, a family of carcinogens produced by the molds that are fairly ubiquitous on peanuts.

And while we're at it, you avoid cow's milk for the first year not because of some silly fantasy about allergies but because there is an as yet unexplained correlation between exposure to cow's milk in the first year and juvenile diabetes.

Allergies, forsooth. The 21st century boogie man.
11.11.2008 3:24am
Francis (mail):
theories are supported by evidence; the word you want is "hypothesis".
11.11.2008 3:32am
A. Zarkov (mail):
David Bernstein:

"My wife said at the time, "I don't care what the doctors here say."


I'm glad to hear someone say that. A long time ago I came to the conclusion that doctors generally tell you things that have little evidence to support them. "Don't put ice on a burn." Wrong. "People with ulcers should a large number of small meals." Wrong. The list is endless. Actually these days a lot of what doctors tell you or don't tell you is based on a fear of litigation and little else. Just recently a doctor told me to take statins even though my lipid panel is excellent. Upon further probing he told me I could do a calcium scan instead. I did that. Excellent. I can only conclude that they tell virtually everyone beyond some age the same thing out of fear that they might get sued one day if they don't.

Postscript. Just today I read that even seemingly healthy people should take statins. But reading further I found that doesn't apply to people with a good level of the c-reactive protein. I'm ok on that too. But some years ago a doc told me I didn't need that test. I said, "do it anyway."
11.11.2008 4:43am
Malvolio:
Dr. Melik: This morning for breakfast he requested something called "wheat germ, organic honey and tiger's milk."
Dr. Aragon: Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties.
Dr. Melik: You mean there was no deep fat? No steak or cream pies or... hot fudge?
Dr. Aragon: Those were thought to be unhealthy... precisely the opposite of what we now know to be true.
Dr. Melik: Incredible.
-- Sleeper
Has preventative medicine advanced at all in the last 50 years? I can't think of one piece of new advice I've been given that hasn't superseded or contradicted.

The only constants have been Grandma's advice.: don't smoke, exercise, eat fruit.
11.11.2008 6:24am
Phil Green:
You must feel so tremendously vindicated in your choice to take a risk with your child's health for the sake of... what, exactly?
11.11.2008 6:34am
PersonFromPorlock:
Perhaps for the sake of his child's not growing up in a world slavishly obedient to self-professed 'authorities'?
11.11.2008 6:43am
corneille1640 (mail):
This may seem strange, but has anyone heard of a hypoallergenic peanut? I thought I've heard of one on the news at some time or other. (Of course, if it was reported on the local evening news, then it MUST be true.)
11.11.2008 6:54am
Smallholder (mail) (www):
For those who did not hear of peanut allergies before they came to America or those Americans who did not ever hear of peanut allergies "back in the day," perhaps we have a data problem. Is it possible that those infants that had peanut allergies died after eating Bamba snacks but the cause of death was not linked to peanut allergies? Therefore, there were no grade school kids who influenced school menus.

I don't know that this is true, but I always wonder about statements contrary to professional medical opinion being influenced by an observer's lack of complete information. For example, anti-vaccination folks point to the higher rates of autism diagnosis in recent decades. This increase is correlated with an increase in the number of vaccines. Many vaccine proponents say that this is correlation, not causation - events happening concurrently but not necessarily sharing a causal relationship. But here's the thing: A good proportion of autism diagnoses are mild on the autism spectrum - Asperger's Syndrome being an example. I wonder if in previous decades the number of mildly autistic people was the same, but instead of being diagnosed and given early intervention, they were called quiet, withdrawn, weird, odd, anti-social, etc.
11.11.2008 7:21am
David Chesler (mail) (www):
Is it possible that those infants that had peanut allergies died after eating Bamba snacks but the cause of death was not linked to peanut allergies?

Good point. What does death by peanut allergy look like? Is it an anaphylaxis thing, where there would be earlier severe reactions to peanuts?

Grumble, grumble, we've become too wimpified, afraid of any injury, believing they can all be prevented. I've got a discoloration on my forearm (it's fading, so it's not a scar) that every time I look at it reminds me that not only is a canoe the best place to watch the Boston Pops fireworks, but you CAN grill hot dogs in a canoe. Apparently if that had been on my kids instead of me it would be evidence of child neglect, rather than evidence that I'm teaching my kids to take big bites, play with pain, but next time use some bungee cords and duct tape. Now get off my lawn.
11.11.2008 7:39am
Eric Muller (www):
Two peanuts were walking down the street. One of them was assaulted.
11.11.2008 8:52am
TJIC (www):
Francis wrote:

> theories are supported by evidence; the word you want is "hypothesis".

Nonsense.

Evidence does not support theories; evidence fails to disprove theories.
11.11.2008 9:23am
Adam J:
TJIC - Care to explain the difference between evidence that supports a hypothesis and evidence that fails to disprove a hypothesis?
11.11.2008 9:30am
Bama 1L:
But here's the thing: A good proportion of autism diagnoses are mild on the autism spectrum - Asperger's Syndrome being an example. I wonder if in previous decades the number of mildly autistic people was the same, but instead of being diagnosed and given early intervention, they were called quiet, withdrawn, weird, odd, anti-social, etc.

Our first pediatrician--a young mother of four--suggested that the rise in autism diagnoses is exactly that: a diagnostic issue. She also explained that some combination of health insurance coverage, social assistance, and stigma causes pediatricians and public health officials to diagnose autism rather than some sort of retardation or affective disorder. Apparently it is cheaper for everyone, including the school district, if your kid is diagnosed as autistic rather than something that would trigger the full panoply of special education. And parents would rather hear that their kid is autistic than retarded.
11.11.2008 9:34am
ChrisIowa (mail):
The immune system needs exercise, so kids need to get outside and eat dirt.

Besides, they have to have something to talk about when they become old farts like us. A few scars are conversation starters.
11.11.2008 9:35am
Jerry Mimsy (www):
Where did this sudden fear of germs come from?

http://www.youtube.com/watch?v=-Y-yH_Qyipc

(George Carlin)
11.11.2008 9:44am
Houston Lawyer:
I don't recall today's plethora of food allergies among children from when I was a child. That could be explained by the activities of today's authorities, who will gladly ban peanuts from an entire school if they think one child may be allergic. In earlier days, your food allergy was your problem.

We were also allowed to play fairly violent games unsupervised on the playground. One thing that the current schools system won't tolerate is boys being boys.
11.11.2008 9:46am
Oren:
The reason not to give you kid Bamba (which are absolutely delicious) at 8 months is probably salt content and a general aversion to giving processed food to young children. Let's face it, Bamba are not the healthiest snack yet invented.
11.11.2008 10:13am
Anderson (mail):
Perhaps for the sake of his child's not growing up in a world slavishly obedient to self-professed 'authorities'?

Right. If the kid's fine, no harm done. If the kid goes into shock &dies, then she's spared growing up in an authoritarian, un-libertarian world. Win-win!

-- Now that I think about it, Libertarian Death Cult would be a good name for a band.
11.11.2008 10:23am
Norman Bates (mail):
There is a growing body of evidence suggesting that allergies and other so-called autoimmune disorders like diabetes, multiple sclerosis, etc,; psychological disorders like schizophrenia; and behavioral disorders like homosexuality and autism may be the results of some type of infection (of the parent or child) or an evolutionary response to an infectious agent, e.g., sickle cell, anemia. See here for further details: A New Germ Theory
11.11.2008 10:29am
arthur (mail):
Since I attended the funeral of a six-year-old friend of my son a few days ago, the low probability event of childhood death in on my mind.

A few things to remember about peanut allergies and day care/elementary schools that ban peanuts

(1) The number of children who died immediately after exposure to "environmental" peanuts (e.g. on another kid's sandwich) is greater than zero.

(2) Environmental peanuts can actually be avoided with very limited restrictins on the other kids.

(2) Unlike oncologists, day care providers expect that the number of children who will die in their care whould be zero.

(3) This really has nothing to do with the fear of being sued. Most day care workers and elementary school teachers are judgment proof. they're also usually not motivated by money. The fear is of having a child die in their care, because unlike Volokh commenters, they find that possibility intolerable.
11.11.2008 11:01am
einhverfr (mail) (www):

For example, anti-vaccination folks point to the higher rates of autism diagnosis in recent decades. This increase is correlated with an increase in the number of vaccines. Many vaccine proponents say that this is correlation, not causation - events happening concurrently but not necessarily sharing a causal relationship. But here's the thing: A good proportion of autism diagnoses are mild on the autism spectrum - Asperger's Syndrome being an example. I wonder if in previous decades the number of mildly autistic people was the same, but instead of being diagnosed and given early intervention, they were called quiet, withdrawn, weird, odd, anti-social, etc.


Just as a note about autism and vaccines. I tend to be alarmed at the rapid increase in the number of routine vaccines but also note that my concerns are longer-range and I don't think that the rise in autism is related.

However, when you do factor out the mild autism cases, you still see an increase. The best theory I have heard to date is that our society is changing so people with mild forms of autism are suddenly more successful and valuable, and getting married and having kids. Natural selection in action.
11.11.2008 11:03am
wyswyg:
Pardon me while I go off topic, but this is too good not to share.

Intelligence policy to stay the same.

Hope and change!
11.11.2008 11:07am
theobromophile (www):
arthur,

I'm not sure why you think that anyone here doesn't care if a child dies. You're missing the point: perhaps if we practised evidence-based medicine, rather than fear-mongering, we would have fewer children with deadly allergies. Fewer children with deadly allergies = liking kids and wanting them to stay alive.
11.11.2008 11:22am
David M. Nieporent (www):
(1) The number of children who died immediately after exposure to "environmental" peanuts (e.g. on another kid's sandwich) is greater than zero.
It most likely isn't greater than zero, but if it isn't, it's within rounding error thereof. The number of people of any age who die from exposure to peanuts of any sort, "environmental" or direct, is in the single digits annually, despite the hysteria.
11.11.2008 11:22am
Dave Hardy (mail) (www):
While all would agree that ensuring children's safety is important, any serious essay at making their injury/fatality rates zero would surely require banning their bicycles (which left me quite busted up as a child), not to mention football, baseball, soccer, climbing trees, etc.. Might be a good idea to keep them indoors in all but winter, too, to guard against allergic shock from bee stings (whose fatality rate is probably far above that of peanut allergies).
11.11.2008 11:27am
MR:
A few things to remember about vending machines and day care/elementary schools that ban vending machines.

(1) The number of children who died after exposure to vending machines is greater than zero.

(2) Vending machines can actually be avoided with very limited restrictins on the other kids.

(2(a?)) Unlike oncologists, day care providers expect that the number of children who will die in their care whould be zero.

(3) This really has nothing to do with the fear of being sued. Most day care workers and elementary school teachers are judgment proof. they're also usually not motivated by money. The fear is of having a child die in their care, because unlike Volokh commenters, they find that possibility intolerable.


BAN VENDING MACHINES. NOW.
11.11.2008 11:28am
autolykos:

We were also allowed to play fairly violent games unsupervised on the playground. One thing that the current schools system won't tolerate is boys being boys.


I think there's a lot to be said for this hypothesis. I can name 3 people with allergies to milk fat - my cousins and my aunt. I don't doubt that other people have this allergy, I just have no reason to know about people that do. We know about peanut allergies because of the intensity of the reaction and the measures our schools take to prevent that reaction. If it wasn't for that, I don't have any reason to believe we'd know about them.

To that point, it's amazing how much has changing just a couple decades in terms of public safety. When I was growing up, the school's playground had asphalt underneath the swings - when I was in third grade, a kid fell backwards and cracked his skull. Now, playgrounds have rocks or rubber or something that won't cause serious injury after a fall. The local park also had a zip-line where the older kids could go careening through the middle of the park and if you weren't paying attention, you risked being run into. They took the zip-line out about 10 years ago.
11.11.2008 11:37am
Richard Nieporent (mail):
If peanuts are so dangerous, why do supermarkets sell loose peanuts, and/or allow customers to grind peanuts to make "natural" peanut butter? Wouldn't the floors of the supermarkets be littered with dead toddlers since they couldn't be prevented from being exposed to peanuts?
11.11.2008 11:39am
Oren:


I think there's a lot to be said for this hypothesis. I can name 3 people with allergies to milk fat - my cousins and my aunt. I don't doubt that other people have this allergy, I just have no reason to know about people that do. We know about peanut allergies because of the intensity of the reaction and the measures our schools take to prevent that reaction. If it wasn't for that, I don't have any reason to believe we'd know about them.

Milkfat allergies are not as serious, nor are the allergens as easily spread (fat being large and heavy molecules). I can probably drink a class of cream next to a milk-fat-allergic fellow and he'll be fine unless I spill all over him. Contrast this with kids that go into anaphylactic shock over peanut dust.


If peanuts are so dangerous, why do supermarkets sell loose peanuts, and/or allow customers to grind peanuts to make "natural" peanut butter?

Because supermarkets are places where parents voluntarily take their children. Presumably, the parents have weighed the risks and have made a choice. You can't say the same for public schools.

Now, I happen to agree that these violent allergies are probably caused by excessive hygiene and other environmental factors. That's largely irrelevant when you've got a kid in you school that already is deathly allergic.
11.11.2008 11:52am
Richard Nieporent (mail):
Because supermarkets are places where parents voluntarily take their children. Presumably, the parents have weighed the risks and have made a choice. You can't say the same for public schools.

Clearly Oren you never heard of trial lawyers.:) Since when has assumption of risk ever stopped anyone from suing?
11.11.2008 11:56am
Preferred Customer:

Wouldn't the floors of the supermarkets be littered with dead toddlers since they couldn't be prevented from being exposed to peanuts?


I don't know where you shop, but this is a constant problem at the Safeway I go to. Kind of gross, really.
11.11.2008 11:57am
Bob from Ohio (mail):

1) The number of children who died immediately after exposure to "environmental" peanuts (e.g. on another kid's sandwich) is greater than zero.


Not to pile on. Well, yeah, ok, I am.

That kind of menatlity is mind boggling.

Under this kind of thinking, no day care should let a child do or eat or drink anything ever.

This is a country of 300 million. Everything imaginable causes "greater than zero" deaths. The question is how many more than zero.

Allergyphobia is like all phobias. Irrational.
11.11.2008 12:12pm
AS Dad:
"Apparently it is cheaper for everyone, including the school district, if your kid is diagnosed as autistic rather than something that would trigger the full panoply of special education. And parents would rather hear that their kid is autistic than retarded."

What is this assumption based on? I don't know about public school, since we went the private school route (primarily because we wanted immediate support, not lengthy litigation). My personal out of pocket costs related to my son's asperger's syndrome was around $120,000 for the 2007-2008 school year. It is my impression from discussions with education lawyers and school officials that you will get more support for your child if they have any diagnosis other than autism/asperger's.
11.11.2008 12:16pm
PersonFromPorlock:
arthur:

The fear is of having a child die in their care, because unlike Volokh commenters, they find that possibility intolerable.

OK, how many rights are you willing to give up to save how many children? Bearing in mind that you're also giving them up for the adults those children will become?
11.11.2008 12:20pm
Robert Farrell (mail):
Link to the full article:

jacionline.org/webfiles/images/ journals/ymai/Peanut_Consumption.pdf

Seems to be a pretty good study. If the results hold up, it will be a victory for the hygiene hypothesis, which proposes that atopy (allergies and asthma) is more prevelent in modern times because there is less early exposure to allergens. The immune system is thought to get a little trigger-happy as a result.

The number of children who died immediately after exposure to "environmental" peanuts (e.g. on another kid's sandwich) is greater than zero.

Lethal allergic reactions, known in medical lingo as anaphylaxtic shock, never occur without prior sensitization to the allergen (i.e., a previous exposure). In rare cases, the earlier allergic reaction may not be recognized for what it is. In the overwhelming majority of cases of this uncommon condition, the allergy is diagnosed prior to an anaphylaxic reaction. At that point you can take special precautions to avoid the allergen, carry an epipen, and make sure the patient (child or adult) has a means of rapidly activating EMS in the event of an exposure.

Swelling in the mouth, tongue, or throat in response to an allergen in a medical emergency, because it can progress to obstruction of the airway (suffocation). Allergic reactions tend to become worse with repeated exposures, so someone who was uncomfortable with their last attack may be in real danger this time.

Whew. Sorry, lapsed into lecture mode there towards the end. End of PSA.
11.11.2008 12:21pm
Fub:
Eric Muller wrote at 11.11.2008 8:52am:
Two peanuts were walking down the street. One of them was assaulted.
Elementary, Watson. The assailant was a maverick billygoat -- a peanut butter.
11.11.2008 12:23pm
MCM (mail):
1) The number of children who died immediately after exposure to "environmental" peanuts (e.g. on another kid's sandwich) is greater than zero.

Not to pile on. Well, yeah, ok, I am.

That kind of menatlity is mind boggling.

Under this kind of thinking, no day care should let a child do or eat or drink anything ever.

This is a country of 300 million. Everything imaginable causes "greater than zero" deaths. The question is how many more than zero.

Allergyphobia is like all phobias. Irrational.


Recognizing the fact that a non-zero number of people die from a particular risk is not a "mentality". It's sort of a necessary first step in any rational risk analysis.

Are you purposefully creating idiotic straw men, or did you just accidentally not read the rest of his post?
11.11.2008 12:23pm
Whadonna More:

arthur

(3) This really has nothing to do with the fear of being sued. Most day care workers and elementary school teachers are judgment proof. they're also usually not motivated by money. The fear is of having a child die in their care, because unlike Volokh commenters, they find that possibility intolerable.



Day care INSURERS are NOT judgment-proof, and ARE motivated by money.

The motivation of parents who ignore medical advice is a much more interesting question. I suspect laziness and misunderstanding of logic in most cases, but would be interested to know how many anti-vaccine kooks advocates profess a primarily libertarian/freedom position.
11.11.2008 12:29pm
Robert Farrell (mail):
I'm unclear on why the doctor would make sure a recommendation in the first place?

Probably, the medical community fell prey to a fallacy; kids with peanut allergies always come to our attention as the result of an early exposure (selection bias). Therefore, is you did a study, the number of kids diagnosed with early peanut allergies who had early exposure to peanuts would be 100%. Solution: limit early exposure.

I'm sure they weren't that gulliable in the way they went about developing the theory, but these problems can be more subtle and hard to avoid than you might think.

But the principle you're describing makes perfect sense; the human body needs exposure to an allergen to learn to cope with it.

I think you're probably right.
11.11.2008 12:31pm
guy in the veal calf office (mail) (www):
Our family phrenologists says food allergies are the result of mis-equilibrium of black bile and phlegm. A simple basilic vein bleed would re-orders the liver and spleen.

PS, you owe a royalty to Taranto for that headline.
11.11.2008 12:37pm
wyswyg:
I"f peanuts are so dangerous, why do supermarkets sell loose peanuts, and/or allow customers to grind peanuts to make "natural" peanut butter?"

Yup. It's becoming clear to me that, right after we legalize pot, we need to make peanuts a controlled substance.

The Bureau of Alcohol, Tobacco, Firearms, and Peanuts has a certain ring to it.
11.11.2008 12:41pm
Robert Farrell (mail):
The motivation of parents who ignore medical advice is a much more interesting question.

There's no need to look for a villian. All of these problems -- overprotective playgrounds and daycare centers, parents who won't vaccinate their kids -- can be traced in part to the fact that the human mind is not very good with statistics. Stories -- anecdotes -- especially if they are charged with fear and horror -- make a much greater impression on our brains than the reassurance rareness of a given outcome. One person falls from the zip line, one child dies of a peanut allergy at daycare, and people are ready to turn the world upside down.

Truly epidemic problems -- like the childhood obesity problem that is presently leading millions of children on a path to a painful, sickly life and an early death -- are much less prominent in people's minds because they don't lend themselves to a good yarn.

If we rationally weigh our risks, most of these problems go away. But this is not a problem of those euphemistically referred to as "low-information voters." Doctors, for example, a well-educated and pretty intelligent subset of the population, learn and teach primarily through stories. And their diagnostic decisions have been found to be heavily influenced by the patients they have seen in the hours and days preceeding a given case.

There is no solution accept to recognize the problem and try to educate, with patience and compassion, the people who are being irrational about risk, knowing that while education can help, lack of education is not the root of the problem; the root of the problem is that our brains are designed that way. We are fighting 4 billion years of evolution for risk avoidance that took place prior to the invention of statistical analysis.
11.11.2008 12:44pm
Robert Farrell (mail):
"Reassuring" not "reassurance," "except" not "accept."
11.11.2008 12:46pm
DeezRightWingNutz:

PS, you owe a royalty to Taranto for that headline.


Royalties are only owed to them if the headline is employed sarcastically.
11.11.2008 12:51pm
Richard Aubrey (mail):
The non-formal statistical judgment is pretty simple, and, more often than not, correct.

The likely thing to happen is the likely thing to happen.
The unlikely thing to happen is not likely to happen.
Therefore, if something happens, it's likely it's the likely thing and not the unlikely thing.
So it's likely it will happen again some time soon.
The unlikely thing probably won't.
But you never know.
11.11.2008 12:54pm
arthur (mail):
OK, how many rights are you willing to give up to save how many children? Bearing in mind that you're also giving them up for the adults those children will become?

I'm willing to give up my ninth amendment right to send my son to school with a peanut butter sandwich, even thought he's not allergic and loves them.

Other rights are discussed above. I'm willing to give up the right to have my son play on an asphalt playground; willing to give up willing to give up his right to ride a zipline across a playground; willing to give up his right to ride his bicycle and his scooter without a helmet, even though I did it at his age. In fact, about thirty years ago I gave up my own right to ride a bicycle without a helmet, and I've ridden thousands of miles since then without feeling much inconvenience. Willing to give up his right not to have him vaccinated. Willing to give up my own right to ride in a car without a seatbelt, even though I did it back in the day.

Of course some children will die no matter what (the recent funeral in my neighborhood was due to illness, not accident). Day care providers nevertheless take reasonable measures to avoid injuries, and when there's an allergic kid in the class, peanut free zones are quite reasonable.

I stand by the claim that it's not fear of lawsuits, but fear of death that motivates most safety masures, especially among child care workers. It amazes me that anyone doubts that.
11.11.2008 1:00pm
Henry Bramlet (mail):
As long as we are talking about fallacies of human nature, how about the one where a bunch of people style themselves experts in fields where they have no relevant training?

My doctor had several restrictions on what my child should or should not eat. It wasn't because he was afraid it would *cause* allergies, but because he wanted my daughter old enough to survive an allergic reaction if she had one. Peanuts was a perfect example of this. He waited until she was old enough to more easily express the symptoms if she had them, and survive the ordeal if necessary.

Children are more likely to die of all sorts of things, from toxins to allergic reactions. It isn't an example of statistical malpractice to try and ensure that if a child is exposed to these risks, they are more likely to survive it.

Our pediatrician is regularly reviewing the literature, and when studies point to a better alternative, I'm sure he will adjust the behavior. Hind-sighted, back-seat practitioners should chill out with the finger-wagging.
11.11.2008 1:03pm
Oren:

Clearly Oren you never heard of trial lawyers.:) Since when has assumption of risk ever stopped anyone from suing?

Show me a single case in which a supermarket was successfully sued by parents on this bizarre theory.

PFP, I don't know how you can connect school rules regarding potentially dangerous foods to "rights" of any sort whatsoever. Is there a penumbra somewhere you think guarantees students the right to peanut butter sandwiches?

If there is a child that is medically shown to be allergic to peanuts (never mind how it happened, it happened and now we have to deal with it), then it's fairly reasonable for the school to require that students not bring in peanuts.

Maybe I'm misunderstanding your position?
11.11.2008 1:04pm
Oren:

Other rights are discussed above. I'm willing to give up the right to have my son play on an asphalt playground; willing to give up willing to give up his right to ride a zipline across a playground ...

That's silly -- you haven't given up any of those rights. You have given up your right to demand that the school district provide playground equipment according to your preferences against the better judgment of the school board. If you don't like the school board, elect a different one.

Of course, you are free to buy any of that equipment for your backyard.
11.11.2008 1:06pm
Oren:
I should add that I wholly disapprove of preemptive bans on possible allergens. I though we were discussing what sort of accommodations schools/daycares ought to provide after it was known that there is an allergy.
11.11.2008 1:08pm
Pauldom:
Arthur:

I stand by the claim that it's not fear of lawsuits, but fear of death that motivates most safety masures, especially among child care workers. It amazes me that anyone doubts that.

A child in my Sunday School class has peanut allergies, and I gave up my right to use animal crackers to teach about Noah's Ark because I couldn't find any that didn't have a peanut warning on them. I gave up the other kids' right to eat animal crackers that day, too. Instead, we played a matching game with pictures.

I guess other VC commenters would consider my decision evidence of a shameful lapse of rationality, but me, I couldn't live with myself if even one child in my Sunday School class died as a result of my lesson plan. Arthur, you have exposed my flaw.
11.11.2008 1:15pm
Pauldom:
Arthur:

I stand by the claim that it's not fear of lawsuits, but fear of death that motivates most safety masures, especially among child care workers. It amazes me that anyone doubts that.

A child in my Sunday School class has peanut allergies, and I gave up my right to use animal crackers to teach about Noah's Ark because I couldn't find any that didn't have a peanut warning on them. I gave up the other kids' right to eat animal crackers that day, too. Instead, we played a matching game with pictures.

I guess other VC commenters would consider my decision evidence of a shameful lapse of rationality, but me, I couldn't live with myself if even one child in my Sunday School class died as a result of my lesson plan. Arthur, you have exposed my flaw.
11.11.2008 1:15pm
xx:
"Probably, the medical community fell prey to a fallacy"

There are perfectly logical reasons to think that early exposure heightens risk, whether it happens to be true in this case. With a number of allergies, having a first allergic reaction is difficult, but having subsequent, serious reactions is quite easy, because the immune system is now primed to over-react to the allergen. Since young children are more likely to have allergic reactions of all kinds, they're more likely to have first allergic reactions to these allergens, and therefore develop lifelong allergies. If they're not exposed to these allergens until later in life, they might never have the first reaction, and hence no life-long allergy

I have no idea if peanuts fall into this category of allergen, and the new study suggests they do not. But I don't think there's anything surprising about the fact that doctors were erring on the side of caution.
11.11.2008 1:25pm
Glenn W. Bowen (mail):
helluva news day.
11.11.2008 1:34pm
Bob from Ohio (mail):

Recognizing the fact that a non-zero number of people die from a particular risk is not a "mentality". It's sort of a necessary first step in any rational risk analysis.

Are you purposefully creating idiotic straw men, or did you just accidentally not read the rest of his post?


The mentality is that if one person dies from something in a country of 300 million, then that is an unacceptable risk.

Because "non-zero" can mean thousands or one.

According to Asthma and Allergy Information and Research,the website of the Leicester Branch of the Midlands Asthma and Allergy Research Association (MAARA), a Registered Charity with its headquarters at 12 Vernon St, Derby, U.K.:


It may surprise you that we think the risk that a pre-teenage child with nut allergy will have a fatal reaction is so small that the wisdom of supplying adrenaline syringes for them is highly questionable. For the whole of the USA we are currently aware of only three such deaths over many years, far fewer than from a huge variety of other causes.


Three, over many years.

If "many" equals only 3, then its one a year. In the entire United States. If its 6 years, its 1/2 per year.

You need a supercomputer to calculate the death rate.
11.11.2008 1:37pm
plutosdad (mail):
because unlike Volokh commenters, they find that possibility intolerable

You must feel so tremendously vindicated in your choice to take a risk with your child's health

The sheer outright hate and refusing to even consider that there may be different ideas about how allergies start is enough to push people the other way. Seriously, do you really think that if I raise my kids different than you that it means I don't mind if my kids die? What is wrong with you.
11.11.2008 1:39pm
Pauldom:
The website of the Leicester Branch of the Midlands Asthma and Allergy Research Association (MAARA) says so? Well, that settles it then.
11.11.2008 1:42pm
wyswyg:
"I guess other VC commenters would consider my decision evidence of a shameful lapse of rationality, but me, I couldn't live with myself if even one child in my Sunday School class died as a result of my lesson plan.

I'm quite sure that nobody here is denying your right to make those judgements which seem best to you.

I think the question is, do you believe that "there ought to be a law"?

If not then there really is no disagreement here.
11.11.2008 1:47pm
Pauldom:

I think the question is, do you believe that "there ought to be a law"?

If not then there really is no disagreement here.

No, I don't think there ought to be a law. Once kids are identified as having allergies, I support rules that would protect them, though.

I guess there is no disagreement.
11.11.2008 1:52pm
wyswyg:
Rules made and enforced by who?
11.11.2008 1:53pm
Richard Nieporent (mail):
Show me a single case in which a supermarket was successfully sued by parents on this bizarre theory.

I have no idea whether or not a supermarket has ever been sued. However your naivety is touching. If you are a reader of Overlawyered.com you would know that stranger lawsuits are filed every day. Clearly you have never heard of trial lawyers. The first think they would do is charge that there was no warming sign displayed by the supermarket. Why do you think food wrappers indicate that the product was made in a facility that also processes peanuts?

However, it looks like this will be a moot point in the future. The quote below is from a September 18th press release from Stop and Shop Supermarkets.


We are working diligently to help our customers with allergies," said Andrea Astrachan, consumer advisor. "For example, due to high incidence of peanut allergies among children, we removed the bulk bins for tree nuts and peanuts and now sell them pre-packaged. We did this in response to parents of children with nut allergies and others who wrote to us with safety concerns, as severe allergic reactions can occur from peanut and tree nut dust."


http://findarticles.com/p/articles/mi_m4PRN/is_/ai_n28570409
11.11.2008 1:56pm
Skyler (mail) (www):
I don't coddle my daughter one bit, but she is sensitive to peanuts. We learned this after my mother-in-law ate a peanut butter sandwich and then played with my daughter. She developed a rash that wasn't severe but scared my wife. I was out of town and my wife brought her to the hospital. The rash soon went away while the doctor was there. But then Grandma showed up, held the baby and the rash returned. Subsequent incidents confirmed that peanuts were the culprit.

Beyond questioning my mother-in-law's hygiene (smile), this shows me that the sensitivity to peanuts can be real. In our case it's not serious at all and I expect that she will grow out of it if she hasn't already. She'll be tested when she's 2 in a few months.

We don't ask anyone to change their eating habits, but we like that daycare is peanut free, as is our house. I hope she is cured soon because I really like peanut butter occasionally.
11.11.2008 2:05pm
David M. Nieporent (www):
Recognizing the fact that a non-zero number of people die from a particular risk is not a "mentality". It's sort of a necessary first step in any rational risk analysis.
And if he had undertaken such an analysis, that would be one thing. But he didn't; he actually said that anything greater than zero was unacceptable.
11.11.2008 2:07pm
Pauldom:
Well, I guess that would depend on who was caring for the child, wouldn't it? Are you suggesting that the child's safety should be up to the whim of the caregiver? Maybe we do disagree after all. :)
11.11.2008 2:09pm
Bob from Ohio (mail):
Pauldom: At least I used a source and did not go on my feelings. It is an allergy research agency.

I found it like anyone else does, I searched through Google.

Do you have a better source?
11.11.2008 2:24pm
wyswyg:
Not sure why you answer a question with a question. Who do you propose make these rules?
11.11.2008 2:27pm
Brian Mac:
Pauldom:

You do realise that there's probably plenty of (unnecessary) things that you do which expose bystanders to a risk of death which is significantly greater than that posed by peanuts?

And it's not just the MAARA which place deaths from peanut allergies in the single digits annually, it's also the scientists who've researched the topic (e.g. here).
11.11.2008 2:41pm
Robert Farrell (mail):
There are perfectly logical reasons to think that early exposure heightens risk, whether it happens to be true in this case.

My point exactly, xx. I think you homed in on the word "fallacy" and got the idea that I was bashing the scientists who came up with this theory. Far from it. I was pointing out one way people might erronously come to believe that early exposure heightens the risk of developing an allergy, when in fact the opposite turns out to be the case.

You can make a superficially attractive "logical" case for either theory. Which is why, in science, we collect evidence. In retrospect, data in hand, we can (and should) look back at how a theory that seemed logical turned out to be faulty, or how what seemed like common sense seems jarringly contrary to common sense in hindsight. This exercise may help us speculate for fruitfully in the future.
11.11.2008 2:46pm
whit:

Has preventative medicine advanced at all in the last 50 years? I can't think of one piece of new advice I've been given that hasn't superseded or contradicted.



of course it has.

but the last place you want to get diet advice/preventative medicine advice is from MD's (especially in the US). medical establishment is often a decade or more behind sports nutritionists, etc.

years ago, i read fats the heal, fats that kill by udo erasmus.

that got me into EFA's supplementation.

again, sports scientists are WAY ahead of medical doctors, and god forbid, the AMA.

in general, MD's are not about optimizing health. they are about giving you drugs to REACT (rarely proactive) to diseases you already have.

it's a mindset thang.

i used to be a personal trainer. one of my clients was an MD. he would always ask me for diet advice. he readily admitted that MD's know f*ck all about diet and preventative medicine. the main problem is that MD's have a god complex and don't like to admit to patients that they don't know what they are talking about.
11.11.2008 3:00pm
Malvolio:
A study in the Journal of Allergy and Clinical Immunology found 31 US fatalities (adults and children) in the prior seven years from all food allergies, two of whom were under eight years old. While they don't claim -- and specifically disclaim -- that this is an exhaustive list, dead people aren't that hard to find, and they found one out of 70,000,000 people per year. Basically, your odds are better of winning PowerBall.
The Bureau of Alcohol, Tobacco, Firearms, and Peanuts has a certain ring to it.
They already added "Explosives" to their name -- if they change their name to Bureau of Alcohol, Tobacco, Firearms, Explosives, Peanuts, and Scantily Clad Women, I'll invite them to every party I ever throw!
11.11.2008 3:05pm
Dan Weber (www):
Allergies are either caused by too much exposure to the allergen too early, or too little too late. Or by something else entirely. We now return you to your regularly scheduled programming, already in progress.
This points needs repeating. We have no clue what causes allergies.

Oh, sure, people have some hunches based on personal experience, but when scientists have actually tested early-versus-late-versus-controlled-versus-no exposure theories, they haven't found one that works.

One correlation is that children in households with pets have less allergies. The hypothesis is that the pets make the house dirty enough that the immune system works against that instead of ordinary things. But, as far as I've heard, scientists have been unable to reproduce this in controlled experiment, despite a lot and a lot of trying.

Whether you expose your kid to allergens early or hold them from him, you're still acting based on a hunch of what's best for your kid. We just don't have the data to say what's really causing allergies.

Just keep your kid out of the kitchen cleaners and then go relax.
11.11.2008 3:10pm
whit:

Has preventative medicine advanced at all in the last 50 years? I can't think of one piece of new advice I've been given that hasn't superseded or contradicted


to add to this. CDC estimates over 60% of all chronic disease is diet/behavior related (smoking and eating and exercise).

iow, it's not rocket science, and it has advanced.

trans fatty acids - bad
EFA's - good
water (hydration) - good
fruits and vegetables (especially brightly colored ones) - good. don't overcook, and vegetables are generally better steamed or lightly cooked or raw. tomatoes are unique in that they are better for you if cooked
minimize - highly refined foods (flours , simple sugars, etc.).
don't smoke
drink - but no more than 2 drinks a day
don't smoke

by eating right, exercising ,and not smoking, you are significantly decreasing your risk of illness (chronic illness especially).

again, it's not rocket science, and it has advanced a LOT.
11.11.2008 3:12pm
Pauldom:
Bob from Ohio,
My point is that informed opinions differ about causes and risks of peanut allergies. The medical questions are not settled. You're right, it is good that you googled a source, and I admit I did not. :) But when I'm acting as a caregiver, I don't care how rare peanut-related deaths might be--I'm not serving peanut-y foods around a kid w/a nut allergy. I don't think schools should do so either.

wyswyg:
My answer is "it depends." Parents are responsible for the safety of their children. Schools are responsible for the safety of kids in their care, etc. I would not support laws that banned peanut substances from the vicinity of all children. But when specific children have peanut allergies, it is appropriate for their schools to make and enforce rules that would protect them.

Brian Mac, you're right. Life is not a risk-free enterprise. But unnecessary trivial risk to bystanders != actual (if trivial) risk to particular children in my care. Anyway, I'm not going to think to myself, "I'll serve cookies that one kid is allergic to because they're all more likely to die on the swingset anyway." If that's irrational, then I'm irrational. But that's why I was agreeing with arthur.

If/when future studies bear out the conclusions of this one, we can all break out the Bamba and celebrate.
11.11.2008 3:12pm
L Nettles (mail):
guy in the veal calf office (mail) (www):
Our family phrenologists says food allergies are the result of mis-equilibrium of black bile and phlegm. A simple basilic vein bleed would re-orders the liver and spleen.

phrenologists phlebotomist
11.11.2008 3:16pm
guy in the veal calf office (mail) (www):
Quite right, L Nettles. These fancy pants consultants confuse me incessantly. My cranial protuberances predict as much.
11.11.2008 3:47pm
PeterWimsey (mail):
Malvolio, the link you gave shows that the paper examined 31 people who died of food allergies. It did not state that only 31 people died of food allergies.

The best number I've been able to find comes from the NIH:

Food allergy is an immunologic disease responsible for significant morbidity. In the United States, the prevalence of food allergy is 6--8 percent of children under four years of age, and is 3.7 percent of adults. The prevalence of food allergy appears to be increasing, with allergies to peanut increasing substantially. Food allergy is frequently accompanied by other allergic diseases, including atopic dermatitis (eczema) and asthma, and asthma is an important risk factor for severe allergic reactions to food. Patients with food allergy may have mild reactions, such as hives, but are also at risk for anaphylaxis, a severe and life-threatening systemic allergic reaction characterized by hives, fall of blood pressure, upper airway obstruction, and severe wheezing. Food allergy accounts for about 35--50 percent of emergency room visits for anaphylaxis and causes about 30,000 episodes of anaphylaxis and 100--200 deaths per year in the United States. Even with assiduous avoidance of known food allergens, each year, approximately one of every four food allergic individuals will have an accidental exposure that leads to a food-induced reaction. Severe, life-threatening reactions occur mostly in adolescents and young adults, and peanuts and tree nuts are the most common causes of such reactions.



This gives maybe 75 annual deaths due to peanut allergies (not a large number, but not a single digit, either), plus a much larger number of very serious reactions that are life threatening. However, most of these deaths seem to be not among children, but among adolescents and young adults - meaning, perhaps, that parents and schools do a good job of controlling contact with dangerous allergens, but teenagers aren't so careful. I suppose that shouldn't be a surprise.
11.11.2008 4:08pm
David M. Nieporent (www):
The non-formal statistical judgment is pretty simple, and, more often than not, correct.

The likely thing to happen is the likely thing to happen.
The unlikely thing to happen is not likely to happen.
Therefore, if something happens, it's likely it's the likely thing and not the unlikely thing.
So it's likely it will happen again some time soon.
The unlikely thing probably won't.
But you never know.
You don't, because the non-formal logic is wrong. It runs aground in step 3. While the statement in step 2 is correct, a more precise way of saying it is that any one specific unlikely thing is unlikely to happen. But there are lots of unlikely things out there, and just because that one particular one is unlikely to happen doesn't mean that they're collectively unlikely to happen.
11.11.2008 4:24pm
PersonFromPorlock:
Oren:

Is there a penumbra somewhere you think guarantees students the right to peanut butter sandwiches?

What there isn't is a delegated power to regulate the consumption of said sandwiches. There is a delegated power to make laws for the public good and if the banning of PB sandwiches works to that end, fine. But let's not go off regulating 'for the children' until we've decided where the public good lies. Maybe a few dead kids is an acceptable price for the freedom to eat what we want, just as a few dead kids is an acceptable price for a greater than 55mph speed limit.

Freedom itself is a 'public good' and we often forget to consider its value when doing utilitarian calculations about the law.
11.11.2008 7:00pm
Dr. T (mail) (www):
David Bernstein:

"My wife said at the time, "I don't care what the doctors here say."

I'm glad to hear someone say that. A long time ago I came to the conclusion that doctors generally tell you things that have little evidence to support them.
Unfortunately, that is true. Far too many doctors choose the easier path of memorizing medicine instead of studying and learning medicine. (I'm sure the same phenomenon occurs in other professions.) When one tries to memorize one's way through a field as huge as medicine, it is easy to remember old teachings and not remember that they were disproved (such as no ice on burns, bed rest for backaches, no vaginal deliveries after a C-section, etc.). The doctors who learned medicine don't have to memorize as much: they understand principles of disease and can apply them to new situations. This type of doctor may soon become extinct, because academic medicine does little to encourage learning instead of memorization.

-- A disgruntled academic pathologist
11.11.2008 7:05pm
Dave Hardy (mail) (www):
"willing to give up his right to ride his bicycle and his scooter without a helmet, even though I did it at his age. "

Doesn't it occur to you as a parent that any amusement that requires a person to wear a helmet to protect against fatal brain injury probably is something a child shouldn't engage in, helmet or no? We don't wear helmets to walk or run, or engage in most sports. This is obviously proof that riding an unstable two-wheeled contraption with cars in its vicinity is highly risky and potentially fatal, not something a child should be doing.

Heck, we didn't even wear helmets when detonating pipe bombs in my day! That tells you how deadly these bikes are.
11.11.2008 8:42pm
Dave Hardy (mail) (www):
Medical knowledge/custom/guesswork brings to mind a personal tale.

I was outside with my son in the summer, throwing a football or some such. We came in, and she almost panicked, and began rubbing him with alcohol. I asked why, and she said that it was the risk of catching a cold from the sudden transition from hot to cold.

Instead of asking if she'd ever heard of this guy Louis Pasteur and his novel germ theory, I said if that is so, why rub him with alcohol? If anything, that makes the transition quicker.

She replied it was to close his pores. I asked what that had to do with disease. She thought about it, and said she didn't really know, she'd just been taught this.

It remained a bit of a mystery to me until I later read a civil war trooper's account. He mentioned being in summer near a swamp, and having to keep coats on and shirts buttoned to the neck. Because their pores were open and the bad air (as in malaria) could sink in.

I chuckled at the thought this was still being followed by a very intelligent person (she had an MA and nearly a PhD) in the late 1980s.
11.11.2008 8:49pm
Fub:
Dave Hardy wrote at 11.11.2008 8:49pm:
It remained a bit of a mystery to me until I later read a civil war trooper's account. He mentioned being in summer near a swamp, and having to keep coats on and shirts buttoned to the neck. Because their pores were open and the bad air (as in malaria) could sink in.
IANADoc, but this might be a case of doing the right thing for the wrong reason.

Keeping skin covered in a swamp won't keep out air (even though air is not the vector), but it might keep out mosquitoes, which are a malaria vector.
11.11.2008 9:09pm
markm (mail):
Yes, the "bad air" theory of malaria is a great example of accurate observation leading to the wrong conclusion.
11.11.2008 9:56pm
Careless:

I was outside with my son in the summer, throwing a football or some such. We came in, and she almost panicked,

(something's missing from this story)

Anyway, my Chinese in-laws have the same hot-to-cold belief without ever having left Asia. I wonder how widespread it was
11.11.2008 11:16pm
Careless:
I should add that they're Indonesian Chinese, which means that they live at sea level within a few degrees of the equator and the lowest temperature it ever gets at home is about 68 degrees.
11.11.2008 11:27pm
Bama 1L:
AS Dad, sorry I expressed my point carelessly. But your story is exactly what the pediatrician was talking about.

The state, your health insurer, etc. don't have to spend as much on an autism-spectrum diagnosis as they would some form of retardation. The burden is shifted back to the family.
Thus the system-wide pressure to diagnose autism, which she thinks has a great deal to do with the higher diagnosis rate.
11.12.2008 1:12am
Anonymouse Troll:

arthur
OK, how many rights are you willing to give up to save how many children? Bearing in mind that you're also giving them up for the adults those children will become?

I'm willing to give up my ninth amendment right to send my son to school with a peanut butter sandwich, even thought he's not allergic and loves them.

Other rights are discussed above. I'm willing to give up the right to have my son play on an asphalt playground; willing to give up willing to give up his right to ride a zipline across a playground; willing to give up his right to ride his bicycle and his scooter without a helmet, even though I did it at his age. In fact, about thirty years ago I gave up my own right to ride a bicycle without a helmet, and I've ridden thousands of miles since then without feeling much inconvenience. Willing to give up his right not to have him vaccinated. Willing to give up my own right to ride in a car without a seatbelt, even though I did it back in the day.


1. There's an important difference between "giving up" a right, which you claim, and "choosing not to exercise" a right, which you apparently mean. It's kind of central to the whole libertarian concept - maybe there's a good blog you could read to learn more...

2. Do we really want to continue on the path that will lead to a generation of military-aged citizens who can be taken out with a peanut-butter or milk-fat bomb? Feed your babies PBJs, milk and strawberries so we can stop wasting resources on the weak.
11.12.2008 9:13am
Dave Hardy (mail) (www):
"(something's missing from this story) "

Oops. The "she" was my late ex-wife.
11.12.2008 11:38am
Suzy (mail):
So many important things are being missed in the above discussion, I can't possibly cover them all, but here are a few to ponder. I'm not a doctor, but I do have food allergies and I've spent a lot of time reading the research on this subject and discussing it with doctors, both for myself and my children's sake.

First, the best current evidence about early vs. late exposure is mixed. If you want to debate early exposure, you're also leaving out the issue of exposure in the womb. Does a mother's consumption of peanut proteins give a protective effect to the developing infant immune system, or give the early exposure that can trigger the childhood allergy? Better studies of this issue could help to answer the question without resorting to exposing young children.

Second, my allergy has a genetic component and I was exposed at very early ages. What's the relationship between the genetic link and early or late exposure? We don't know. However, when you have a genetic predisposition you should aim for later exposure, and most who have one wouldn't know that.

Third, not all food allergies are created equal. Some people begin with serious reactions in childhood and gradually develop a tolerance. Some people start off with mild reactions and progress with relative degrees of swiftness to more serious, life-threatening reactions. The problem with this happening among young children is that they cannot communicate what is happening to them. So even if we suspect that early exposure could be beneficial, it's a risky game when 6-8% of children have food allergies, the exposure can kill them, and they can't tell you that their throat is itching and starting to close up!

Fourth, decades ago when I was a child with a food allergy, NOBODY understood what that meant. I was constantly being exposed to risks because of this ignorance, and despite being very aware and cautious, I had several accidents that resulted in anaphylaxis. Thank God we no longer live in that time, because it is so much easier to handle this issue with children now that more people are aware. The burdens placed on others are SO minimal in return for safety. Some kids have to eat at separate tables? Or not bring peanut butter when they know a slight accident could kill a classmate with a known allergy? You can't give out Snickers bars in the Valentines? These are not difficult accommodations and they make a real difference.

Fifth, people have cited low (and I might add, too low) numbers of deaths as evidence that this is no biggie. The numbers of emergency room visits and actual cases of anaphlaxis are much higher, and this IS a big deal, if only in terms of totally unnecessary and avoidable health care costs that burden everyone! Having experienced it, I'll also tell you it's no fun and games to nearly suffocate to death. Even if you don't DIE, this is a major crisis every time it happens, and it's terrifying when it involves a child because time is of the essence. The patients who die are more likely those, like kids, who don't recognize what's happening and can't get treatment quickly.

My question to those of you on the other side is: what's your POINT? People overreact? Sure, of course they do. People are burdening you in some outrageous way because of this? Nonsense! So where is your complaint? What's the problem here? Medical science doesn't know for sure and is making provisional predictions that might be wrong? Well what's new? Take with a grain of salt and make your best guess. This is not a negative.
11.12.2008 12:24pm
John Burgess (mail) (www):
Death seems to take children. I'm not all that old, but a kindergarten friend died after playing with matches. A second-grade friend died of polio. My third-fifth grade friend drowned in a canal.

My younger brother was born with an allergy to almost everything. My parent had to keep a watch on him, 24/7 to ensure he did not stop breathing, that there no wool touched him. He was allergic to milk and ended up drinking soy formula. When he was about six-months old, the allergies went away for good.

My sister was born with the same milk allergy, but not the others. She, too, went the soy milk route for about six months. She, unlike my brother, is allergic to bee stings and carries an injector with her at all times.

Neither I nor my other brothers has an allergy to anything, yet.

My wife, however, has one of the most rarified allergies of which I've ever heard. She is allergic, only, to female blue crab and roe. Male crabs present no problem. Crabs other than the blue crab present no problem.
11.13.2008 1:39am
neurodoc:
Just recently a doctor told me to take statins even though my lipid panel is excellent. [A. Zarkov
You're doctor may have told you right, if you have an elevated C-reactive protein level. This news was loudly trumpted last week after publication in New England Journal of Medicine of clinical trial results showing that notwithstanding normal lipids, there was a much lower incidence of cardiovascular morbidity and mortality among those who had been placed on a statin. (Crestor was the statin used in the study, because Glaxo that drug's manufacturer paid for it, but no reason to think the results would have been different with a different statin.) The results were so clear, that the study was stopped very early, something that doesn't happen often, because the the benefit conferred by the treatment was so significant statistically, and of course medically.

I don't know how they found the elevated CRP patients they enrolled in the trial, and whether a routine determination of CRP is the thing to do so as to discover if one does have an elevated CRP. Since I have been on a statin for >20 years, I don't feel the need to know my CRP value, at least not for these purposes.

A. Zarkov, since you regularly make valuable contributions to VC threads, I would encourage you to talk to your doctor again about his recommendation of a statin in light of these new findings, especially if you have any evidence of vascular disease despite a normal lipid profile. The study was undertaken because many people have heart attacks in the face of normal lipids. It was speculated that that might relate to "inflammation" within the vascular system, hence the trial of statins, which are thought to have useful effects in addition to lipid lowering. (Please don't share this information with a few regular VC contributors who may not know that their CRP levels are elevated and who would not be missed here.)
11.13.2008 8:14am
neurodoc:
I tend to be alarmed at the rapid increase in the number of routine vaccines... [einhverfr]
If you believe your concern about "the rapid increase in the number of routine vaccines" is a well-founded one, please tell us the basis for it. Or, is it just some inchoate fear, perhaps stirred by the anti-vaccine crowd, which you can't articulate. Throughout our lives, those of us who don't have Severe Combined Immunodeficiency requiring us to live in a bubble to stay alive are regularly exposed to untold numbers of antigens that cause us to make antibodies to them. Why should the antigens in vaccines (which ones?), or whatever else goes into vaccine preparations, be particularly feared?

Vaccines confer huge health benefits. Which ones do you think might be done without, the result being more gained in health benefits than lost?
11.13.2008 8:26am
neurodoc:
Eric Muller, this is a place for serious adults, not puerile punsters. (Note to self: remember this peanut/assaulted silliness for when may wish to seem a more "regular" guy.)
11.13.2008 8:31am
neurodoc:
A long time ago I came to the conclusion that doctors generally tell you things that have little evidence to support them..."People with ulcers should a large number of small meals." Wrong.
That advice was given because up until sometime in the '70s, it had always been thought that peptic ulcers were almost always the result of overproduction of stomach acid, and manipulation of diet was recommended. Then along came the first generation of acid-blocking drugs (e.g., Tagamet and Zantac), which were a real boon, and soon thereafter the shocking (I couldn't believe it) discovery that most ulcers were caused by a bacterium that many people have in their stomachs. Hence the different approach to management of most ulcers (not those due to unusual stressors, steroids, a very rare tumor, etc.) these days.
11.13.2008 8:41am
neurodoc:
any serious essay at making their injury/fatality rates zero would surely require banning their bicycles
How about the less radical measure of requiring them to wear helmets, thus reducing greatly the incidence of head injuries. (Ban skate boards, that is if you can.)
11.13.2008 8:44am
neurodoc:
water (hydration) - good [whit]
Really? What evidence can you adduce that one should strive to drink X number of glasses of water a day regardless of environmental circumstances (i.e., not liable to develop heat stroke)?
11.13.2008 8:50am
neurodoc:
Clearly Oren you never heard of trial lawyers.:) Since when has assumption of risk ever stopped anyone from suing? [Richard Nieporent]
Right, trial lawyers are at the root of all evil in the United States. Well, maybe not all evil, but surely much evil, and there is nothing good that can be said on behalf of trial lawyers, wouldn't you agree?

(Why are only those who represent plaintiffs in personal injury cases referred to as "trial lawyers" inasmuch as their counterpart defense attorneys are surely just as much "trial attorneys"? And why not style those who do criminal defense or prosecution as "trial lawyers"?)
11.13.2008 9:08am
neurodoc:
OK, how many rights are you willing to give up to save how many children? Bearing in mind that you're also giving them up for the adults those children will become?
Call me a misanthrope if you will, but I wouldn't have given up so much as a proverbial peppercorn, let alone an important right like that to hum at times while I eat, so that some adults I can think of would have made it out of childhood. (I wonder how early in their lives it might have been appreciated what miserable human beings they would turn out to be as adults.)
11.13.2008 9:14am
neurodoc:
Dr. T, "disgruntled academic pathologist" that you are, you must know the difference between an internist, surgeon, and pathologist.

[An internist knows everything, but does nothing; a surgeon knows nothing, but does everything; a pathologist knows everything and does everything, but a day too late.]
11.13.2008 9:17am