I'm a fan of science. I've little patience with those who consider science an optional means of understanding the world (in my experience, exclusively people who've never studied it), and I believe evidence-based medicine - which uses rigorous scientific method - is the best means of approaching truth.
It would be logical, then, for me to be a fan of Sense About Science - a charitable trust which champions science and evidence, and 'equips people to make sense of medical claims in public' - and indeed I am. They do terrific work. But that doesn't mean I consider them immune from criticism. I found a piece attacking 'free from' labelling - written by a member of their 'youth' wing, the Voice of Young Science - blinkered, mis-targeted and lacking consideration for those living 'free from' lives - and said so here.
SAS have now published a report, Making Sense of Allergies, in collaboration with charities, immunologists, and other experts - but, disappointingly, no dietitians - which I'd been looking forward to since August.
Read it. There's a lot of great stuff in it: explanations about antibodies, the immune system, cross reactions with latex and pollen (in OAS), the increase in allergic disease, how allergies should be diagnosed, the likely multi-factorial causes of allergy, up-to-date research, including the LEAP study. I like that the 'honey for hay fever' fiction - which resurfaces annually when the sneezing kicks off - is outed. It addresses the myth of the necessary better-ness of natural, of the silliness of 'toxic overload', the unproven existence of 'A1 milk-protein intolerance', on which A2 milk claims are founded. There is more. Read it!
But, there's a but ...
Fears about allergies are causing parents to cut food groups from their kids' diets, the report says, adding "It may seem surprising in advanced societies, but these are leading to cases of malnutrition". What's surprising to me is that this last claim of malnutrition is referenced to a study which is 17 years old, is from Finland, and the objective of which was to examine the impact of a milk-free diet on children with proven milk-allergy. This is the paper. What it has to do with malnutrition in non-diagnosed children in Britain, 2015, I can't imagine.
Any restricted diet is arguably likelier to lead to malnutrition than an unrestricted one, but that in itself is no proof it is actually happening. And yet it is this claim which has been the focus of much of the coverage given to the report, underpinning headlines in The Mirror, WebMD News, The Daily Mail, The Times, the International Business Times and The Telegraph.
The Mail headline singles out the middle-classes, and this seems to stem from comments made by SAS director Tracey Brown concerning socio-economic groups A-C and parents speculating about allergies at nurseries. The Times goes further - bogglingly, those middle-class children are actually 'starved' - and in their sub-head claim 40% of people think they have a food allergy, when only 5% do. This stat has been tweeted by SAS (below), but is not included in their report; despite several requests, I've not yet been told its source. *
I am sceptical (do almost half the people you know think they have food allergy?), but even if true why this huge discrepancy? The Report mentions the 'worried well' - which is polite speak for 'all in the head' - a favourite target of the media when this subject is concerned, which has frustrated me for some time. Worth reading is this excellent article by Laurie Laforest which, in the 'Self-reported rates' section, explains issues such as food aversion, allergy/intolerance confusion, and lifetime versus point prevalence could be key, often ignored answers.
Will things ever change?
But why examine other possibilities, when it's easier to let readers assume it's down to over-fussy people with imaginary allergies who are attention-seeking and precious about their or their kids' diets?
Because to some extent that's what has happened, of course, with the media coverage. The focus on middle-class parents and '40% think / 5% do' shines the spotlight on those people who are worried for their kids or confused and unwell themselves, and unable to obtain an orthodox diagnosis, who are being castigated for perhaps not being aware of the precise meaning and nature of 'allergy'. Further, it risks damaging parents of children with diagnosed serious allergies, who have enough on their plates keeping their children, you know, alive, without having to deal with consequences of people suspecting they're fantasists guilty of child neglect.
As Alexa of Yes No Bananas has remarked on social media, all this detracts from the more deserving targets of scrutiny, such as manufacturers and marketeers of - and spokespersons for - unsubstantiated food sensitivity testing, which the Guardian (well done them) chose to headline.
To that list, I'd add some newspapers themselves, many of which have previous form covering these tests positively. See the Daily Mail here or the Telegraph here or the Daily Mirror here, for instance, on IgG. Ditto publishers such as Bantam Press, for using perfectly good trees to inflict the largely science-free poppycock on stilts that was Novak Djokovic's Serve to Win on the British public.
What can be done?
The SAS page dedicated to the Making Sense of Allergy report quotes allergists Paul Seddon and Adam Fox optimistic that it will help bring change. But I fear it won't. I've been in this game long enough to remember the RCP's 2003 report, Allergy: The Unmet Need, which called out Vega, iridology, hair analysis and their like. What has changed in 12 years? Little, to my mind. If anything, we have new tests being marketed, such as some of the Cyrex panels, which experts have also questioned.
No. We've been here before. What we need is a new approach. Two ideas.
One: Publications, newspapers especially, could be asked to sign up to some kind of 'allergy reporting' standard. Reporting guidance exists for such difficult subjects as HIV and mental health / suicide, and there's no reason why we can't have something similar in allergy / intolerance.
Two: Advertising and marketing for tests considered useless should be required to meet stricter standards, or should be compelled to carry some form of 'health warning'. Though, frankly, if these tests really are as worthless and dangerous as experts say, then I do not see why they can't be banned.
It is these two - the tests, and those behind them, and the media, and those who report for it - on whom the spotlight needs to fall.
In other words, this sorry mess can only ever be resolved if we focus not on the people who may be wrong or needlessly worried about their health or their children's health, but on the people who are directly responsible for instilling that paranoia and misinformation and doubt into them.
* On 11th June, SAS contacted me to tell me they'd printed a clarification on the 40% figure quoted. You can read it here. The referred-to study can be seen here.
Labels: 'all in your head', Daily Mail, food allergy tests, food intolerance tests, IgG testing, media / journalism, nutrition, self diagnosis, The Guardian, The Telegraph, The Times