To start his new book Another Person’s Poison, which covers more than 100 years of the medical and cultural history of food allergy, author Matthew Smith spirits the reader away to Edmonton, Canada in 2009. An AC/DC concert is soon to take place in the local football stadium, and tens of thousands of fans have just learned that there is a peanut ban in place. An online shouting match erupts over the merits of the rule. Several fans seem, well, “Thunderstruck” that they can’t chomp on peanuts while headbanging along to the band’s music, while stadium officials counter by citing the swiftly rising rates of food allergy and the seriousness of anaphylactic reactions.
Smith, a medical historian, employs the colorful, contemporary anecdote as an entry point into an intriguing and thorough history of how food allergy has been transformed from being considered a “fringe” discipline at best, and “witchcraft” or “fad” at worst. In the process, Smith manages to trace food allergy’s path through the wilderness of 20th century medical science.
The author doesn’t shy away from the politics – corporate, medical and governmental – over the decades. Also at the core of his story are the mavericks in the field – from the likes of London physician Alfred Schofield, who in 1908 became an early pioneer of desensitizing patients with egg allergies, to a pair of German researchers who proved early connections of food allergy to immunological mechanisms by using themselves as human guinea pigs to test theories.
The winding road from the discovery of IgE antibodies to banning peanuts from large public events is strewn with turf wars among research scientists, clinicians and patients, whose voices went virtually unheard during some periods. Smith’s history shows that food allergy has undergone not just one, but several revolutions in medical approach over the course of 100-plus years.
Allergic Living’s Jason Rehel caught up with Matthew Smith by phone from Glasgow where he works as a senior lecturer at the University of Strathclyde’s Centre for the Social History of Health and Healthcare to discuss his book.
Charting more than a century of food allergy history is an ambitious undertaking. What is your overriding message in this book?
The big story has to do with how we as physicians, patients, parents, policy-makers, manufacturers, all those parties – how we make decisions about controversial areas in medicine. To understand that, you need to understand why these topics are controversial in the first place.
In the first chapters, you see that these controversies have their roots in the 19th century and even further back. And when we want to solve controversies, we turn to the sciences. You hear it all the time: “The science says this, the science says that.” But what exactly is this science, and how did we get to that? That’s really what the book is about.
Can you tell us why you found food allergy rich terrain for a broader discussion of how medicine is practiced?
Using food allergy as a case study shows that these debates are very basic ideas about how you derive medical knowledge, what role you see the environment, broadly defined, playing in changes to human health. In the later chapters of my book, a lot of this evolves into a question about pathologies of progress.
To what degree is food allergy an example of a disease of our civilization? So my overall argument is that if we want to resolve a lot of these issues, if we want to really find out what food allergy is and why it’s seemingly on the increase, we need to marry some of these contrasting viewpoints.
The precise definition of food allergy was hotly contested throughout the 20th century. Do you think this is partly because people blurred the lines to include a wider range of patients who self-diagnosed?
People self-identify with having intolerances. And there’s such a vast continuum. More orthodox allergists would say there’s a spectrum, and this is where [food allergy] starts and this is where it stops. History tells me that it’s more of a continuum. And partly because of the psychosomatic parts of it, it’s difficult to draw that line.
Now gluten-free (diets) is the big one, and they’re not just catering to people with celiac disease, or people that have definite gluten intolerance. Once the continuum gets past real intolerances, and gets to people going on these gluten-free diets – not because gluten does anything to their digestion, but they think it makes them fat, or whatever – they’re definitely self-identifying, and now there’s this massive food industry that’s willing to cater to their wishes. And I hesitate to say whether that’s right or wrong. It certainly speaks to our fraught relationship with food.
Throughout your book, a tension reappears between the contrasting viewpoints and hypotheses of the laboratory and clinicians. How has that affected food allergy’s development as a part of science?
When the ground is really contested, it creates a gulf in understanding. When people become really dogmatic in their views, and an innovator does arrive on the scene, sometimes they can end up ignored or dismissed.
In my first book (on ADHD and food additives), the real punchline was that the history included all these medical debates about the Feingold diet and all these scientific trials, but when you look at them in detail, they really tell you nothing.
But beside that, running parallel, are the experiences of hundreds of thousands of parents and kids who were on Feingold’s diet. So why do we just reject that as a source of knowledge? In the case of food allergy, there’s something similar going on. We need to listen to patients and we need to listen to clinicians as well.
So who should we turn to in order to push research on food allergy ahead in ways that seek out root causes?
It’s going to be FARE, and groups like that, who will likely lead the way. A really basic thing would be to get the patients and docs talking together. Instead of medical doctors going to their conferences and talking to each other exclusively every year, there need to be more opportunities for patients and doctors to talk in a way that is respectful. Saying, “Oh that’s nonsense we disproved 25 years ago” isn’t always as helpful as just listening to patient experiences.
As we move deeper into an era of “big data” and the ability to both collect and analyze large swaths of information, how do you think food allergy research needs to adapt?
That depends on a couple of things: What questions are we asking that we think the data can help us answer? How open-minded are we in interpreting the data? These days one of my biggest problems with medical science is that it asks questions where they think they already know the answer, instead of asking questions where they don’t have a clue. Hypotheses need to be a bit more open, and leave more room hopefully for the data to just speak for itself.
It also depends on how you define data. One of the interesting things with the Internet is that you have this huge wealth of patient experiences that are articulated on Facebook, Twitter and on blogs. I’m going to the Food Allergy Bloggers conference in Denver in November. There’s actually a Food Allergy Bloggers conference! That’s amazing!
We don’t often think of that stuff in terms of being data, but it’s qualitative data that can really help shape our understanding.
Matthew Smith will discuss his book in person at the Food Allergy Bloggers Conference in Denver on Nov. 14 at 6 p.m. Click here for more details about the conference.