Medical Help in Allergy
The days when doctors wanted their patients to obey orders and ask no questions are largely gone. Patients with allergies and other forms of sensitivity - or their parents -
have to play a key role in managing the disease. Most doctors now recognise this, and encourage their patients to learn about their illness, its diagnosis and treatment, and to
be partners in their own medical care.
Quite apart from this, there are aspects of allergy management where few doctors can afford the time to become experts. The nitty-gritty details of dust-mite avoidance or food
labelling practices are good examples. You can usefully supplement your doctor’s treatment here, by informing yourself.
But where should this process stop? That is a difficult question which doctors are increasingly forced to consider. One modern phenomenon, being discussed in many medical
journals at present, is the abundance of medical information on the Internet. Some doctors dread the arrival of patients who have logged on the night before their appointment
and are armed with a huge number of facts about their illness -some accurate, some utterly wrong and some highly debatable. But other doctors welcome the fact that patients are
actively interested in their health problems.
The reactions of doctors to ‘Internet patients’ highlight an issue that also runs right through this
book - that of medical orthodoxy. Who decides what is true and what is false in medicine, and how do they do it? Make no mistake - this is a deep and abiding problem which
afflicts not just scientific medicine, but science in general.
If a doctor, confronted with a web-page claiming that allergies are caused by space aliens intent on
destroying Western civilisation, snorts ‘Rubbish!’, he or she is not, strictly speaking, taking a scientific approach. In science, you should consider all the different
hypotheses.
In theory, science works by questioning everything and taking nothing on trust - but you can’t make much practical progress if you stick rigorously to that approach. Neither
scientists nor doctors start their careers by running experiments to establish the truth of everything they were ever taught. At some point in science, and in scientific
medicine, you have to assume that certain things are probably true, and proceed accordingly. If you make significant progress working on those assumptions, then the chances are
they were correct. But a good scientist always remembers that they are only assumptions.
Scientific medicine rests on a huge number of assumptions. Some of these are clearly accurate - for example, that eating wheat triggers coeliac disease -and it would be
time-wasting to argue about them. But this ‘fact’ about coeliac disease began as just a theory (see p. 70), and a highly debatable one. It has taken time for it to become
substantiated by more and more evidence.
Some medical assumptions become enshrined as facts rather too quickly. Fifty years ago, orthodox medicine accepted as a ‘fact’ that many asthmatic children had ‘intrinsic
asthma’, which was psychological in origin. Research since then has shown that there is almost always an allergy underlying childhood asthma. Many other examples could be given
of medical ‘facts’ that are overturned by subsequent research.
Doctors thirst for certainty, something that is quite understandable when they are faced with so much human need. A significant part of the healing power of medicine comes from
placebo effect (see p. 233), and that relies on patients having faith in the doctor. The traditional way for doctors to cultivate that faith was by assuming an air of absolute
certainty - about their diagnosis of the patient’s illness, about the treatment, and about medicine in general. This need for certainty has always hastened the transformation of
assumptions into facts.
The fatherly authoritarian attitude of old-fashioned doctors was, in large part, a reflection of how little they had in the way of useful treatments, and how much they relied on
placebo effect. Modern doctors have far more genuinely effective remedies to offer and can afford to take a different approach. Many now rely on a different kind of authority,
one based on intelligence, good information, flexibility, curiosity and openness. It’s a form of authority that allows a doctor to say ‘I could be wrong…’ or, ‘Let’s try this
and see what happens…’ without losing face.
Unfortunately, there is another powerful force at work in this complex situation, and that is quackery -the age-old business of selling phoney cures (see p. 209). Official
bodies within the medical community try to curb quackery by weighing the evidence about novel treatments and coming to decisions on their validity. This can be very useful. But
in deciding what is, and what is not, good scientific medicine, medical organizations always run the risk of mistaking their own unverified assumptions for facts.
Establishing criteria for good treatment is essential in medicine, but when this develops into dogmatism, that is decidedly unhealthy. Among the treatments that are being
dismissed as valueless today, there are
several that deserve a fairer hearing.
Some of these treatments have been shown to work by the most excellent of scientific methods. The use of elimination diets in Crohn’s disease is a good example - for some
patients, there is a huge and sustained improvement, suggesting that their disease was caused, at least in part, by food sensitivity. The tactic used by those who want to reject
this evidence is simply to ignore it. When scientific review papers (summaries of all the current knowledge and latest research) are written about Crohn’s disease, the research
on diet is usually not mentioned. Evidence that is routinely ignored in this way slips into oblivion because most doctors only have time to read the review papers, not the
original research reports.
Occasionally - and this is even more shameful -good scientific evidence that goes against the grain of current orthodoxy is actually misreported in review papers. This happened
with an impeccable scientific study showing the benefits of an elimination diet for some patients with rheumatoid arthritis. By missing out certain key facts, a review author
managed to give the impression that the results of this study supported the conventional view on the subject (that diet makes no difference to rheumatoid arthritis), whereas
they actually disputed the conventional view.
Unthinking rejection of new treatments often occurs with currently untreatable diseases such as autism and Chronic Fatigue Syndrome (CFS). Such medical problems always attract
experimental treatments, just as they always attract sheer quackery, and sorting out one from the other is not easy - it takes time, and a clear-headed approach, not knee-jerk
dismissal.