Posts Tagged ‘health problems’

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.

What is Allergy?
Words matter, particularly in medicine. Using the same words to mean different things is a major difficulty for patients when discussing allergies with a doctor. Unfortunately, few patients realise this, and doctors are frequently too busy to explain what they themselves mean. The result can be a great deal of misunderstanding, confusion and mutual irritation.
Unclear meanings can also create problems if you start exploring other treatment options. The word `allergy’ is like one of those cats that eat at six different houses in the neighbourhood: everyone feels as if they own it exclusively. A conventional allergist will understand one thing by ‘allergy’, while a more unorthodox doctor may have a broader definition, and a herbalist or naturopath may be using the word in a completely different way again.
This is an absolute jungle for the medically unqualified, and it can be an expensive jungle if you are looking around for an answer to your health problems. With the help of this book, you should be able to make sense of all this, and understand the seemingly contradictory advice on offer.
The word allergy was coined in 1906 when it was used to mean altered reactivity - any change in the way the body responds to the environment, whether immunity to a disease already encountered, or a sudden fit of sneezing from pollen. Immunity to disease was soon shunted off into a separate category
altogether, leaving allergy with a narrower meaning:
any adverse reaction to substances that are normally harmless - definition 1. In this book, that meaning is covered by the word sensitivity.
One group of American doctors, who later became known as clinical ecologists, stuck with this definition. Their broad view of allergy is still found among some other doctors today, generally those whose approach to medicine is fairly unorthodox. It is a concept of allergy that is also shared by most practitioners of alternative medicine or complementary therapists.
The rift between the clinical ecologists and mainstream medicine came in the 1920s when the definition of allergy used by conventional doctors was narrowed further to mean reactions to harmless items where the immune system is definitely involved -definition 2. The term immune sensitivity is used in this book to convey that meaning.
In the 1960s, conventional allergists narrowed the definition of allergy again. It was an exciting time because the antibody known as IgE (sometimes called the allergy antibody - see box on p. 12) had just been discovered. The new, tighter meaning of allergy was
reactions to harmless items where IgE is involved -definition 3.
If asked to define allergy, most doctors would give the second of these definitions.
However, when they talk of ‘a tendency to allergy’, ‘allergy treatment’ or `the allergy epidemic’, doctors are generally using the third definition, and just mean IgE-mediated allergy. They may not be conscious of the fact that they are switching from one definition to another. This is not an ideal situation but, generally speaking, it does not create too many problems.
This book deals with ‘allergy’ in the very broadest sense of the word - all kinds of sensitivity. However -and this is purely for the purposes of clarity - where the word allergy is used in the text it always means IgE-mediated allergy (definition 3).
Other immune-mediated problems are called non-IgE immune sensitivity in this book.
Finally, any reaction where the immune system has no proven central role is called an intolerance. (As for other technical words, if you want to find the full definition, look in the index and turn to the page number shown in bold type.)
If you are reading widely on this topic, you may come across sensitivity used either according to definition 1 above, or as another name for intolerance. You may also encounter the word hypersensitivity. This is actually a precise medical term,
but be warned that some writers use ‘hypersensitivity’ very loosely to mean just ’sensitivity’ (definition 1).
Remember that medical politics and economics are powerful forces in all this debate over meanings. Words are quite often redefined by medical interest
groups (such as professional associations) with the clear intention of staking out territory and claiming sole access to medical truth. What is at stake, ultimately, is the right of different doctors to treat patients with certain conditions - and the right of patients to choose for themselves. To add to the longstanding battle over ‘allergy’, there are now rival claims about the meaning of intolerance (74) which have distinctly political overtones.
When you talk with doctors, using the most appropriate terms will help enormously. Talking to a mainstream doctor about ‘food allergy’ when the symptoms suggest food intolerance, for example, is very likely to cause annoyance. This is not unreasonable because IgE-mediated food allergy, unlike food intolerance, is a disease that can very suddenly kill an otherwise healthy person. Using the term `food allergy’ for a headache or mild bowel symptoms is, doctors feel, trivialising a potentially fatal condition.
The important thing is to get along well and communicate clearly with doctors, not to get into a battle about what words mean (in that sense, words don’t matter - they are just labels). Avoid using the word ‘allergy’ unless you are sure it fits in with your doctor’s perception of what is wrong. Just describing how you react - the actual symptoms - is usually the best approach. If you need a general word for your condition, ’sensitive’ is usually a much more diplomatic choice than ‘allergic’.