There was a period of a few decades (I guess still ongoing, really) where parents sheltered their kids from everything. Playing in the dirt, peanuts, other allergens. It seems like all it's done is make people more vulnerable as adults. People assume babies are super fragile and delicate, and in many ways they are, but they also bounce back quickly.
Maybe part of it is a consequence of the risks of honey, which can actually spawn camp infants with botulism. But it seems that fear spread to everything.
Not to confuse things: There quite simply is a long list of things that can kill an infant and we get increasingly better evidence for what's on there and what is not. Avoiding death at all cost is ludicrous, but for a child born in the 1950s in high income countries the mortality rate was ~5%. 1 in 20 kids dead before the age of 5. For contrast, now it's closer to 1 in 300. That's not a coincidence but a lot of compounding things we understand better today.
Are there missteps? Certainly. Figuring out what is effective, what has bad secondary effects (fragility, allergies etc) and what is simply wrong is an ongoing effort and that's great, but less dying is a pretty nice baseline and progress on that front is inarguable.
To be a bit morbid, one could also explain OPs observation that "people are more fragile" by the lower child mortality by the hypothesis that these more fragile people wouldn't have made it through infancy before.
I don't particularly believe this, but it fits Occam's razor, so it seems to deserve some examination.
It’s not just save as many lives as possible at all costs, saving 20 kids but 2 will develop debilitating peanut allergies isn’t worth it. Progress must be done slowly ensuring no harm is done along the way.
What on earth are you saying? It's better to kill 20 children than to risk that 2 of them develop peanut allergies? I don't see how this can even begin to be an arguable position to take. And that's ignoring the fact that it isn't even a correct assertion in this case.
One could argue that science being celebrated too much leads to this type of present-day outcome. Science can tell you how to do something, but not why, or even what we should do to begin with.
Rational and science might be pretty far apart. Flying a key in a thunderstorm for example isn't the most rational decision. Neither scraping open your family's arms and applying cowpox pus.
Pretty irrational, but definitely celebrated.. eventually
I have a great example of this. For our first kid, we had created a Sterile Field in our kitchen for pacifiers, baby bottles, etc. The sanctity of the Sterile Field was never violated. We would wash things by hand and then BOIL them and place them into the Sterile Field. This kid is allergic to tree nuts and a few other things.
For baby number 2, soap and water is enough. There's no time for Sterile Field nonsense. This kid isn't allergic to anything.
There was a local mom who had 4 thriving kids. When their baby dropped the pacifier in the dirt, it just got brushed off and handed back to the baby. I don't think those kids had any allergies.
It seems like all it's done is make people more vulnerable as adults.
In 2000, the American Academy of Pediatrics recommended not allowing your kids peanuts until they were 3 years old. It was just parents following doctor's (bad) advice.
Not to confuse: peanuts cannot directly be eaten because of risk of choke, as infants cannot chew them. The advice is to add as ingredient, as e.g. peanut butter.
A timely reminder that although doctors aspire to follow science, and many doctors are scientists, and most doctors advocate evidence-based medicine, the practice of medicine is not a wholly scientific field, and particularly the big associations like the AAP are vulnerable to groupthink just like any big org.
"What doesn't kill you makes you stronger" makes for a fun little statement. It's not actual natural law though, right? I feel like it's fairly well documented that good hygiene is a win for humanity as a whole, so I have some skepticism for generally saying "well let the kids eat dirt". We did that for centuries already!
The thing I'm a bit curious about is how the research on peanut allergies leading to the sort of uhhh... cynic's common sense take ("expose em early and they'll be fine") is something that we only got to in 2015. Various allergies are a decently big thing in many parts of the world, and it feels almost anticlimactic that the dumb guy take here just applied, and we didn't get to that.
Maybe someone has some more details about any basis for the original guidelines
A justification I read once is that the human immune system evolved to deal with a certain amount of pathogens. If you don’t have enough exposure to pathogens, the immune system still tries to do its job, but winds up attacking non-pathogens.
> Various allergies are a decently big thing in many parts of the world
Maybe we live in bubbles.
I am from Asia. I have only seen people need to be taken to emergency hospital in American tv shows for any allergies. Here I've never seen it in my whole life and didn't even know allergy can be this dangerous. We don't have peanut allergy too. First time even I saw it in TV, I was very confused.
Allergies do exists here, but "not to the extent" like what I've seen in American TV shows or heard online.
Only thing I remember is people need to take medicine for to allergy from venomous caterpillar hairs, they mistakenly touched those. And stung by honey bees, wasp etc.
I always think about how animals eat - basically their food is never clean and always mixed with dirt. Evolution dealt with this problem since forever.
And one of the ways evolution dealt with this problem is evolving intelligence the can then tell you to improve hygiene practices to reduce the "natural" death rate
I grew up in a smoking house. We didn't have any house cleaners. We wore our shoes in the house. I spent my childhood outdoors playing in the dirt. When we were thirsty we drank garden hose water or went inside for some Kool-Aid.
That kind of assumes they are sheltering kids, but to be honest peanuts aren't really that common a food, certainly not in foods you would commonly give a four month year old child.
> There was a period of a few decades (I guess still ongoing, really) where parents sheltered their kids from everything.
The hygiene hypothesis is not impossible, but evidence for and against it is questionable. But anyway, for peanuts it's not the hygiene.
It's a much more complex mechanism that retrains your immune system from using the non-specific rapid-response allergic reaction to the T-cell-mediated response.
The same method can be used to desensitize yourself to poison oak or ivy. You need to add small amounts of them into your food, and eventually you stop having any reaction to urushiol contact with the skin.
Most likely you know already, and if that's the case just ignore this comment please. Spawn camp in this context is referred to gaming terminology where it indicates an enemy that camps/waits for for a long time and kills you as soon as you are put in the battlefield, which is your spawn point, hence spawn camping
"[eg] women aged 30–34, around 1 in 70,000 died from Covid over peak 9 weeks of epidemic. Over 80% pre-existing medical conditions, so if healthy less than 1 in 350,000, 1/4 of normal accidental risk"
The biggest reason I took covid19 seriously was because many countries in separate parts of the world took drastic measures, unlike nut allergy which is the poster child for first world problems.
Something about this just reminds me of when I did a literature review in my anatomy class to address the question: "Is running bad for your knees?"
I had to decide which of two sets of peer-reviewed publications that contradict each other was least guilty using the data to support the conclusion rather than letting the data speak for itself and making an honest conclusion.
Compared to PhDs, MDs hate designing an experiment and would rather just extrapolate a different conclusion from the same longitudinal study by cherry-picking a different set of variables. The only articles I bother reading from the NEJM anymore are case studies because they're the only publications that consist of mostly-original information.
One of the difficult parts of this advice for me was that my daughter wasn't eating food at the time when we were supposed to introduce it. In those cases, you're supposed to add peanut butter to the milk, which we did a few times. We let it slip for a few weeks, because it was one more thing in a pile of many things. We got her back eating peanut butter once she started eating food, but it was too late. She had developed a peanut allergy.
After going through the desensitization program at an allergist, we're on a maintenance routine of two peanuts a day. It's like pulling teeth to get her to eat them. She hates peanut M&Ms, hates salted peanuts, hates honey rusted peanuts, hates plain peanuts, hates chocolate covered peanuts, hates peanut butter cookies, and will only eat six Bamba sticks if we spend 30 minutes making a game out of it.
I highly recommend being very rigorous about giving them the peanut exposure every single day. It would have saved us a lot of time.
How long did you delay for? It's not like there's some tiny window of opportunity before 10 months or whatever. Consider that the Spanish conquistadors who literally never saw a peanut as a child and tried their first peanuts as adults all survived long enough to make peanuts a globally accepted food. You can't blame yourself. To think that somehow not delivering peanut exposure was a sure cause of the allergy is nonsense.
There's a certain wealthy area near me where restaurants ask first if you have allergies, and ice cream shops ask if dairy is ok. My wife and I always joke, "we're in that part of town."
Here is another study, as early as 2008 that shows similar results:
Objective: We sought to determine the prevalence of PA among Israeli and UK Jewish children and evaluate the relationship of PA to infant and maternal peanut consumption
I wonder why the old advice was being given if it was so wrong? If nobody understood what to do, shouldn't there have been no advice instead of something harmful?
You seem to be suggesting that doctors should not suggest any health precautions until controlled experiments have found them effective. That is the position taken by the highly-cited paper "Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials", which you must read immediately, because in a peculiar way it is a paper about you: https://pmc.ncbi.nlm.nih.gov/articles/PMC300808/
You don't need a controlled experiment if you have a good enough understanding of the mechanism, such as with parachutes. But since they apparently had no idea how peanut allergies worked nor had any adequate studies, they should have just shrugged their shoulders when asked for advice.
Even with parachutes, you could do a study (not a RCT) by looking at historical cases of people falling with and without parachutes. The effect would be so strong that you wouldn't need those clever statistical tricks to tease it out.
If people are developing allergies to food, isn’t a logical first step to not expose babies to the allergens? It seems logical. It turns out to be exactly backwards.
It would seem logical, until you learn what allergies are. They are the body's immune system overreacting to something that would normally be harmless, and acting as if it's an invading pathogen. Once you learn that, then realizing "hey, expose the body to this thing early on, and the body's immune system will treat it as normal" is a logical step.
If this theory (that early exposure teaches the immune system not to overreact) is right, then another logical consequence would be that kids who play outside in their early years would have fewer pollen allergies than kids who mostly play indoors and are exposed to far less pollen than the outdoors-playing kids. I don't know where to look for studies to prove or disprove that thesis; anyone have any pointers?
Well, I mean, did you know that skin exposure can sensitize and oral exposure builds tolerance? I certainly didn’t. That’s a subtlety of the exposure game that I did not know.
E.g. from age 27 weeks my daughter has played in a little herb garden full of mud and grass I built for her. She grabs and eats leaves from the herb plants (the basil is entirely denuded so that’s a complete loss). At first I just wanted her to play in the garden out of the same naïve exposure to tolerance model. I never would have considered that skin exposure is different from oral exposure. As it so happened she ate the plant leaves and it doesn’t matter either way since this part of immunity (to microbes here) doesn’t work in the same way as peanuts anyway.
There is a joke that the book "Immune System 101" is 1000 pages long. Meaning the immune system is one of the most complicated systems in biology, simple logic arguments like yours above rarely apply, everything needs to be tested to be sure.
People did understand what to do, it just turns out their understanding was wrong. We might still be wrong though, one study isn't definitive proof of anything. We have to make decisions with the knowledge we have at the time, and it's normal for those decisions to look dumb in hindsight.
Lots of things kill infants that harm children, so keeping them away from things that harm some children probably seemed correct. The mechanism for allergy development wasn’t well known and it seems reasonably to avoid it in case it was genetic or something and would cause a hard to treat allergic reaction in the infant.
Bad advice that has a very long return on investment is quite sticky.
For instance the "cry it out method" did massive amounts of psychological damage to more than one generation, but it seemed to work in the short term as the babies eventually learned to "self-soothe".
Even now I still see parents and grandparents suggesting it in parenting groups; and taking extreme umbrage at the idea that it might have damaged them/their children.
Hindsight is 20/20. The fact is that thousands of children were dying and public health officials were set to task to identify interventions that help.
They know that skin and mucosa sensitization can occur in response to allergens.
A reasonable hypothesis is that there’s some boot-up process with the immune system that needs to occur before anything happens. The kids are dying today. “Avoid the thing that can cause sensitization” is a conservative position.
It is unusual that it should have been opposite and that oral exposure induces tolerance. It’s the fog of war.
The standard conservative intervention has helped in the past: I’m pretty sure seatbelts didn’t have strong mortality data before they were implemented. If it had turned out that more people were killed by seatbelts that trapped them in vehicles it would make for a similar story. I think they also got rid of all blood from donors who were men who have sex with men during the initial stages of the HIV pandemic (no evidence at the time).
Edit for response to comment below since rate-limited:
Wait, I thought it was on the order of ~150/year people dying from food anaphylaxis though I didn’t research that strongly. It was off my head. If you’re right, the conservative advice seems definitely far too much of an intervention and I agree entirely.
Undoing of the effects of excessive and unnecessary social guidance takes ages.
At some point through the times of civilizations, humans started having less work to do and more idle people around. The idle people started spending their time for preaching a life style other than what was evolved naturally through centuries and millennia. They redefined the meaning of health, food, comfort and happiness. The silliest thing they did was creating norms, redefining good and bad based on their perception of comfort and happiness and enforcing those norms on populations.
Human race continued to live under the clutches of perceptions from these free-thinking idle people whose mind worked detached from their bodies and thus lacked the knowledge gained from the millennia of human evolution.
I think people seek out these restrictions on their own. Almost everyone I know has some sort of belief about what's healthy and what isn't.
Some people become vegetarians, some people become vegans, some people believe eating big steaks of red meat is healthy, some people avoid pork, others do not eat cooked food on some days of the week, others eat only fish on special holidays, some people tell you that yoghurt is good for your gut, others tell you to avoid dairy at all cost, some tell you to avoid carbohydrates, ....
Some of these are backed by science, some are batshit crazy, some are based on individual preferences.
I don't think this is a new phenomenon. People just love coming up with rules, and even if our society allows you to eat pretty much whatever you want, people still seek out restrictions for themselves (and their kids...)
Yes, when the mind is over-confident of it's education and perceptions, it starts to disobey the signals from body and force the body to follow what mind says. That's when the mind loses the support of knowledge encoded in the body, the knowledge which wass collected through evolution.
The mind tries to compensate the loss with experimentation that can't undergo the same extent of evolution. Then it dictates body to follow the results of these puny and tiny experiments, and ignores the rich knowledge already encoded in the body.
There was a period of a few decades (I guess still ongoing, really) where parents sheltered their kids from everything. Playing in the dirt, peanuts, other allergens. It seems like all it's done is make people more vulnerable as adults. People assume babies are super fragile and delicate, and in many ways they are, but they also bounce back quickly.
Maybe part of it is a consequence of the risks of honey, which can actually spawn camp infants with botulism. But it seems that fear spread to everything.
Not to confuse things: There quite simply is a long list of things that can kill an infant and we get increasingly better evidence for what's on there and what is not. Avoiding death at all cost is ludicrous, but for a child born in the 1950s in high income countries the mortality rate was ~5%. 1 in 20 kids dead before the age of 5. For contrast, now it's closer to 1 in 300. That's not a coincidence but a lot of compounding things we understand better today.
Are there missteps? Certainly. Figuring out what is effective, what has bad secondary effects (fragility, allergies etc) and what is simply wrong is an ongoing effort and that's great, but less dying is a pretty nice baseline and progress on that front is inarguable.
To be a bit morbid, one could also explain OPs observation that "people are more fragile" by the lower child mortality by the hypothesis that these more fragile people wouldn't have made it through infancy before.
I don't particularly believe this, but it fits Occam's razor, so it seems to deserve some examination.
> but it fits Occam's razor
How? You can use that to decide between two (or more) explanations, but you only presented one.
It’s not just save as many lives as possible at all costs, saving 20 kids but 2 will develop debilitating peanut allergies isn’t worth it. Progress must be done slowly ensuring no harm is done along the way.
Science failed here.
What on earth are you saying? It's better to kill 20 children than to risk that 2 of them develop peanut allergies? I don't see how this can even begin to be an arguable position to take. And that's ignoring the fact that it isn't even a correct assertion in this case.
I wish society at large could be on par with this nuanced and rational opinion. I miss when science was celebrated.
> I miss when science was celebrated.
One could argue that science being celebrated too much leads to this type of present-day outcome. Science can tell you how to do something, but not why, or even what we should do to begin with.
Rational and science might be pretty far apart. Flying a key in a thunderstorm for example isn't the most rational decision. Neither scraping open your family's arms and applying cowpox pus.
Pretty irrational, but definitely celebrated.. eventually
I have a great example of this. For our first kid, we had created a Sterile Field in our kitchen for pacifiers, baby bottles, etc. The sanctity of the Sterile Field was never violated. We would wash things by hand and then BOIL them and place them into the Sterile Field. This kid is allergic to tree nuts and a few other things.
For baby number 2, soap and water is enough. There's no time for Sterile Field nonsense. This kid isn't allergic to anything.
There was a local mom who had 4 thriving kids. When their baby dropped the pacifier in the dirt, it just got brushed off and handed back to the baby. I don't think those kids had any allergies.
It seems like all it's done is make people more vulnerable as adults.
In 2000, the American Academy of Pediatrics recommended not allowing your kids peanuts until they were 3 years old. It was just parents following doctor's (bad) advice.
Not to confuse: peanuts cannot directly be eaten because of risk of choke, as infants cannot chew them. The advice is to add as ingredient, as e.g. peanut butter.
A timely reminder that although doctors aspire to follow science, and many doctors are scientists, and most doctors advocate evidence-based medicine, the practice of medicine is not a wholly scientific field, and particularly the big associations like the AAP are vulnerable to groupthink just like any big org.
"What doesn't kill you makes you stronger" makes for a fun little statement. It's not actual natural law though, right? I feel like it's fairly well documented that good hygiene is a win for humanity as a whole, so I have some skepticism for generally saying "well let the kids eat dirt". We did that for centuries already!
The thing I'm a bit curious about is how the research on peanut allergies leading to the sort of uhhh... cynic's common sense take ("expose em early and they'll be fine") is something that we only got to in 2015. Various allergies are a decently big thing in many parts of the world, and it feels almost anticlimactic that the dumb guy take here just applied, and we didn't get to that.
Maybe someone has some more details about any basis for the original guidelines
> "What doesn't kill you makes you stronger" makes for a fun little statement. It's not actual natural law though, right?
I'm pretty sure it is.
https://en.wikipedia.org/wiki/Immunological_memory
https://en.wikipedia.org/wiki/Supercompensation
No, it is not in any way a universal principle. The counterexample is Lead. A little lead in the diet does not make you stronger.
A justification I read once is that the human immune system evolved to deal with a certain amount of pathogens. If you don’t have enough exposure to pathogens, the immune system still tries to do its job, but winds up attacking non-pathogens.
> Various allergies are a decently big thing in many parts of the world
Maybe we live in bubbles.
I am from Asia. I have only seen people need to be taken to emergency hospital in American tv shows for any allergies. Here I've never seen it in my whole life and didn't even know allergy can be this dangerous. We don't have peanut allergy too. First time even I saw it in TV, I was very confused.
Allergies do exists here, but "not to the extent" like what I've seen in American TV shows or heard online.
Only thing I remember is people need to take medicine for to allergy from venomous caterpillar hairs, they mistakenly touched those. And stung by honey bees, wasp etc.
It makes for good TV. I think only a couple hundred Americans die a year from anaphylaxis. And many of those are from medication allergies.
> "well let the kids eat dirt"
I always think about how animals eat - basically their food is never clean and always mixed with dirt. Evolution dealt with this problem since forever.
And one of the ways evolution dealt with this problem is evolving intelligence the can then tell you to improve hygiene practices to reduce the "natural" death rate
And most of them die young.
But mostly not because of what they have eaten.
You have to balance the future immune system with current dysentery.
Yes, evolution kills the weak. I don't think you're saying "let them die"?
[delayed]
Sheltering kids from lead paint flakes is certainly beneficial
The Hygiene Hypothesis has been around for a long time.
It will be interesting to see what happens with allergies for those who were born in the 2020-2023 timeframe.
I grew up in a smoking house. We didn't have any house cleaners. We wore our shoes in the house. I spent my childhood outdoors playing in the dirt. When we were thirsty we drank garden hose water or went inside for some Kool-Aid.
No allergies.
You might be confusing bouncing back with survivor bias. A lot of them used to not bounce back. They had funerals.
That kind of assumes they are sheltering kids, but to be honest peanuts aren't really that common a food, certainly not in foods you would commonly give a four month year old child.
Peanut butter?
Really depends where you are. Here in Germany you probably would have Nutella rather than peanut butter.
> There was a period of a few decades (I guess still ongoing, really) where parents sheltered their kids from everything.
The hygiene hypothesis is not impossible, but evidence for and against it is questionable. But anyway, for peanuts it's not the hygiene.
It's a much more complex mechanism that retrains your immune system from using the non-specific rapid-response allergic reaction to the T-cell-mediated response.
The same method can be used to desensitize yourself to poison oak or ivy. You need to add small amounts of them into your food, and eventually you stop having any reaction to urushiol contact with the skin.
> the risks of honey, which can actually spawn camp infants with botulism
I hadn't heard of this. Very intriguing that only camp infants would be affected.
Most likely you know already, and if that's the case just ignore this comment please. Spawn camp in this context is referred to gaming terminology where it indicates an enemy that camps/waits for for a long time and kills you as soon as you are put in the battlefield, which is your spawn point, hence spawn camping
> There was a period of a few decades (I guess still ongoing, really) where parents sheltered their kids from everything
Not just parents sheltering kids. Take a look at this (in)famous tweet https://x.com/d_spiegel/status/1271696043739172864 from *June 2020* ...
"[eg] women aged 30–34, around 1 in 70,000 died from Covid over peak 9 weeks of epidemic. Over 80% pre-existing medical conditions, so if healthy less than 1 in 350,000, 1/4 of normal accidental risk"
The biggest reason I took covid19 seriously was because many countries in separate parts of the world took drastic measures, unlike nut allergy which is the poster child for first world problems.
> many countries in separate parts of the world took drastic measures
Putting China to one side, broadly speaking weren't the most stringent and prolonged restrictions mostly in wealthier, highly-developed countries?
Poor countries have lots of people who can’t afford masks and shelter at home without risking starvation.
Developing countries also have significantly younger populations, who are at much lower risk.
"Older adults are at highest risk of getting very sick from COVID-19"[0]
[0] https://www.cdc.gov/covid/risk-factors/index.html
By that logic, children who got anaphylaxis during a study should later develop resistance to allergies.
Something about this just reminds me of when I did a literature review in my anatomy class to address the question: "Is running bad for your knees?"
I had to decide which of two sets of peer-reviewed publications that contradict each other was least guilty using the data to support the conclusion rather than letting the data speak for itself and making an honest conclusion.
Compared to PhDs, MDs hate designing an experiment and would rather just extrapolate a different conclusion from the same longitudinal study by cherry-picking a different set of variables. The only articles I bother reading from the NEJM anymore are case studies because they're the only publications that consist of mostly-original information.
Running experiments is really really hard due to regulations. Difficult to blame doctors for that.
https://www.astralcodexten.com/p/book-review-from-oversight-...
Thanks for this link, very interesting.
Notable citation:
> A system that began as a noble defense of the vulnerable is now an ignoble defense of the powerful.
Glad to hear grandmas approach of "just give them a bit of everything" has now been proven correct :)
The problem is there are always exceptions, like honey for infants.
Or alcohol. Or boiled poppy to make them calmer.
My ex girlfriend had an infant when we met, and the pead apparently told her that he baby is lactose intolerant.
NOT ON MY WATCH.
Just one or two nights of pain and the baby was on normal formula without any issues.
That kid can now enjoy milk and cheese, and not be a little bitch.
One of the difficult parts of this advice for me was that my daughter wasn't eating food at the time when we were supposed to introduce it. In those cases, you're supposed to add peanut butter to the milk, which we did a few times. We let it slip for a few weeks, because it was one more thing in a pile of many things. We got her back eating peanut butter once she started eating food, but it was too late. She had developed a peanut allergy.
After going through the desensitization program at an allergist, we're on a maintenance routine of two peanuts a day. It's like pulling teeth to get her to eat them. She hates peanut M&Ms, hates salted peanuts, hates honey rusted peanuts, hates plain peanuts, hates chocolate covered peanuts, hates peanut butter cookies, and will only eat six Bamba sticks if we spend 30 minutes making a game out of it.
I highly recommend being very rigorous about giving them the peanut exposure every single day. It would have saved us a lot of time.
How long did you delay for? It's not like there's some tiny window of opportunity before 10 months or whatever. Consider that the Spanish conquistadors who literally never saw a peanut as a child and tried their first peanuts as adults all survived long enough to make peanuts a globally accepted food. You can't blame yourself. To think that somehow not delivering peanut exposure was a sure cause of the allergy is nonsense.
There's a certain wealthy area near me where restaurants ask first if you have allergies, and ice cream shops ask if dairy is ok. My wife and I always joke, "we're in that part of town."
Who are you making the joke to?
These jokes are always of the form "we are in a superior group who know things those outside the group don't".
In this case: "allergies and intolerances are made up stuff for weaklings, haha".
Here is another study, as early as 2008 that shows similar results:
Objective: We sought to determine the prevalence of PA among Israeli and UK Jewish children and evaluate the relationship of PA to infant and maternal peanut consumption
https://pubmed.ncbi.nlm.nih.gov/19000582/
I wonder why the old advice was being given if it was so wrong? If nobody understood what to do, shouldn't there have been no advice instead of something harmful?
You seem to be suggesting that doctors should not suggest any health precautions until controlled experiments have found them effective. That is the position taken by the highly-cited paper "Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials", which you must read immediately, because in a peculiar way it is a paper about you: https://pmc.ncbi.nlm.nih.gov/articles/PMC300808/
You don't need a controlled experiment if you have a good enough understanding of the mechanism, such as with parachutes. But since they apparently had no idea how peanut allergies worked nor had any adequate studies, they should have just shrugged their shoulders when asked for advice.
Even with parachutes, you could do a study (not a RCT) by looking at historical cases of people falling with and without parachutes. The effect would be so strong that you wouldn't need those clever statistical tricks to tease it out.
If people are developing allergies to food, isn’t a logical first step to not expose babies to the allergens? It seems logical. It turns out to be exactly backwards.
It would seem logical, until you learn what allergies are. They are the body's immune system overreacting to something that would normally be harmless, and acting as if it's an invading pathogen. Once you learn that, then realizing "hey, expose the body to this thing early on, and the body's immune system will treat it as normal" is a logical step.
If this theory (that early exposure teaches the immune system not to overreact) is right, then another logical consequence would be that kids who play outside in their early years would have fewer pollen allergies than kids who mostly play indoors and are exposed to far less pollen than the outdoors-playing kids. I don't know where to look for studies to prove or disprove that thesis; anyone have any pointers?
https://www.science.org/content/article/great-outdoors-good-...
Well, I mean, did you know that skin exposure can sensitize and oral exposure builds tolerance? I certainly didn’t. That’s a subtlety of the exposure game that I did not know.
E.g. from age 27 weeks my daughter has played in a little herb garden full of mud and grass I built for her. She grabs and eats leaves from the herb plants (the basil is entirely denuded so that’s a complete loss). At first I just wanted her to play in the garden out of the same naïve exposure to tolerance model. I never would have considered that skin exposure is different from oral exposure. As it so happened she ate the plant leaves and it doesn’t matter either way since this part of immunity (to microbes here) doesn’t work in the same way as peanuts anyway.
There is a joke that the book "Immune System 101" is 1000 pages long. Meaning the immune system is one of the most complicated systems in biology, simple logic arguments like yours above rarely apply, everything needs to be tested to be sure.
People did understand what to do, it just turns out their understanding was wrong. We might still be wrong though, one study isn't definitive proof of anything. We have to make decisions with the knowledge we have at the time, and it's normal for those decisions to look dumb in hindsight.
Lots of things kill infants that harm children, so keeping them away from things that harm some children probably seemed correct. The mechanism for allergy development wasn’t well known and it seems reasonably to avoid it in case it was genetic or something and would cause a hard to treat allergic reaction in the infant.
Bad advice that has a very long return on investment is quite sticky.
For instance the "cry it out method" did massive amounts of psychological damage to more than one generation, but it seemed to work in the short term as the babies eventually learned to "self-soothe".
Even now I still see parents and grandparents suggesting it in parenting groups; and taking extreme umbrage at the idea that it might have damaged them/their children.
Hindsight is 20/20. The fact is that thousands of children were dying and public health officials were set to task to identify interventions that help.
They know that skin and mucosa sensitization can occur in response to allergens.
A reasonable hypothesis is that there’s some boot-up process with the immune system that needs to occur before anything happens. The kids are dying today. “Avoid the thing that can cause sensitization” is a conservative position.
It is unusual that it should have been opposite and that oral exposure induces tolerance. It’s the fog of war.
The standard conservative intervention has helped in the past: I’m pretty sure seatbelts didn’t have strong mortality data before they were implemented. If it had turned out that more people were killed by seatbelts that trapped them in vehicles it would make for a similar story. I think they also got rid of all blood from donors who were men who have sex with men during the initial stages of the HIV pandemic (no evidence at the time).
Edit for response to comment below since rate-limited:
Wait, I thought it was on the order of ~150/year people dying from food anaphylaxis though I didn’t research that strongly. It was off my head. If you’re right, the conservative advice seems definitely far too much of an intervention and I agree entirely.
"The fact is that thousands of children were dying"
What? That's insane, 4-5 kids were dying a year. The whole thing was mass hysteria, that then started to create the problem when there had been none.
[dupe] https://news.ycombinator.com/item?id=45647133
Undoing of the effects of excessive and unnecessary social guidance takes ages.
At some point through the times of civilizations, humans started having less work to do and more idle people around. The idle people started spending their time for preaching a life style other than what was evolved naturally through centuries and millennia. They redefined the meaning of health, food, comfort and happiness. The silliest thing they did was creating norms, redefining good and bad based on their perception of comfort and happiness and enforcing those norms on populations.
Human race continued to live under the clutches of perceptions from these free-thinking idle people whose mind worked detached from their bodies and thus lacked the knowledge gained from the millennia of human evolution.
I think people seek out these restrictions on their own. Almost everyone I know has some sort of belief about what's healthy and what isn't.
Some people become vegetarians, some people become vegans, some people believe eating big steaks of red meat is healthy, some people avoid pork, others do not eat cooked food on some days of the week, others eat only fish on special holidays, some people tell you that yoghurt is good for your gut, others tell you to avoid dairy at all cost, some tell you to avoid carbohydrates, ....
Some of these are backed by science, some are batshit crazy, some are based on individual preferences.
I don't think this is a new phenomenon. People just love coming up with rules, and even if our society allows you to eat pretty much whatever you want, people still seek out restrictions for themselves (and their kids...)
You really think a sense of embodiment can be lost voluntarily?
Yes, when the mind is over-confident of it's education and perceptions, it starts to disobey the signals from body and force the body to follow what mind says. That's when the mind loses the support of knowledge encoded in the body, the knowledge which wass collected through evolution.
The mind tries to compensate the loss with experimentation that can't undergo the same extent of evolution. Then it dictates body to follow the results of these puny and tiny experiments, and ignores the rich knowledge already encoded in the body.