Science, Expertise, Trust…and Peanuts

Yann LeCun, who is  Chief AI Scientist at Meta and an ACM Turing Award Laureate, is obviously a very smart and accomplished guy.  At X, he has been arguing for the trustworthiness of science and scientists and asserting that it makes sense for scientists to lean Left…because “they care about facts.”  (here, for example)  I don’t think many of us would disagree with the value of the scientific method and the importance of objective information; I do feel, however, that Yann’s remarks fail to address the importance of funder pressure, peer pressure, and Groupthink on scientific priorities, scientific conclusions, and especially on what gets asserted as The Science by media and politicians.

There has also been some discussion of this cartoon and various experiences that various people have had with doctors who wouldn’t listen.

Very relevantly, there is an article in today’s WSJ about peanut allergy.  The writer, Dr Marty Makary, says that concern about these allergies that began to rise in the 1990s…but that in fact, peanut allergies at that time were rare and mostly mild.  But starting in the year 2000, the prevalence began to surge:

What had changed wasn’t peanuts but the advice doctors gave to parents about them. The American Academy of Pediatrics (AAP) wanted to respond to public concern by telling parents what they should do to protect their kids from peanut allergies. There was just one problem: Doctors didn’t actually know what precautions, if any, parents should take. Rather than admit that, in the year 2000 the AAP issued a recommendation for children 0 to 3 years old and pregnant and lactating mothers to avoid all peanuts.

The AAP committee was following in the footsteps of the U.K.’s health department, which two years earlier had recommended total peanut abstinence. That recommendation was technically only for children at high risk of developing an allergy, but the AAP authors acknowledged that “the ability to determine which infants are high-risk is imperfect.” Using the strictest interpretation, a child could qualify as high-risk if any family member had any allergy or asthma.

Dr Makary notes that the peanut allergy epidemic is largely a US and UK phenomenon…his African students report no such allergies in Africa, and Makary says that there is also no peanut problem in his own origin country of Egypt.  And, interestingly, Jewish children in Israel have one-tenth the rate of peanut allergies compared with Jewish children in the UK, suggesting that genetic predisposition is not responsible for the country-to-country difference.

Many Israeli children are fed a peanut-based food called Bamba, and Dr Gideon Lack, a pediatric allergist and immunologist in London, suggested that early consumption of peanuts leads to a low prevalence of the allergy at older ages. He coauthored a paper making this point in 2008, but (this) publication was not enough to uproot groupthink. Avoiding peanuts had been the correct answer on medical school tests and board exams, which were written and administered by the American Board of Pediatrics. For nearly a decade after AAP’s peanut avoidance recommendation, neither the National Institute of Allergy and Infectious Diseases (NIAID) nor other institutions would fund a robust study to evaluate whether the policy was helping or hurting children.

From 2005 to 2014, the number of children going to the emergency department because of peanut allergies tripled in the U.S. By 2019, a report estimated that 1 in every 18 American children had a peanut allergy. Schools continued to ban peanuts, and regulators met to purge peanuts from childhood snacks as EpiPen sales soared.

and

In a second clinical trial, published in the New England Journal of Medicine in 2015, Lack compared one group of infants who were exposed to peanut butter at 4-11 months of age to another group that had no peanut exposure. He found that early exposure resulted in an 86% reduction in peanut allergies by the time the child reached age 5 compared with children who followed the AAP recommendation. 

From 2005 to 2014, the number of children going to the emergency department because of peanut allergies tripled in the U.S. By 2019, a report estimated that 1 in every 18 American children had a peanut allergy. Schools continued to ban peanuts, and regulators met to purge peanuts from childhood snacks as EpiPen sales soared.

Makary is basically asserting that peanut allergy is largely an iatrogenic disease.  One would think that if this was the case, the original recommendations on draconian peanut-avoidance might need to be modified.  But after talking with an allergist friend, Dr Makary said:

The AAP’s absolutism in 2000 had made the recommendation hard to walk back.

I am sure that there are many, many other examples like this, some of them with a lot worse consequences than the Peanut Panic.  It is actually dangerous to treat any individual or institution as beyond challenge.  In aviation, the reluctance to challenge authority (as in the case of a Captain and a First Officer) was identified as a significant safety problem quite a few years ago, and is explicitly addressed in the training of flight crews.  The same principle should apply more broadly.

The Platonic Form of what Science should be, is subject, when translated into operational form, to all the factors that affect other human activities and institutions: incentives, groupthink, political pressure, ambition, cliquishness, etc.

See also my related post Starvation and Centralization.

Paging Dr Kennedy

Maxwell Tabarrok, at X, asks:

Does anyone have good resources or a blog post on how surgery practice and outcome has improved or changed over the past several decades?

My first thought was that I’ll bet Michael Kennedy can provide some insight on this.

Michael, any thoughts?