The Forest

I spent last week in Buenos Aires at my field’s international conference, talking about my research and learning about what others are studying and thinking about. Now that I’m back, I’ve got a cascade of deadlines between now and early December: guest blog posts, dissertation writing fellowship applications, a dissertation chapter draft to accompany one of the fellowship applications, travel funding opportunities, and two more presentations. And tomorrow, I’ll be chatting with one of my academic advisors about my progress and plans for the semester.

For all of these tasks, I need to step back from the specifics of my research on food allergies to think about what it all means. Or, as one advisor once said, I need to think about things from 5,000 feet up in the air – high enough to see a bigger picture but not so high that I lose sight of the specifics of what’s going on at ground level. Being able to generalize – to relate specific findings to bigger, long-standing questions about social behavior and organization – is what sets social science writing apart from other kinds of writing about current or true events.

For the sake of organizing my own thoughts, I want to list a few of the take-home lessons I can see starting to emerge from my interviews, physician shadowing, and immersion in the online food allergy world. Some of these points summarize previous blog posts, others foreshadow some topics I’ll deal with in the future. The list goes roughly from least to most intellectually sexy; 3 and 4 would be the safest ideas to pursue to get an academic job in my field, I think. Some combination of 4 and 5 is the angle I would really like to develop, with the other interpretations as secondary concerns and ways to provide context. I would be excited to hear what others think about these connections, and to hear about others that come to mind!

• Studying food allergy communities can teach us a lot about how and why people with a particular medical condition come together into groups for support and political action. As I discussed in an earlier post, this phenomenon has been called “biosociality” by anthropologist Paul Rabinow in the context of genetic disorders. My contact with food allergy parents and advocates via online channels updates this thinking by showing how information technologies are increasingly an important part of how “patients” and their family members offer each other support. There is also an interesting story to tell about how pharmaceutical companies – in the case of food allergy, primarily Mylan and Sanofi – support such communities both financially (sponsoring events, offering coupons that are shared through blogs and email listservs) and technologically (providing epinephrine autoinjectors that work reliably). 

• Studying trends in food allergy research shows how central the immune system has become to medical science. It wasn’t always obvious that acting directly upon the immune system to permanently change how it responds to intruding allergens would be a promising line of research. Only 25 years ago, second-generation antihistamines were the big thing, even though they only temporarily subdued symptoms. This interest in intervening in the immune system in allergy is occurring alongside similar trends in oncology (and probably in other medical fields that I don’t know well), and alongside intense popular interest in the so-called “microbiome,” the theory that the human immune system works as well as it does due to the cooperation of symbiotic microbes. If the post-war era was the era of antibiotics and the 1980s and 1990s was the era of the gene, perhaps we are now firmly in the era of the immune system.

• Food allergy presents an interesting opportunity to understand the different kinds of “expertise” people can have about a medical condition. Research institutes, like those at the Jaffe Food Allergy Institute at Mount Sinai, are undoubtedly sites where expertise about food allergy is concentrated and put to work researching new ways to treat the illness. But I would argue that food allergy researchers are not the only people who can be considered food allergy “experts.” People with food allergies (and parents of food allergic kids) develop their own “lay expertise” (as it is called in the literature). They learn how to do things like read food labels, cook without flour, eggs, and dairy, prepare 504 plans, participate in the legislative process at the local, state, and federal levels, and write and speak about food allergies for a variety of audiences. There is also a sort of middle ground of non-profits and small businesses where a mix of lay expertise and “expert” or technical expertise meet: organizations like FARE or KFA bring together scientific advisors, people with a personal stake in food allergies, and professional administrators and fundraisers to advocate for issues that help people with food allergies live safely and happily. In food allergy, the divisions between these groups can also be very fluid. Studying how each “kind” or “group” of experts are assembled and work could enrich the social science literature on expertise, which rather unfortunately still often maintains that professionally trained scientists are the only “real” experts.

•  The experiences of people with food allergies can tell us something about what it’s like to live “at risk.” People with food allergies are perpetually at risk of experiencing anaphylaxis. Blogs and listservs are full of stories about close calls or unexpected reactions. In a world where every negative thing that can happen can be described in terms of risk – risk of a bank melting down, risk of developing an illness later in life, risk of defaulting on a mortgage loan, risk of being in an accident, risk of a town experiencing a hurricane or earthquake, and so on – social scientists have developed theories for talking about how risk is calculated and how those calculations impact different groups of people in different ways. Less attention has been paid to how individuals who are “at risk” experience this sense of precarity and what they do to manage it in everyday life. Studying the steps that food allergic people take to minimize their risk and how they plan for possible reactions could connect the big picture theories to everyday life.

• Studying food allergy can help illuminate the moral dimensions of biomedicine (that is, medicine based on modern biological science, often called “Western medicine” or sometimes “allopathic medicine”). Morality and ethics are sexy topics right now in anthropology. Scholars are thinking about how learning cultural habits, religious techniques, and professional skills shapes how a person understands “right” and “wrong,” “good” and “bad.” So far, the only medical topics to contribute to this conversation in a major way are the ethics of organ transplantation and the formation of doctors’ ethical codes through medical training. Thinking about morality in the context of food allergies would highlight how ordinary decisions (like what to cook for dinner) can become morally loaded when the objects or activities involved have the potential to cause life threatening harm. Or, on the flip side, I might consider the social importance of objects with the ability to save lives, like epinephrine auto-injectors. Measures like peanut-free zones at schools and on airplanes also force us to think about who in a society ought to be responsible for changing their habits in order to protect people with an illness – a question that is also, I think, deeply moral. The challenge here would be to come up with some compelling definition of “morality,” since it’s not yet well defined in the literature.