The LEAP Study
This morning, I got into a discussion about how the media has been reporting the recent LEAP study results, prompted by Robyn O’Brien’s discussion of the issue. The study, Learning Early About Peanut Allergy (LEAP), showed that among study participants there was a statistically significant difference in the development of peanut allergies between children who consumed peanuts in accordance with study protocols and those who didn’t. Children who consumed peanuts as part of the study had lower rates of peanut allergy at age 5, whether they initially showed some evidence of peanut allergy or not.
Initial reports about the research tended to herald the study as providing evidence of a “cure” for peanut allergy. “Eating peanuts can cure peanut allergy” was the take-home message of much of the coverage.
Several things got lost in the reporting, as many bloggers in the food allergy community have pointed out:
- The LEAP study participants ate peanuts under the guidance of medical professionals.
- Children who were already severely allergic were excluded from the study.
- The study tested a preventive strategy to prevent the development of allergies, not reverse them.
- There’s no clear way to translate these results into action for children and adults who are already severely allergic to peanuts.
The conversation I had this morning concerned pet peeves of science and health journalism. The coverage of the LEAP study has touched on some of them for me and for others who follow food allergy research. My biggest pet peeve is the way the popular media reports on research for “cures” for complex medical issues. As I’ve learned more about the history and sociology of science, which has taught me to think more carefully and critically about how scientists do their work, my dismay has only deepened.
Problems with “Cure” Thinking: Expectations, Research Infrastructures, and Preventive Care
To me, the way the media ran with “the peanut cure” is indicative of how popular understanding of what science is and can do does not lining up with what medical science actually does and is capable of. I think in general people expect a “cure” on the order of aspirin and penicillin – a pill that can cure what ails you by quickly adjusting your biochemistry or killing off microorganisms. Even widely effectively therapies on the order of AZT (introduced in the 1980s for AIDS) or tamoxifen (introduced in 1990s for breast cancer) were much more significant in terms of slowing or reversing disease than most pharmaceutical treatments being researched today.
Compared to the era of our grandparents and great-grandparents, when medical science seemed poised to fix all ailments very, very soon, pharmaceutical “cures” are much harder to stumble upon these days. In fact, research on chronic conditions like food allergies is rarely about finding a cure at all. It is more often focused on how to improve long-term management through the use of multiple high- and low-tech tools. The object of study is often not a miracle pill, but how to optimize the combined the use of tools already in existence. Even for those conditions where there are medications in the pipeline that promise to be highly effective, how to use pharmaceutical “cures” most effectively alongside other lifestyle measures is still often an important part of the conversation. I think food allergy research, broadly speaking, offers a great example of this.
Modern standards of medical ethics makes it harder to experiment with extracts from other forms of biological life (like penicillin) or chemicals synthesized in a lab on humans or on animals. In general, we favor contemporary ethical protections, but it has added extra steps to the medical research process, making it take longer to turn an idea into a widely-used treatment. The more complex infrastructure needed to ensure safety means that medical research is much more expensive than in the past. Researchers take fewer risks as a result. Instead, research proceeds incrementally, seeking small adjustments to strategy or test molecules that will ensure safety while, hopefully, providing small improvements to treatment.
Contemporary medicine is also more focused on prevention than on cures. Prevention is hard work, though. In the case of the LEAP study, “prevention” means eating peanut in prescribed ways at prescribed times. For those children who participated despite having some sensitization already, it meant ignoring mild symptoms and eating something that makes you feel bad for a better outcome later in life. Prevention in a broader context means eating well, exercising, and reducing stress – things that are hard to do in contemporary life. Preventive steps don’t always feel like medical care, which, I have to imagine, also makes it hard for doctors to have serious talks with patients about routine self-care. In the context of American medicine, where patients pay a large portion of even routine doctor’s visits, preventive care doesn’t get much in the way of support from insurance companies, adding to the inconvenience of talking to a doctor about preventive care. Plus, it’s just not very sexy.
“Cure” Thinking and the Media
Despite these realities of medical research, there’s still an expectation among many non-scientists that a magical cure – something as easy as taking a pill – can be found for every disease and disorder. If only enough time and money is thrown at the problem, a fix will be found. When it comes to media coverage of medical research, editors and reporters know that that’s what we want to hear, even if they “know better” and could frame their articles in other ways. Media outlets fulfill our expectations about what medical science can and should do when they publish articles declaring a “cure” has been found. Despite the objections of scientists and science-informed members of the public, they need to attract views to survive in today’s competitive media environment. Giving people what they want is an easy way to do this.
In the case of reporting on the LEAP study, people in the food allergy community with nuanced knowledge of food allergies and allergy science have called the media’s bluff. The study does not say that feeding peanuts to children is a cure for food allergies; it is much more specific and nuanced than that. The debate has touched on many issues that frequently arise in controversies concerning new scientific research, including where funding for the study came from, the design of the study, and how study findings may eventually be used in clinical and preventive care. It’s fascinating to me to watch all of this unfold in real time.