Allergies are a real problem, and for some people are life-threatening. Allergies also appear to be on the rise in developing countries, and scientists are not sure why.

Meanwhile, charlatans are exploiting fears of allergies and making bogus allergy diagnoses based upon bogus tests. Sense about Science recently published an excellent guide for the consumer to help make sense of what is real and what is fake when it comes to allergies. It is getting increasingly difficult for the consumer, as regulations increasingly fail to maintain a single science-based standard of care in medicine.

Narrative-Based Medicine vs Science-Based Medicine

Fake allergy diagnoses is just one manifestation of what might be called “narrative-based medicine.” I am seeing this phenomenon increasingly, both in my office as patients tell me their tales of their diagnostic misadventures, and as part of my science-based medicine (SBM) activism. The problem is that it takes a genuine dedication to, and thorough understanding of, science-based medicine in order to avoid falling into the trap of confirming your own compelling narrative. There is no sharp demarcation line, but there are examples at the extremes.

Naturopaths and chiropractors are great examples, in my opinion, of narrative-based medicine. What this means is that they have a story to explain what is causing a patient’s symptoms, how to diagnose it, and how to treat it. This story, however, is largely cut off from objective reality. The story itself might make varying degrees of internal sense, and this is deemed sufficient by its practitioners. The narrative is often compelling in that it provides simple direct and confident answers, often to complex health problems. Further, the narrative offers a straightforward diagnosis, and a confident treatment.

The treatments are, unsurprisingly, directly related to what the specialist offers. Chiropractors who fall into this category, therefore, offer adjustments for whatever ails you. Naturopaths offer a wide range of nonsense, but often involve supplements and dietary changes. Often times the treatments are packaged as “natural” or “holistic” and are generally optimized for marketing purposes. However, interestingly, some are harsh, like the recently exposed scam of industrial bleach being sold as an autism cure.

What is most fascinating (and horrifying) to me is that the alternative health narrative can be so powerful for its practitioners and clients. They often involve an elaborate belief system (homeopathy is a good example of this) which is treated by the practitioners as if it were established scientific fact. Belief in the fantasy is reinforced largely by confirmation bias fed by placebo effects.

To make matters worse, a cottage industry is developing to act as a support infrastructure for the fantasy treatments. Independent labs have cropped up that will perform pseudoscientific tests (but superficially seem like the real thing) that are guaranteed to produce the positive result the practitioner is looking for, or at least some positive result.

Unsuspecting patients, therefore, might see a state licensed health care practitioner, who has a degree, who takes a history and does an exam, orders a laboratory test, and arrives at a diagnosis complete with a scientific-sounding explanation. They then prescribe a fake treatment for the fake diagnosis which was confirmed by the fake test. The patient is reassured by the attention of the practitioner and the direct and confident diagnosis, and they therefore feel a little better. Perhaps their self-limiting illness spontaneously resolves. This provides confirmation to the client and the practitioner of the entire fantasy infrastructure.

Allergy Scams

Diagnosing allergies by “alternative practitioners” often falls into the narrative-based medicine category. They rely upon unvalidated and often fanciful tests to “confirm” the presence of allergy. Perhaps the worst is the use of applied kinesiology – muscle strength testing. The patient holds a vial of the suspected allergen in their hand while they hold out their arm to the side. The examiner then pushes down on their arm. If their strength holds, they are not allergic. If the arm gives way, that indicates that the allergic vibes from the test sample are weakening the patient. Applied kinesiology is 100% complete nonsense.

There is also allergy testing through skin conductance. The trick here is that you can change the results by adjusting how you hold the machine against the skin. It is a noisy system, which is perfect for self-deception as you can manufacture apparent signals out of the noise. Hair analysis, IgG testing, cell analysis, and pulse testing are also bogus allergy tests.

Practitioners may use acupuncture or homeopathy to treat the fake allergy. Or they may prescribe removing the allergic item from their diet. This may seem benign, but I have had patients who were convinced they were allergic to dozens of foods, resulting in malnutrition. The negative impact on quality of life, including on those around the patient, should not be underestimated.

Those from the anaphylaxis campaign who advocate for those with serious allergies also warn that the sea of fake allergy diagnoses is a genuine risk for those with allergies.  It creates a background noise that dilutes out legitimate concerns about allergies. Restaurant owners, for example, may have so many patrons with alleged allergies that turn out to be just mild food intolerances that they become lax about genuine allergies. The same can be true of schools, as parents and students become frustrated with the skyrocketing restrictions on food because of students with allergies. Those with genuine allergies need to be protected, their life literally depends on it, and so hiding them in a herd of students with fake allergies is dangerous.

Conclusion

We are increasingly seeing in our modern culture two worlds living side-by-side. In the science-based world practitioners have a genuine commitment to basing their practices on what is truly real. They are flawed people also, and do fall prey to confirmation bias and all the flaws I write about frequently here. In the end, however, they are genuinely trying to be science-based and in this way medical practice grinds slowly forward.

In the other world there is either a complete lack of a science-based standard, or there is an attempt to be science-based but it is so superficial and flawed that in practice it is not science-based at all. In this world philosophy replaces scientific theory, the standard of evidence is shockingly low, and confirmation bias rules.

From the outside, especially for the non-expert,  it can be difficult to distinguish between these two worlds – narrative-based and science-based medicine. The narrative-based crowd is increasingly successful and blurring the lines between the two, gaining the trappings of legitimacy, and using scientific terminology to disguise themselves as science-based. Academia is largely failing to call out the fantasy-based world for what it is, out of misguided openness and political correctness. Politicians are also failing to maintain the regulatory infrastructure that ensures a science-based standard of care. They are too easy to fool by the tireless promoters of nonsense.

Until we reverse this trend, the consumer is left to fend for themselves, and therefore education is critical. The Sense about Science campaign is making a great contribution.