Your Second Opinion

June 9, 2010

Raw Milk – think Tevya

Filed under: Health Risks — drsecondopinion @ 6:09 pm
Tags: , , , , , ,

Sorry for taking so long to finish up on diabetes—the diabetes project has turned out to be more complicated than I thought and is now in its 3rd revision. I’m trying to do something useful that does not read like a PhD thesis.

I have also been on service lately, which is fatiguing.

So, to relax, I decided to get into a semi-religious argument about raw milk.

Recently, here, there has been an outbreak of toxigenic E. coli infection in people who have obtained raw milk from an area farm. Obtaining and drinking raw milk is semi-legal in this state.

E. coli (an organism) is a normal resident in cow bowels and in cow manure. It doesn’t bother the cows but is a major player in lethal food poisoning outbreaks in people (think Jack-in-the-Box). It is fairly obvious how this bug got into the milk—perhaps that was what gave it some special flavor. As far as I know, five people were infected: two children were hospitalized, no deaths. The total number of people actually infected is, of course, unknown, as this farm’s sales practices did violate the state law here, and the enthusiasts may be reluctant to report unless they were very ill.

In the cow, geographically, the place where the manure comes out is fairly close to where the milk comes out. If the manure is on the floor, it is even closer. It is not hard to see how in the absence of very careful practice, the two could become mingled. This bug reproduces about every 20 minutes in a good growth medium, so it doesn’t take a lot of them to get a big population very quickly.

Did you see the movie Fiddler on the Roof? Tevya was the milkman. He milked his cow in the small stall (when was it last cleaned?), into a bucket (same question), then into a larger container (and again). He had no refrigeration. Then he went through the village ladling it out with a utensil that was banging around in his cart. On a larger scale, this was about what milk production was like in this country at the turn of the twentieth century, and, as a result, milk was the second most important source of food borne disease. Only contaminated water was worse, at that time.

The recognized diseases then associated with milk were primarily typhoid and tuberculosis. Disease related to E. coli, listeria monocytogenes (more about this later), and other salmonella were described, but their relationship to milk was not clear then. These were very serious and common diseases at the time.

The problem was overcome by pasteurization. The term pasteurization refers to a technique initially ascribed to Louis Pasteur. He was a chemist by training in mid 1800’s France, when France was the center of true scientific thought and practice. The story is that he was studying the formation of tartaric acid crystals in wine, looking at it with a microscope, when he observed microscopic entities that he associated with different types of spoilage in the wines. He decided these were alive, and began a career as a microbiologist. One of his early interests was how to keep the wine from going bad, and he found that heating the wine eliminated what he was seeing and preserved the wine. He later applied this to beer, with mixed results. He never applied this technique to milk. (Who in France drank milk as an adult?)

The technique has since been applied to many different foodstuffs, including milk. Depending on how it is done, it can eliminate virtually all of the organisms in a material. It was applied to milk in the early twentieth century bringing a miraculous drop in milk-borne disease. When this was combined with testing dairy herds for TB, and eliminating it, milk-borne disease was practically eliminated. When was the last time you heard of milk-borne outbreak from supermarket (highly regulated) milk?

Like many other previous biologic terrors (such as polio), milk-borne disease is not known to current generations, and therefore has no ability to induce fear. Outbreaks of these diseases in small populations don’t get much attention. Nonetheless, they are still out there.

The primary pathogens out there now in raw milk are toxigenic E. coli, salmonella, and listeria monocytogenes. The last is a bug not well known in the population, but well known to us in critical care and neurology as it tends to cause meningitis and sepsis (very bad), particularly in people who have lost their spleen. There are others. There was an outbreak in Minnesota several years back of a diarrheal disease, Brainerd diarrhea, linked to raw milk from a specific farm. No clear etiology was found. The infected had the disease for many months. There have been outbreaks of listeria particularly in the southwest, traced to unpasteurized cheese brought up from Mexico.

Raw milk has become a cause célèbre, very trendy, in this country. It is mostly illegal by state laws, so obtaining it has the extra cachet of defying The Man. It is available through clubs, on farms, and in a semi-underground economy; usually expensive. Its proponents are very enthusiastic, stating that there are almost magical properties of cow’s milk that will improve the person – which magical properties are destroyed by pasteurization. I see many references to how raw milk is supposed to improve the immune system, although I’m not sure how that is defined, what evidence there is, or even what evidence there could be (how would you study this in a healthy population?).

And considering that the immune system of the healthy human being is pretty robust (after all, there are about 6 billion of us), do we need our immune system tweaked? I have taken care of enough people with lupus, rheumatoid arthritis, various forms of vasculitis, aplastic anaemia, polymyositis, Sjogren’s syndrome, one guy with Behcet’s, Reiter’s Syndrome (now known as reactive arthritis, Dr. Reiter was a very bad man) and so on to wonder if an overly active immune system is a good thing.

Other purported benefits of raw milk I have read of include supporting local farming, generally improving vitality, tasting better, and some concept of generally improving karma. Except for the taste, which I am told people can really distinguish (although I’d like to see that myself), I haven’t seen any proof of any of these.

Although milk is a very good food, we were not really designed to drink it as adults. Many people, perhaps the majority worldwide, do not tolerate it well. Even children were not designed to drink cow’s milk. I don’t know many vegans, but those I do know seem to be doing very well, and I have not heard of widespread immune dysfunction in that group. Therefore, if there is a benefit to drinking raw cow’s milk, it must be very small.

Given the known risks, and the hard-to-find benefits, it is hard to see why one would drink raw milk (other than taste).

It intrigues me that when there is a raw milk related disease outbreak, the media is filled with the testimonials of supporters of raw milk. If a bottle of pasteurized milk, from the grocery store, was implicated in such a thing, there would be an immense hue and cry about public safety. This is, to me, evidence of an implicit agreement by the users of raw milk concerning its risks, which may add to its attractiveness for some.

Bottom Line:

  1. If you know and are willing to take the risks of drinking raw milk, fine with me. It may qualify you for a Darwin award, but some people like to cliff dive while others like to drink raw milk. We all choose our risks.
  2. I, and my colleagues, will help bail you out if you lose the gamble, and you will survive—maybe.
  3. I have concerns about your children. They are not able to truly weigh the risks and do not have the power to make decisions against the wishes of their parents. They also are more ferociously attacked by the pathogens, particularly the E. coli (the condition they get is called hemolytic-uremic syndrome, and it is worse than it sounds, even). To me, it seems morally sketchy to expose them to this unnecessary risk for no proven benefit, but unfortunately, worse things do happen to children in our society.

I would not be surprised to get vehement responses. No death threats, please.



  1. No death threats from me. I LOVE this.

    Raw milk has always looked like huge amounts of ridiculous to me. But maybe because I have a history degree and have a better idea of what life was like in The Good Old Days…

    Comment by maggie — June 9, 2010 @ 6:55 pm | Reply

  2. Raw Milk…

    My father-in-law’s fourth blog post is published now. All of the non-oil-spill news for the last 24 hours here has been about an E. coli outbreak from raw milk….

    Trackback by Patrick — June 9, 2010 @ 6:59 pm | Reply

  3. My father is a working on a book on Pastur. Nice article I shared it on facebook.

    Comment by Zachary Kessin — June 9, 2010 @ 9:49 pm | Reply

    • you just like it cause it’s got Tevya in it :D

      Comment by Hannah — June 10, 2010 @ 5:50 pm | Reply

      • Not actually a huge Fiddler fan, but very much a microbiology fan.

        Comment by Zachary Kessin — June 11, 2010 @ 9:18 am

    • In the good old days, say 1915, the life expectancy of a man was 45(mean), of a woman 36(mean) – childbirth death was the major difference – when the social security bill was passed, life expectancy for a man was abut 65 years(strike a bell?) and a woman’s was about the same

      Comment by drsecondopinion — June 13, 2010 @ 10:23 pm | Reply

    • Although he was overshadowed later by the amazing work of Robert Koch, Pasteur’s originality of thought was truly breathtaking

      Comment by drsecondopinion — June 13, 2010 @ 10:25 pm | Reply

  4. Wait – you mean that if it was done for hundreds of years, and then we changed it radically, the old way isn’t automatically better?

    Insanity! Bring back smallpox! Bring back polio!

    And for heaven’s sake, let’s stop giving women pitocin after giving birth. Hemorrhaging to death is NATURAL! Women did it for generations.

    Comment by LeahGG — June 9, 2010 @ 11:09 pm | Reply

    • I agree with the sentiment -the lack of experience with exactly how bad things can be is altering behavior. I recall two children my age on our block coming down with polio, ending with shriveled and weak limbs (but alive) – since none of us have seen these things in our adult lives, we worry more about minimal risks, such as vaccine risks, and not the real problems. Didn’t someone say that those who do not learn from history are bound to repeat it?

      In my earlier years as a physician in the south, I did see, on a couple of occasions, women die from exsanguination after childbirth.

      Comment by drsecondopinion — June 13, 2010 @ 10:30 pm | Reply

  5. (Who in France drank milk as an adult?)

    Sensible people, the French.

    I see many references to how raw milk is supposed to improve the immune system, although I’m not sure how that is defined, what evidence there is, or even what evidence there could be (how would you study this in a healthy population?).

    Maybe they’re mixed up with breast milk for babies?

    I don’t know many vegans, but those I do know seem to be doing very well, and I have not heard of widespread immune dysfunction in that group.

    Wow, that was quite unexpected and very pleasant. I don’t often hear many votes of confidence for veganism from within the general medical profession, just a lot about how we need to supplement with perhaps some diversions into the four food groups. But I suppose given your first post on vitamins I should have expected that you’d be different/better!

    Just a curiosity: you still say that milk is a very good food, despite our not really being designed to drink it as adults — or even as children (I know Dr Spock ended up of this view also). What do you see as the benefit of milk, and is there anywhere else we can get that benefit?

    Comment by Bronwen — June 10, 2010 @ 2:20 am | Reply

    • Milk is a good food in that is contains fairly large amounts of biologically valuable protein (casein) which contains a number of essential amino acids (these are amino acids we need to produce vital proteins, but cannot sythesize ourselves – you could consider them vitamins, but they are present in many, many different food stuffs.) It has some niacin, and an amino acid one can convert to niacin. In the late 1800’s and early 1900’s, thorough the 1920’s, pellagra (niacin deficiency) was a scourge in the south, killing many children. It was found that milk would cure/prevent this terrible disease. In order to promote mild production (not easy in the southern climate), milk production was subsidized by the federal government, with the amount of the subsidy determined by the distance the location was from Eau Claire, Wisconsin. As far as I know, that is still the case today. It also contains carbohydrate (lactose) and some fat, up to 4% in standard homogenized milk, more in some mild form our local co-ops (pasteurized, thank you). This makes it a very good overall food, which needs to be consumed in moderation, as with most things.

      Comment by drsecondopinion — June 13, 2010 @ 10:38 pm | Reply

  6. […] Raw Milk – consider Tevya « Your Second Opinion […]

    Pingback by The raw milk debate | Blood pressure Blog — June 10, 2010 @ 7:13 am | Reply

  7. Hello, Dr. Second Opinion!

    I’m an old e-friend of P and H. Quite enjoying your work on this blog. You’ve got a great conversational tone.

    I noticed there was one reference to cheese from unpasteurized milk. Do you think it falls in the same category? I’ve been led to believe that these “artisanal” cheeses have better flavour than their pasteurized counterparts. Are they equally dangerous, or does the process of making cheese eliminate some of the risks for e-coli, etc? I know that listeria is still a risk, as do most women who’ve been pregnant in the last decade. I was even warned against pasteurized soft cheeses when I was carrying my daughter.

    Have you had any experience with these kinds of cheese? What are your thoughts?

    Take care and keep blogging!

    Comment by Kat — June 10, 2010 @ 8:21 am | Reply

    • I personally do not have a great deal of experience with them – people who know about cheese tend to agree about the use of raw milk in some of them. I understand that the European Union has outlawed raw cheese, raising a great brouhaha in France, particularly. There was a major listeria outbreak of listeria about 10 years ago, in the San Diego area, some deaths, and our current outbreak in Minnesota does have some cheese related cases, I am told.

      We all decide what risks we are willing to take – I admit to eating hamburger that is not cooked to 160 degrees, knowing that this could be problematic – I take other precautions, but I know they are not foolproof. The key point, to me, is the comment you made about pregnancy – We all can take whatever risks we think reasonable for ourselves, but taking them for someone else who has no say in the matter seems dicey.

      Comment by drsecondopinion — June 13, 2010 @ 10:43 pm | Reply

  8. Frankly, I’d be happy to simply find regular pasteurized goat milk on the shelves. Why is it so hard to find?! Stupid ultra-pasteurization.

    @Kat: There are quite a few people who say cheeses are more cheesy with raw milk – I think there’s definitely a degree of truth to that, since the organisms in the cheese can affect the flavor, sometimes dramatically so. Aging cheese does reduce the risk of foodborne pathogens (such as after 60 days), but it doesn’t eliminate it.

    I certainly wouldn’t recommend eating raw milk cheese if you’re worried about getting food poisoning, and definitely not if you’re pregnant or at risk or anything. I guess it’s one of those risks you take in life, like eating raw cookie dough.

    Raw milk is pretty silly, though. It’s not healthier, it’s not more flavorful… it’s just a bad idea all around.

    Comment by April King — June 10, 2010 @ 11:22 am | Reply

    • My undersatnding about ultra-pasteurization is that is really a commercial thing -that is, it extends shelf life and allows for boxed milk,like Parmalat markets – I have been told by several people that it rell does change the taste of milk, makes it taste cooked – to my knowledge, it has no health advantage over the standard technique

      The problem with goat milk, and other organic milks, is that it may take longer to actually get them into the hands of the consumer, and the ultrapasteurization is done so that the milk doesn’t go sour

      Comment by drsecondopinion — June 13, 2010 @ 10:47 pm | Reply

      • Parmalat/UHT milk tastes radically different from “regular” milk you get in the store. And not for the better.

        Comment by LeahGG — June 14, 2010 @ 6:45 pm

  9. On taste: I think a substantial number of people who enjoy raw milk are doing it for the taste, and a substantial number of those people like the taste because it’s 1) fresh 2) full-fat (whole) 3) non-homogenized. That taste is substantially different than what most of us non-farmers grew up with: the sitting-in-the-superamerica for a week 1% milk that’s a staple of city dwellers, and I can totally understand the appeal.

    I’m sympathetic to the general thought that diets which substantially differ from what our bodies have been used to over the previous hundred thousand years are going to be “worse” than ones full of things which, as has been said (Michael Pollan, I think) “Your grandfather would not call food.” I don’t find that argument too compelling for raw milk, since cow-milk drinking is of relatively recent origin, and so poorly tolerated by many bodies.

    At the heart, though, you seem to be questioning the popular notion that, as healthy children and adults, we’re _under_exposed, in small quantities, to certain microorganisms (or even other toxins) that, in extreme cases, can kill you. I’ve seen this described as the “hygiene hypothesis” (example article: How do you see E. coli, salmonella, listeria, etc in raw milk as different? Is the difference purely quantitative?

    Comment by Jer Smith — June 11, 2010 @ 2:28 pm | Reply

    • The hygeine hypothesis has been around for a long time – In the abscence of evidence that people who are exposed to lots of diseases at a young age live longer, or better, makes it hard to support – it would be very difficult to ethically do such a trial, so I tend to ignore that view

      however, a thought totally unrelated to milk, there is an organism call helicobacter pylori, very common, a cause of duodenal ulcers, but also atrophic gastritis over years, which eliminates your ability to make stomach acid – in the third world, people pick up this bug as children, and after about 30 years, do not make acid – in the industrialized world, we either pick it up much later, or not at all- there has been, over the last few decade, a major increase in a particular type of esophogeal cancer in the industrialized countries, adenocarcinoma – classically, esophogeal cancer has been a different type, squamous cell – the interesting thing, is that adenocarcinoma is strongly associated with a condition called Barret’s esophagus, which is caused by acid reflux into the esophagus – in addition, the widest selling pharmaceuticals in the industrialized world are the acid treatments, PPI’s, such as omeprazole, lansopearazole, etc. to reduce stomach acid- this is really food for thought

      As for listeria, toxigenic e.coli, etc, these are true pathogens, and they will harm/kill anyone, anywhere, and do – the primary cause of childhood mortality worldwide is diarrheal illness, which these organisms cause

      Comment by drsecondopinion — June 13, 2010 @ 10:58 pm | Reply

      • Having looked at the pro-raw-milk link posted elsewhere, let me explain my layman’s understanding of the principles which make the argument for raw milk convincing to some people, and you can explain where exactly the logic breaks down:

        1. Almost all food we eat contains microorganisms.

        2. Most of those organisms are harmless: our body either has these naturally present, ignores them, or people with a mostly functioning immune system handle them quickly without any medical intervention or long-term damage.

        3. Some organisms are clearly beneficial, usually in the breakdown of other organisms/chemicals, and are usually referred to as “probiotics.”

        4. Other organisms are beneficial in that, in small amounts, they increase our bodies’ protection from larger amounts or similar more harmful organisms.

        5. No claim has been made that we’ve been able to track and classify all of these microorganisms, just the major ones. In human breast milk, we continue to discover new benefits.

        5. Pasteurization only discriminates based on temperature, there’s no attempt to distinguish bacteria A from B. In some cases, known probiotic microorganisms are added back into milk after pasteurization.

        6. The dairy industry run by huge agribusinesses, who regularly influence food safety legislation (as well as subsidies, etc) in a way that benefits them.

        7. Pasteurization allows for relative safety of cow milk, even in cases when it’s obtained uncleanly. Historically, clean farming operations are expensive and it’s cheaper to use antibiotics or chemical processes to sterilize food after the fact than to verify the food remains uncontaminated throughout.

        So, if the net result of all of this is that a raw-milk advocate claims that there are beneficial microorganisms or chemicals (either directly (3) or indirectly (4), in milk that we have not yet classified, and those organisms are destroyed during pasteurization, I find that difficult to argue.

        Of course this doesn’t mean that on balance, one is much better off with pasteurized milk (or no milk at all, for that matter). It does bring the discussion into the realm of comparing known risks to relatively unproven benefits, something that we’re terribly poor at doing, particularly with respect to substances we ingest.

        Comment by Jer Smith — June 14, 2010 @ 6:27 pm

    • I don’t know about your neck of the woods, but at least here in Minnesota, it’s quite possible to get (pasteurized) local whole milk that is so rich that it does the cream-on-top separation. Expensive, but delicious, and Cedar Summit Farms puts it in glass bottles :)

      In short, it’s not pasteurization that makes milk less fatty or tasty. Pasteurization just means the milk gets heated up. The fat is not burned off or anything.

      Comment by heyelid — June 14, 2010 @ 9:00 am | Reply

      • Re-reading I didn’t make my point clear…there are several obvious taste differences (like you mention, packaging makes a difference too) besides pasteurization between “typical” cow milk and raw milk, and I can imagine many people confusing the source for the taste difference. I’m 100% certain I could “take the pepsi challenge” between a cardboard carton of Wal-Mart’s finest and raw chilled milk. I’m not confident I could do the same between raw milk and equally fresh fatty non-homogenized milk.

        Comment by Jer Smith — June 14, 2010 @ 4:45 pm

  10. I am a survivor of raw milk luckily. We were raised to believe milk was the perfect food. These days I never drink milk and eat little dairy. There is too much processing going on and even the organic craze is questionable and sometimes means lets add more organic cane sugar.
    Life is just fine without it, surprisingly.

    Comment by susan duby — June 12, 2010 @ 7:05 am | Reply

    • Did you have one of the bad consequences? Ecoli with thrombotic thrombocytopenic purpura, or sallmonella sepsi – I have personally treated about 6 people with the TTP, 4 of whom were food borne – I’m curious as to how prevalent this really is.

      Comment by drsecondopinion — June 13, 2010 @ 11:00 pm | Reply

  11. Just another thought, I agree with the taste hypothesis: who doesn’t like cream rolling around in their mouth full of fat and calories? It’s the american way to find another way to indulge in high content fat foods.

    Comment by susan duby — June 12, 2010 @ 7:08 am | Reply

    • I am all about high-fat foods, myself – but in the case of milk, one need not remove the fat to pasteurize.

      Comment by heyelid — June 14, 2010 @ 10:38 am | Reply

  12. With all due respect, there are many things I take issue with as stated in your blog. I will not take the time to itemize them, but I will point you and your readers to the website for very clear (and referenced) responses to the arguments against raw milk. In case anyone is interested in an intelligent discussion and not one based purely on emotion.

    Comment by raw milk advocate — June 12, 2010 @ 9:23 pm | Reply

    • I don’t think that ‘e-coli is bad’ is based on emotion …

      Comment by Maggie — June 13, 2010 @ 2:50 pm | Reply

      • There’s always one in every crowd.

        Comment by Kat — June 13, 2010 @ 8:56 pm

    • I don’t feel particularly emotional about the subject, actually – I have treated TTP (I don’t see children, and so have not dealt with HUS, the child form of this) – it is challenging, intellectually difficult, requires plasma exchange and frequently dialysis, but I haven’t actually lost anybody with it.

      The risks are clear, I did not make them up. I have people i see who smoke 2 packs a day, some who have used, maybe still do, IV drugs, are rock climbers, many motorcyclists – we all choose what risks we wish to take, and have our own reasons for doing it. I have not heard of outbreaks of these classical milk borne disease in commercial pasteurized milk.

      In our current outbreak, the newspaper tells me there are now 2 more cases, no deaths.

      Comment by drsecondopinion — June 13, 2010 @ 11:09 pm | Reply

    • FYI, the outbreak the dr. is referring to is a recent outbreak of E.coli in Minnesota due to consumption of raw milk.

      Initial article in Star Trib:

      A follow up from last friday here:

      Two children have been hospitalized in this outbreak, one for three days.

      Comment by heyelid — June 14, 2010 @ 9:11 am | Reply

  13. [quote]The hygeine hypothesis has been around for a long time – In the abscence of evidence that people who are exposed to lots of diseases at a young age live longer, or better, makes it hard to support – it would be very difficult to ethically do such a trial, so I tend to ignore that view[/quote]

    I think that you and I have heard two different versions of this theory. The version that I learned [and that is ethically able to be proven/disproven] is that children who are kept in overly sterile environments are more prone to allergies and auto-immune disease and also just plain get sick more often because their wonderful G-d given immune systems do not have the normal amount of pathogens to act against and sometimes end up turning against the person’s own body. It has nothing to do with deliberately making children sick or exposing them to contagious disease; instead it means allowing children to live in a “normal” environment in which their bodies are able to come into contact with a normal range of pathogens and thereby create immunity to these “normal” buggies.

    Whether or not you disagree with this theory the fact is that certain allergies [one example is peanut allergies] have become more prevalent and more severe in recent years; when we see this type of trend we must research what has changed environmentally that is causing this change. The jury is still out and research is still being done so we will see what results time and further research brings.

    Comment by Rena — June 14, 2010 @ 1:54 am | Reply

    • Rena, I think you are assuming without evidence that “certain allergies have become more prevalent and more severe in recent years”. We have only recently even been somewhat able to track these things. Furthermore, whatever tests we have for allergies have only recently been invented, let alone standardized.

      What is recent is that people have had the time and ability to think and worry about things like allergies and autism. That is because, thanks to vaccination, pasteurization, availability of clean milk and other foods, we no longer have to worry about things like polio, e.coli, and pellagra.

      When my father was a child, kids on his block were dying or being crippled for life by polio and there was nothing the doctors could do. Everyone was terrified, parents had no way to protect their children. I assure you people weren’t measuring the number of kids with allergies. They were worried about healthy kids becoming paralyzed.

      Because, thank G-d, we now have ways to prevent things like polio, we are now focusing on lesser problems. Consequently it probably appears that there are MORE of these lesser problems. I think this is just an issue of perception.

      Comment by heyelid — June 14, 2010 @ 9:21 am | Reply

  14. Rena – I wonder how much of that is related to awareness – how many people died of peanut allergies without it being known what they died of? That is – people who died of their first or second exposure without ever having received the diagnosis of allergic.

    That could account for some of the rise in allergies. Remember that children died in childhood of all kinds of things and the documented reasons were (and still are) best guess for the time.

    Comment by LeahGG — June 14, 2010 @ 8:23 am | Reply

  15. I’m not sure what you mean by recent — do you mean that these things weren’t known about in ancient Mesopotamia or in the years before Van Leeuwenhoek invented his microscope? Anaphylactic shock is a pretty obvious thing to diagnose even if we don’t know exactly which allergen is causing it.

    As far as food allergies becoming more prevalent the statistical evidence is there without question and doesn’t take too much effort to locate.

    We in the medical field have been treating allergies even while polio and other diseases were more prevalent.

    Comment by Rena — June 14, 2010 @ 4:37 pm | Reply

    • Rena: I disagree that there is scientifically valid evidence of allergies “recently” becoming more prevalent. If you believe it is so easy to find, why don’t you present some.

      I warn you that I will examine what you present for actual validity, so please don’t waste time linking to some holistic website that bases its conclusions on what people reported in telephone surveys.

      The question isn’t whether anaphylactic shock is “easy” to diagnose (most allergies don’t reach that level, of course.) The question is whether we had scientific methods of gauging pervasiveness of allergies prior to about 50 years ago, or anyone even attempting to do so. And we didn’t.

      Comment by Hannah — June 16, 2010 @ 3:02 pm | Reply

    • Another thing – Apparently, anaphylactic shock was in fact only “discovered” (described) about 100 years ago:

      The persons who discovered it actually received a Nobel Prize for so doing.

      This discovery was relatively recent – probably because in fact, anaphylactic shock is not “easy” to “diagnose” when you don’t know what it is or what causes it.

      Observationally, you might see a person get stung by a bee, then later fall over dead. You might reasonably assume it was a particularly deadly kind of bee.

      Comment by Hannah — June 21, 2010 @ 4:07 pm | Reply

  16. As I stated above, anaphylactic shock is pretty obvious to diagnose even if we don’t know the exact allergen causing it so no, people were not just dropping dead fifty years ago from allergies while we physicians were just saying, “gosh, what was that all about?”

    So far as childhood mortality, sometimes children died and we couldn’t be sure of the cause but much of the time we could be sure what killed them — pertussis, flu, diarrheal illnesses, and so forth. What is probably more accurate is that most people were rather ignorant of what their own children died from and many did not have access to good medical care or information and so the family histories that were passed down included stories of children that died “from unknown illnesses”.

    Comment by Rena — June 14, 2010 @ 4:44 pm | Reply

    • so no, people were not just dropping dead fifty years ago from allergies while we physicians were just saying, “gosh, what was that all about?”

      So you have access to death rates from allergies from fifty years ago? Please do link to them.

      And these studies you are claiming show increased rates of allergies – they are based on death rates, are they? Please link to those too, cause I can’t find any.

      Also, my point is that any increase we COULD find based on our sketchy records might be correlated with decreases in other risks. Because fifty years ago people were dying of all kinds of OTHER things (see, e.g., polio, above) there would naturally be fewer dying of allergies. I doubt there was much alzheimer’s disease in 1700. Alzheimer’s-related deaths have probably increased substantially since then – simply because now more people live long enough to die of alzheimer’s.

      Increases can also be based on increased DIAGNOSIS as opposed to increased incidents. People may be more likely to get medical care for allergies (most of which are obviously not fatal) now than they were in the past.

      Comment by Hannah — June 16, 2010 @ 3:10 pm | Reply

  17. fair enough. I’m guessing that before the age of cars, if you didn’t have a doctor living very nearby and your kid went into anaphylactic shock, you didn’t bother to call the doctor, because it was too late. The coroner (if there was one and you didn’t just bury the kid without anyone ever taking a look) would probably often mark it as natural causes if there was no reason to suspect foul play, because why would they care if it’s heart attack, allergy, stroke, etc?

    I’m guessing that reporting is part of the issue. I’m certain that reporting accounts for much of the rise in autism diagnosis.

    Comment by LeahGG — June 14, 2010 @ 5:01 pm | Reply

    • Leah: I agree. We didn’t even have a diagnosis for autism until recently and it certainly wasn’t standard for children to be detected, tested and treated. Increased diagnosis should not be confused with increased incidence.

      Regarding death rates, I don’t know when “allergic reaction” became a nationally compiled cause of death – or even if it is now! I think Rena may be assuming a lot of things here.

      Comment by Hannah — June 16, 2010 @ 3:13 pm | Reply

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