Thomas Platts-Mills
Appearances
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Because the public doesn't decide which grants get funded.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
This is Thomas Platts Mills. I'm a professor of medicine at the University of Virginia, and I've been studying allergic disease for a long time. And where does allergic disease fall in the pecking order of medical research? It's actually much worse than anything you imagine. Neurosurgeons are at the top, cardiac surgeons, and all these people fight with each other.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
But they know that at the bottom, there are dermatologists and psychiatrists and allergists. I got very little from the university, a little bit in the first few years, but then basically in the last years, nothing. We've always had to get our own money, and I was getting NIH money, and the NIH has been very generous. This last time, I actually got a one on a grant.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
It actually means you're in the top 1%. And then I got a merit award, and the merit award is absolutely wonderful because from 18 to 28, I'm funded by the NIH 10 years instead of five, tick bite research is hot.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
that Congress voted $100 million for it so that we can get tick bite related grants for different aspects of our research. And that's been tremendously helpful.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Oh, come on. God had finished making the earth and then the devil reached over and sprinkled ticks all over it. You know that. No, ticks are very interesting. The deer are absolutely infested with ticks. It is not unusual for hunters to shoot one of our deer and find the thing with so many ticks they couldn't possibly count them.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
They always say I'm bonkers. No, no, I've got away with murder several times. My father taught us that if we think A and the rest of the world thinks B, that is formal proof that A is correct. Being educated in an environment like that, is really extraordinary.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Because the public doesn't decide which grants get funded. The trouble is that the drug companies are so powerful and they advertise so much that people just get the idea that that's what it is. And actually, the guidelines are warped. I've been on a guideline panel for asthma where we were told that we should focus on large controlled trials published in the last five years.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Well, that basically means drug studies. The number of large controlled trials of tick avoidance that are being done is zero. No one could afford to do them. Companies have a lot of money, and they do big, well-controlled trials, some of which are really important, but many of which are me too, or trying a new drug, which is a very tiny variant of the previous.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
it's much more important to try and understand what's happened. I've written a history of food allergy, and there are three forms of food allergy, which are peanut and the other allergens that cause immediate hypersensitivity, eosinophilic esophagitis, and the alpha-gal syndrome.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
And why I pull those apart is because they're mechanistically completely different, causally different, and the reasons why they've increased are different. Peanut is probably ridiculous washing of the skin with detergents. EOE, we've just published a hypothesis that the processing of milk is a major part of that.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Instead of pasteurizing milk at 84 degrees centigrade, all the milk you drink is heated to 135 degrees centigrade. It's dead, and it's homogenized, which means the particles are all changed, so they're much smaller, and we say weaponized to immunize the esophagus. And the third one, the alpha-gal syndrome, we believe is primarily due to the loss of dogs in the suburban areas.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
What happened in the early 80s is leash laws. And now the dogs can't get together to drive the deer out. And so we all have a herd of deer on our lawn and the deer are covered with ticks.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
I was very well known in the 70s for saying that television had had a major effect on asthma. We published a paper in which we showed that if people watched a screen, they took less deep breaths. If they're reading a book, they still breathe normally. If your child is watching television and you touch their shoulder, they actually jump slightly because they're in a trance.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
They're not unconscious, they're not asleep, but they're in a trance. And during that time, the hypothesis was that that prevents their breathing and that deep breaths are a better bronchodilator than albuterol. What's happened since then, if you want something really silly, is the children are no longer watching television because they've got cell phones.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
And the cell phones don't put them into a trance. And asthma has actually become less of a problem. The asthma doctors will be horrified if they hear anyone suggesting that asthma is anything but the total problem. But actually, peanut allergy has become more of a problem than asthma.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Yeah, Gideon Lack, who did the LEAP study, has been looking at celiac and seeing whether natural exposure to wheat in early childhood would prevent celiac disease. And I think he's got some evidence, but it's not of a level comparable to the LEAP study. The LEAP study was a tremendous breakthrough.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
A whole generation of doctors were trained thinking that penicillin allergy was very dangerous. And very common. And very common. And it isn't. When I got here in 82, I already was saying things that, no, you don't need to worry about it as much as this. You need to ask the question first. and take precautions and be sensible.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
If someone had no history in 15 years, the chances that they're penicillin allergic are very small.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
I'm waking my head. People have been trying for a long time. I can't tell you how many of the residents who apply for our fellowship have been doing a study on de-labeling penicillin. So this is not something that people are ignoring.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Well, there's quite a lot of literature that says you can't quite rely on a blood test. And that's what we should have is a simple blood test for IgE to penicillin that absolutely solves the problem.