Like tens of millions of people, Stephen Dubner thought he had a penicillin allergy. Like the vast majority, he didn’t. This misdiagnosis costs billions of dollars and causes serious health problems, so why hasn’t it been fixed? And how about all the other things we think we’re allergic to? SOURCES:Kimberly Blumenthal, allergist-immunologist and researcher at Mass General Hospital and Harvard Medical School.Theresa MacPhail, associate professor of science and technology studies at Stevens Institute of Technology.Thomas Platts-Mills, professor of medicine at the University of Virginia.Elena Resnick, allergist and immunologist at Mount Sinai Hospital. RESOURCES:Allergic: Our Irritated Bodies in a Changing World, by Theresa MacPhail (2023)."Evaluation and Management of Penicillin Allergy: A Review," by Erica S. Shenoy, Eric Macy, and Theresa Rowe (JAMA, 2019)."The Allergy Epidemics: 1870–2010," by Thomas Platts-Mills (The Journal of Allergy and Clinical Immunology, 2016)."Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy," by George Du Toit, Graham Roberts, et al. (The New England Journal of Medicine, 2015). EXTRAS:Freakonomics, M.D.
Full Episode
They say that the new year is a good time to express gratitude. So here's what I am most grateful for right now. My health. For much of last year, I was sick. It started in the spring with a cough that turned into a respiratory infection. That turned into a whole other thing. And for a few months, I was miserable. It hurt to talk or swallow.
Every time I laughed, it would trigger a coughing fit, which is a problem because I like to laugh. Thanks to the cough, I couldn't sleep through the night. I also had some ferocious night sweats and crazy dreams. During the day, my entire body ached like I'd been hit by a car. Also, no appetite, no energy. Physically, it was the worst few months of my life. But at least I got a story out of it.
This one. Today's episode is about penicillin. You may remember the famous story of how penicillin was discovered accidentally nearly 100 years ago by Alexander Fleming. This was at St. Mary's Hospital in London. Fleming was just returning from holiday. In his lab, he had left behind a petri dish where he'd been culturing bacteria, and he found some mold growing in the dish.
Interestingly, where the mold grew, the bacteria did not. It turned out that this mold juice, as Fleming called it, could kill many types of bacteria, not just the one growing in that Petri dish. Penicillin was eventually used to treat strep throat, meningitis, dental infections, gonorrhea, and much more. It came to be thought of as something like a miracle drug.
The penicillins are in fact a family of antibiotics, including amoxicillin, ampicillin, methicillin, and several others. All these years later, they are still among the safest, cheapest, and most reliable drugs around. They have saved hundreds of millions of lives. Even with all the new antibiotics since then, penicillin is still prescribed at the highest rate of any antibiotic.
But there's one big problem. 10% of Americans, more than 30 million people are allergic to it. At least that's what the conventional wisdom says. But the new year is also a good time to tear down conventional wisdoms, especially if they are disastrously wrong. And this one is. So today on Freakonomics Radio, why do so many of us think we have this allergy?
Huh. This patient told me they were allergic to penicillin. Oh, it's that your mom told you when you were a kid. Well, what happened? Oh, you don't even know what happened?
What should be done about all these false positives?
We should be screaming from the rooftops. This is a misdiagnosis.
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