(published in BSEM newsletter, Summer ’04)
Dr David L. J. Freed, MB, MD, MIBiol
I once overheard a colleague defining an allergist as “a doctor who believes his patients.” Allergists of our type have to be prepared to believe quite bizarre stories, so we are either open-minded or gullible, depending on how you look at it. My own introduction to this mind-set came at age 28, when I broke a tibia (and divided the adjacent nerves) in a motorcycle accident and suffered excruciating pain for several months. My doctors refused me effective analgesia because – according to the book – the pain of a fracture like mine only lasts 48 hours. I was disbelieved, patronised and humiliated, on top of the pain, by the very doctors who could have relieved that pain. I resolved that henceforth I would try never to disbelieve what a patient told me. True, that policy has caused me occasionally to be misled by some plausible malingerer, but for every one of those there must have been a hundred genuine sufferers whom I have been able to help.
In 1978 I was 33, an immunologist at Manchester Medical School. My chief, Geoffrey Taylor, had emigrated to the USA leaving the department in my temporary charge, and although the allergy clinic at Manchester Royal was nominally run by one of our dermatologists, de facto it was my clinic (until the new consultant immunologist arrived).
A colleague and I had conceived a new hypothesis about the rôle of gut immunology in digestion [1], and that had started me out on my lifetime preoccupation with food allergy and intolerance. I soon discovered however that I was treading a well-worn path: the subject was already popular with naturopaths, reflexologists and a whole host of alternative characters. One could hardly walk into a health-food shop without tripping over a mound of popular paperbacks about food allergy, usually promoting some wonder cure. Any scientist becoming interested in this field was clearly going to attract suspicion of guilt by association.
I was therefore delighted to see the paper in the Lancet by Finn and Cohen, “Food allergy – fact or fiction?” which was the first good scientific study of the subject I had seen [2]. Those were heady years for the Lancet, with papers practically every week describing unfolding aspects of digestive immunology. Solving half the problems of medicine seemed just around the corner, so I was even more delighted when later that same year I met Ronnie Finn in person, at a symposium on gut permeability.
Ronnie and I were both pretty unusual at the time in our joint interest, and both realised that it could be damaging to our academic careers. He remarked that he could afford the risk because he was already established as a consultant physician at Liverpool (besides which he had the impressive CV of having solved, with Lord Clark, the problem of rhesus disease). He was however worried about my future. I was full of youthful confidence and arrogance and dismissed his concerns (I was however riding for a fall, as we shall see).
We talked about how to bring this cindarella subject into the mainstream of medicine, and he mentioned that in the wake of the Lancet paper he had been contacted by George Hearn with a view to setting up a medical society to study the whole emerging field of clinical ecology. I remember I advised against it! I am glad to say that they ignored my advice and the first group of us came together at the RSM the following year. Prof John Soothill was there and also advised against proceeding, but John is the fairest and most scientific of men, and has given us much support from the sidelines over the years. My conventional allergy colleagues were (sadly but predictably) scathing about the new Clinical Ecology Group and made it clear that by joining it I was jeopardising my own status in respectable academe, but I was still confident that science would win the day.
Of the many bones of contention, the biggest undoubtedly was the neutralisation phenomenon, which was held to be a useful method for both treatment and diagnosis. We classic allergists had little to offer by way of desensitisation (and nothing to offer for food allergy) and I remember wishing fervently that I could believe in neutralisation, which held out the alluring prospect of effective desensitisation not only for pollens but also food and chemical intolerances. But I just couldn’t, it was too bizarre, and totally at loggerheads with everything we knew about immunology. Then in 1984 I saw the paper by Rea et al describing a double-blind trial of neutralisation therapy [3], and I felt the world lurching. This, I realised, was good science; I could no longer evade the issue. On the other hand it would be professional suicide to attempt the method in my clinic at Manchester Royal.
I invited Keith Mumby, who was already working locally with neutralisation, to come into the clinic and demonstrate the method on some of our patients there. This he did, without charge and with some success, but he also irritated the consultant dermatologist, my nominal boss, so much that I had to ask Keith to leave. That effectively stopped that.
And there the matter rested until our first international Congress in Torquay. I met for the first time some of our energetic American colleagues, and came away fired with enthusiasm. Shortly afterwards I was recruited by the Northwest Allergy Clinics Ltd in Manchester (later Bolton).
Already fed up with the galloping bureaucratisation of University life, I resigned my Lectureship and went to work for them. My relationship with the company was rather strained both professionally and personally, and I do not nurture fond memories of the 3½ years I spent there, but two good things did come out of it. Firstly, the propretrix Anna Foster was herself a classic MCS/food intolerance sufferer and I got to know all aspects of that condition at close quarters. And secondly, I observed neutralisation in daily clinical practice and gradually got used to seeing miracles. I would never have found the courage to start neutralising were it not for that. The patient who turned the tide for me, I think, was a young woman who was desperately allergic to dogs. After administering her neutraliser I told her to go out into the corridor and play with the owners’ pet dog. Fifteen minutes later she returned radiant. “I never knew,” she announced joyfully, “how soft dogs were!” [NB: that was beginner’s luck – it’s not always so quick, or so effective!]
I departed the company amidst mutual acrimony in ’88. After a period of chaos (and dire poverty) I set up on my own, an independent Clinical Ecologist, and here I am.
I see the history of British Clinical Ecology in two phases. Until the Torquay meeting we were discovering what everybody thought and what techniques were thought to be useful. We learned about neutralisation, EPD, the Candida hypothesis, elimination and rotation diets, nutrition, the dangers of xenobiotics and hormones. We heard claims for methods both weird and wonderful, including applied kinesiology, dowsing, urine therapy, blood tests, hair tests and skin tests, various electromagnetic devices and their applications to our field of interest. Everyone who had a bright idea used our Society as a shop window for his wares.
After Torquay came the phase of consolidation in which we are now. Our meetings gradually became scientific and evidence-based. One of my enduring memories is of Dr Virginia Alun Jones, serenely reporting research results from Cambridge while rocking her baby in her arms. She had been breast-feeding him earlier in the audience, while listening to the previous speaker - had the infant started crying now, one felt, she might well have resumed suckling him there on the rostrum, without interrupting the flow of either talk or milk. Now that, I thought admiringly, is what I call ecology!
We learned a lot of relevant physiology and environmentology, and realising the intimate relevance of nutrition to our work, we amalgamated with the nutritional medicine society. As with all marriages there have been moments of strain between allergists and nutritionists, but by and large it has been a harmonious and fruitful union. We fought off with reasonable success the first wave of attacks from our more reactionary colleagues by publishing top-quality scientific reviews and a textbook. We survived, bloodied but unbowed, the so-called “Campaign for Health Fraud” and its unsavoury campaign of television “exposés”. We gradually became more politically savvy, and have started to organise ourselves into something more like a recognisable medical speciality.
I am somewhat shocked, looking around the membership and those of us who in ’79 were young, bright-eyed and bushy-tailed, to observe how the rest of you have all aged! I doubt if many of us have become rich out of ecomedicine, but we have learned a tremendous amount, we have snatched success from the jaws of defeat with many thousands of patients, we have started to make a mark on medicine to its betterment – and we have had enormous fun along the way! Not bad for 25 years.
REFERENCES
1) Freed DLJ, Green FHY. Antibody-facilitated digestion and its implications for infant nutrition.
Early Human Development 1977, 1: 107-112.
2) Finn R, Cohen NH. Food allergy – fact or fiction? Lancet 1978, 1: 426-8.
3) Rea WJ, Podell RN, Williams ML et al. Elimination of oral food challenge reaction by injection
of food extracts. Arch Otolaryngol 1984, 110: 248-52.
