Dr David L. J. Freed, MB, MD, MIBiol
You have kindly invited me to contribute to a Fourth Round of debate, but there is now so much agreement between us, Stewart, that there is not much left to debate!Of course that does not prove that our colleagues agree with us, but neither have they overtly disagreed, so we carry the day for the time being. Just a bit of tidying-up now:
1) re: my policy of neutralising substances that test negative, using no 2 as the strongest practicable strength. You raised the question of illogical treatment, over treatment and/malpractice. Well, it's not illogical, as there is a logic behind my practice and I have explained it (though it remains to be proven whether or not it works out in practice). Although almost certainly it does entail over treatment, the wastefulness of that is counterbalanced by the fact that we miss nothing. I explain this reasoning orally and in writing to each patient before he commits himself, and if he agrees to it there is then no question of malpractice.
2) This now touches upon a matter we have not discussed so far, and I guess we should: the question of fee structure.All patients want to know how much it is all going to cost, and you can't answer that question unless you've got a pretty clear idea in advance of how many items you're going to neutralise. In most cases I do, so there is little danger nowadays of pitching my estimate too low. And since with my method I can estimate pretty accurately how much time the testing is going to take, and the number of syringes likely to be used, I am able to quote a single all-in fee for the whole testing package. There are still some patients who only need a few specific substances neutralising, and for those I charge so much per item neutralised, rather than by the hour.
3) Thank you for mentioning that you start testing with the least likely allergens, to establish a pattern if there is one. I do the same thing, but forgot to mention it.
4) Our other disagreements can only be settled by experiment. The ultimate objective is to establish neutralisation and optimise all parameters. Tally ho!
