Can certain illnesses become fashionable and, consequently, attract more sufferers, asks Sylvia Thompson
Have you ever wondered whether we bring upon ourselves certain illnesses and diseases? Not just through the way we live - poor diet, lack of exercise and sleep and long hours sitting in offices and cars - but in a much broader context.
For instance, is there a fashion for some illnesses and diseases which gives them higher profile and subsequently more sufferers? And do we, through political and media debate about the risk of certain illnesses, increase the frequency of the very conditions we aim to reduce?
Mark Jackson, professor of history of medicine and director of the Centre for Medical History at the University of Exeter, England, presents a fascinating in-depth study of allergies in his new book, Allergy - The History of a Modern Malady (Reaktion Books, £25).
Through his meticulous research into the rise of allergies throughout the 20th century, he is able to draw sharp insights into how cultural, medical, pharmaceutical and environmental forces have brought us to the point that one in three people will be diagnosed with an allergy at some point in their lives.
Jackson writes, "the eruption of allergy in the modern world constitutes a striking story, one that encompasses major transformations in theories of disease and clinical practice, the emergence and co-ordination of global public health interests and the growth of multinational pharmaceutical, cosmetic and cleaning industries".
He says the rise in allergies has played a part in changing domestic, atmospheric and occupational conditions. It has encouraged theories of ecological and environmental sensitivities and fuelled a more technical and culturally complex approach in biomedical science.
Historically, Jackson makes some interesting comparisons between the public perception of allergies now and earlier public perceptions of conditions such as gout and consumption (tuberculosis). In the past, tuberculosis was described as a self-inflicted illness, a disease of modern civilisation, a direct consequence of contemporary lifestyles and environment and - get this - the product of an emergent consumer economy. See any resemblances?
He suggests the historic rise in allergies - and chronic degenerative diseases - is linked to the decline in infectious diseases. In some ways, you could say that as cures were found for infectious illnesses, people no longer had the same worries about them so they turned their attention to less serious ones. In a peculiar way, by turning their attention to allergies, for instance, the problem of allergies grew. And our perceptions of what constituted a serious illness changed.
In the period after the second World War, drug companies turned their attention to developing new treatments for these new diseases. In his book, Jackson provides detailed history of the different treatments - and the varying levels of clinical evidence for their use - that have been used for allergies throughout the 20th century.
One of the most striking sections is on how the over-use of bronchodilators introduced in the treatment of asthma in the 1960s became associated with rising numbers of deaths from asthma in Britain, New Zealand, Ireland and other countries.
Researchers at the John Hopkins University suggested that many countries, including the US, were spared an epidemic largely because they did not market or sell large volumes of the highly concentrated form of isoprenaline that was available in Britain.
Curiously, the fatal consequences of this treatment was transformed in the public imagination into a belief, for the first time, that asthma itself was a life-threatening illness. Ironically, this drove the public to seek out more medication for asthma. In Britain, the proportion of the population consulting GPs for asthma increased from 8 per cent in 1955 to 18 per cent in 1981.
Calls for greater education and support for patients also led to the creation of dedicated asthma clinics, a national asthma campaign and the emergence of asthma societies as a source of advice for sufferers and families.
Over time, the view of asthma as life-threatening was replaced by a view of asthma as a condition you can live with while participating in sports. Various sports personalities were used in campaigns to encourage children with asthma to participate fully in school sports.
By the 1960s, clinical allergy was well established in many western countries as a distinct medical discipline with national professional societies, academic journals and widening international network. Many of these international initiatives were co-ordinated by the newly created World Health Organisation.
Jackson argues that the emergence of WHO drove and fuelled a more expanded view of allergic diseases. Significantly, Jackson says, the first central research unit at the WHO headquarters in Geneva was dedicated to immunology.
A new era of research led to definitions of various types of hypersensitivity and later over time led orthodox allergy specialists to develop a more limited view of allergy, defined by the presence of the sensitising antibody known as immunoglobulin E (IgE).
The impact of the narrowing of the definition of allergy in orthodox medicine gave rise to a burgeoning number of alternative medicine practitioners who argued for a wider definition of allergy.
Jackson outlines how, on a broader political level, allergies were considered to be caused by progressive ecological imbalances and thus enlisted in campaigns against environmental degradation.
While the public focused on outdoor air pollution as a major cause of ill health, clinicians and laboratory scientists were focusing on the indoor environment. And rather than focus solely on house dust, they looked at gas, smoke, paint fumes and other volatile organic compounds found indoors.
Ultimately, Jackson argues that we get the chronic illnesses we deserve. "It is possible that the global epidemic of allergies carefully charted by allergists and epidemiologists, sensationally revealed by the media, and deeply dreaded both by patients and by national and international health organisations was, in some senses, imagined," he writes in one of his closing chapters.
Quoting risk analyst Ulrich Beck, he writes, "health risks can be both real and unreal, shaped not only by knowledge of the past but also fear of the future". Beck argued that widespread fears of plagues of diseases "served both to promote public awareness of new threats to health and to encourage the elaboration of national and global strategies aimed at reducing risks".
The big question is whether we are on the cusp of the wave in terms of society's fascination with allergies. Did allergy simply fit the medical zeitgeist and was it a pseudo-epidemic? Could the emergence and rejection of "total allergy syndrome" in the 1980s have been the height of the disease? Is it significant that public demand for information and support expanded at a time when clinical and public health facilities for the treatment of allergic diseases declined in Britain?
The answers to some of these questions may lie in the promise of a new definition for allergy. Rather than seeing allergy in the traditional way as the body's response to attack, a researcher at the National Institute of Allergy and Infectious Diseases in the US has suggested that the role of immune responsiveness is to preserve biological identity and integrity. In other words, an allergic reaction may be a protective reaction both at an individual and evolutionary level. If this is the case, will this change the public's mindset on allergies? And, what illness will capture the public imagination next? If the WHO is the harbinger of our times, then depression is set to become one of the most debilitating illnesses of this century.
But, can we, as a society, prevent ourselves from succumbing to the illnesses we foist upon ourselves? Or, are we in a Catch-22 situation because even by putting workinto prevention, we are creating the conditions for the illness itself to roll out in front of our eyes.