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One Picture is worth a thousand words: immunotherapy, painting, and the birth of photography

What?  ANOTHER history lesson?  First King Canute, then St. Benedict...now THIS?  More pictures of people long dead?  Oh noooooooooo you say...well I happen to LIKE history.   And those who don't understand history's lessons are prone to repeat them.  So suck it up. But I've got good news for you.  Actually great news. News that will probably keep you reading farther than you thought you would in this journal entry.  For as it happens,

 

This wasn't my idea at all.  

 

One of my many blessings is having creative colleagues at our clinic and one of them, Mary Morris provided me with the ideas behind the little story that I'll be tell you.   The comments, on the story are my own, however...so Mary doesn't have to worry...And the reason I'm telling this story is to give us some insight into the current controversey concerning traditional subcutaneous injection immunotherapy (SCIT) and the "new" more radical alternative--sublingual immunotherapy (SLIT).  In short, what can history tell us about happens when competing 497px-Louis_Daguerre.jpgtechnologies "collide"?  In the early 1900's the frenchman Louis Daguerre (building on earlier work by (Johann Heinrich Schultz)refined a process  of making an exact image of a scene by exposing silver coated copper plates to iodine, making silver iodide.  He exposed the plates to light for several minutes, followed by coating the plate with mercury vapor heated to 75 degrees celsius to bind the image to mercury, and then fixed the image in salt.  The "Daguerreotype" produced an exact image of the scene--and photography was born. 

But that's not most interesting part of the story.  The really interesting part of the story is what the reaction was by experts in a competing field (painting)--as opposed to the public masses.  Across Europe, the new technology of the Daguerreotype was greeted with excitement and awe by the general public.  Exhibitions of this new technology of "painting in light" were held in the storied cities of Europe.  However, Paul Delaroche, one of the most respected French painters of the nineteenth century, solemnly reported on August 19, 1839--"After today, painting is dead."   On the other hand, at the 1860 Paris Exhibition, Charles Baudelaire denounced photography as "the refuge of failed painters with too little talent. It is obvious that this industry has become art's most mortal enemy.  If photography is allowed to supplement art in some of its functions, it will soon have supplanted or corrupted it altogether, thanks to the stupidity of the multitude which is its natural ally."

And what might this story tell us about our current controversey between SLIT and SCIT?   I believe there are three ideas to be taken away from this story:

1.  There may be room for two competing technologies--SLIT AND SCIT.  We all know that painting has "survived" photography.  In fact, far from destroying  painting, photography has actually been a major factor in its evolution. Just as photography is not the "mortal enemy" of paiinting, so SLIT shouldn't be seen as the mortal enemy of SCIT.  Similarly, I believe that SLIT and SCIT can coexist.  In fact, I currently have patients receiving SCIT from University-based allergists for their pollens, and who receive SLIT from me for their food and mold allergies.  Photography does not replace painting.  SLIT may not replace SCIT. 

2.  When it comes to a new technique, the "experts" can't always be trusted to have an accurate perspective on events.  We did not see the "death" of painting with the advent of photography.   Photography is not the "mortal enemy" of painting.  Yet many allergists, I suspect, are mortally "fearful" of SLIT.  And the American allergy community is about as enthusiastic for SLIT as european painters were enthusiastic for the advent of photography.  The masses of people, however, WERE enthusiastic about photography, and so it is with SLIT.  

800px-Boulevard_du_Temple.jpg

3.  Although one technique may not supplant another, one technique may dominate another over time.  I have to admit it.  I like to take pictures.  I don't do a whole lot of painting.  In fact, none.  Most of my friends are the same way.  And when I read the newspaper or read magazines, photographs of course dominate.  Let's face it--photographs are just too convenient, accurate, and easy to take--and produce a darn good likeness.  They get the job done.  And SLIT, I feel, is the same way.  It's convenient, easy to take, and gets the job done. 

   So the allergist has to ask himself,  which will he/she be--the photographer or the painter?   Will he put down his needle and pick up a drop bottle?  Put down his brush and pick up the camera?  Or will he use both?  The choice is ours. 

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