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The Screwtape Letters...for Allergists

One of the great theological writers of our time was C.S. Lewis,--a true "Thinking Man's Theologian".  One of his greatest works was "The ScrewTape Letters", and it was largely because of this work (and others) that he eventually made the cover of Time Magazine.  The Screwtape Letters" is a Christian Satire, first published in book form in 1942. The story takes the form of a series of letters from a senior demon, Screwtape, to his nephew, a junior tempter named Wormwood, so as to advise him on methods of securing the damnation of an earthly man, known only as "the Patient.  It's a truly great work...and as I was reading it again, I couldn't help but think...


                   What if there was a Screwtape Letter...                               for Allergists?   

Well, read on...

                                                                                     My dear Wormwood,

I have been informed of a most dire circumstance in your patient--namely, that he wants to become an Allergist.  This is very worrisome, and bears extreme concern and attention--for Allergists have the capacity to help many people (30% of humankind, so I'm told), and offer relief from suffering in the human condition--something that obviously we want to perpetuate whenever possible and The Enemy weeps to see.  However, we must make the best of the situation, and there is no need to despair, provided you work hard on certain things. At best, we can render him a frustrated, ineffectual healer who misses the true Potential of what Allergy care and treatment is, and lives out his life in a dull, monotonous manner, helping as few people as possible.  How do we do this?  It's not hard:  

First, if you notice, infectious disease specialists never have forgotten that they have to deal with bacteria, viruses, all the time.  Their starting point is the organisms that affect humans.  They seem to have the nasty habit of dealing with all organ systems affected by viral and bacterial particles.  The Allergist has exactly the same relationship with the environment--except with allergens instead of bacteria.  Therefore, it is extremely important that you do everything possible to help your patient forget that allergens are the focus of his work, and that they can effect multiple organ systems, just like viruses and bacteria.  There is fortunately, much you can do in helping him along this pathway of amnesia.  For one thing, make him think of himself as a one-organ doctor.  "Asthma, not allergens", should be the mantra whispered in his ear whenever you get the chance.  Get him enamored with the various colored inhalers that humans so like to use.  Make him lose site of his focus.  Remember--loving asthma (as if "love" is a word that we even approve of down here!) is not enough--we prefer to have him passionately obsessed (there it is!  a much more favorable word!) with it.   This will help immensely in limiting his potential to help all people who suffer from allergy.  Because It's true that all mucous membranes (and the skin!) can have allergic manifestations--but don't let your budding allergist realize that!  And remember--one of our great Allies in this effort are the many medical societies now-in-days that seem to focus on asthma, to the exclusion of the "bigger picture".  Remember, we want him to see Allergy as Asthma, and Asthma as Allergy. Period.   It's that simple!  

Secondly, stifle his sense of curiosity whenever possible. The most dangerous characteristic an allergist can have is curiosity.  You can do this in several ways.  By all means, encourage him wherever possible to view lab tests and prick tests as Gods themselves.  He should "stop thinking and start pricking" whenver he sees a new patient. Believe me, this works!  If a patient has a curious story that doesn't "fit" with a few negative tests, encourage him to--and I repeat myself--stop thinking.  Another good phrase to whisper in his ear when he can't come up with an easy answer to a human's problems is, "you do not have IgE mediated allergy".  That will make him superficially satisfied, and the human can continue to suffer!  Get him solely--completely--interested in IgE mediated issues.  The discovery of IgE was the best thing--and the worst thing--to happen in allergy.  Let's concentrate on the "worst" part whenver possible.  It will pay rich dividends for us!  

Thirdly, whenver possible, your future Allergist should not be encouraged to use immunotherapy for his patients.  For it's the only disease-modifying therapy at his disposal, and it carries the grave risk of helping patients to the greatest degree.  How do we keep the allergist from dealing with allergens, and using immunotherapy?  It's not really that hard--especially with the number and amount of symptom relieving medications at his disposal.  Help him get disoriented--to think he is helping the most when he merely controls an allergic process symptomatically.  Human Allergists love the word control.  They talk about controlling asthma.  Controlling allergic disease, etc. etc. etc.  Get him to love the word control. But better yet--get him to be (and here's one of my favorfite words used once again!) obsessed with it.  Avoid the word "cause" wherever possible.  You will have magnificently and completely failed if he becomes a curious allergist trying to find a cause for his patients illness! He should not be thinking of "causes" for his patients ills--just control.  The irony is that when he is thinking he is "controlling" asthma with his fancy inhalers and monitoring peak flow charts, all the while the "allergic march" they talk about continues!  The irony is he really isn't "controlllng" anything at all!  

But now I have to mention one more item...of gravest consequence and concern.  There is currently a movement in Europe espousing a newer form of immunotherapy.  As I mentioned earlier, your young allergist should not even be thinking about immunotherapy.  But I'm afraid it's to no avail in this case...he'll hear about sublingual immmunotherapy (SLIT) no matter what--and be thinking about it.  A dangerous development, to be sure.  But I'm confident we can make the most of it, if we're careful.  First, remember what I told you earlier about curiosity--you must stifle it in this regard.  Keep him happy with his old ways.  Bring up the emotions of fear and uncertainty and confusion to nullify any temporary excitement he might have for this new business of treatment.  Above all, make him think in a defensive manner when it comes to change in his field.  Again, our great Allies in this area will be his professional societies, so encourage him to dutifully follow their dictums, rather than thinking for himself.  Rather than embracing newer forms of immunotherapy it, he should be fighting them!  Remember, it's dangerous for the Allergist to think about allergens.  He could help somebody.  

I'm confident if you follow my advice above, you'll get the desired result, and we'll have one more unhappy, frustrated allergist brought into the fold!  

Your affectionate uncle, 


Posted on Saturday, November 15, 2008 at 03:37PM by Registered CommenterGeorge F Kroker MD FACAAI in | CommentsPost a Comment

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