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The "Allergy Industry": Heading for a Bailout?

It's happening already, and a major crisis is present:  A powerful American institution, whose leaders lack vision, has largely pursued a "business as usual economic  model".  They suffer increasing competition from their more visionary overseas counterparts,who are more  aggressively promoting alternative (hybrid) technology. Demand by U.S. consumers for the overseas products increases, perceived by the consumer as more safe, and efficient.  In addition, workers in the industry, who have generous benefits through their contracts, are reluctant for change.  In short, the American institution is in increasing danger as being perceived by consumers as "out of touch".  They don't want a "business as usual" business model.  They want--and indeed demand--innovation.  

Think I'm talking about the Big 3 Automotive industry?  Wrong.  Think again.

I'm talking about the "Allergy Industry." 

Bailout:  An ugly word for ugly times.  Yet, that's what Detroit Automakers want (and think they need).  And the American public doesn't like it.  One bit.  Thomas Friedman, in the New York Times, wrote a devastating commentary on this issue in "How to Fix a Flat"  In it he states the frustration of The Common Man on this matter:

How could these companies be so bad for so long?  Clearly the combination of a very un-innovative business culture, visionless management, and overly generous labor contracts explains a lot of it....We have to subsidize Detroit so that it will innovate?  What business were you people in other than innovation?" 


And what's with the flood of big truck commercials?  Personally, as I watch commercials for American vehicles, I ask--does everyone in the world really NEED a big honkin' truck that has 4 wheel drive and can climb 50 degrees up the side of a mountain while hauling the Titanic behind it with a steel chain?  Does my vehicle really need to survive a chain-suspended drop from a helicopter? Maybe a simple fuel-efficient Honda would do just fine.  Know what?--it does for me. I don't need a vehicle that can survive being tossed out of the lake by the Loch Ness Monster.  I need a vehicle to get me to work and back home again as efficiently and safely as possible. And I suspect most people do too.  

Which gets me to the Allergist and the Allergy Profession...

Sublingual immunotherapy (SLIT) has now proven a convenient, efficient way to deliver disease-modifying treatment to the allergy population.  At the recent ACAAI conference, there was no longer any questionas to whether SLIT is effective.  (And that's a first). Meanwhile our overseas European counterparts don't just talk about SLIT, they continue to use  SLIT effectively and produce prodigious research.  I've never really heard of SLIT described as a "hybrid" technology. but if we continue to use our "automotive industry analogy",  that's exactly what it is--a blending of a conventional form of treatment (antigen extracts initially designed for injection) and combining it with a new delivery system (sublingually).  And, like most automotive hybrid technology now-in-days, it will continue to evolve and become more and more efficient.  SLIT as it now exists, will give way eventually to "second generation" vaccines designed exclusively for the sublingual mucosa.  Case in point:  Razafindratsita et al in the JACI (vol 120, pp 278-285), in an article entitled "Improvement of sublingual immunotherapy efficacy with a mucoadhesive allergen formulation", concluded that 

Mucoadhesive formulations offer the opportunity to improve dramatically sublingual immunotherapy in human beings, most particularly by simplifying immunization schemes. 

I've stressed throughout this blog how the individual allergist needs to develop his/her sense of curiosityin order to be a superior allergy clinician.  On an individual basis, working allergists, like their unionized labor counterparts in the automotive industry,  have "generous benefits" in terms of reimbursement for allergy injection immunotherapy (SCIT).  They worry about losing these benefits if they start utilizing SLIT.  As one allergist said, "I make a good living with SCIT--why should I change?"  Since insurance contracts largely don't cover SLIT, the average allergist doesn't  want to "risk" changing over to SLIT, even though the literature shows it to be more economicaly efficient, convenient, and safe.  Insurance companies won't pay for it if it isn't a "usual and customary" procedure, and allergists don't want to do SLIT if they lose their lucrative insurance contracts.  A "Catch-22" of the first order...

However, the problem is compounded by our "institutional leaders".  Our institutional leaders in allergy need not only curiosity, but the capacity for creative innovation.  While our overseas counterparts were developing "hybrid technology", we continued to have our own "allergy factory" geared towards injection immunotherapy exclusively, effectively ignoring the obvious public interest in alternative forms of immunotherapy that have potential for increased convenience and safety.  As an organization, we should be falling all over ourselves in aggressively investigating SLIT.  Instead, our institutions have a defensive posture.  The glass is either half full or half empty.  And they see it as half empty.  Plenty of old, tired arguments abound regarding SLIT:  "the European literature doesn't apply to our American (polysensitized) patients", or "homeopathic doses are used", or "there is no consistenet recognized effective dose for SLIT", or "It's not FDA approved for use" (a blatant lie--it's off-label use of an FDA approved extract--perfectly legal) My response to all this nonsense by the allergy community?

So What?  Let's get a life.  Dickering with tired, old arguments is  getting us nowhere--fast.  Let's be thinking creatively.  Let's be innovative.  Let's pursue new "technology" aggressively--in a positive fashion.  In short:

Let's get to work. Let's get a vision.  

Because if we continue dickering amongst ourselves on technicalities, other groups will bypass us, and we'll simply be left with a less efficient, less convenient outmoded technology, utilized by a dwindling "customer base".  And then the real crisis begins...

Is the Allergy Industry headed to a bailout?  It's already there--we're not financially bankrupt, but we have a more serious bankruptcy issue--with creative innovation.  Someone needs to rescue us from ourselves. I'm afraid we have run out of new ideas, creativity, and innovation.  We're scared. Not innovative. In short, we're intellectually bankrupt--and that, my friends, is where the bailout is needed.  

Later, Dude







Posted on Thursday, December 4, 2008 at 04:42PM by Registered CommenterGeorge F Kroker MD FACAAI in | Comments5 Comments

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Reader Comments (5)

Haha am I actually the only comment to this awesome writing?!

May 29, 2010 | Unregistered CommenterNorbert Washburn

this is fantastic writing and so very true. I am in health care, and deal mostly with allergies- your speak the absolute truth about the "modern allergy machine" not stepping up to the plate. I tell patients that they may be reacting to food allergies, and they think it is the weirdest thing they have ever heard- my doctor has never told me that. Just getting an allergy work up is hard to get from some practitioners. I also suggest an allergy to nightshade vegetables when they have chronic pain- another idea that has been lost in translation. Please keep up the great work.

July 21, 2010 | Unregistered Commenterstephanie

Big difference between alergy and sensitivity, your industry is peddling sensititivty and claiming it is alergy. That is dis-honest.

July 12, 2012 | Unregistered CommenterBiles

I didn't talk about sensitivity or allergy in this post. Rather, I was outlining the problems in the allergy industry as I see it. And they are big problems. The only thing I am "peddling" is 1: having the Allergy Industry have an honest self-appraisal of their short-comings and 2: exploring all potential treatments (including SLIT) that might help our patients.
Now THAT's honest!

July 12, 2012 | Unregistered CommenterRenaissance Allergist

Hi there - completely agree and love your writing... I posted last night on your Uveitis page but my post has gone :(
I'm in the UK and I think we are suffering the same - yet other countries in Europe take this seriously.

Keep up the fight for all our sakes!

Thank you...

December 31, 2014 | Unregistered CommenterSean

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