> I think you mean that it's intuitive, but I don't think it's logical, for exactly the reason that it turns out not to be a good idea.
If operating with the best model you have is intuitive and not logical, then everything in science it intuitive and not logical, so we might have to redefine your use of "logical" to be more useful.
Peanut exposure caused anaphylaxis in some kids. Many kids in the world are never exposed to peanuts with no ill effects (in fact, a large portion of the globe went all of recorded history up until the Columbian exchange without exposure to peanuts). If we still want peanuts in anyone's diets, waiting until the child is older for controlled exposure is a logical response. Yes we didn't know how that would affect developing allergies, but as I mentioned in my comment, we still don't understand how allergies develop, so the only difference is we conducted a massive peanut exposure experiment with other countries operating as incidental controls.
> I don't know if this increased the total number of people who died. That'd be an interesting question
In fact, this (plus quality of life + cost of prevention/treatment) is the only measure on which the old guidance could be "exactly wrong", which hopefully gives some insight on why talking about it being "backwards" is itself wrong. It's not Thalidomide. Exposure at 6 months isn't the opposite of exposure at age 3. And whatever harm metric you can define is going to be a result of a mixture of effects, including allergic kids that weren't exposed and kids that (probably) developed an allergy because of the lack of exposure. It's almost certainly on the cost side that it's come out negative, because treatment has improved and exposure prevention has become so widespread.
> It's based on a wrong model of how the world works. Yes, that wasn't known. But I feel like we have to account for the fact that we might not know everything. (Admittedly, this drives me particularly nuts because I think this fallacy pervades so much public health advice, especially for kids.)
I mean, all models are wrong, some are useful. We'll never know everything and you have to work with the evidence you have. Delaying exposure to something that could kill 1% of kids is categorically different than some new study saying "we detected a small magnitude but statistically significant result on speech acquisition due to magnesium supplementation".
If you instead mean we need to better communicate uncertainty in developmental and health recommendations, I completely agree. You can see it in this thread, for instance, assuming that early exposure prevents all peanut allergies. Even if you assume exposure is the only causal variable here (almost certainly wrong), we can observe a baseline level of peanut allergy incidence, so, no, early exposure is not a panacea, but that doesn't seem to have been communicated well.
If operating with the best model you have is intuitive and not logical, then everything in science it intuitive and not logical, so we might have to redefine your use of "logical" to be more useful.
When you're defending a position now known to be wrong, this sort of statement is more rude than it is enlightening (or convincing).
> If operating with the best model you have is intuitive and not logical, then everything in science it intuitive and not logical, so we might have to redefine your use of "logical" to be more useful.
Fair enough. The reason I don't like "logical" here is that it implicitly leaves out the possibility that the conclusion is wrong despite the data being correct.
>> I don't know if this increased the total number of people who died. That'd be an interesting question
> In fact, this (plus quality of life + cost of prevention/treatment) is the only measure on which the old guidance could be "exactly wrong", which hopefully gives some insight on why talking about it being "backwards" is itself wrong. It's not Thalidomide.
You're right -- it's not, like, the worst possible thing they could have said, and it wasn't like immediately fatal to kids that followed it. The sense in which I think the old recommendation was "exactly wrong" or "exactly backwards" is just that the organizations that made the old recommendation decided that doing what the old recommendation said to do (avoid peanuts altogether for the first several years) was worse than doing something that's basically the opposite (expose peanuts early).
> If you instead mean we need to better communicate uncertainty in developmental and health recommendations, I completely agree.
Yes, I think that's a good idea. (I know it has problems, too: most patients need clear, simple guidelines. But I think you can have clear, simple guidelines as well as more nuanced versions.)
I'm definitely not an expert here and I don't claim to know the answer. What I'm looking for is any introspection from the organizations involved. Something like a (blameless) postmortem. Something acknowledging "hey, it seems like this was a pretty big mis-step -- is there something we could have done better here?" Even if the conclusion was "no, we think our methodology in making recommendations is sound for [these reasons], there's just uncertainty, we got unlucky, and the risk of harm is lower than the risk of not saying anything", that would give them more credibility. Without something like that, as a parent, why would I continue trusting their recommendations? (Candidly, it doesn't help that this is just one of many examples of this from public health. See things like: eat margarine instead of butter (oops! we didn't know about trans fats.))
If operating with the best model you have is intuitive and not logical, then everything in science it intuitive and not logical, so we might have to redefine your use of "logical" to be more useful.
Peanut exposure caused anaphylaxis in some kids. Many kids in the world are never exposed to peanuts with no ill effects (in fact, a large portion of the globe went all of recorded history up until the Columbian exchange without exposure to peanuts). If we still want peanuts in anyone's diets, waiting until the child is older for controlled exposure is a logical response. Yes we didn't know how that would affect developing allergies, but as I mentioned in my comment, we still don't understand how allergies develop, so the only difference is we conducted a massive peanut exposure experiment with other countries operating as incidental controls.
> I don't know if this increased the total number of people who died. That'd be an interesting question
In fact, this (plus quality of life + cost of prevention/treatment) is the only measure on which the old guidance could be "exactly wrong", which hopefully gives some insight on why talking about it being "backwards" is itself wrong. It's not Thalidomide. Exposure at 6 months isn't the opposite of exposure at age 3. And whatever harm metric you can define is going to be a result of a mixture of effects, including allergic kids that weren't exposed and kids that (probably) developed an allergy because of the lack of exposure. It's almost certainly on the cost side that it's come out negative, because treatment has improved and exposure prevention has become so widespread.
> It's based on a wrong model of how the world works. Yes, that wasn't known. But I feel like we have to account for the fact that we might not know everything. (Admittedly, this drives me particularly nuts because I think this fallacy pervades so much public health advice, especially for kids.)
I mean, all models are wrong, some are useful. We'll never know everything and you have to work with the evidence you have. Delaying exposure to something that could kill 1% of kids is categorically different than some new study saying "we detected a small magnitude but statistically significant result on speech acquisition due to magnesium supplementation".
If you instead mean we need to better communicate uncertainty in developmental and health recommendations, I completely agree. You can see it in this thread, for instance, assuming that early exposure prevents all peanut allergies. Even if you assume exposure is the only causal variable here (almost certainly wrong), we can observe a baseline level of peanut allergy incidence, so, no, early exposure is not a panacea, but that doesn't seem to have been communicated well.