In a recent Wall Street Journal article titled "Save the Children (and Make Money)," fund manager James Altucher suggests investing in an "autoimmune index," a mix of stocks that have "good, lower multiples and that will supply the arms in our ongoing war against autoimmune diseases." I thought the article was a joke—until Altucher recommended buying stock in Novartis AG because its allergy drug Xolair was going into Phase II trials to see whether it could be useful in suppressing peanut allergies.
Altucher is on to something: Anybody who comes up with a new food allergy drug stands to make a boatload of money. The annual cost of allergies is estimated at $7 billion, according to the Asthma and Allergy Foundation of America, and the School Nutrition Association reports that about 35 percent of schools have some kind of allergy-related food ban in place. Every time I read something about Xolair or food allergies, I am reminded that our fear of children's food allergies is so very disproportionate to the likelihood of serious harm. Many more children die in car accidents on the way to school than from food allergies in the lunchroom; lightning strikes kill more people every year than do food allergies. It raises the question: Are we so afraid of food allergies because they represent a clear and present danger, or have our fears been exaggerated by the vast amounts of money we've thrown at the issue?
Most of what we know about food allergy danger, from the medical literature and in the popular press, comes from a single source: the Food Allergy and Anaphylaxis Network, a nonprofit located in Fairfax, Va. It was started in 1991 by Anne Munoz-Furlong, the parent of a formerly food-allergic child and a onetime researcher at Time-Life Books. FAAN has a substantially pedigreed medical advisory board, including Hugh Sampson and Scott Sicherer, both of whom are highly regarded allergists at the Jaffe Food Allergy Institute at Mount Sinai hospital in New York.
Sampson and Sicherer are excellent clinicians and biomedical researchers, and Munoz-Furlong is undoubtedly one of the most influential parent-advocates of the last 20 years. Their statistical work, however, is problematic. Sampson and Sicherer (who are medical doctors, not statisticians or epidemiologists) co-authored a 2004 paper in the Journal of Allergy and Clinical Immunology with Munoz-Furlong (who is not a statistician, an epidemiologist, or a medical doctor) on their attempt to determine how many people in the United States are allergic to seafood. They concluded that "physician-diagnosed and/or convincing seafood allergy is reported by 2.3% of the general population, or approximately 6.6 million Americans. … [S]eafood allergy represents a significant health concern."
Consistent with the journal's policy to disclose conflicts of interest, the statement attached to the paper read, "Funding sources paid for administrative costs and use of the company that performed the actual survey. The same funding sources have ties to the authors in other ways, but the authors do not perceive a conflict of interest on these accounts, and the relationships are public knowledge."
The authors may not have perceived a conflict of interest, but a close look suggests that a problem may, in fact, exist.
The funding sources for the paper include FAAN, the organization run until recently by Munoz-Furlong and her husband, and the Food Allergy Initiative, a private foundation that finances Sampson and Sicherer's research and clinical practice. Like many social causes, the food allergy movement depends on the assistance of a few wealthy patrons. Elliot and Roslyn Jaffe, who made their fortune with the Dress Barn women's clothing stores, became concerned about their granddaughter's food allergies in the late 1980s. That concern was magnified by an article that Sampson—himself the anxious parent of a food-allergic child—published in the New England Journal of Medicine in 1992. The article sent ripples of alarm through the food allergy community. The Jaffes have helped a wide variety of social causes over the years, so they directed their considerable philanthropic resources toward what they saw as a worthy effort. There wasn't a nationally renowned research center for food allergies, so they established the Elliot & Roslyn Jaffe Food Allergy Institute at Mount Sinai. The family also put $500,000 into the Food Allergy Initiative to help fund the research center at Mount Sinai. Sampson was drafted from Johns Hopkins to run the new Jaffe Food Allergy Institute.
FAI has given millions of dollars to Mount Sinai in the years since. In 2004, the year of the seafood allergy paper, FAI donated $1.6 million, specifically earmarked for salaries and clinical efforts at the Jaffe Food Allergy Institute—basically, to pay the salaries of Sampson, Sicherer, and/or their staff. Munoz-Furlong has also received substantial contributions from FAI for her organization's projects. Sampson currently heads the FAI medical research board, a position for which he receives a $10,000 honorarium. (Under Mount Sinai's institutional guidelines on conflicts of interest, any amount over $10,000 constitutes a "significant" conflict of interest: $10,000 is not reportable, but $10,000.01 is.) He also has financial interests in two allergy drug development firms and holds several peanut-allergy-related patents, including one for a Chinese herbal treatment that, as an "herbal supplement," is not subject to conventional FDA regulations.