#842: The Story Behind EpiPen, The Rise of Food Allergies, and What Doctors Got Wrong
Timestamps are as accurate as they can be but may be slightly off. We encourage you to listen to the full context.
Podcast Summary
This Drug Story episode explores the fascinating and alarming connection between food allergies and the EpiPen, revealing one of medicine's biggest blunders. Host Thomas Goetz takes listeners through the surprising discovery of anaphylaxis in 1901 by French scientists studying Portuguese man o' war jellyfish, to the development of epinephrine as a treatment, and ultimately to the creation of the EpiPen auto-injector. (00:58) The most shocking revelation: medical recommendations in 2000 to avoid feeding babies potentially allergenic foods like peanuts may have inadvertently caused millions of children to develop food allergies. (25:00)
- Main Theme: The unintended consequences of well-meaning medical advice and how the precautionary principle in healthcare can sometimes backfire spectacularly, creating the very problems it seeks to prevent.
Speakers
Thomas Goetz
Thomas Goetz is a senior impact fellow at the University of California, Berkeley School of Public Health and the host of Drug Story podcast. He served as executive editor at WIRED magazine from 2001 to 2013, leading the publication to a dozen National Magazine Awards. His writing has been repeatedly selected for Best American Science Writing and Best Technology Writing anthologies, and he has authored bestselling books on health and technology.
Dr. Gideon Lack
Dr. Gideon Lack is a professor of pediatric allergy at King's College London whose groundbreaking research revolutionized food allergy prevention. His LEAP study provided definitive evidence that early exposure to peanuts prevents allergies rather than causing them, directly contradicting decades of medical guidance and leading to new recommendations endorsed by Dr. Anthony Fauci in 2017.
Key Takeaways
Early Food Exposure Prevents Allergies
Contrary to decades of medical advice, exposing babies to potentially allergenic foods as early as 4 months dramatically reduces allergy risk. (48:54) Dr. Gideon Lack's LEAP study found that children who consumed peanuts early had only a 1.9% allergy rate compared to 14% in those who avoided peanuts. This 86% reduction rivals the effectiveness of successful vaccines. The key insight: the immune system needs early exposure to learn tolerance, and avoidance actually sensitizes children to develop allergies later.
The Precautionary Principle Can Backfire
The American Academy of Pediatrics' 2000 "one-two-three rule" (avoid dairy until age 1, eggs until age 2, peanuts until age 3) was based on the precautionary principle rather than scientific evidence. (25:00) This well-intentioned guidance created a feedback loop: more avoidance led to more allergies, which led to more fear and avoidance. The lesson for professionals is that "better safe than sorry" approaches require rigorous scientific validation, especially when dealing with complex biological systems.
Challenge Conventional Wisdom with Data
Dr. Lack's breakthrough came from questioning why Israeli children, who eat peanut-flavored Bamba snacks from infancy, had dramatically lower peanut allergy rates than UK children. (27:26) Rather than accepting established medical dogma, he designed rigorous studies to test his hypothesis. This demonstrates the importance of cross-cultural observation and the courage to challenge established practices when data suggests alternative approaches.
Understand Unintended Consequences in Business Strategy
Mylan's EpiPen pricing strategy demonstrates how companies can exploit captive markets through strategic positioning. (41:36) By training teachers only on EpiPens (not competitor devices), lobbying for school requirements, and creating exclusive purchasing agreements, Mylan achieved "lock-in" that allowed them to raise prices from $109 to over $600 without losing customers. This illustrates how regulatory capture and monopolistic practices can emerge even in life-saving industries.
Scientific Paradigm Shifts Require Gold Standard Evidence
Despite Dr. Lack's compelling 2008 observational study showing lower allergy rates in Israel, medical practice didn't change until his randomized controlled trial provided definitive proof. (47:49) The LEAP study's rigorous methodology—640 children followed for 5 years—was necessary to overcome decades of established medical practice. This highlights that in high-stakes fields, extraordinary claims require extraordinary evidence, and observational studies, while valuable, may not be sufficient to drive policy change.
Statistics & Facts
- Food allergies affect approximately 10% of adults in the US and between 6-10% of children as of 2024, representing a massive increase from about 1% of children in the 1970s. (19:54) This dramatic rise coincided with the hygiene hypothesis era and increased avoidance recommendations.
- The LEAP study showed an 86% reduction in peanut allergies when children consumed peanuts early (1.9% allergy rate vs 14% in avoiders), a protection level comparable to successful vaccines. (49:02) Dr. Lack noted they were only statistically powered to detect a 50% reduction, making the 86% finding astonishing.
- EpiPen revenue grew from $200 million in 2007 to nearly $2 billion by 2023, with prices increasing from $109 per device to about $350 (in a required two-pack totaling $700). (53:12) This represents more than a 600% price increase over 16 years despite the core drug, epinephrine, being over 100 years old.
