 | Jill Fisher Professor - University of North Carolina at Chapel Hill |
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01.03.2023-29.03.2023
Challenging Allergies: The Search for a Magic Bullet for Pediatric Food Allergies
The primary objective of this book is to ground the analysis of these emerging medical interventions in the lived experiences of families who struggle with managing their children’s food allergies, including how such experiences shape their perceptions of benefit and risk when pursuing treatments for their children. I will use the concept of pharmaceuticalization to guide my analysis.
Scientific research and product development are reshaping the food allergy landscape. This transformation can be understood through the lens of pharmaceuticalization, wherein normal human experiences or conditions become targets of pharmaceutical intervention and defined as disease. The availability of a drug shapes how people understand their bodily experiences and how medicine is practiced, for better and worse. Scholars who have focused on the pharmaceutical industry have argued that there is a problematically low bar for new drugs to make it to the market, their clinical benefits are rarely as impressive as companies’ promotional materials imply, and their risks to patients are typically far greater than is known at the time of FDA approval. The US context is ripe for pharmaceuticalization given the cultural penchant for technological fixes and a desire for a “pill for every ill.” This is not to diminish the health risk faced by children with food allergies, but it is vital to analyze the development of such treatments as part of the political economy of pharmaceutical use and a culture of consumer convenience.
Given the phenomenon of pharmaceuticalization, the question of how to define therapeutic benefit is of paramount importance. Should benefit be tied to how much of an allergen someone can safely consume? Should benefit instead include changes in quality of life, and if so, for whom? In the world of pediatric care, the benefit could be defined not only for food-allergic children but also for their parents. Critically, children’s food allergies have substantial impacts on families. Following food allergy diagnosis, many families severely restrict their activities, including avoiding restaurants, travel, and socializing with other families. Indeed, food allergies are perceived of as a “family project,” with high degrees of vigilance and planning that decrease patients’ and families’ quality of life. From the standpoint of families, the emphasis in determining benefit from food allergy treatments might be placed on the degree to which they feel less stress or anxiety about their children’s food safety and risk of accidental exposure to allergens. However, by increasing parents’ sense of control over allergies, treatments may improve parents’ quality of life while diminishing their children’s who end up suffering more allergic reactions from their treatment.
Dr. Fisher’s NIH-funded research examines how clinical trials are conducted and who participates in them as researchers and human subjects. In her 2009 book Medical Research for Hire, she shows how clinical trials have become a revenue stream for physicians and an important source of medical “care” for uninsured patients. Her more recent work has explored healthy volunteers’ participation in clinical trials. Healthy volunteers gain no health benefits and expose themselves to risks for the stipends that pharmaceutical companies pay for their time. In her 2020 book Adverse Events, Dr. Fisher analyzes healthy volunteers’ participation in these drug trials through the lenses of stigma and social inequality. She is currently conducting research on the involvement of children in clinical trials for peanut and other food allergies.
In addition to her work on clinical trials, Dr. Fisher has published on the social construction of Munchausen syndrome, tattooing as a cultural practice, gender and science, hospital tracking and location technologies, non-human animal research, and qualitative methods.
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