Thursday, February 25, 2010

Does lactose intolerance really need a NIH panel?

I will go out on a limb: I think that lactose intolerance should not be medicalized.

I stumbled upon this story on WebMD discussing the NIH panel on lactose intolerance. First of all I was shocked that my tax dollars are even spent on a NIH panel on lactose intolerance. Reading the rest of the story provided ample opportunity for further shock. 

For example, did you know that we do not have an idea of what the prevalence of this scourge is? So, clearly, we need large representative studies to establish this. OK, so gathering evidence is never a bad idea. But in an odd juxtaposition to the call for evidence was this statement:
"The numbers may be elusive, but outcomes of a dairy-poor diet are easy to predict."
Really? Is this statement evidence-based, or is it setting up the argument that some associations are just too obvious to need evidence behind them? Because if it is the latter, I for one do not appreciate the double standard. In fact, the statement, though not ostensibly a direct quote from an "expert", seems rather irresponsible to me, implying that we should feel free to apply opinion-based and consensus-based principles to this question.

My final outrage came when reading that (I paraphrase) for a bona fide diagnosis one should really undergo a breath test, and other (by implication) more serious conditions need to be ruled out, such as irritable bowel syndrome and celiac disease.

Why, you might wonder, does this engender such a visceral reaction from me? Surely it is not because I do not feel compassion for those people who suffer these conditions. And it is not because I do not want to learn more about them. What worries me is that having a diagnosis requires treatment, usually with a drug directed at the symptom. I am very concerned that, instead of understanding and dealing with the underlying causes of, say lactose intolerance symptoms, we will slap the band-aid of a pill, a course much more expedient, though potentially far more detrimental, than looking for a preventive solution. In the case of lactose intolerance, the non-pharmacologic solution may have something to do with the way our milk is produced and processed: our terror of things microbial has driven us literally to sterilize milk prior to consumption. Some people feel that this "deadness", lack of organisms that through their own lactase production may potentially help us digest it, exacerbates the symptoms of the intolerance.

But this answer would be neither simple nor politically palatable. Who would support this type of research? Milk manufacturers, who would have to overhaul their operations completely? The government whose regulations drive our milk production? The small community of committed farmers who produce raw milk, but do not have corporate muscle behind them? Not likely. And what about public opinion, so durably skewed by the establishment to fear all microorganisms?

So, when a NIH panel begins looking at an issue like this, I naturally worry. And while I do want to know more about it, I am skeptical of the end-result. Are we going in the direction of 100% prevalence of chronic disease requiring 100% penetration of prescription drugs in the US?


  1. I agree with every thing which was stated in the blog. This particular "affliction" effect many people, yes. Does it need medical/pharmacological treatment, no. It is my understanding the easiest way to "treat" lactose intolerance is diet. And then there are questions of degree. How sever are the symptoms? Can the person live with them? can the person never have ice cream?

  2. The Wall Street Journal either had an article on lactose intolerance of folded it into a recent story on genetics and evolution. Since some of us are predisposed towards it, can we say that it's not a problem that needs fixing so much as a part of our physical heritage that needs simple respecting? Or am I beinge naive? People in my family have it and while it sucks on the one hand, it's really only gently debilitating.

    I do find the potential long term consequences interesting though - colon cancer etc. - these are issues we are concerned about, yes?

    This makes me wonder though, in terms of inside baseball, how does an issue even get this far with the NIH? Who benefits right now? I assume lactose intolerance is competing with other issues for attention . . .

  3. Thanks both Anonymous and Sean for your comments. Both of you are right on target and have articulated the whole idea of priorities quite well. The questions are:
    1. Is lactose intolerance a disease or a nuisance condition, possibly a normal variant, as implied by Sean's comment, that can be gotten around fairly easily?
    2. On the scale of priority diseases to address, where does lactose intolerance rate?
    Although I do not know the process by which topics get selected for the NIH to address, it does seem to be a catch-as-catch-can approach that mirrors our "market" approach to healthcare in general. Is there a lactose intolerance lobby? :)

    Again, thank you both for your comments.