Earlier quoted context omitted.
> It's absolutely not backwards. But it is. The best population-level guidance (now) is early exposure. We told people to do the opposite. The result was a lot more kids with anaphylaxis-level allergy. (I don't know if this increased the total number of people who died. That'd be an interesting question, but given that we reversed the guidance, I assume from a public health perspective people now believe the original…
> 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 exp…
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.))