In a recent Washington Post article, our CEO Aaron Carroll Drawing on earlier work in JAMA Pediatrics along with his co-author Ron Keren, M.D., highlight the impact on trust and population health of issuing guidance for the public to follow before the evidence can catch up. The example they highlight, relates to an American Academy of Pediatrics (AAP) recommendation that breastfeeding mothers and infants should avoid foods they may become allergic to like peanuts, tree nuts, and eggs. However, for years, pediatric guidelines in multiple countries told parents to do something that may have increased the risk of the very outcome they feared most. And later, research found that early introduction of these foods actually protects people from developing allergies.
He argues that the central issue was not misinterpreting strong evidence, but acting before strong evidence existed, leading to guidance that was delivered with more certainty than the data could support. Carroll also highlights how long it took for recommendations to be updated and how deeply earlier guidance persisted in shaping behavior even after being rescinded because the original message had been so ubiquitous. This “contributed to the problem everyone was trying to avoid. Research conducted in the last decade has shown that early introduction of allergens to children protects them against developing food allergies. Withholding allergens makes reactions more common. Expert advice caused more allergies than would have developed if those experts had remained quiet.”
Ultimately, this is about the pace of plausible, well-meaning guidance moving faster than the evidence. We saw this most recently during the COVID-19 pandemic where decisions had to be made rapidly without understanding the cascading consequences of these policy recommendations.
The updated guidance on allergies is meaningful for children and families. However, we shouldn’t move past this moment without acknowledging what happened, and what it should teach us. The role of HSR isn’t just course-correcting but about being honest when we do not have the evidence to support a recommendation, we should say so, clearly and without embarrassment, rather than fill the silence with confident advice that turns out to be wrong. This is a problem that Aaron Carroll has been writing about for years. From claims regarding foods that raise cholesterol, health of margarine vs. butter, and school closures during the pandemic. Following the evidence in practice means acknowledging limitations. The USPSTF, which AcademyHealth has advocated for through attempts to disband the task force, provides ongoing recommendations that are updated. They are transparent about what they know, how sure they are about it, and why.
Read the piece in The Washington Post, as well as the article in JAMA , as well as coverage of it in MedPage Today and CNN. Aaron also reflects on avoiding allergens when his own children were born and the role of HSR in evaluating real‑world outcomes, informing better decision‑making over time, and improving health guidance in the Washington Post.