From the desk of the EMD: Back to the future

November 6, 2017

I hope that you saw the Summer 2017 issue of the College Advantage and specifically the article entitled “A Glimpse into the Future.”  The article contained predictions on the future of allergy – made by members on the College’s 50th anniversary in 1992. The predictions were sealed in a time capsule, and revealed and commented on for the 75th anniversary. I found some of the insights into our future fascinating, and was lucky enough to read all the submissions from 25 years ago. I’m going to share with you some more of these predictions – and by the way – not all were about advances in the field of allergy.

Several allergists predicted that allergy would be cured. One wrote, “I predict that by the year 2017, allergy testing and immunotherapy as we know it today will be a thing of the past. Allergy manifestations will be treated with a reduction of IgE by blocking its production or by neutralizing its ability to elicit an allergic response.” Of course, we are still performing allergy testing and immunotherapy, but this allergist definitely foresaw omalizumab for our patients.

Another theme on the brave new world of allergy treatment was genetic manipulation leading to control and/or cure of allergy and asthma. Here was one comment on this prediction: “Genetic engineering will allow the prevention of allergic diseases by altering the appropriate genes either before fertilization or in utero.” While we are not there yet in allergy, genetic treatments are entering clinical medicine, especially with the recent approval of a gene therapy for cancer treatment.

Another prediction that gave me a laugh was “RASTs will be done in machines on street corners and Woolworth’s”. I grant that this allergist was correct with RAST being done by more than just allergists, but at Woolworth’s? Of course, I am old enough to remember Woolworth’s, but for our younger members, it was a retail store and one of the original five-and-dimes. It ceased business in the U.S. in 1997.  

Not only were there predictions on allergy treatments, but also on the state of allergy practice in 2017. Several allergists made the forecast that “allergists and all physicians will be on salary”. There is no doubt that this trend has continued to grow over the last 25 years though not as rapidly in allergy as in other medical specialties.

Another theme was more regulations in medical practice, and that we probably are headed towards “socialized medicine.” “I believe we’ll all be working for the government,” wrote one allergist. “Allergists will be severely restricted in their access to patients by gatekeepers. To have satisfactory patient relationships we will be ‘moonlighting’ seeing fee for service patients after hours. Because of decreased funding and more governmental regulation, very little new medication and other therapies will have been advanced since 1992,” he (?) went on. Thank goodness, the practice of allergy is not as bad as this allergist prophesied. I think we can all agree that there has been an explosion of new therapies, such as biologics, for our patient population.

There was a prediction by a fellow in training that 30% of allergy fellows would be female by 2017. In fact, it is in the 50% range.  Two allergists thought that the US would have a woman president within 25 years, but as yet that prophecy has not been fulfilled.

My favorite forecast for 2017 was, “It will be learned that compliance is brought about by a good doctor-patient relationship. All the rest is conjecture.” The field of allergy and the ACAAI have grown tremendously in the last 25 years and I predict that allergy and our organization will continue to make exciting strides in the next 25 years. We must not forget, as mentioned by one of our colleagues 25 years ago, that it is our relationship with the patient that must always be at the forefront.