Lift Up Your Hearts!

Awesome news.

I just learned that one of the young doctors in our family is going into the field of pediatric allergies, and I can't be happier. Brilliant as she is, I don't expect her to find all the answers to some very complex questions, but I'm thrilled that she thinks the problem worth working on.

For decades I have been wondering: What is causing the great increase over my lifetime in allergies, autism, and autoimmune disorders? Growing up, I'd never even heard of someone allergic to peanuts, and now I'll bet everyone knows at least one person who is. In my day (by which I mean not only my childhood and earlier but my children's childhood as well), peanut butter and jelly sandwiches were even more of a childhood staple than chicken nuggets later became. I suspect everyone today also knows someone on the autism spectrum—a lot more than one that if you live in Silicon Valley or the Seattle area. I hear the location association often blamed on "nerds marrying nerds," and I'm sure that's a factor, but hardly the only, or even the biggest one.

Throwing the net wider now than the three A's I mentioned above, it's my impression that, despite decades of medical advances, children are in general significantly less healthy than they were when I was a child. We were, in some ways, a lucky generation. Antibiotics were new and therefore very powerful. Vaccines were vanquishing dangerous diseases like smallpox, diphtheria, whooping cough, and polio; tetanus was no longer routinely killing infants. (I'm one of the few people remaining who may still have a residual advantage over the general population if we ever get an outbreak of smallpox.) Improved sanitation had largely freed us from other dread ills, although in the case of polio it was a mixed blessing.

We also mostly had mothers who both were there for us day and night, and yet encouraged us to spend most of our free time playing outdoors, roaming the neighborhood, exploring the nearby woods, until dark and without sunscreen. (Yes, we did have and use sunscreen on the beach when visiting Florida, but never, as happens these days, for the hours and hours we spent outside at home.) We didn't have "devices" that encouraged us to live indoors, except for books and games, and even so we were frequently admonished to "go outside and get some fresh air and sunshine."

We had school, which was bad enough for our health, but it rarely intruded on our after-school lives. We did not have social media, and our parents were married (to each other). I didn't meet someone whose parents were divorced until I was a sophomore in high school. Our parents had a different approach to cleanliness, too. Environmental dirt was mostly considered "clean dirt"—there were no antibiotic soaps or cleaners, and if we washed our hands after using the bathroom and before meals, we were good to go. Hand sanitizer was non-existent in our lives. Face masks? They were for surgeons, not children. Catching measles, mumps, German measles (now generally known as rubella), and chicken pox was about as routine as catching a cold, except that we didn't have to stay out of school for a cold. And most of us caught them all in kindergarten despite the mild quarantine. Best "vaccination" I ever had: my rubella titre was still extremely strong after I graduated from college; for all I know, it still is.

"Artificial foods" were on the rise, but for the most part we knew where our food came from; not all, but most of our milk, fruit, and vegetables were local, fresh, and more nutritious than what our children are eating today. Sadly, I didn't grow up with access to raw milk, but our home-delivered milk was at least not homogenized. We had local stands that sold their own fresh-from-the-field fruits and vegetables, quite a contrast to the "farmers' markets" that I can shop at today, which are likely to have more craft booths and out-of-state (or country!) produce than local food. This was changing rapidly, but our food was still much more likely to have natural, beneficial microorganisms than artificial chemical preservatives. "Convenience food" was virtually non-existent, and any kind of restaurant meal very rare.

Then again, we also had very unnatural childbirthing, and doctors who actively encouraged mothers not to breastfeed, and clouds of radioactivity passing overhead, and margarine. No generation has all the advantages. The point is not so much that our childhoods were idyllic as that they were very different, and sorting out what factors might contribute to the rise in allergies, autism, and autoimmune disorders cannot be easy. "Welcome to complex systems."

Here are a few possibilities that I, as an experienced layman, think might be contributing to our children's diminished physical, mental, and emotional health:

• Nothing. The apparent increase in frequency of these afflictions is not actually real, but an artifact of the fact that we've started to pay attention to them, and perhaps changed a few definitions along the way. I used to accept that as an answer, but I'm no longer buying it. It's too much, too pervasive, and we don't dismiss other diseases just because we're paying more attention to them. There are more cancer cases showing up in part because more people are living to get cancer, instead of dying of something else earlier. And our new technologies are making us more aware of the disease at earlier stages. But that doesn't mean that there hasn't been a real increase in cancers, nor that cigarette smoking, chemical spills, bad diets, and radiation aren't significant factors in that rise.
• Greatly increased quantity, frequency, and complexity of routine vaccines. (Have we saved them from traditionally rare and/or mild childhood diseases only to saddle them with life-long disabling conditions?)
• Too little challenge to children's developing immune systems (variations on the "hygiene hypothesis").
• Breastfeeding may have made somewhat of a comeback since I was a baby—at least it's no longer routinely discouraged by doctors—but for most nursing is vastly different from the experience of past generations, which were exclusively breastfed for many months and continued to enjoy this transfer of benefits from the mother's own immune system till age two or three.
• Children are spending much less time outdoors, which by itself comprises many changes: less exercise; less exposure to sun, wind, rain, and other vagaries of nature; less interaction with wild animals and plants; less chance for independent action and exploration; less opportunity for social interaction in the form of pick-up games; less time for solitary walks and thought, for staring at the sky and watching the clouds—each of which is actually a broad spectrum of experiences which no amount of vitamin D supplement, Discovery Channel videos, organized sports, and zoo, garden, and museum visits can replicate.
• Smaller families. It's a lot easier to say, "go out and play," when you several children, and your neighbors have several children each; not only are your children almost guaranteed to find playmates, but there's safety in numbers; if someone gets hurt there will most likely be people there to help, and to run for additional help if needed. Large families also have a built-in support system—ask anyone who found his family isolated under COVID restrictions.
• Hidden environmental toxins. Certain kinds of pollution have been cleaned up beautifully since my earlier days—our air, rivers, and lakes look a lot cleaner, and we're much more careful now about heavy metals and radioactivity—but they're full of less obvious but perhaps more harmful junk, such as herbicides that have been shown to change male frogs into females. What could go wrong with that?
• Changed eating habits. Unbalanced diets, artificial colors and flavors, lack of micronutrients, excessive processing, accumulated pesticides, unhygienic conditions along the food chain, allowing children to be picky eaters, Coke for breakfast, eating on the run instead of at the family table—any number of factors could be trivial, or highly significant.
• Unstable family situations. A good family may be the best predictor of good health.
• Repeated exposure, at earlier and earlier ages, through social media, movies, television, books, video games, school, peer conversation, and even personal experience, to levels of violence, sexual content, adult acrimony, and general divisiveness—once experienced only by children in truly appalling situations, such as war zones.
• Stress levels for children at an all-time high, again excepting the rare appalling situations. What's more, many of their stressors are novel—our bodies have been training for eons to deal with periodic starvation, but being bombarded daily with tragic news from all over the world, not to mention having to decide whether one should be a boy or a girl, is not something we've been equipped to handle. This kind of stress has physical as well as mental and emotional effects.

I'm sure you can easily add to this list.

Of a few things I'm certain: (1) Our children's mental and physical health is in serious danger, (2) there is not one clear culprit in this tragic situation, but an interaction of many factors, and (3) as a society, our priorities are really screwed up.

While not denying climate change, nor the need for integrity in sports, nor our sins of the past, nor our inter-relatedness with other parts of the world, it's clear to me that we are spilling vast multitudes of ink, money, and angst on relatively distant and/or contested issues, while barely acknowledging the suffering and even death of children "right next door." There's been a remarkable improvement in prevention and treatment of adult cancers, but for decades almost none for children, probably because it isn't a research priority. We obsess over slavery from 200 years ago, but a film like Sound of Freedom, which brings to our attention the beyond-shocking world of modern-day slavery, not to mention pedophilia, child pornography, and the role of Americans in producing, facilitating, and consuming the evil, is mocked, derided, and trivialized by those with the most power and influence. (It's hard not to speculate that there might be some conflict of interest there.)

There's a place for training children to avoid the things they are dangerously allergic to, and for teaching compensatory strategies to those with autism spectrum disorders, and for developing new medications and strategies for dealing with autoimmune diseases. But it's high time we recognized that these are stopgap, third-best measures, far inferior to prevention and cure.