3.5/5 stars
Recommended if you like: nonfiction, science, medicine, allergies
Honestly, I'm not really sure if this is a 3.5 or 4 stars. I was already on the fence, though I had it listed as 4 stars before I looked further into MacPhail, and then I decided to drop that half star once I saw and read some of her other writing. If you're looking for someone with scientific acumen with a firm grasp on the human and sociological implications of said science...look elsewhere. If you're looking for a primer on the topic before diving into more rigorous text, then it works well enough for that purpose.
I should note, I looked into MacPhail, she has no research publications that I could find from after 2015 and little to no non-academic work that I could find since then up until the publication of this book. While I wasn't planning to read anything else by her, I did see that she had a book on Ebola and global health, as well as a (non-academic) article about the topic from the 2014 Ebola epidemic, which I believe is an excerpt from said book (though I could be wrong). I read the article and Big Yikes. While her book on it might articulate her thoughts better, the framing of global health in the article I read was quite frankly ridiculous. Are there problems in the field of global health and with global health responses? Absolutely. Is saying that global health doesn't exist and framing it as a virus helpful to literally anyone? Absolutely not. It 100% turned me even further off to reading anything else by her and succeeded in convincing me my review should be dropped down a star.
This book wasn't what I wanted it to be, and while informative, it also felt quite repetitive. One of the areas where the book fails is the tone. MacPhail doesn't seem to have grasped that if someone is reading this book, then they already have an interest in its contents. She does not need to convince them that allergies matter or are worth studying, and she likely does not need to inform the reader that allergies decrease quality of life. If someone is reading about allergies....don't you think they already know those things?
Another area where I think this book fails is that MacPhail tries to make herself too relatable. Her writing puts on a kind of wide, doe-eyed innocence that isn't quite believable, chuckling slightly as it proclaims 'I had no idea how bad allergies had gotten' or 'how many people had them' or 'other people really don't understand,' and elbow nudges the reader as if she expects us to agree to this level of ignorance on the topic. It didn't make me 'relax' or feel as if we'd found common ground, rather it almost immediately made me distrust the rest of the book. MacPhail's father died of a bee sting....and she simply never bothered to research allergies at all until now? Likewise, MacPhail is a medical anthropologist, yes, but she fails to bring that knowledge and experience to the forefront in any meaningful way (and in what I have to say is a marked departure from every other medical anthropologist I've read). Why am I reading a book about a topic that seems to be a hobby from a woman who fails to use her own expertise?
Beyond the narrative issues with the book, I did learn some interesting things from it. Like, did you know fire ants are natural predators of ticks? But also about the distinction between IgE-mediated allergies and non-IgE allergies and why that distinction makes it so hard to diagnose and treat allergic conditions. This is the kind of stuff I was interested in, so I'm glad at least some of it made it into the book, even if we did get repetitive info.
I found the history of allergies to be interesting as well, and I hadn't realized allergic conditions had arisen so recently in our evolutionary history. I guess that answers the question to what happened if a royal taste tester had a food allergy, lol, they simply probably didn't. Likewise, I found the history of how we treat allergies to be interesting, though not wholly unsurprising. Of course doctors thought it was in patients' heads at first, at least until the science was further along and the number of allergy sufferers became impossible to ignore. But some of the early treatments were downright astonishing, I'm shocked in some cases that allergy sufferers survived.
I liked the summaries MacPhail provided on the hypotheses for why allergies occur and what's making them worse. I do think we could've gotten a more in-depth look at allergy evolution. MacPhail poses the question a few times in the book, but I feel she never really digs into it satisfactorily enough. If she is a medical anthropologist and science writer, surely she has her own thoughts? MacPhail makes sure to emphasize that allergies, and their increasing prevalence, are a multifactorial issue and no one hypothesis can explain them. That being said, she never really follows through with combining the hypotheses. Yes, genes play a role. And yes, so does climate change. And yes, so does the hygiene hypothesis and chemicals and food additives. But none of them play the whole role, and what I was yearning for as I learned more about each of these hypotheses was for MacPhail to put it all together into a comprehensive hypothesis detailing how each aspect worked in tandem to create some of the effects we're seeing today.
I also liked the interviews we got from allergists and allergy sufferers. The allergists were able to provide some deeper insight into their research, as well as the research of the past 30-40 years. On the flip side, the allergy sufferers were able to provide insight into both common and uncommon allergy conditions and the struggles they face socially and medically. I was particularly interested in Emily Brown's story (now there's someone who should write a book) and wish the constraints of the book had allowed for a deeper look into her family's journey.
Overall, the book is a decent read and does have some good information in it about allergies, new research and hypothesis, and the history of allergy research. That being said, it also suffers from having long chapters and being repetitive, and also from an author who seems to be trying too hard to be relatable, to the detriment of the narrative tone.