risk society - ReviseSociology

How do we explain the 500% increase in prescriptions for Cow’s Milk Allergy between 2006 to 2016?

In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise this documentary and throw in a few links and additional commentary

You can watch the documentary on BBC iplayer until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.

There has been a dramatic increase in prescriptions for children with Cow’s Milk Allergy (CMA) in recent years: A 500% increase in the 10 years to 2016 in fact!

A ‘prescription’ basically means that children with CMA get put on a specialist cow milk free ‘alternative milk’ formula, which costs twice as much as regular milk formula for children, and costs the NHS £64 million/ year.

In this section of the second episode of the series: ‘The Dr Who Gave Up Drugs, Dr CVT asks why there has been such a rapid increase in prescriptions for specialist formula to treat Cow’s Milk Allergy.

He says that as a new parent, he keeps hearing about it, which is odd because only 2% of children suffer from it, and so he’s wondering whether or not the above increase in prescriptions is due to increase in the underlying numbers of children who actually have cows milk allergy (or better detection) or whether there is something else fuelling the increasing public awareness of the condition.

The Normalisation of diagnosing and treating CMA

The documentary also visits one parent who thought her child had CMA when he developed XMA (one of the possible symptoms, but also something which 20% of babies suffer from), she visited her GP, who confirmed he didn’t have CMA. However, when she took her child to hospital for a bump, the pediatrician there noticed the XMA and prescribed specialist formula for CMA.

The child hated it, and so often went to be hungry. It too a visit to a Dr Robert Boyle (in the skeptical about CMA camp) who confirmed the child didn’t have CMA and so normal milk service was resumed.

The worrying thing about the above case is that alternative formula is being pushed on parents against their will, the normalisation of the diagnoses and treatment for a condition which in this case didn’t actually exist.

Industry lead education for NHS staff

One of the reasons Dr CVT is sceptical about the increase in awareness and prescription being linked to an actual underlying number of cases of children with CMA is that a lot of the education provided to Doctors about food allergies among children is sponsored by the companies who make alternative, specialist formulas to treat allergies.

To illustrate this point, the documentary visits a training day for NHS staff in Newcastle, aimed at educating staff about food allergies in babies – the event is sponsored by Danone, the company which makes one of the specialist CMA formulas, and what Dr CVT finds is advertising literature (various ‘glossy mags) and product samples alongside proper medical advice.

Another ‘test’ for the involvement of industry in educating about food allergies is to simply Google ‘cows milk allergy’ – which Dr CVT does and finds that most of the advice websites which help parents to self-diagnose their children are run by the companies who make specialist formula to treat the condition.

He also explores the web sites which parents and professionals use to diagnose for CMA, again run by the companies, and finds that the ‘symptoms’ which indicate Cow’s Milk Allergy are pretty much the kind of symptoms which every child has at some point, whether or not they have the allergy – things such as ‘colic’ and ‘vomiting’

Finally, he interviews Dr Adam Fox, who is a consultant for the ‘Allergy Academy’, sponsored by Danone, and he doesn’t seem able to convince Dr CVT that there isn’t a conflict of interests between the companies who profit from increased diagnoses of Cow’s Milk Allergy providing education on how to diagnose for the condition.

Application to Sociology

There are lots of applications – mainly centering around labelling theory and the power of corporations to shape agendas! Also risk society.

Image Source:

screen capture, BBC from documentary above.

Contemporary Sociology: The Parsons Green Tube Bomber

The Tube Bomber: A “Duty” to Hate Britain?

The case of Ahmed Hassan, the 18 year old Iraqi asylum seeker who planted a homemade bomb onto a London tube train in September 2017, injuring 51 people is a good candidate for the most serious crime of 2017. Had his device worked properly (it ‘only’ created a fireball rather than actually exploding) dozens of people would have died.

Hassan was sentenced to life in March 2018, and ordered to serve a minimum of 34 years.

Hassan claimed that he never wanted to kill anyone, he said he was depressed and seeking attention and thrills, having watched Mission Impossible films and developed the fantasy of being a fugitive pursued by Interpol across Europe.

However, there was also the fact that he seemed to have harboured intense loathing of the UK, which he blamed for his death in an explosion in Iraq a decade ago. When he arrived in the UK in 2015 (illegally in the back of a lorry) he told immigration officials that he’d been seized by Islamic State and ‘trained to kill’ (although he claimed to have made this up in court); and he had previously been seen watching extremist videos and apparently sending money to Isis. He’d also told one of his teachers that he had a ‘duty to hate Britain’.

What’s interesting about this case, is how all of the ‘standard’ preventive measures just failed to work….he had been given a foster couple who ‘showered him with love’ and was getting on well with his education – in fact, he seemed to be flourishing, having been made student of the year in 2017 in his college in Surrey: although he actually used his £20 Amazon voucher prize to buy chemicals for his bomb, which he then packed with knives, screwdrivers and nails.

Hassan had also been referred to the ‘Prevent’ deradicalisation programme, but this clearly didn’t work, and social services didn’t even warn his foster parents about his extremist leanings.

Relevance to A-level sociology…

At first glance, this seems to be a good case study which illustrates the necessity the take a stronger line on illegal immigration…if someone can commit a crime of this magnitude with all of the Preventative measure we already have in place, surely it’s impossible to prevent something like this happening again? Maybe a tougher line on immigration would have prevented this?

However, what we’re not seeing with just one dramatic case study is the bigger picture – all of the other cases that the authorities are preventing with their various crime control techniques… and let’s not forget that in complex risk society it is practically impossible to eradicate all ‘bad things’ from happening, so perhaps we just have to need to learn to live with this without panicking unduly.

This could also possibly show us the failings of ‘categorical suspicion’ as a means of crime control – possibly the fact that Hassan had ‘good foster parents’ and he was doing well at college were enough for the authorities to disregard all the other warning signs?

The Risks of Big Data

There are three main risks of Big Data:
the paralysis of privacy,
punishment through propensity,
the fetishization of and dictatorship through data

There are three main risks of Big Data:

The paralysis of privacy
Punishment through propensity

Fetishization of and dictatorship through data

Here I continue my summary of Mayer-Schonberger and Cuker (2017) Big Data: The Essential Guide to Work, Life and Learning in the Age of Insight’.

Three Risks of Big Data

Firstly, simply because so much data is collected on individuals – not only via state surveillance but also via Amazon, Google, Facebook and Twitter,it means that protecting privacy is more difficult -especially when so much of that data is sold on to be analysed for other purposes.

Secondly, there is the possibility of penalties based on propensities – the possibility of punishing people even before they have done anything wrong..

Finally, we have the possibility of a dictatorship of data – whereby information becomes an instrument of the powerful and a tool of repression.

Paralyzing Privacy

The value of big data lies in its reuse, quite possibly in ways that are have not been imagined at the time of collecting it. In terms of personal information, if we are to re-purpose people’s personal data than they cannot give informed consent in any meaningful sense of the phrase – because in order to so you need to know what data a company is collecting and what use they are going to put it to.

The only way big data can work is for companies to ask customers to agree to have their data collected ‘for any purpose’, which undermines the concept of informed consent.

There are still possible ways to protect privacy – for example opting out and anonymisation.

Opting out is simply where some individuals choose not to have their data collected – however, opting out can itself identify certain things about the users – for example, when certain people opted out of Google’s street view and their houses were blurred – they were still noticeable as people who had ‘opted out’ (and thus maybe had more valuable stuff to steal!)/

Anonymisation is where all personal identifiers are stripped from data – such as national insurance number, date of birth and so on, but here people can still be identified – when AOL released its data set of 20 million search queries from over 650K users in 2006, researchers were able to pick individual people out – simply by looking at the content of searches they could deduce that someone was single, female, lived in a certain areas, purchased certain things – then it’s just a matter of cross referencing to find the particular individual.

In 2006 Netflix released over 100 million rental records of half a million users – again anonymised, and again researchers managed to identify one specific Lesbian living in a conversative area by comparing the dates of movies rented with her entries onto the IMD.

Big data, it appears, aids de-anonymisation because we collect more data and we combine more data.

Of course it’s not just private companies collecting data… it’s the government too, The U.S. collects an enormous amount of data – amounts that are unthinkably large – and today it is possible to tell a lot about people by looking at how they are connected to others.

Probability and Punishment

This section starts with a summary of the introductory scene of minority report…

We already see the seeds of this type of pre-crime control through big data:

Parole boards in more than half the states of the US use big data predictions to inform their parole decisions.

A growing number of precincts use ‘Predictive Policing’ – using big data analysis to select which streets to parole and which individuals to harass..

A research project called FAST – Future Attribute Screening Technology – tries to identify potential terrorists by monitoring people’s vital signs.

Cukier now outlines the argument for big-data profiling – mainly pointing out that we’ve taken steps to prevent future risks for years (e.g. seat-belts) and we’ve profiled for years with small data (insurance!) – the argument for big data profiling is that it allows us to be more granular than previously – we can make our profiling more individualised – thus there’s no reason to stop every Arab man under 30 with a one way ticket from boarding a plane, but if that man has done a-e also, then there is a reason.

However, there is a fundamental problem of punishing people based on big data – that is, it undermines the very foundations of justice – that of individual choice and responsibility – by disallowing people choice – big data predictions about parole re offending are accurate 75% of the time – which means that if we use the profiling 100% of the time we are wrongly punishing 1 in 4 people.

Dictatorship of Data

The problem with relying on data to inform policy decisions is that the underlying quality of data can be poor – it can be biased, mis-analysed or used misleadingly. It can also fail to capture what is actually supposed to measure!

Education is a good example of a sector which is governed by endless testing – which only measure a slither of intelligence – the ability to demonstrate knowledge (predetermined by a curriculum) and show analytical and evaluative skills as an individual, in written form, all under timed conditions.

Google, believe it or not, is an example of a company that in the past has been paralysed by data – in 2009 its top designer, Douglas Bowman, resigned because he had to prove whether a border should be 3,4, or 5 pixels wide, using data to back up his view. He argued that such a dictatorship by data stifled any sense of creativity.

The problem with the above, in Steve Jobs’ words: it isn’t the consumers’ job to know what they want’.

In his book Seeing Like a State, the anthropologist James Scott documents the way in which governments make people’s lives a misery by fetishizing quantitative data:they use maps to reorganise communities rather than asking people on the ground for example.

The problem we face in the future is how to harness the utility of big data without becoming overly relying on its predictions.

Actuarial Justice and Risk Management

Feely and Simon (1994) argue that a new ‘technology of power’ is emerging throughout the justice system. It differs from Foucault’s disciplinary power in three main ways:

It focuses on groups rather than individuals
It is not interested in rehabilitating offenders, but simply in preventing them from offending

It uses calculations of risk or ‘actuarial analysis’. This concept comes from the insurance industry which calculates the statistical risk of particular events happening – for example the chances of drivers having an accident.

Feely and Simon argue that this actuarial approach is increasingly used in crime control – airports for example screen passengers before they come to an airport – passengers are awarded points based on gender, age, ethnicity, criminal convictions, and the more points, the more likely you are to be stopped at customs.

Social Sorting and categorical suspicion

David Lyon (2012) argues that the purpose of sorting is to be able to categorise people so they can be treated differently on the basis of risk. This subjects people to ‘categorical suspicion’ – they become suspects simply because they are a particular age or ethnicity (or combination of factors).

In 2010 West-Midlands police sought to introduce a counter-terrorism scheme to surround to mainly Muslim suburbs of Birmingham with about 150 surveillance cameras, some of them covert, thereby placing whole communities under suspicion.

One of the most obvious problems with actuarial risk management strategies of crime control is that it may reinforce the processes of labelling and the self-fulfilling prophecy emphasised by interactionists.

Young Minds – An example of social control through actuarialism?

The text below is taken from the Young Minds’ web site – how would Simon and Feely interpret this advice?

Young People at Risk of Offending – Advice for Parents (Young Minds)

No parent wants their child to become a ‘young offender’. But unfortunately, many young people do end up getting involved with crime or antisocial behaviour. Parents Helpline advisor Claire Usiskin advises parents on how they can help support their child.

The factors that cause young people to offend are often complex. Both parents/carers and the young person may feel blamed and stigmatised, although the factors contributing to the situation are often not their ‘fault’.

Young people who experience the following issues are more at risk of offending:

◾Poor housing or living in a neighbourhood with poor services
◾Financial hardship
◾Difficulties achieving at or attending school
◾Bullying (as a victim or perpetrator)
◾Behavioural problems
◾Hyperactivity or poor impulse control (for example ADHD)
◾Specific learning difficulties (for example dyslexia)
◾Violence or conflict within the family or social environment
◾Drug or alcohol issues within the family or social environment
◾Family or peer group attitudes which condone crime
◾Abuse or trauma in childhood
◾Spending time in local authority care

These ‘risk factors’ tend to add up, so the more of these factors a young person is exposed to, the more likely they are to get involved with crime.

As a parent or carer it can be very difficult to support your child or young person to stay the right side of the law. Peer groups can be very powerful, and teenagers may feel it is more important to stay ‘in with’ their friends than to respect the law.

Even if the child is experiencing some of the risk factors above, parents and carers can do a lot to support their child and try to prevent them breaking the law.

◾ Just one strong, positive child-carer relationship can offset many other problematic issues. Spell out clearly what is and isn’t acceptable, and tell them why this is. If relatives or friends are around, ask them for help in backing you up and giving your child firm but caring messages about keeping to boundaries.

◾ Do your best to get help and support for the child around education and mental health – even if services are not so easy to access, it is worth fighting for the child’s rights. If you think your child has learning difficulties or another condition that has not been diagnosed, ask your GP or school for an assessment.

◾Youth services, mentoring schemes and anti-crime, drug or gang projects are often run by practitioners, including ex-offenders, who have a lot of expertise in engaging with young people and motivating them to change their behaviour.

◾If you are struggling to parent your child and feel things are getting on top of you, ask for some support for yourself via the GP or a local counselling service. It’s not a sign of failure, it shows strength in wanting to be the strongest you can to support your child.