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Your expectation is a worthwhile ideal, but it's very far out of the reach of modern medicine. Doctors are pretty good at treating symptoms, but when it comes

• carbocation 16y ago
  > Doctors are pretty good at treating symptoms, but when it comes to root causes of serious diseases, they're pretty bad at treating them without inflicting collateral damage on some other body system. I'm sure this is true, but the examples that immediately come to mind don't fit. New tyrosine kinase inhibitors inhibit the fusion "always-on" tyrosine kinases that cause many cancers. Antibiotics kill bacteria. Statins stop the production of cholesterol. All of these get at the root cause of the problem and don't merely treat symptoms. When you say "good at treating symptoms," which things are you thinking about? I'm in medical school and always want to improve my understanding of what thoughtful people see as symptomatic treatments that don't get at the root cause of problems. (Like I said above, I know that there are tons of these, but would really like to know which ones come to mind for you; perhaps these are the places where we, as a profession, are failing.)
  • orangecat 16y ago
    I'm in medical school and always want to improve my understanding of what thoughtful people see as symptomatic treatments that don't get at the root cause of problems. A huge amount of medicine is essentially treating the symptoms of aging.
    • carbocation 16y ago
      What do you see as "aging," and do you see that as a disease process?
      • orangecat 16y ago
        Decreased physical and often mental capabilities, and increased susceptibility to other diseases and incidents like heart attacks and strokes. Whether aging itself is a disease is just a matter of definition, but preventing it or undoing its effects would substantially reduce the need for other medical treatments, as well as saving tons of money and greatly increasing quality of life. It may not be possible, or may require currently unavailable capabilities like advanced nanotechnology, but I believe it's worth seriously investigating.
        • carbocation 16y ago
          The cause of the constellation of symptoms that we associate with aging remains outstanding. Perhaps it is environmental; perhaps it is genetic. Certainly, one cannot expect us to treat the root cause of that which we don't even have more than a rudimentary understanding. Gaining that understanding will (hopefully) be one of the defining achievements of the 21st century -- most likely too late for you and me, but of tremendous import for those to come later. If we had advanced nanotechnology that could do whatever you asked to ameliorate the root cause of aging, what would you ask it to do? I submit that we don't know yet, so trying to choose the right technology for the job (such as nano) at this point is a bit like putting the cart several feet in front of the horse. The above notwithstanding, I honestly fail to see how making people live longer would save any money. Presumably it would just delay the inevitable, expensive end-of-life care by a few (or many) years. Do you not see it that way? I would love to have a more optimistic view.
          • orangecat 16y ago
            Certainly, one cannot expect us to treat the root cause of that which we don't even have more than a rudimentary understanding. Agreed; gaining that understanding is the first step, and I believe it should be a top priority. The above notwithstanding, I honestly fail to see how making people live longer would save any money. If you have the physical health of a 25 year old indefinitely, your medical expenses per year would be far less. Yes, you'd still occasionally get sick and eventually die of something, but a greater percentage of your life would be healthy and productive.
  • starkfist 16y ago
    One of the most common symptomatic treatmeants that doesn't get at the root cause of the problem is prescribing meds for high blood pressure.
    • carbocation 16y ago
      I think this is a good point; in fact, we don't know the root cause for most cases of hypertension (idiopathic). In fact, >90% of people who are normotensive at age 50 become hypertensive before they die. This is an astounding stat. We're not going to be able to fix this, IMHO, until we understand the genetic (and/or environmental) basis for HTN. Nevertheless, treatments for HTN also reduce the sequelae, such as cardiomyopathy, so these are better than just "symptomatic treatments."
  • nitrogen 16y ago
    One could perceive antibiotics alone as ignoring a deeper root cause, such as the patient engaging in risky behavior (not washing hands, eating rotten food, etc.). A prescription for statins doesn't necessarily address why the body is producing excess cholesterol. But, of course, I am not in the medical field.
    • randallsquared 16y ago
      the patient engaging in risky behavior (not washing hands, eating rotten food, etc.). I see where you're going, but this may not be the best example. I believe it's currently thought that exposure to some bacteria and other uncleanliness is essentially exercise for your immune system, especially in childhood.
    • carbocation 16y ago
      Over 50% of the variability in cholesterol levels is attributable to genetic factors. The root cause of high cholesterol will typically be an unlucky genetic profile. Hundreds of genes participate in cholesterol metabolism, and since cholesterol is a complex trait, most people will have various polymorphisms in multiple lipid genes, each of which confers only a modest effect. Consequently, while the root cause(s) will ultimately become known in the next few years, it seems unlikely to change the standard of care: statins. Sure, this knowledge will help us develop new cholesterol lowering drugs, but the fact remains that it will be impossible and, in general, pointless to target a specific therapy to a specific genetic profile (at least for LDL). I don't think that patient behaviors are a good example of medicine's failures. A rational actor may decide to value many things over their own personal health. It's like saying that intravenous drug use and unprotected sex are the root causes of AIDS. That's more a public health viewpoint. I see HIV as the root cause of AIDS, and I find treatments or cures as a far more interesting medical problem. Likewise, the public health perspective on bacterial infection is to avoid it (clean clothes thoroughly to reduce staph transmission between wrestlers). From a medical perspective, the interesting question is, once you have staph, can we cure it? Killing the causal bacterium is basically the definition of a treatment aimed at the root cause. I don't think that redefinition of "root cause" makes the problem more interesting; it just makes it less medical.
  • ippisl 16y ago
    I can think of three categories helpfull when looking for "root causes medicine": 1.Better more in-depth information, using tools like genetic medicine and new bio-markers that can give us a more precise diagnosis(using genetic medicine , hypertension can be classified into more then 10 categories , each with his own preferred treatment). with more precise diagnosis , the chances are greater that we treat the core problem. 2. In many cases, we know the core problem, but the tools we can only treat symptoms. For such diseases , a good place to look is emerging technologies focus on the core problem. for example today we treat diabetes type 2 mostly symptomatically, but the core problem is that pancreas cells die or stop functioning. Stem cell therapy is offers big hope as a cure for diabetes type 2 by replacing the bad pancreas cells with new cells. 3.i wonder if prevention, in the general case, is relatively more focused on the core mechanisms, simply because when you prevent something , you have no symptoms and symptoms never appear.
    • carbocation 16y ago
      I agree with 1 and 3. I disagree with point #2. The root problem with Type II diabetes is insulin resistance peripherally. The damage done to the pancrease is actually a secondary problem. If you cure the peripheral resistance to insulin, you fix the problem. If you add back pancreas, you simply end up becoming hyperinsulinemic and, while that will work for awhile, it doesn't get at the core of the problem. In other words, what you are proposing is more symptom oriented than current cause-oriented treatments.
      • rsheridan6 16y ago
        "If you add back pancreas, you simply end up becoming hyperinsulinemic and, while that will work for awhile, it doesn't get at the core of the problem. " That's pretty much what we do now with sulfonylureas and other insulin secretagogues, not to mention insulin therapy.
        • carbocation 16y ago
          Agreed. That's why diabetes treatment sucks so badly (yes, better than nothing). The PPAR agonists seem promising, in theory. In practice they don't seem quite so awesome. I'm still hopeful; GWAS has offered us some new targets that should be exploited in the near future.
  • etal 16y ago
    Those examples do fit: Tyrosine kinase inhibitors turn an always-on enzyme into an always-off one, when the normal behavior is for it to act as an on/off switch according to the cell's immediate environment. http://en.wikipedia.org/wiki/Erlotinib#Side_effects http://en.wikipedia.org/wiki/Erlotinib#Side_effects http://en.wikipedia.org/wiki/Imatinib#Tolerability_and_adverse_effects http://en.wikipedia.org/wiki/Imatinib#Tolerability_and_adver... Once the gene mutates in a cancer cell, it's never going to work properly again (unless all the cancer cells are killed, or the gene is somehow replaced). It's just less harmful if it's disabled than if it's permanently active. Antibiotics tend to kill good bacteria in the body, too. Most people are willing to take a week or two of GI problems and some extra servings of yogurt in exchange for survival, but still, that's some collateral damage. The common problem is, once one part of a system in the body begins malfunctioning, it's very difficult to fix that part without affecting the surrounding system, or other parts that work similarly but aren't malfunctioning.
    • carbocation 16y ago
      Neoplastic TKs are not on/off switches; they are always on. Once you inhibit effectively, they are always off, like you said. But you still have a copy of the normal TK, so most likely things could be perfectly normal if you identified a highly specific TK inhibitor. The current -inibs just aren't specific enough yet, so they have serious side effects. I argue that antibiotics get to the heart of an infection, not that they only kill the bacteria you want to kill. Is it possible to create a drug or engineer a phage to do wo? Yes, sure. But the cost tradeoff is not worth it, on balance. Very few people develop any side effects from most antibiotic treatment, much less weeks of GI discomfort. It definitely happens, but you outlined the treatment for it -and eating yogurt is much cheaper than paying for a theoretical, patented, new superantibiotic that causes mo GI problems.
  • nunb 16y ago
    You replied to this person: >>are pretty good at treating symptoms, but when it comes to root causes of serious diseases, they're pretty bad at treating them without inflicting collateral damage on some other body system. [Especially bad when messing with systems designed by evolution] saying: >Statins stop the production of cholesterol .. these get at the root cause of the problem and don't merely treat symptoms. No, statins do not treat the "root cause of the problem" and in fact, merely "treat" symptoms. In doing so they do great damage and kill people. Look up torcetrapib or clofibrate for examples. 0) Wikipedia http://en.wikipedia.org/wiki/Torcetrapib http://en.wikipedia.org/wiki/Torcetrapib 1) pubmed http://www.ncbi.nlm.nih.gov/pubmed/6147641 http://www.ncbi.nlm.nih.gov/pubmed/6147641? ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum 2) Pubmed Clofibrate http://www.ncbi.nlm.nih.gov/pubmed/20535009 http://www.ncbi.nlm.nih.gov/pubmed/20535009 Production of cholesterol is not the root cause of the problem. Starting from wrong axioms always produces wrong results. It's the kind of stuff that leads to blood-letting being the leading treatment of the age. If you're in medical school I would urge you to read Gary Taubes' book -- the man makes some interesting observations about how medical textbooks have changed over the years (esp. in the fields of diabetes, iirc). Also, sure antibiotics kill bacteria, but they also take a toll on the body (granted they get at the proximate cause of the problem).
    • carbocation 16y ago
      You will do well to note that I said statins, not CETP inhibitors (torcetrapib) nor fibrates. There is an ocean of difference between them, so you can't just go around making it look like I endorsed a drug that never got FDA approval (torcetrapib), for example. After antibiotics, statins have the clearest risk-benefit profile of just about any drugs ever invented, and their effectiveness and safety have been under continuous study for decades. You assert that the production of cholesterol is not the problem. Since you claim that I am starting from the wrong axiom, what do you believe is the root cause of hypercholesterolemia? Since hypercholesterolemia is the canonical asymptomatic disease, I suspect you are misusing the term symptom. Finally, it is natural for medical textbooks to change as our knowledge changes. I haven't read the book you are referring to but if he says that drug companies are having an evil influence, I wouldn't be surprised and I'd probably agree.
• bbgm 16y ago
  Medicine is still very reductionist and that is not going to change for a while, even though we know that isn't the right way to go about doing it. The thing is that I am not sure that we will necessarily be able to fix the impact of "bad behavior" even at a systems level, because no two perturbations, even with the same behavior are going to be alike. Yes, we'll be able to detect a lot earlier and thus fix things, but in the end, the responsible thing to do is either to take a "I will be better with my body" approach or bear the consequences.
  • carbocation 16y ago
    Being reductionistic is the source of all of medicine's success in the past 100 years, and I don't see that changing - ever - without evidence that another approach is superior. Which non-reductionistic approach do you see as supplanting reductionism? Behavior isn't really a medical problem so much as it is a series of choices between different 'goods' - both medical and nonmedical. I see it as a public health problem. Want people to eat less McDonald's? We know that counsel from your doctor is very modestly effective. We also know that price changes are very effective. So tax McDonald's food at 100% and subsidize produce with that extra money. People can still choose McD's, but you just made it a whole helluva lot easier to eat well. Large-scale systemic interventions are the only things that will be able to change behavior, and this is neither surprising nor particularly problematic.
    • mhd 16y ago
      Sorry, but for what reason should the state intervene here? I could see the point in a system where everybody has state-run health care, but even then a junk food tax would probably attack the problem at the wrong end. Never mind that the criteria for additional taxes would be pretty hard to specify and justify...
      • carbocation 16y ago
        The state's interest here is about as obvious as it gets. The state already intervenes. It pays (entirely) for the training of all physicians during their residencies. It determines physicians' reimbursements. It runs Medicare. It runs Medicaid. In other words, if the state could reduce the usage of Medicare by improving the health of its citizens with targeted taxation, it could save itself money. Oh, and let's not forget that the state intervenes on the other side of the argument, too: it subsidizes high fructose corn syrup, etc. The state is already intervening every step of the way. I'm just showing you the way it could do so to the benefit of people, instead of to their detriment. My major point in that post was that behavior is not a medical problem. I'm not actually saying that I think the state should do this (in fact, if it just stopped subsidizing the bad stuff, we'd be much better off already). I was just giving an example of what one could do to effect large-scale behavioral change, which is not a medical problem but instead a political one. If one opposes statist interventions, as you seem to, then one would not like this solution. Large-scale private solutions to effect behavioral change could be just as effective. To reiterate, my point is that behavioral change is not a medical problem. Oh, as an aside -- taxing these products would be no harder than subsidizing them: a problem that has already been solved, unfortunately.