3 ms·

Chronic illness - other than palliatives. What's the root of the incredible expansion of chronic illnesses? What aren't we trying to recreate some of the condit

Chronic illness - other than palliatives. What's the root of the incredible expansion of chronic illnesses? What aren't we trying to recreate some of the conditions that applied 300 years ago when MS, atopy, autoimmunity, diabetes, seasonal allergies, and so much more were rare or nonexistent, to find out what's up? Large numbers of deaths can be attributed to chronic illnesses, but scrape away the money-grab for palliatives and the proportion of research dollars is tiny. (Most "animal models" of diseases can only be used to test for palliatives, not cures or prevention, since the cause of the model disease is obviously not the cause of the human disease. The EAE "model" of MS being a prime example.)

nextos 8y ago
Yes. I work in this area, and there's a ton of money waiting and not enough talent to hire.
- Nomentatus 8y ago
  Sounds a bit like you think the talent is turning its back because they are very pessimistic about finding causes and solutions within our lifetime... sad if true; I'm seeing interesting progress and think we're close to real breakthroughs.
davidjnelson 8y ago
Something that has changed in that time frame is the massive amount of human created chemicals present in human bodies. Micro plastics, heavy metals, pesticides etc.
- Nomentatus 8y ago
  Very true. Might be a chunk of the answer. But a crazy amount of things have changed, and you're naming what we have researched a fair bit - finding some effect, but not a massive effect. UV light exposure is the largest lifestyle factor we know of to improve lifespan (more, better) with exercise coming in second, for example. But there are so many more - artificial light messing up our ipRGCs, etc, etc, etc.
  - davidjnelson 8y ago
    Oh awesome, thanks! Do you recommend any studies on the UV light exposure?
Someone 8y ago
”when MS, atopy, autoimmunity, diabetes, seasonal allergies, and so much more were rare or nonexistent” Are you sure? My money would be on them being ‘rare’ because of underdiagnosis (why complain about an allergy such as hay fever if people regularly die of smallpox, measles (which is relatively new, being mutated from rinderpest after the year 500. See https://en.m.wikipedia.org/wiki/Measles#History https://en.m.wikipedia.org/wiki/Measles#History), during childbirth, etc, and many others have deformations due to vitamin deficiencies, badly set broken bones, etc?) or because they killed people. Examples: https://en.m.wikipedia.org/wiki/Multiple_sclerosis#Historical_cases https://en.m.wikipedia.org/wiki/Multiple_sclerosis#Historica..., https://en.m.wikipedia.org/wiki/Diabetes_mellitus#History https://en.m.wikipedia.org/wiki/Diabetes_mellitus#History, https://en.m.wikipedia.org/wiki/Systemic_lupus_erythematosus#Classical_period https://en.m.wikipedia.org/wiki/Systemic_lupus_erythematosus.... http://www.bbc.com/news/magazine-28038630 http://www.bbc.com/news/magazine-28038630, https://en.m.wikipedia.org/wiki/Allergic_rhinitis#History https://en.m.wikipedia.org/wiki/Allergic_rhinitis#History
- Nomentatus 8y ago
  Yes, I'm sure, and it's not just my opinion, but consensus. Autoimmunity was doubling every couple decades, but won't again 'cause more than half the population now has eczema. Diabetes had been doubling, too. Diabetes as a rare disease existed anciently (as did asthma, more commonly) but exploded in the nineteenth century, as did seasonal allergies, starting in the cities and only later smaller towns and rural areas, to the astonishment of doctors. It was unknown before, as was MS. (Temporary loss of sight can be caused by many things, including CCI or trauma.) Lupus goes back further. (One famous case "first case of MS" a few centuries earlier was thought to be MS, but is now thought to be lupus.) I don't know of any ancient identification of seasonal allergies, and the Razi Wikipedia page doesn't give one that. It wasn't common before the nineteenth century, according to nineteenth-century doctors who watched it balloon during their lifetimes. We also have (a diminishing number) of native populations to study and atopy is very rare, MS was unknown amongst them. Similarly diabetes. Etc. My sources aren't general but journal articles, those notes aren't easily available to me. I read at least the abstracts of getting on to 500,000 journal articles over about ten years and retain notes on 100,000 articles (not all the original journal articles.) One recent source re asthma: https://www.ncbi.nlm.nih.gov/pubmed/26439263 https://www.ncbi.nlm.nih.gov/pubmed/26439263
csense 8y ago
I have a few thoughts on these issues. - Hygiene hypothesis: Cleaner environments and changes in social patterns (for example, less undirected outdoor play, fewer siblings) are leading to being exposed to less germs as kids, which causes the immune system to become oversensitive and trigger itself. - Diet / exercise: Particularly for diabetes and obesity. The cheapest, most convenient food is unhealthy due to subsidies and a less local supply chain (100 years ago local stores probably stocked a lot of local produce and little packaged / heavily processed food, not so today). Restaurants increase portion size (I suspect this may have something to do with labor costs increasing due to Baumol cost disease and other factors). Fewer people have jobs with lots of physical activity. Erosion of traditional gender roles and modern economic pressures mean fewer couples/families have someone who stays at home and cooks a labor-intensive dinner every day. - Low-hanging fruit: Diseases that are easy to vaccinate or otherwise cure have already been mostly eliminated from advanced nations (and in some cases, worldwide). Diseases that are hard to cure have been turned from death sentences into chronic conditions. (If you had diabetes before the medical community knew much about blood sugar or insulin, you'd probably die pretty quickly.) - Perverse incentive structure: As other posters have noted, it's a lot more profitable to develop a drug that alleviates symptoms. Possible solutions: Cash prizes for curing diseases (money comes from a non-profit-oriented party, risk taken on by private sector), government/non-profit funding of research (money and risk both borne by non-profit-oriented party), and government/insurance allowing cures to charge equivalent rates (e.g. a shot for diabetes "should" cost about $36,000, because that's the price of taking $100 of insulin every month for 30 years, but would the developer be allowed to charge that much? Money comes from patients or their insurance, risk taken on by private sector).

nextos 8y ago

Yes. I work in this area, and there's a ton of money waiting and not enough talent to hire.

Nomentatus 8y ago
Sounds a bit like you think the talent is turning its back because they are very pessimistic about finding causes and solutions within our lifetime... sad if true; I'm seeing interesting progress and think we're close to real breakthroughs.

davidjnelson 8y ago

Something that has changed in that time frame is the massive amount of human created chemicals present in human bodies. Micro plastics, heavy metals, pesticides etc.

Nomentatus 8y ago
Very true. Might be a chunk of the answer. But a crazy amount of things have changed, and you're naming what we have researched a fair bit - finding some effect, but not a massive effect. UV light exposure is the largest lifestyle factor we know of to improve lifespan (more, better) with exercise coming in second, for example. But there are so many more - artificial light messing up our ipRGCs, etc, etc, etc.
- davidjnelson 8y ago
  Oh awesome, thanks! Do you recommend any studies on the UV light exposure?

Someone 8y ago

”when MS, atopy, autoimmunity, diabetes, seasonal allergies, and so much more were rare or nonexistent” Are you sure? My money would be on them being ‘rare’ because of underdiagnosis (why complain about an allergy such as hay fever if people regularly die of smallpox, measles (which is relatively new, being mutated from rinderpest after the year 500. See https://en.m.wikipedia.org/wiki/Measles#History https://en.m.wikipedia.org/wiki/Measles#History), during childbirth, etc, and many others have deformations due to vitamin deficiencies, badly set broken bones, etc?) or because they killed people. Examples: https://en.m.wikipedia.org/wiki/Multiple_sclerosis#Historical_cases https://en.m.wikipedia.org/wiki/Multiple_sclerosis#Historica..., https://en.m.wikipedia.org/wiki/Diabetes_mellitus#History https://en.m.wikipedia.org/wiki/Diabetes_mellitus#History, https://en.m.wikipedia.org/wiki/Systemic_lupus_erythematosus#Classical_period https://en.m.wikipedia.org/wiki/Systemic_lupus_erythematosus.... http://www.bbc.com/news/magazine-28038630 http://www.bbc.com/news/magazine-28038630, https://en.m.wikipedia.org/wiki/Allergic_rhinitis#History https://en.m.wikipedia.org/wiki/Allergic_rhinitis#History

Nomentatus 8y ago
Yes, I'm sure, and it's not just my opinion, but consensus. Autoimmunity was doubling every couple decades, but won't again 'cause more than half the population now has eczema. Diabetes had been doubling, too. Diabetes as a rare disease existed anciently (as did asthma, more commonly) but exploded in the nineteenth century, as did seasonal allergies, starting in the cities and only later smaller towns and rural areas, to the astonishment of doctors. It was unknown before, as was MS. (Temporary loss of sight can be caused by many things, including CCI or trauma.) Lupus goes back further. (One famous case "first case of MS" a few centuries earlier was thought to be MS, but is now thought to be lupus.) I don't know of any ancient identification of seasonal allergies, and the Razi Wikipedia page doesn't give one that. It wasn't common before the nineteenth century, according to nineteenth-century doctors who watched it balloon during their lifetimes. We also have (a diminishing number) of native populations to study and atopy is very rare, MS was unknown amongst them. Similarly diabetes. Etc. My sources aren't general but journal articles, those notes aren't easily available to me. I read at least the abstracts of getting on to 500,000 journal articles over about ten years and retain notes on 100,000 articles (not all the original journal articles.) One recent source re asthma: https://www.ncbi.nlm.nih.gov/pubmed/26439263 https://www.ncbi.nlm.nih.gov/pubmed/26439263

csense 8y ago

I have a few thoughts on these issues. - Hygiene hypothesis: Cleaner environments and changes in social patterns (for example, less undirected outdoor play, fewer siblings) are leading to being exposed to less germs as kids, which causes the immune system to become oversensitive and trigger itself. - Diet / exercise: Particularly for diabetes and obesity. The cheapest, most convenient food is unhealthy due to subsidies and a less local supply chain (100 years ago local stores probably stocked a lot of local produce and little packaged / heavily processed food, not so today). Restaurants increase portion size (I suspect this may have something to do with labor costs increasing due to Baumol cost disease and other factors). Fewer people have jobs with lots of physical activity. Erosion of traditional gender roles and modern economic pressures mean fewer couples/families have someone who stays at home and cooks a labor-intensive dinner every day. - Low-hanging fruit: Diseases that are easy to vaccinate or otherwise cure have already been mostly eliminated from advanced nations (and in some cases, worldwide). Diseases that are hard to cure have been turned from death sentences into chronic conditions. (If you had diabetes before the medical community knew much about blood sugar or insulin, you'd probably die pretty quickly.) - Perverse incentive structure: As other posters have noted, it's a lot more profitable to develop a drug that alleviates symptoms. Possible solutions: Cash prizes for curing diseases (money comes from a non-profit-oriented party, risk taken on by private sector), government/non-profit funding of research (money and risk both borne by non-profit-oriented party), and government/insurance allowing cures to charge equivalent rates (e.g. a shot for diabetes "should" cost about $36,000, because that's the price of taking $100 of insulin every month for 30 years, but would the developer be allowed to charge that much? Money comes from patients or their insurance, risk taken on by private sector).