5 ms·

I assume this is a "here's another way this can happen" rather than "actually this is caused only by this and not by what we used to think"?

lostlogin 1y ago
Surely this? The number of ‘oh, it turned out to be more more complicated’ scenarios in medicine is high.
tialaramex 1y ago
Of course it depends on fractions. You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection. So knowing that all the plans towards eliminating this disease focus on HPV. On the other hand most people with "flu" in summer months are not infected with Influenza, so an improved influenza treatment isn't going to make a big difference for them unlike in winter. We know other reasons you might get those symptoms which are more likely in summer.
- dredmorbius 1y ago
  Peptic ulcers are another well-known case, in which most (though not all) instances can be traced to a Helicobacter pylori infection. Other causal factors include NSAID usage, stress, and diet. <https://en.wikipedia.org/wiki/Peptic_ulcer_disease https://en.wikipedia.org/wiki/Peptic_ulcer_disease> <https://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disease_and_Helicobacter_pylori https://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disea...> One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis. Successful treatment and elimination of syphilis in patients and populations through antibiotics. As one of the few cases of near-total elimination of a class of mental conditions, this a useful reminder to the psychiatric profession that not all mental conditions have causes limited to the brain and its function, whether through its biochemistry or neural/behavioural processes. <https://en.wikipedia.org/wiki/General_paresis_of_the_insane https://en.wikipedia.org/wiki/General_paresis_of_the_insane>
  - ejstronge 1y ago
    > One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis. I think a better example is the very recent (i.e., in the 2000s) discovery of anti-NMDAR encephalitis which can very closely resemble schizophrenia [1]. In syphilis, there were at least other manifestations of disease that can (and were) known, unlike this totally unappreciated mechanism (which better resembles Barry Marshall and H. pylori). 1. https://www.ncbi.nlm.nih.gov/books/NBK551672/ https://www.ncbi.nlm.nih.gov/books/NBK551672/
    - DaveZale 1y ago
      sure, let's not forget about the brain. Toxoplasma is another that is transmitted from cats to humans. It's pretty creepy and something that cat lovers don't like to hear about. Extremely common, and it lies dormant in the brain for decades.
- ejstronge 1y ago
  > You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection. What are these other ways? There's an intuition that bodies are like computer programs that can fail in unpredictable ways, but this is usually false and belies a failure to see links between 'novel' and previously described mechanisms.
  - deleted 1y ago
    [deleted]
  - epcoa 1y ago
    Spontaneous mutations? Which no matter how much you carve out modifiable risk factors will always be a thing. At least 5% of cervical cancers are HPV negative, so it's not even all the uncommon (not I would call "vast, vast" IMHO)
    - tialaramex 1y ago
      Where did you see 5%? I'm not an expert (though I think I know one) but the study I'm looking at says 0.3% - hence my "vast, vast". That's 3 patients out of 1000. In that study they take cancer cells and check for HPV, get about 7% negatives which I'm guessing is what you're describing too, but they take those negatives and PCR them to figure out, well, OK, what was wrong with these cells and when you take the cells to pieces very often your assay goes oh, these instructions are HPV. So, you know, the cancer cells aren't "infected" with HPV but well the genetics are just HPV, the replication has gone haywire and tangled parts of HPV with the human cell instructions and now it's cancer. Crucially we can assume that if you don't get infected with HPV this wouldn't happen. So HPV was still causal.
      - deleted 1y ago
        [deleted]
      - epcoa 1y ago
        > Crucially we can assume that if you don't get infected with HPV this wouldn't happen. So HPV was still causal. Nope. This is literally “correlation does not equal causation” 101. Based on the 0.3% I’m gonna guess you’re (either directly or indirectly) citing a famous, 1999 paper in J Pathology (Walboomers et al). It’s outdated, missing a control *, and it’s pretty well accepted that just finding a bystander HPV DNA fragment around somewhere is not conclusive of causality. We have much more sophisticated assays of gene expression. Try looking for review articles in the last 3 to 4 years rather than 30, the prevalence of truly HPV independent cervical cancer is not precisely characterized but it’s almost certain much greater than 0.3%. https://www.mdpi.com/2076-0817/14/7/668 https://www.mdpi.com/2076-0817/14/7/668 https://journals.lww.com/md-journal/fulltext/2024/10110/research_progress_on_human_papillomavirus_negative.88.aspx https://journals.lww.com/md-journal/fulltext/2024/10110/rese.... (3% to 8%)
lithocarpus 1y ago
It's not even "here's another way this can happen" - there's no real evidence that the bacteria are causing the heart disease. Just a fact that 40% of the 200 people with the heart disease had the bacteria, and no baseline for whether everyone else normally has those bacteria.
- tengbretson 1y ago
  Ninety percent of house fires have these giant red trucks out in front of them. How do I apply for a grant?

lostlogin 1y ago

Surely this? The number of ‘oh, it turned out to be more more complicated’ scenarios in medicine is high.

tialaramex 1y ago

Of course it depends on fractions. You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection. So knowing that all the plans towards eliminating this disease focus on HPV. On the other hand most people with "flu" in summer months are not infected with Influenza, so an improved influenza treatment isn't going to make a big difference for them unlike in winter. We know other reasons you might get those symptoms which are more likely in summer.

dredmorbius 1y ago
Peptic ulcers are another well-known case, in which most (though not all) instances can be traced to a Helicobacter pylori infection. Other causal factors include NSAID usage, stress, and diet. <https://en.wikipedia.org/wiki/Peptic_ulcer_disease https://en.wikipedia.org/wiki/Peptic_ulcer_disease> <https://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disease_and_Helicobacter_pylori https://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disea...> One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis. Successful treatment and elimination of syphilis in patients and populations through antibiotics. As one of the few cases of near-total elimination of a class of mental conditions, this a useful reminder to the psychiatric profession that not all mental conditions have causes limited to the brain and its function, whether through its biochemistry or neural/behavioural processes. <https://en.wikipedia.org/wiki/General_paresis_of_the_insane https://en.wikipedia.org/wiki/General_paresis_of_the_insane>
- ejstronge 1y ago
  > One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis. I think a better example is the very recent (i.e., in the 2000s) discovery of anti-NMDAR encephalitis which can very closely resemble schizophrenia [1]. In syphilis, there were at least other manifestations of disease that can (and were) known, unlike this totally unappreciated mechanism (which better resembles Barry Marshall and H. pylori). 1. https://www.ncbi.nlm.nih.gov/books/NBK551672/ https://www.ncbi.nlm.nih.gov/books/NBK551672/
  - DaveZale 1y ago
    sure, let's not forget about the brain. Toxoplasma is another that is transmitted from cats to humans. It's pretty creepy and something that cat lovers don't like to hear about. Extremely common, and it lies dormant in the brain for decades.
ejstronge 1y ago
> You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection. What are these other ways? There's an intuition that bodies are like computer programs that can fail in unpredictable ways, but this is usually false and belies a failure to see links between 'novel' and previously described mechanisms.
- deleted 1y ago
  [deleted]
- epcoa 1y ago
  Spontaneous mutations? Which no matter how much you carve out modifiable risk factors will always be a thing. At least 5% of cervical cancers are HPV negative, so it's not even all the uncommon (not I would call "vast, vast" IMHO)
  - tialaramex 1y ago
    Where did you see 5%? I'm not an expert (though I think I know one) but the study I'm looking at says 0.3% - hence my "vast, vast". That's 3 patients out of 1000. In that study they take cancer cells and check for HPV, get about 7% negatives which I'm guessing is what you're describing too, but they take those negatives and PCR them to figure out, well, OK, what was wrong with these cells and when you take the cells to pieces very often your assay goes oh, these instructions are HPV. So, you know, the cancer cells aren't "infected" with HPV but well the genetics are just HPV, the replication has gone haywire and tangled parts of HPV with the human cell instructions and now it's cancer. Crucially we can assume that if you don't get infected with HPV this wouldn't happen. So HPV was still causal.
    - deleted 1y ago
      [deleted]
    - epcoa 1y ago
      > Crucially we can assume that if you don't get infected with HPV this wouldn't happen. So HPV was still causal. Nope. This is literally “correlation does not equal causation” 101. Based on the 0.3% I’m gonna guess you’re (either directly or indirectly) citing a famous, 1999 paper in J Pathology (Walboomers et al). It’s outdated, missing a control *, and it’s pretty well accepted that just finding a bystander HPV DNA fragment around somewhere is not conclusive of causality. We have much more sophisticated assays of gene expression. Try looking for review articles in the last 3 to 4 years rather than 30, the prevalence of truly HPV independent cervical cancer is not precisely characterized but it’s almost certain much greater than 0.3%. https://www.mdpi.com/2076-0817/14/7/668 https://www.mdpi.com/2076-0817/14/7/668 https://journals.lww.com/md-journal/fulltext/2024/10110/research_progress_on_human_papillomavirus_negative.88.aspx https://journals.lww.com/md-journal/fulltext/2024/10110/rese.... (3% to 8%)

lithocarpus 1y ago

It's not even "here's another way this can happen" - there's no real evidence that the bacteria are causing the heart disease. Just a fact that 40% of the 200 people with the heart disease had the bacteria, and no baseline for whether everyone else normally has those bacteria.

tengbretson 1y ago
Ninety percent of house fires have these giant red trucks out in front of them. How do I apply for a grant?