And it's not unprecedented. It was in my lifetime that we found out that stomach ulcers could be caused by H. pylori infections. For many people, what'd previously been a chronic condition could be cured with a round of antibiotics.
I speculated last year that various known diseases could turn out to have some sort of microbe, or microbe-like cause that we're unaware of; things we haven't seen or noticed yet. And that we might occasionally find out, with new tools, that a difficult condition has an understandable, discrete, physical cause. Similar to how people discovered that the flu and strep-throat and meningitis etc were caused by the tiny living or life-like critters (are viruses alive?).
I was insulted and mocked by everyone I said it to
But if nobody looks, we'll never find out. It looks like somebody looked in the case of ulcers and arthritis
"Everyone you said it to" was probably the wrong audience? Because digging into potential infection/inflammation related precursors for a number of chronic conditions has been a thing for over a decade now.
> ...was probably the wrong audience? Because digging into...
I think the casm separates testers from non-testers.
I've noticed that there are either doctors who will order ALL of the blood tests (all at once, and a few times to track trends), or doctors who will not order any, even if it's clear that tests are absolutely necessary.
A LOT of stories I've read on HN, or heard from others I've spoken with about this subject mention that somewhere along their journey to recovery, they (the patient):
- Did some research,
- Requested their doctor order a few labs,
- Were denied by their doctor (not for insurance reasons),
- Ordered the tests on their own from jasonhealth / ultalabtests etc.,
- Received high/low results as predicted.
...and only then did their doctors respond appropriately.
The fact that we can order our own tests is the difference -- I think -- because it's very similar to the difference between GenZ and Boomers with respect to being tech-native.
From my own experience, younger doctors, generally, order as many tests as possible and want as much data as possible (since data and testing are now cheaper, faster, and more available -- and this is native to their experience, now), whereas older doctors are less likely to behave that way (since tests used to be more expensive, slower, and generally not covered by insurance).
-HOWEVER-
Looking from the other side of the table, sometimes it might not be best to order lots of tests all the time for certain patients, since some (possibly acute or false-positive) results might just stress them out...
Especially when most patients are happy with the current standard. Patient has a rash. Doctor prescribes steroid. Rash goes away, and the patient is happy. No need to dig into the root cause of the rash, and if that cause might lead to cancer 10 years down the line, if ...for 99% of people... it won't.
That said... for the patients who do show an interest in debugging, I think some accommodations should be made that don't involve the frustrating "self-ordered tests process" listed above.
You should read "The Next Fifty Years" [1], specifically the essay named "Mastering Disease" by Paul W. Ewald.
In a nutshell he argues that the current batch of scientists should either die or retire before the new generation can start investigating alternative theories:
> A sufficient proportion of the old guard will have to retire or expire, and a sufficient number of young people entering the arena without these vested interests must mature into positions of influence, to tip the balance of expert opinion.
It's been 20+ years since that essay was written, so it looks like it is slowly becoming a reality.
There's the problem. People don't need to die off; the hierarchy of influence (especially as it pertains to funding, and secondarily as it pertains to publication) has to level out and be evidence-based.
> My guess is that this point will have been reached by 2015 for atherosclerosis and Alzheimer’s disease.
For AD the point was reached because of evidence of past research misconduct, and inability to replicate. Not because of new evidence per se. Or at least that's what I gather.
Germ theory is not widely believed. Not really. We wash our hands because we've been trained since a young age to do so, and generally accept that touching stuff is unsanitary.
But that's about it. Witness the reaction to aerosol spread of disease despite literal videos that can capture and show aerosols being spread around a room. People simply don't believe it.
They likewise don't believe in any kind of long run response to an infection. We associate the symptoms of acute immune response to be the virus itself, and the entirety of the virus.
I believe that car accidents cost lives, that power tools can take off my fingers, that illnesses like coronavirus can kill me or give me chronic lung conditions.
I also believe that it's worth driving, woodworking, and interacting with people in public despite those risks.
Most people, excluding the rare nutjobs, are like that. If you force them on an issue and don't accept variants of "I don't care" as an answer, they might come up with a bizarre explanation, sure.
It's hard for a lot of people to simply be honest and say - yes, sure, but I think it's worth it, instead of trying to deflect.
> They likewise don't believe in any kind of long run response to an infection. We associate the symptoms of acute immune response to be the virus itself, and the entirety of the virus.
Funny you should mention that. The UK has avoid giving children the chick pox vaccine in order to keep up natural immunity. Thus ensuring shingles in later life.
I spoke flippantly. There are specific diseases people do recognize cause specific issues.
But even in a case like shingles a society like the UK calculates it knows all the consequences. For instance I’m not sure anyone can say whether fighting shingles for decades makes our immune response less flexible in targeting other pathogens.
What matters is that there’s more and more evidence for microbiota in the gut having impact on seemingly unrelated systems like CNS. I think we’ll find many more surprises of how disregulated host-microbiome interactions lead to some kind of diseases.
>I was insulted and mocked by everyone I said it to
Quit, trying to tell anyone. You really would end up making a fool in most cases of yourself if you tried. The world is not kind to people who go against the narrative, even if you are provably correct.
Look up the Marshall Protocol, it's old news in some circles.
Lyme disease also causes symptoms that overlap with RA, due to the Borrelia burgdorferi bacteria. It is latent in some people and causes serious symptoms in others.
I truly wonder sometimes whether antibiotics are actually underused in medicine (while simultaneously being overused in the food supply chain).
> Based on [Pediatric Crohn's Disease Activity Index], 7 of 9 patients were in remission at 2 weeks and 5 of 9 patients who did not receive additional medical therapy were in remission at 6 and 12 weeks.
> No or modest improvement was seen in patients who did not engraft or whose microbiome was most similar to their donor.
So I think it's either a case of pathogens that fit in with the established microbiome or that the microbiome is missing vital components.
Once your microbiome is disrupted, I believe studies indicate that it's unlikely that adding probiotics in will fix it. I could see antibiotics followed by probiotics being an effective treatment for a microbiome gone haywire.
You still should consider collateral damage - we've been throwing broad spectrum antibiotics at damned near everything for decades.
We've started an arms race with a staggeringly dynamic enemy, and our solution thus far has been to attack them with static munitions, until those munitions stop working.
You can mitigate the issue with combination antibiotic therapy (it's harder to evolve resistance on multiple fronts simultaneously), but in general (when we use them) we need to move towards targeted antibiotics.
The difficulty being that you actually need to diagnose the specific problem before treatment, not just that it's bacterial in nature.
In the case of Chrons and Ulcerous colitis diet changes have big impact. There have been studies that show that high consumtion of processed food increase the likely hood of getting sick.
> I truly wonder sometimes whether antibiotics are actually underused in medicine
Killing gut microbiota is also being increasingly linked to diseases, so it's likely a very complicated balancing act where we need to maintain the correct bacterial flora.
Antibiotics are both overused and underused in medicine. We still see antibiotics being prescribed as a prophylactic measure even without a confirmed bacterial infection, or for minor bacterial infections that patients could probably clear on their own. People think of antibiotics as being benign but they come with significant risks and side effects, including disrupting the gut microbiome.
At the same time we lack evidence-based medicine guidelines for treating most low-grade chronic bacterial infections. In many cases there aren't even reliable diagnostic tests for such conditions, so it's not clear what the root cause of a patient's symptoms are and physicians have to try treatments at random in an attempt to find something that works. More basic research is needed in this area.
>I truly wonder sometimes whether antibiotics are actually underused in medicine (while simultaneously being overused in the food supply chain).
In the US, this is basically a given. You don't have to look past the lobbying numbers to understand why.
I'm curious outside the US, how often antibiotics are given out. From my buddies telling me stories about Mexico + the fear mongering with US Physicians, you'd expect a superbug to have broken out by now.
Multiple superbugs have broken out and are killing thousands every year. The irresponsible overuse of antibiotics in places like Mexico is certainly part of the problem.
There is no mention on your page, or the wiki, that antibiotics are the cause the resistant bacteria.
I can logically see why we would believe this, but you'd expect given the use of antibiotics on the farm and in non US pharmacies; we'd have such a superbug scientifically proven by now.
Scientifically it's nearly impossible to prove things. However, scientific evidence supporting the antibiotic-driven increase in antibiotic resistant "superbugs" has been found.
Antibiotics, and antibiotic resistance genes, have existed for an uncountable number of megayears. Antibiotic use by humans is probably not creating many new antibiotic resistance genes, if any at all. But is is driving the increase in bacteria that contain these genes, as well as encouraging the horizontal transmission of antibiotic resistance genes and the accumulation of multiple such genes in so-called "superbugs".
One of the biggest risk factors for a C. difficile infection is being treated with fluoroquinolones (ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin), which are often used in outpatient settings.
