Nomentatus 6 years ago

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.)

  • Someone 6 years 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), 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#Historica..., https://en.m.wikipedia.org/wiki/Diabetes_mellitus#History, https://en.m.wikipedia.org/wiki/Systemic_lupus_erythematosus.... http://www.bbc.com/news/magazine-28038630, https://en.m.wikipedia.org/wiki/Allergic_rhinitis#History

    • Nomentatus 6 years 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

  • davidjnelson 6 years 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 6 years 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 6 years ago

        Oh awesome, thanks! Do you recommend any studies on the UV light exposure?

  • nextos 6 years ago

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

    • Nomentatus 6 years 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.

  • csense 6 years 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).

sunstone 6 years ago

Child malnutrition can be substantially mitigated with those peanutbutter balls.

lsiebert 6 years ago

Vaccines and other infrequent medical interventions. Something you can pop once a day for the rest of your life is much more lucrative then a cure or once every 7 years booster shot vaccine.

Chicken Pox is a type of Herpes virus. There's a vaccine for it, but not for the two strains of herpes most associated with the term herpes.

Development of one seems to have been embroiled in... well lets just say some trouble based on unethical experiments. But really, apparently 90% of people are infected with either type 1 or type 2 herpes simplex.

https://en.wikipedia.org/wiki/Epidemiology_of_herpes_simplex

https://www.cnn.com/2018/04/23/health/fda-halford-herpes-vac...

Likewise, Lyme Disease, has a vaccine for animals but not for humans, because production stopped in 2002. https://www.cdc.gov/lyme/prev/vaccine.html

Oh, and while there is a non profit foundation for it, reversible male contraception like RISUG/Vasalgel seems underfunded. https://www.parsemus.org/

keithnz 6 years ago

Climate Change / Waste Management / Many "Green" issues

  • Regardsyjc 6 years ago

    Adding to climate change- water management. Cape Town, South Africa had over 10 years to find a solution to their water problem but delayed. I read that Bangalore, India might have used up to 80% of their groundwater... Water management can be solvable and lack of clean water affects 2 billion people.

    Not only that but climate change will dramatically affect coastal cities and couple hundred more million people especially in Asia.

    I've been researching water management lately trying to figure out what potential solutions I could work on but haven't figured anything out yet. There are sensors for identifying leaks or testing water. Better graphene filters for desalination. Problems with microplastics/pharmaceuticals in tap water that might be able to be fixed through reverse osmosis (RO) systems... I've considered importing a bunch of RO systems and starting an RO business to learn more. I recently learned that there might be 6 carcinogenic chemicals in New York City tap water that is unregulated and a byproduct of the bleach they use to sanitize the water...

    Water management is directly connected with population growth. When people move due to water scarcity or conflict from water scarcity it will only exacerbate cities more.

    Currently reading The Big Thirst and looking forward to reading Living with Water Scarcity.

    • imhoguy 6 years ago

      And for dry places with sun abundance the solar powered reverse osmosis is the future. Absolutely interesting topic!

  • saeranv 6 years ago

    One I've been thinking about: the building design industry's ability to couple mechanical energy systems to passive energy strategies and building geometry/material.

    Mechanical engineers have figured out all sorts of clever ways to couple different parts of the HVAC system together ensure maximum efficiency. Air is recirculated, if air can't be recirculated, just the sensible heat or moisture is captured and added to supply air. There are increasingly complicated loops of supply and return cooling/heating water to reduce the energy cost of exhausting waste heat or absorb heat from outside conditions. All of which is calculated with building energy models, and can easily be parameterized and optimized for specific load scenarios.

    And yet, anything that is the architect's domain is never as tightly coupled. So you end up with mech engineers recommending these sort of plug-and-play systems, architects implementing fairly generic "sustainability" strategies, and the efficiency gains from coupling the two are lost.

    Off the top of my head, here are some reasons for this (beyond just the disciplinary division between mechanical engineers and architects): - lack of sophisticated computational geometry methods that plug into the energy simulators - the huge upfront cost of developing a mechanistic simulation models - the dependency of energy modeling on complex fluid modeling and the prohibitively huge computational cost associated with that - the inability to capture local microclimate conditions that can inform hyper-localized building design - the lack of a database of building energy models with accurate geometry/material options that would allow architects to predict energy impacts of geometry - the general ambiguity of classifying "shapes" and "geometry", it seems impossible to break down geometry into feature vectors for ML or statistical analysis.

    I don't know if this actually has a huge energy impact, but my instinct is that there's a lot of potential "coupling" that could occur that is left on the table because the building design industry tends to silo the active/renewable energy systems. Granted, there's plenty of activity in the industry around this, but at this stage it's all based on the idea of hooking up existing state-of-the-art simulation modelers to CAD geometry modelers, and then doing fairly simple optimization design solution space searching between the two. As the divide between the two software "silos" (energy simulation/CAD models) starts to break down, and more sophisticated methods to break down the solution space trickles down into the industry from ML/data science, I think this should lead to a scenario where we can implement more tightly coupled building designs.