A Medical Mystery of the Best Kind: Major Diseases Are in Decline • Hacker News Board

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#81

Post by carbocation » Sun, Jul 10, 2016, 10:56 PM UTC

Gibbon1 wrote: post #75

mrob wrote: post #63

Earlier quoted context omitted.

You might be thinking of CETP inhibitors. This class of drug modifies cholesterol levels to numbers associated with better health, but so far none of them have conclusively improved health outcomes: https://en.wikipedia.org/wiki/CETP_inhibitor Anacetrapib is still in stage III trials so it's too early to consider the concept a failure, but I think the bad results so far are evidence that hyperlipidemia is a symptom n…

Yes those drugs. Hard to say conclusively, but the failure of most of CETP inhibitors is troubling news for the hyperlipidemia theory. Meaning possible hyperlipidemia has multiple causes and in and of itself isn't bad. AKA Cause A results in hyperlipidemia. Cause B results in hyperlipidemia. Cause C results in hyperlipidemia and arterial plaques. Cause D results in hyperlipidemia.

Numerous lines of evidence, including randomized controlled trials, single gene studies, and Mendelian randomization studies, are not consistent with your interpretation.

Multiple agents that reduce cholesterol, including ezetemibe and statins, reduce cardiovascular disease outcomes and death.

Multiple cholesterol-related genes, including HMGCR, LDLR, APOB, PCSK9, and ANGPTL3, contain variants which influence both LDL cholesterol and the risk for coronary artery disease, myocardial infarction, and death.

And Mendelian randomization studies that rely upon a dose-response relationship between genes that influence cholesterol and the cardiovascular outcomes that they cause have also demonstrated a link between genetically driven cholesterol levels and hard endpoints.

So, one set of drugs (CETP inhibitors) that don't seem to follow the story are more likely to be the exception, rather than the rule. Interesting biology awaits us in the explanation of why the CETP inhibitors don't do what we imagined they would with hard outcomes.

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#82

Post by seizethecheese » Sun, Jul 10, 2016, 10:57 PM UTC

amorphid wrote: post #62

transcranial wrote: post #59

Earlier quoted context omitted.

Apparently Parkinson's disease has been on the rise over the past several disease, some say due to the decrease in smoking. Which is fascinating, as smoking has been shown to be actually protective against Parkinson's.

Or maybe you die from something smoking related before getting Parkinson's.

Or maybe both.

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#83

Post by lastres0rt » Sun, Jul 10, 2016, 10:58 PM UTC

Put bluntly: All of these 'little increases" are starting to add up in big ways. I'm not that surprised that a decline in one disease is leading to declines in others. As we all live a little longer, we make each other healthier as well, being better able to cope with the expanded safety net.

As someone who's seen her grandparents suffer with a cacophony of diseases right before death? Sometimes, one thing really DOES lead to another.

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#84

Post by robbles » Sun, Jul 10, 2016, 11:00 PM UTC

Is it possible that medical advances in the last couple of decades have simply delayed the deaths of many sufferers? Heart disease and cancer survival rates are usually qualified with a number of years, given that they are difficult to fully cure. With a larger aging population just barely hanging on, perhaps an upswing is just around the corner but hard to see now. i.e. the rate of death has not actually dropped, the average survival time is longer.

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#85

Post by GFK_of_xmaspast » Sun, Jul 10, 2016, 11:00 PM UTC

SilasX wrote: post #64

transcranial wrote: post #56

Earlier quoted context omitted.

The correlation is one of the strongest there is, and indeed, causal -- there's a almost perfect lag time of ~20 years [1]. [1] https://en.wikipedia.org/wiki/Lung_cancer#/media/File:Cancer...

The graph stops at 1970.

Are you suggesting that some post-Nixonian mechanism is in play here.

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#86

Post by GFK_of_xmaspast » Sun, Jul 10, 2016, 11:01 PM UTC

illumin8 wrote: post #80

autokad wrote: post #40

Earlier quoted context omitted.

stomach cancer was spiked due to h-pylori. water treatments put a huge dent in that

A comment like this could be very insightful, but you didn't mention what h-pylori is, or why water treatments help reduce it.

The cool thing about the internet is there's a whole universe of information at your fingertips: https://en.wikipedia.org/wiki/Helicobacter_pylori

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#87

Post by codecamper » Sun, Jul 10, 2016, 11:01 PM UTC

sgt101 wrote: post #7

wow - I have no clue (obviously) but possible reasons : - better home heating (less open fires, more heated bedrooms) - increased time from atmospheric nuclear bomb testing (and the various dispersals of plutonium in the 60's and 70's) - better nutrition in general - higher genetic diversity in breeding populations; not many peoples grandparents all come from the same village in the developed world now - less polluti…

You beat me to it. My guess would be increased time from those atmospheric nuke tests.

Those were crazy days! The Tsar Bomba. What was the world thinking?

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#88

Post by JacksonGariety » Sun, Jul 10, 2016, 11:03 PM UTC

rgarrett88 wrote: post #78

cma wrote: post #74

Earlier quoted context omitted.

That's lower than population growth so would still be a global per-capita reduction.

I would imagine a global smoking increase statistic would be per-capita as well but without a citation we won't know.

"In his own studies of smoking, Stebbins has shown how the tobacco industry has turned to markets in the developing worl to make up for loss in sales first in the United States and subsequently in parts of the European market. Governments in developing nations often do not have the ability to limit tobacco marketing and, usually in need of financial help, they are open to introducing taxable commodities to their citizens. As a result of extensive advertising in developing nations, Stebbins notes that worldwide tobacco consumption has increased at the rate of 1 percent per a year, and countries such as Brazil, India, and Kenya exhibit the greatest increases (1990)."

This is from Bryan Page's "Comprehending Drug Use." It's a textbook but it's accurate, well-cited, and well-written.

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#89

Post by alexandercrohde » Sun, Jul 10, 2016, 11:17 PM UTC

magila wrote: post #44

On the other hand, autoimmune diseases have been increasing in prevalence over the last century. While these diseases are rarely immediately fatal, in severe cases they can have a major impact on quality of life. Onset often occurs in early adulthood so the cost of treatment over a lifetime can be extremely high. The usual treatment, immunosuppressive therapy, also has serious risks of its own. While there has been m…

Absolutely. I wish this article wouldn't speak so generally when I hear consistent articles about major spikes in:

- Autoimmune issues (especially allergies) - Obesity (particularly in children) and diabetes - Autism - Depression, ADD, and similar disorders

Re: A Medical Mystery of the Best Kind: Major Diseases Are in Decline

#90

Post by codecamper » Sun, Jul 10, 2016, 11:18 PM UTC

I wonder if all the benefits may be coming from people having kids later in life. You'd think this would lead to more disease, but maybe we are actually evolving to be longer living and the kids later in life is what is causing it.