What if we tolerated diseases?

https://knowablemagazine.org/article/health-disease/2023/what-if-we-tolerated-diseases

by Brajeshwar • 3 years ago

55 112 3 years ago

aurizon3• 3 years ago

if we tolerated disease - as man did from time immemorial, we would allow diseases to reach a steady state. We would soon die out as a race due to population decline as we are well below the required rate of replacement in a diseased population. We would have to outlaw birth control as the current rate of replacement would not be enough if half our children died by the age of 5 - as they did in the 1700-1800's. Survivors might be more resistant, but I and many others do not feel this is a good strategy. Nature 'saw' the need for an immune system - it was that or die. About 90% of the native populations of North, South and Central America died from the diseases brought from Europe by Columbus and those that followed. This huge wave of deaths spread from the points of contact by tribal passage and preceded the later growth of hybrid populations of europeans/natives. It was only by later LIDAR surveys of large land areas that these ancient agricultural zones were revealed - some of which are now being explored - large structures - over grown by vegetation. Some were killed by older disease spreads prior to Columbus - it is not a new/unique phenomenon. So the article's premise is false - we can not back to the old ways.

That said, a better understanding might allow the linked pathogen/prey relationship between diseases and their host populations to be broken - as we have done with smallpox?

lesiki• 3 years ago

We would soon die out as a race due to population decline as we are well below the required rate of replacement in a diseased population

Isn't there a strong correlation between birth rate & child mortality? Most rich societies have slowed down their birth rate in large part because you don't need 5 kids in order to ensure 1 makes it to adulthood.

If we tolerated disease, we would probably increase birth rates to compensate for the spike in child mortality.

HelloNurse• 3 years ago

Conversely, increasing child mortality necessarily increases child care effort per adult child: a bad deal that can only be compensated by having children at a significantly younger age.

slushh• 3 years ago

We would have to outlaw birth control as the current rate of replacement would not be enough if half our children died by the age of 5

We could also make rising children less of an obstacle. If you build the infrastructure around rising children so that rising 2 children is not a full-time job, then parents would get more children.

vidarh5• 3 years ago

There is little evidence of that. Countries with more support do not necessarily retain higher fertility rates. Look at e.g. the legal right to nursery places with capped costs, long parental leave, and subsequent financial aid in Norway. It might be it'd happen if you exceed a certain level of support, but we've not cracked that nut yet.

explorer832• 3 years ago

We do sacrifice a lot of our time to raise children. But it's the cost of childcare that makes it really difficult imo. Unless you have a high paying job, you are quite literally going to work so you can afford to pay other people to watch your children while you're at work.

aurizon3• 3 years ago

True, many women/couples delay children, but look at Japan where the population has been in decline for many years to the point that there are thousands of empty houses - the converses of many places where zoning rules designed to block new homes for the express reason of forcing scarcity = upwards $$. There is huge inertia in the trades to build it the old way = codes the old way. We even have laws that mandate windows in all rooms from the days when coal/wood fireplaces were in every room. We got central heat, but we still build no inner rooms with no windows these days. Want a window = wall screen with a video of a scene you like - not brick walls 6 feet away.

maxboone4• 3 years ago

That's quite the extreme, this article doesn't remotely propose tolerating a potentially devastating pathogen.

It's more about the idea that someone can be healthy, even if they carry a pathogen.

XorNot• 3 years ago

Could you please read the article before typing?

The article is about research into non-immune system based adaptive systems of the body that reduce disease susceptibility - i.e why some animals and people can tolerate higher bacterial or viral loads without dying then others, and can we develop drugs which enhance these effects or augment them (i.e. giving glucose support to malaria infected rats which arr experiencing an overactive drop in glucose production due to natural responses to effects of malaria).

It's about therapeutic agents to boost survivability without looking directly at pathogen kill paths - it is admittedly weirdly titled.

maxboone4• 3 years ago

Thank you.

dang• 3 years ago

Please edit out swipes like the first sentence here. The rest of your comment would be just fine without that.

If you'd please review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it. One of them is "Edit out swipes", and there's even another about this specific case:

"Please don't comment on whether someone read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that.""

nkrisc• 3 years ago

When I read articles like this, I can’t help but think that the author takes it for granted that humans are destined to exist.

teekert• 3 years ago

Maybe we aren't, but the deeply ingrained believe that we are may certainly be useful. I hate lies or partial truths, but if the full truth is incomprehensible by our intellects, the best we can do is live with and by models and mantra's that are helpful in making the now a nice place to be.

Not that we should even give up the search for more truth, at least, that's one of my mantras.

Dudeman1122• 3 years ago

What do you mean?

Looks to me like you are reacting to the title instead of the article

I expected the standard anti-medicine fare from the title, but got neat biological investigation/hacking instead. That was an interesting read

ragingrobot2• 3 years ago

If I read your comment right, I fully agree.

We take it for granted, we believe that we have the right to exist. At every turn we're trying to defeat death and illness. Trying to defeat nature's (and the planet's) mechanisms of a form of population control.

Then on the other hand, we sort of complain about overpopulation.

Don't get me wrong, I don't want to see people die, but on the other hand I fully understand that we must die. Me must get ill.

Dudeman1122• 3 years ago

I don't want to see people die, but on the other hand I fully understand that we must die

Those are not mutually compatible

Well, unless you take some esoteric interpretation where one can be absolved from the immediate implications of what they think are the most desirable states for the universe

If one considers it necessary for people to die, one wants people to die. It's part of the whole considering death necessary

darkwater• 3 years ago

We are not destined, we just want to exist, just like every other animal (well, maybe there are some exceptions).

maxboone4• 3 years ago

Today in "it's a bit of both".

I guess this is a very Dutch thing, but usually the GP here sends you home with the advise to take some rest, an antipyretic and call again if it gets worse or it doesn't go away after a week.

Still, interesting read - good this is thought and discussed about.

braymundo• 3 years ago

Yup, paracetamol being prescribed for everything is a bit of a meme here.

AstralStorm• 3 years ago

These days it tends to be ibuprofen.

maxboone4• 3 years ago

Yeah, sometimes it's a bit much.

Especially because I already do the paracetamol & wait myself before I go to the GP to begin with, but at least my current GP understands that.

BrandoElFollito• 3 years ago

Same in France, especially for children.

The time is that you send a kid at school until they "have temperature". Before that they sneeze, cough, whatever, together with the rest of the pupils. Eventually everyone gets ill and the general immunity increases.

When they are are ill it is paracetamol. It used to be also antibiotics, now an increasing number of GP do tests before.

EDIT: following up on comments, please note that I am neither the Ministry of Health, nor the Ministry of Education - just relying the status in France. And a parent who suffered of this first-hand.

ClumsyPilot7• 3 years ago

Before that they sneeze, cough, whatever, together with the rest of the pupils.

This is not a good thing - repeated infections with the same virus only cause damage. Then they infect parents or grandparents. Especially now that covid is about, and life expectancy has fallen across the world by several years.

Schools could install air purifiers for a few hundred bucks per room and greatly reduce infections

PS: a lot of responses perpetuate the urban legends about immunity. So I thought I would respond here:

1 - getting many infections as a child does not keep you safe when you are a pensioner. Immunity does not last the rest of your life.

Most vaccines need to be refreshed every 10 years. The proper term is Immunological memory, and is a complicated subject I don't fully grasp. That's why we had booster shots for COVID, immunity from it disappears quickly.

2 - getting infected is not consequence free. Just because you gully recovered does not mean you have no lasting damage. Serious infections cause microscopic damage in your organs. That damages is patched by connecting tissue / scar tissue. That tissue is not functional - if it patches a kidney, that kidney is less capable. You don't need to get Ebola to suffer damage - even a serious case of flu takes a toll.

3 - many immunities are worthless - for example the flu mutates every year, and if you want immunity from it, in UK we do flu vaccines. So if you want immunity from it, take every vaccine when it's offered. But if you got a vaccine 3 years ago, chances are that particular mutation will not reoccur in your life, and it offers no particular benefit ever again.

4 - pathogen load is a thing - you don't need to fall ill to generate immunity. When you are walking about, your body is getting tiny amount of pathogens - and most of the time the quantity is too small to get you sick, but your immune system deals with them. You do not get infected because someone sneezed 20 miles downwind and you inhaled 1 virus particle. Schools / kindergartens with poor ventilation create pathogen hot-tubs with unnaturally high pathogen loads. This is like an infection hot boxing. We know ventilation is terrible because often have CO2 concentration in excess of 2000. There is nothing natural about this, cavemen did not encounter such conditions. Improving ventilation reduces how many pathogens are floating in the air, even if the same number of kids are sneezing.

Bottomn line is, immune system is not like a dog that you train once, and it's also dangerous because you can get allergies or autoimmune diseases.

There is no evidence that subjecting people to excessive number of infection by creating disease petri-dish conditions in school has any benefit.

Also Kurzgesagt has many videos on immune system: https://youtu.be/M-K7mxdN62M

jacquesm2• 3 years ago

Yes, and then they expose other kids who then take it home who in turn expose their parents. And as one of those parents I can't avoid getting ill so often through that one vector of exposure that I can't control that it stopped being funny long ago.

konschubert• 3 years ago

I think the article says: "Some scientists think that sometimes it may be better to tell your immune system to take it slow, such that you have fewer symptoms caused by the immune response".

We are already doing this, no?

Every time we take medication that lowers our fever during an infection (antipyretic ), we trade a bit of immune response for a much more comfortable illness.

The other aspect of this is that carrying more pathogen, for longer, increases the chance that you will infect others.

giantg2• 3 years ago

"increases the chance that you will infect others."

Or that it could do more damage, depending on the type of infection. For example, HPV os though to only lead to cancer for those who have a persistent infection for a few years.

chrisan• 3 years ago

Ya, you aren't suppose to take an OTC pain reliever around the covid vaccine as it could reduce your immune response

gautamdivgi• 3 years ago

Not sure why you got downvoted. But I believe you’re right. I did read that you should not take the otc pain reliever before the shot but can do so when symptoms develop after the shot.

ryanbrunner3• 3 years ago

Doesn't it also increase the odds that you'll create new variants of the illness? I remember a lot of theorizing that some COVID variants developed in immunocompromised individuals who hosted the virus for months.

echelon• 3 years ago

Every immune cell recruitment and proliferation event gets you closer to the Hayflick limit.

You cause damage to your body through inflammation. You invoke deleterious pathways that normally sit idle.

Getting sick primes the immune system for defense, but it is also damaging to healthspan.

sudosysgen• 3 years ago

Don't most immune cells derive from stem cells? Stem cells express telomerase so they aren't really subject to the Hayflick limit.

nradov4• 3 years ago

Inflammation isn't necessarily damaging. In some cases it actually accelerates the healing process.

The Hayflick limit really isn't relevant here.

scotty79• 3 years ago

I think the jury is still out whether the fever is beneficial of harmful for the recovery process in most common illnesses.

My personal theory is that fever arose as a specific mechanism against specific pathogen that humanity encountered some time in the past. Probably very lethal. The only people who survived were ones that were getting fever when encountering large number of various antigens. That pathogen I think is long gone and most human pathogens are completely not influenced by the fever. But the mechanism largely remained.

Or perhaps fever works against bacteria so if you keep yourself isolated when you are having viral disease it's useless, but if you still contact people when virally ill maybe fever protects you from secondary bacterial infection to some degree.

MrVandemar• 3 years ago

Most organisms function within a given temperature range. For example, try dropping the temperature to 0C or raising it to 60C and see how you like it.

Fever, I suspect, is the body trying to exceed the operating temperature range of the pathogen to either kill or impede it.

I don't know if there has been any research on this that either confirms my genius theory or disproves my rambling uninformed delusion.

lamontcg2• 3 years ago

The other aspect of this is that carrying more pathogen, for longer, increases the chance that you will infect others.

There's no evidence of this tradeoff.

BulgarianIdiot• 3 years ago

We've already reached a point where medicine, in some cases, is doing more damage than good. Plastic surgery is clear example of this.

Followed by surgery like gastric bypass which is largely ineffective long-term, but of course they don't track it long term. People return to old habits, and the body tries to adapt, but now with newly crippled digestive system.

"Everything in moderation" is something we've not learned yet, as a culture.

robertlagrant• 3 years ago

Plastic surgery is clear example of this.

Lots of plastic surgery is done to restore features. I think that practice does far more good than harm.

enkid• 3 years ago

Plastic surgery is one of those things you are much more likely to notice if it's done poorly then well. This, ironically, makes people think most plastic surgery is "bad" when really most plastic ic surgery that you notice is bad.

nik_s• 3 years ago

While I agree with the general sentiment of your message, there are quite a few meta-analyses on pubmed on the long-term safety and efficacy of gastric bypass surgery. They mostly show that while some patients do end up back obese, the majority do improve on many markers of health (weight, diabetes, ...).

Here's an example of a study if you're interested [1]!

[1] https://pubmed.ncbi.nlm.nih.gov/29340676/

jacquesm2• 3 years ago

There is elective plastic surgery for fashion reasons and there is reconstruction after trauma or to correct birth defects, you should probably not toss the two into the same bin.

DanHulton• 3 years ago

There is also elective plastic surgery to help address body dysmorphia. And even "fashion reasons" aren't as frivolous as some would think. A lot of people will judge you based on "fashion reasons," and being able to address that can potentially measurably improve you life. There are plenty of studies that have shown that people perceived as "more beautiful" are more respected and have an easier life. The inverse is also true, and being able to address that is powerful.

xwdv• 3 years ago

Plastic surgery is not a clear example, tell that to a burn victim or cleft lip child or anyone with a deviated septum.

culopatin• 3 years ago

If we call plastic surgery medicine then are piercings medicine? I’d argue that plastic surgery relies on medicine, but it’s not fixing any illnesses.

sylware• 3 years ago

We would be batmen.

KingOfCoders• 3 years ago

Like the plague? Together with the Swedes it killed 85% of the inhabitants of my hometown.

feintruled• 3 years ago

That 'survival of the fittest' interpretation is not the angle the article is coming from, I think. It's saying 'if you can control the symptoms, why worry if you have the disease?' Or rather, what if you were sufficiently tolerant to a pathogen you didn't display any symptoms.

ryanbrunner3• 3 years ago

There's absolutely viruses that we tolerate currently and take basically no effort to fight, because in the vast, vast majority of the population they're benign. I had an organ transplant a couple of years ago, and as part of that I now have to do monthly blood screening for some of these benign diseases (CMV and BK) since they aren't as benign for someone on strong immunosuppressants.

Maybe this is a selfish thought, but moving towards tolerating diseases objectively increases risk for people like me who can't tolerate diseases to the same extent as others, and others tolerating them more increases the odds that I'll catch them, so this isn't a medical advancement I'm particularly excited about.

fovc• 3 years ago

CMV is also strongly associated with pregnancy complications

PaulKeeble• 3 years ago

A lot of these benign viruses are turning up in diseases we go on to develop later in life, they might not be benign they just don't kill us right away.

MichaelZuo4• 3 years ago

Yes, supposedly quote-on-quote benign not actually proven in fact.

1bent• 3 years ago

I think you're responding to your interpretation of the title, rather than the article.

They aren't proposing increasing asymptomatic disease, they're discussing trying to reduce damage done to individuals.

ryanbrunner3• 3 years ago

Right, but that shifts treatment of the disease from being mostly focused on elimination to a mixture of elimination (you're right that the article makes it clear that these researchers are not advocating abandoning elimination altogether) and building tolerance. That's inevitably going to shift focus away from trying to rid the patient of the virus when building tolerance is a more productive approach.

Which 100% sounds like the right approach to take and I don't consider this immoral or wrong or anything, just unfortunate.

iamcasen• 3 years ago

Illness is largely a function of overall health. As a society, we generally lead very unhealthy lives: eating mountains of processed food, working too much, sitting indoors and staring at screens. We have a failed concept of the nuclear family, which means very little support with child-rearing, and soaring costs around everything involving the home and family.

All of this stacks the deck against the majority of Americans.

Is it any wonder our bodies cannot fight off disease naturally?

When you also add in that we have an absurd fear of illness and death, our behaviors get more and more neurotic, which then adds to the stress, which then further compromises our health.

SketchySeaBeast2• 3 years ago

Is it any wonder our bodies cannot fight off disease naturally?

You need to prove that we could previously. The various plagues and epidemics (Athens, Antonine, and Black to namea few) are excellent proof that returning to unprocessed food won't much help.

When you also add in that we have an absurd fear of illness and death

The Momento Mori rose in response to the Black Plague, so that's not new either.

chrisdhoover• 3 years ago

I’m not sure that you understand the meaning of nuclear family. It is a family composed of mom, dad, and kids. This differs from single parent households. You may want to rethink what you wrote.

mvdl• 3 years ago

"And vaccines work because they teach immune systems to recognize — and so more effectively resist — pathogens before the actual bug is encountered." Is a bold claim that has yet to be proven empirically.

jrussino• 3 years ago

a bold claim

Isn't that just the definition of a vaccine?

"A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease." ... "The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future."

https://en.m.wikipedia.org/wiki/Vaccine

SketchySeaBeast2• 3 years ago

What proof do you require? The first vaccines for smallpox were literally teaching the immune system to fight it by using the less dangerous but very similar cowpox. If you were infected with cowpox you were much less likely to be sick with smallpox. What are you taking exception to there, and if you are taking exception, please describe in detail what proof you'd require.

msla• 3 years ago

Tolerating disease means dooming some people to die.

I know that's popular among some political groups, but it is still inhuman.

11235813213455• 3 years ago

I help merchants sell fruits, eat many, forage also in my area, people are always a bit shocked when I directly eat tomatoes, kiwis (with their skin), dates, peppers without washing them, but I don't get ill at all, my immune system is probably stronger than theirs after decades of a forager lifestyle, it sorts what needs to be, digest correctly

lamontcg2• 3 years ago

This is exactly what the SARS-CoV-2 vaccines do.

The neutralizing antibodies aren't durable, so protection against infection and mild illness wanes, but the T-cells that protect against hospitalization and death are likely permanent.

frankreyes• 3 years ago

This is how it already works. Vaccines are just a learning experience for the immune system, which is the one doing the actual work. Vaccines per se do not cure diseases.

What if we tolerated diseases?

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