The 12th Invest in ME Conference, Part 1
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Why are we always treating symptoms and not causes? Examples from IBD.

Discussion in 'Other Health News and Research' started by Waverunner, Aug 15, 2014.

  1. Waverunner

    Waverunner Senior Member

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    23andMe is currently offering its patients to share data with Pfizer to find new treatments for IBD. In my eyes this is a great idea but I also want to share my thoughts on why we always treat symptoms and not causes. In the end, I don't have a clear answer but the difficulties become clear.

    Lets look at IBD for example. IBD is fascinating because it affects the gut and many, many people have problems with their guts (IBS, CFS, cancers etc.). That is why diets and probiotics are so popular today. It is true, that we have 10 times more bacteria in our gut, than we have human cells in our body but what causes these gut problems and how can we treat them?

    If you take a scientific approach, you realize very soon, that things are more complicated, than you think they are. I'm no expert but the causes for IBD are manifold. I certainly miss some or many but lets start with the barrier function. The gut needs to maintain its barrier function because if it does not, it will certainly get inflamed and affected persons will be confronted by all sort of problems. You don't want bacteria to leak into your bloodstream! Unfortunately the gut barrier has many ways, where it can fail. The last barrier of gut defense consists of tight junctions. Tight junctions should open, when the time is right, but they certainly should be closed, when it's not, e.g. the environment is loaded with things you want to keep out. Gluten can open these tight junctions in some celiac patients and the gut gets inflamed then.There is a drug (5-6 years till approval) called AT-1001 which hopefully works and closes these tight junctions in celiac disease.

    The next barrier is mucus. Nearly nobody knows this, but there is always a very thin layer of mucus on these tight junctions and therefore the whole gut. Why? Because these tight junctions never have contact to our gut microbiome/bacteria. If they do, inflammation occurs. Mucus is produced by goblet cells. What problems can occur? Mutations in goblet cells, bad bacteria which eat the mucus away, genetic defects or diseases that lead to a shortage of phosphatidylcholine (see pubmed) which is a main building block of this mucus and is currently used as enteric coated(!) form to treat IBD. In addition to this we have mutations pertaining IL-10, VDR, viruses and microbiome imbalances and certainly some other possibilities, which can cause IBD.

    So if you want to maximize profits by treating as many IBD patients as possible, what do you do? Well, you start at a symptom which is shared among all IBD patients irrespective of cause, so all patients are potential customers for your drug.What is this shared symptom? Inflammation! All drugs in IBD lower inflammation. We see microbiome transplants emerging but there is no pharma drug, which looks at causes besides inflammation.

    How could the patient population look like, if you wanted to treat causes? Probably XY% of patients have malfunctioning tight junctions. So closing these tight junctions could be a very good thing. But what if goblet cells don't produce enough mucus? Then you want to treat goblet cells. What if phosphatidylcholine is lacking? Then you want to supply phosphatidylcholine. What if bacteria are eating away the mucus or other microbiome imbalances are present? You want to treat the microbiome then. What if a virus is the cause? Antivirals! What if a genetic defect regarding IL-10 or VDR is the cause? Gene therapy. And so on and on and on.

    What happens if patients go to a doctor and say they have IBD, IBS, gut problems in general, what of the above does the doctor test for? The answer is: Nothing.

    As soon as you understood this, you know, why our healthcare system is so bad in many parts. We don't diagnose and we don't treat the causes, we only treat the last common symptom, which is inflammation, constipation or diarrhea in gut diseases. Why is this the case? I have no idea but what I do know is, that our healthcare system has to change. We should start looking for the causes of diseases and we should have drugs, that treat these causes. Anything else is inefficient, suboptimal, costs huge amounts of money (around 40.000 USD per IBD patient and year on monoclonal antibodies) and only causes problems in later stages of the disease. It's time for change.

    http://www.ncbi.nlm.nih.gov/pubmed/24989095

    http://www.ncbi.nlm.nih.gov/pubmed/24969297
     
  2. anciendaze

    anciendaze Senior Member

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    Just one example of an identified pathogen which uses molecular mimicry to divert immune response against itself to commensal bacteria in the gut, HIV. Nothing in nature requires that such pathogens produce acute disease lethal in a few years.
     
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  3. jimells

    jimells Senior Member

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    Maybe the answer's not really complicated. Which is more profitable, taking a pill (that sort of does something) every day for the rest of our miserable lives, or treating the actual problem one time?

    Surgeons agree, they made a lot more money cutting away stomach ulcers, often more than once, than they do now by prescribing antibiotics for H. pylori.

    Last year my mom developed bad chronic diarrhea. She was steadily losing weight, and she is already too thin. So naturally the doctors ordered both a colonoscopy *and* the camera that goes in from the top (endoscopy?), since these are very profitable procedures. As usual, they showed nothing. Only after expensive invasive procedures did they test for H. pylori. Bingo! A course of antibiotics and the problem disappeared.

    It only took months and months to get a diagnosis. Not bad by today's standards.
     
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  4. nells49

    nells49 [banned as spam]

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    wow that is pathetic
     
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  5. RYO

    RYO Senior Member

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    Waverunner - you make some valid points but have you known anyone with IBD? it is true that anti inflammatory medications have been the mainstay of treatment for decades for IBD. However, within the past 5 years, drugs like remicade have been life altering for many patients. The pharmaceutical industry's mission is not always humanitarian. is that a surprise to anyone. Most of us live in a capitalist society. There are countless examples of diseases where current medical treatment can only manage symptoms but offer no cure. I share in your frustration. A cure for a sick medical delivery system may be harder to obtain than cure for diseases.
     
    NK17 likes this.
  6. Waverunner

    Waverunner Senior Member

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    Thanks for your answer. It is true, that monoclonal antibodies like Remicade are a huge progress compared to cancer causing immune suppressants like azathioprine (which are still standard therapy because they are cheaper) but in the end Remicade only suppresses inflammation and in addition to this it stops working in many patients at some point of time. Moreover it acts systemic and can have certain side effects. Vedolizumab is a nice new alternative because it acts specifically in the gut but let me get back to my main point. I'm not interested in suppressing inflammation, when the actual cause lies in the microbiome, the goblet cells, tight junctions or mucus. Treating inflammation (like we do in nearly all chronic diseases) is important but it will always be inferior to treating the actual cause.
     
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  7. xchocoholic

    xchocoholic Senior Member

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    This is what integrative or functional doctors are doing. Since they're trained in the use of medications, diets, supplements, etc they're open to using whatever seems most effective.

    Of course the patient will need to listen to their bodies for positive or negative side effects to any treatments. We're all individuals so it's impossible for doctors to predict every patients reaction.

    Tc ... x

    Eta. My experience with integrative medicine included cdsas, cbcs, thyroid panels including antibodies, glucose + insulin testing, hormone testing, ultra sounds or other special tests if needed, etc. Many of these tests are available to traditional doctors but were never ordered so I see integrative doctors as being more thorough than traditional.
     
    Last edited: Aug 23, 2014

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