MS coincedence?

[TiredSam]

@TiredSam likes things like this.

I most certainly do . Clusters happen, and if you're in one it looks like something must be going on. There was a good section on it concerning plane crashes on "More or Less" recently when we were having all those plane crashes.

I have no idea whether such a cluster in MS is just what you would expect to arise somewhere sometime, or whether this one is so unusual that even normal clustering doesn't explain it.

Interesting point about Dr bias. By sheer coincidence I was reading Oliver Sachs' autobiography during my 10 minute lying in the sun to get some vitamin D this morning, and he was describing when he and some colleagues examined the brains of 5 MS patients (post-mortem) and discovered that all 5 of them had been misdiagnosed.

What are the chances of me reading that on the same morning I'm tagged in a thread about MS diagnoses .

Perhaps @alex3619 can add something?

 

[Mij]

Interesting point about Dr bias. By sheer coincidence I was reading Oliver Sachs' autobiography during my 10 minute lying in the sun to get some vitamin D this morning, and he was describing when he and some colleagues examined the brains of 5 MS patients (post-mortem) and discovered that all 5 of them had been misdiagnosed.

Did they say what the actual diagnosis was or if the brain indicated infection? They dont' know the cause of MS.

They have also found C pneumoniae present in post mortem brains of Alzhmeimers patients.

 

[TiredSam]

It was just a small aside when he was writing about his life in the seventies:

The neuropathology department organised brain cuttings once a week ... These brain cuttings were popular sessions which attracted, among others, clinicians eager to see if their diagnoses held up. On one memorable occasion, we examined the brains of five patients who had been diagnosed in life as having multiple sclerosis. The brain cuttings, however, revealed that all of them had been misdiagnosed.

That's all he writes about it.

 

[alex3619]

That Canada has a high rate of MS is consistent. The further north or south you are the higher this risk. In a country with a high rate you should not be surprised by some clusters just by chance. That does not mean it should not be investigated.

I am rereading Osler's Web. One of the first stories is about an MS cluster outbreak of MS in Miama, which is a warm sunny clime. This was regarded by many as simply wrong, as the doctrine is that MS does not cluster, even though people went to Miama from all over just for the climate. I think the upshot of this is that they mostly had ME, not MS, but I forget the details as I read OW a very long time ago now.

One study I read of a while back, however, went looking for causes of childhood developmental problems in Mexico. I forget the details now, its been years. They found no match with any chemicals etc. However they looked at chemical usage, I think it was pesticides, and found that the areas that used a particular combination, two pesticides I think, matched the locations of these childhood developmental clusters. One of the things that investigators can get wrong is they do not look at how chemicals and other factors combine. Its a combinatorial problem. We just don't have good enough technology and science to do this reliably yet.

We know there are different types of MS. The first thing I would want to know, if I saw an apparent cluster outbreak, is were they mostly the same type?

 

[Chrisb]

That Canada has a high rate of MS is consistent. The further north or south you are the higher this risk.

I was recently told (by a retired GP) that people in Australia do not suffer from MS if they have not visited northern latitudes. Have you heard of that theory? It surprised me.

 

[barbc56]

We know there are different types of MS. The first thing I would want to know, if I saw an apparent cluster outbreak, is were they mostly the same type?

I think that's an important point. There's progressive MS and relasping and remitting MS. My dad's wife has relapsing/remitting MS.

I'm now curious about the difference between the two, other than the severity and progression of the symptoms.

What are the chances of me reading that on the same morning I'm tagged in a thread about MS diagnoses

What are the odds that a random memory about a random comment you made on this thread would pop up in my mind. Down to saying something about it being your cup of tea. Yet if someone had asked me what I remember about the thread, other than I had started it and it was about a book and even that's iffy, I would have drawn a blank. I had to go back to that thread because I couldn't remember the title of the book.

I used to do this all the time. Random memory.

 

[JohnCB]

The example of the coin toss does illustrate probability over a fairly simple process but the fact is we do not know if the causes of MS are random or not and cases like this could point to a strong likelihood that they are not always random distributions.

"could point to a strong likelihood" is in fact the other way of saying this may well be random. The question is whether this case is unique or whether there are other similar case and if together they produce sufficient reason to claim common cause.

I have no problem with clusters being investigated. I would expect the public health officials to do just that. Apparently clusters have already been investigated. The question is whether there was evidence to establish common cause. I don't have knowledge either way on that last point.

There was a case of an office in Australia where over a period of time all of the women who worked in a certain part of the building developed breast cancer. It was never determined why but the area was eventually shut down because the pattern was so unlikely to be random that it was considered a health and safety risk.

Which doesn't illuminate the present case.

I agree with you that it's all an unknown but the societal norm has been to discount the experience of ill people and I think we all have seen how that plays out as ME patients.

If you re-read my first sentence, I was keeping away from these issues.

Let's go back to the original article quoted in the thread. The basis of the argument was that this could not be coincidence. What I am saying is that it can until some stronger evidence is brought forward, that it can be coincidence. If someone brings forward good evidence to show that the clustering has causes other than randomness and bad luck, then I will accept that argument, but I won't accept the argument that it can't be random because we don't like it being random.

There have been cases of apparent clustering of a variety of health issues. The last one I remember reading about was a cluster of teenage suicides in Wales. Of course each of these suicides is very sad in its own right. However after the fuss had died down, there was nothing to indicate any meaningful connection between the cases. That latter point got much less press coverage than the original claim that they must be connected.

My point is still that random events can create apparent patterns that we intuitively believe indicate some commonality where there is none. And I still don't have enough knowledge of MS to say that there is likely any non-random connections in the Canadian case or not. Just having a desire to see a connection is not enough to say that there is a connection.

 

[Living Dead]

MS may have an infectious cause:

http://www.abc.net.au/catalyst/stories/3572695.htm

CFS/ME is like atypical MS and antibiotics have helped me a lot!

I think the reason minocycline (mentioned in the article) helps for ME is because it reduces iNOS. Not because there is an ongoing infection.

Edit: This mechanism is also more plausible in the context that it has to be taken for a whole year or more (also mentioned in the article).

 

[alex3619]

I was recently told (by a retired GP) that people in Australia do not suffer from MS if they have not visited northern latitudes. Have you heard of that theory? It surprised me.

I would be surprised too. It would be an interesting finding though, and if correct would indicate a second environmental factor. Indeed, given plant life and pathogens change with climate it may indicate a natural environmental factor that is triggering MS. Who knows?

 

[JohnCB]

According to MS Australia

https://www.msaustralia.org.au/what-ms

"MS affects over 23,000 in Australia and more than two million diagnosed worldwide."

According to Wikipedia global prevalence is about 30 per 100,000. Australia has a population of about 24 million.

 

[Mij]

In Canada it's 1 per 350! 100,000 cases in a population of 36 million. wow

I am trying to find the stats for M.E

 

[ScottTriGuy]

400,000 Canadians disabled by CFS

http://www.shoutoutaboutme.com/about-me/400000-canadians-disabled-by-cfs/

"The 2014 Canadian Community Health Survey (CCHS) (published June 17, 2015) reveals that, among Canadians aged 12 or older, 1.4% have been diagnosed by a health professional with CFS, relatively unchanged from figures collected in 2010 and 2005."

 

[L'engle]

@JohnCB I think we can agree that we are both saying it can either be random or not, that we have no proof either way. I did not say 'there is no chance this is random'.

My only concern is the example of a random system like a coin toss cannot necessarily be extrapolated to what might be a different type of complex and potentially non random system.

I definitely agree with you that people misunderstand probability terribly and make poor choices with regard to those false understandings in cases that are known to be random processes.

 

[Hutan]

MS global incidence map - affected by variable rates of diagnostic effort I expect.

Many New Zealanders and Australians do spend time in Europe/North America.
And a large proportion of New Zealanders and Australians share the genes of the people in Western Europe and North America.

But still, it seems likely that there is an MS risk factor associated with low latitudes.

We really need good epidemiological studies of the incidence of ME/CFS in equatorial countries to see if there is any similar trend. I think there may be a lot more ME/CFS in equatorial countries than is currently recognised.

 

[Forbin]

An interesting thing about the geographic risk of MS is that it seems to relate to how far away you live from the equator before you turn 15. If you grow up far away from the equator but then move closer to it after age 15, your geographic risk remains the same as that of children who stayed at the |higher| latitude. The same is true for those who move closer to the poles after age 15; they retain the smaller risk they had at lower absolute latitudes.

 

[alex3619]

Substantive incidence in Mexico and central Africa suggest there is an environmental issue other than sunlight or just latitude, at least for some cases. I wonder how much of the issue is because in lots of places its just not diagnosed due to medical service provisions failing.

 

[Daffodil]

I think the reason minocycline (mentioned in the article) helps for ME is because it reduces iNOS. Not because there is an ongoing infection.

Edit: This mechanism is also more plausible in the context that it has to be taken for a whole year or more (also mentioned in the article).

not sure that is the case. i have spoken to people who have maintained remission of their MS for years even after stopping the antibiotics.

maybe it takes a year to show improvement with minocycline because the bacteria is intracellular?

mind you i have also spoken to those for whom antibiotics did not work

 

[barbc56]

not sure that is the case. i have spoken to people who have maintained remission of their MS for years even after stopping the antibiotics

I'm not sure what you are saying here. My brained fogged early today!

 

[barbc56]

My point is still that random events can create apparent patterns that we intuitively believe indicate some commonality where there is none. And I still don't have enough knowledge of MS to say that there is likely any non-random connections in the Canadian case or not. Just having a desire to see a connection is not enough to say that there is a connection

Our brains default mode is to perceive parrerns. The fact that this cluster exists may or may not be significant. We just don't know. But it's certainly an intriguing subject and I would think this is being looked at by the health authorities.

I'm too tired to write myself so will use quotes.

our brains have evolved as pattern recognition machines. Our brains create meaning from patterns we see or at least think we see in nature (Shermer, 2008). Often, the patterns are real, while other times they are manifestations of chance. Pattern recognition tells us something valuable about the environment from which we can make predictions that help us with survival and reproduction. Pattern recognition is imperative to learning.

http://psychcentral.com/lib/patterns-the-need-for-order/

 

[Daffodil]

I'm not sure what you are saying here. My brained fogged early today!

just that its possible that MS is an infection...