Sucks to your asthmar!

  By Shamus   Jan 30, 2008   37 comments

Steven muses about the rise of cancer and asthma. He cites a common concern that these killers are the result of our immune system being underworked by living in such clean conditions.

One thing I’ve always feared is that asthma is growing because we’ve stopped it from killing us, and so asthmatics are breeding. I wouldn’t have made it to adulthood without modern medicine to keep my asthma at bay. Good for me, but perhaps it let me pass the curse on to my kids. (One of our three has Asthma. Thank goodness she’s nowhere near as bad as I was at her age. I’m actually pretty confident she can grow out of it.) Before we had these drugs, people who had severe asthma got weeded out, which always kept our numbers low. (Medicine hasn’t always been our friend. My grandmother died of asthma years before I was born. When she was diagnosed, the doctor wrote her a prescription for cigarettes. To treat her asthma.)

This is not to say I discount the “Hygiene hypothesis“. Like many problems, I suspect that asthma is even more complicated than it seems at first. I’ve met and exchanged notes with many other asthmatics in my life, and one of the most infuriating things about it is how different each case is. Some people grow out of it in their teens. Some people – like me – actually get worse. Some people develop it later in life, after middle age. Some people have attacks triggered by certain allergic reactions. Some by exercise or heavy breathing. Some by certain combinations of temperature and humidity. Some by stress. Some for no discernable reason at all. Some people get attacks that come and go. Some people get attacks that escalate until they intervene with medicine. Some can combat their attacks with folk remedies like caffeine, relaxation, humidifiers, bathing, breathing exercises, or diet changes. Other people only respond to drugs. Some people get attacks deep in their lungs which produce the “wheezing” sound. Some get attacks higher up, where the effect is silent and just produces a “tightness” in the chest.

This is just an overview of the variables in place, as I’ve observed them over the last 30 years or so. I imagine things get more complex, not less, as you get down to the nuts and bolts of what is going on inside the body. The more I learn about asthma the more it seems like a group of conditions which share a common set of symptoms.

It sucks.

201737 comments. Hurry up and add yours before it becomes passé.


  1. Deoxy says:

    Yes, it does suck.

    I ascribe fairly strongly to the “we aren’t letting them die” camp in regards to many things (stupidity and laziness for just two), but in the case of asthma (mild case myself, wife has a more noticeable case, one child has it), I suspect that there are other issues in addition (not instead).

  2. Mike R. says:

    I’d probably dead too. Or at least I’d be such a sucky peasant that no lass would want to marry me and hence I wouldn’t spread the genes. Not being able to find a mate has the same genetic effects as dieing before you mate.

  3. MintSkittle says:

    For the asthmatics out there, I’d recommend joining a music group, like a band or singing group. I played in a band when I was is school, and we did breathing techniques to improve our intake of air. I still get a little wheezy now and then, but nothing like when I was a kid.

  4. Will says:

    I’m worried that one day most of humanity will be functionally blind because we can correct our genetic vision problems with glasses and surgery. I lucked out in that my father’s far-sided vision canceled my mother’s near-sided vision. Skin cancer runs heavily on my mother’s side so I’ve go that to worry about (and it doesn’t help that I grew up in Arizona, #2 for skin cancer in the world last I checked).

  5. Deoxy says:

    “Not being able to find a mate has the same genetic effects as dieing before you mate.”

    Actually, not being able to find a mate MEANS you die before you mate, as you never mate, and you definitely DO die.

    Oh, and I think increases in cancer are largely due to two factors: we aren’t dying of other stuff first, and we take the time to figure out what caused the death (that is, if someone died of, for example, a brain tumor even 50 years ago, who would know that’s what caused the death?).

    Edit: one last thought about asthma – could it just be that we see more of it, as many asthmatics can basically ignore their asthma if they are in good enough shape, and people used to be in better cardiovascular shape? Sure, the serious cases would still die, but infant mortality being what it was back then, who would really notice?

  6. Henebry says:

    As someone who’s worn glasses since age 8, I’ve had similar thoughts about corrective lenses. They’ve been around since the Middle Ages, I think.

    But with myopia, as with asthma, the situation may be more complex than Darwinian (or anti-Darwinian) inheritance. I ran into an article (in the NYTimes Science section around 9 years ago) that suggested nearsightedness in children (which is due to malformed eyes, whereas farsightedness in adults is due to the increasing rigidity of your eyes’ lenses as you age) is caused by the widespread prevalence of night lights. The theory is that the developing eye in young children (ages 0-3 or so) needs deep darkness to grow properly; with too much light (too much stimulus), it grows into the wrong shape, resulting in a far greater prevalence of nearsightedness in our culture than in prior (read: primitive) cultures.

    [edit: added link to original NYTimes article]

  7. Davesnot says:

    I suppose I shouldn’t joke.. but does it suck.. or wheeze??..

    I think it’s a combination of lots of stuff.. plus.. there are lots more particulates where we live now.. we put lots of stuff up in the air.. the more crap we put out.. the more sophisticated we get at trying to scrub it out..

    In the old days people with lung ailments would move to dry hot places… of course.. then they had to worry about the dust storms that go along with deserts..

    We may be breeding asthma (the worst spelled word on the planet).. but worse.. we’re breeding stupidity… the dumber a person is (sorry.. the lower the IQ).. the higher the number of kids they are likely to have..

    Thus.. smart people are breeding less .. dumb more… pair this with global warming.. yeeeehaa!!

  8. Miako says:

    I saw a documentary that linked Jamaican Asthma to Global Warming (20 year long drought in Africa — they get Africa’s dust).

    Note that California gets China’s dust.

    I live in Pittsburgh — i’m sure the asthma rate is down around here (less dust to make problems).

  9. Don Monkey says:

    Your collection of asthma symptoms reminds me of fibromyalgia. My girlfriend suffers from fibro, and I have often thought that it, too, is actually a collection of conditions with similar symptoms.

    Modern medicine can do many great things, but there is still plenty of room to improve on the specificity of our diagnoses.

  10. Rebecca says:

    I’ve read suggestion that asthma, allergies, ADD/ADHD, dyslexia, and autism spectrum disorders are all related somehow.

  11. Mari says:

    Shamus, I wish I’d had you around to explain asthma to my high school gym teacher back in the day. If your wheeze didn’t suit her, you didn’t stop running laps to puff your inhaler.

    Interestingly, I’ve managed not to pass on discernible asthma to either of my children, both of whom are approaching the teen years. You’d think severely asthmatic dad + exercise-induced asthmatic mom would = at least one asthmatic kid. Of course, you’d also think two steps from legally blind parents would produce kids with poor vision but you’d only be half right. One has 20/20 vision.

    I’m telling you, this genetics stuff is way more complicated than we learned in AP biology.

  12. Alan De Smet says:

    For many genetic diseases, I believe we’re seeing more diagnoses, but not necessarily more actual cases. Sometimes it’s because we’ve become better at identifying them. Sometimes it’s because the standards for treatment have become more strict. I know the latter is true for asthma, as my allergist mentions almost every time I visit. In the last decade or so, the definition of “well controlled” for asthma has gotten increasingly strict, and people who twenty years ago were considered to be fine are now having more aggresive treatment recommended. I also suspect that the former is true. A family member was diagnosed with asthma in her 70s. Based on her symptoms, she probably had it all her life, but when she was a kid it wasn’t diagnosed.

    To be clear, I’m not saying that asthma, cancer, and a host of other things aren’t more common, or that pollution, cell phones, and space aliens aren’t the cause. But I think part of the reason these are seem more common is increased diagnoses of conditions.

  13. Ozy says:

    There’s actually a word for that phenomenon: dysgenics, evolutionary weakening due to relaxation of natural selection or negative selection.

    So what do you propose be done about it?

  14. Annon says:

    I don’t have asthma, but rather have diabetes. I swear, when I was diagnosed my chance for catching every disease and disorder in existence went up 500%…

    Back on topic, the “we diagnose more stuff now” only applies so much, especially when you start talking about immune system problems (which asthma can many-times be put in). Children are very much more likely to have severe allergic reactions to things, and I think the “we’re too clean” hypothesis has some credibility. I think even the doctors from 100 years ago should have been able to spot severe anaphylactic shock.

    What I wonder is what benefit have we gotten for our obsession with cleanliness? I have seen poeple live in squalor and I have seen people who are obsessed with Lysolling everything. The Lysolians seem to get sick more. What the hell is the point?

  15. Erik Lund says:

    Population genetics is one of the most complex of applied mathematical sciences. I remember going to a philosophy of science seminar given by a population geneticist and discovering that I actually needed my Calculus IV to follow the discussion.
    A propos, I suggest we wait for the experts to speak before leaping into eugenic intervention, which has a history of ending badly.

  16. Ryan says:

    Funny you should bring this up. I was just hospitalized (over Christmas no less) when I choked on some food and it became stuck in my throat. To make a long story short, the GI doctor discovered that I have enosinophilic esophagitis. It’s related to asthma, but it’s an allergic reaction in the esophagus rather than trachea.

    One interesting thing the doctor noted was that there’s been a significant rise in E.E. over the past several years. The doctors in his office used to see about 1 case a year (each). Now, they are all seeing one a month.

    It makes me wonder whether there truly is a rise in all of these conditions (including autism, etc.) or whether our diagnostic tools are just much better.

  17. Ozy says:

    Intervention won’t be nessecary: the wealthy will probably use genetic technology on their children anyway, but that sounds like a good setup for a Time Machine situational.

  18. Pholm says:

    There was an excellent article on asthma in Mother Jones, the investigative reporting magazine, a few years back. Worth a read.

  19. GAZZA says:

    It’s a tricky one; all sorts of moral ambiguity. But given that the world doesn’t suffer from underpopulation of humans, and that some sort of population control is all but inevitable (already happening in China), I think we’re going to see the attitude that “abortion is murder” become less common in the future. That will open the door to more genetic screening. In Australia at least you can already screen for a few traits (Down’s Syndrome, for example); asthma may well be another such trait. Medicine has indeed helped sustain some traits that perhaps would otherwise have disappeared, but via genetic screening it also has the potential to undo any “damage” this may have done.

    But I know that this is extremely controversial territory.

  20. Robel says:

    As I`ve realized thus far, asthuma is much more common in the USA than it is in other countries. I myself have never met in person someone who is currently suffering from asthuma, although I know two people who had it as children but eventually beat it through exercise. I myself had something the doctor called “about 1/10th of asthuma”, I had problems breathing sometimes, my lungs were feeling too tight. The doctor said I need to exercise and especially run a lot. When I was about 10 I couldn`t run for more than 200 meters. When I was 16 I could run for 1 kilometer but almost fainted after and saw sparkly things before my eyes. Right now I can run over 2 kilometers (I haven`t really tried more), so I guess the doctor was right. But, as you said, each case is different. I suspect you can only beat it with exercise if it`s harmless enough. If it`s not then you could just kill yourself, so it`s not a good idea to try to “push your limit”. Anyway, I hope my children don`t suffer even that little of asthuma which I had, because it was a real bugger and it stopped me from accomplishing many things when I grew up. I can only imagine what you`re going through but I really admire your strength for going through this for so long. Hope you`ll be as healthy as possible as soon as possible and that your daughter will grow out of it completely in due time. Cheers!

  21. Erik Lund says:

    Notice that –what, 1/3? of the world’s population belongs to nations that have tipped over into a negative replacement rate, if not yet (I’m thinking of China) negative population growth. At the moment there is little reason to think that this trend will except any nation. India and Pakistan’s recent fertility decline, for example, has been spectacular. The experts seem agreed that world negative population growth is in the cards unless something changes dramatically. They do disagree on when it will happen, though.
    State control of population, and hence a state eugenics programme, is a fantasy (nightmare) of the 1960s.

  22. NobleBear says:

    I’m trying hard not to be reactionary or hyperbolic but what am I supposed to take away from this?

    That using science to overcome obstacles in our daily lives is bad?

    or if The Hygiene Hypothesis is correct, what sort of solution would be recommended? (the answer to this could be either reasonable or disturbing)

    [This matters in both a general social sense but also a personal sense, being married to an asthma sufferer.]

  23. Mephane says:

    Well, I suppose one day medicine will be able to do an in-vivo gene-therapy. That means, correctly genes that are damaged and thus causing a disease even in an adult person. Today they are just trying to correct those errors within embryos, but I can foresee that sooner or later you might just get a DNA analysis, they check for any errors, and a couple of days later get some sort of vaccination that will correct the errors.

    The only thing I am strongly against is euthanasia. We should be better than that, and after all, what is all the progress in biology and medicine worth if we started killing those that have any genetic disease?

    I’ve once also come to the thought that without today’s medicine, a lot of people would have died in their early childhood, instead of growing up and raising children themselves. But I suppose that genetic technology will overcome any possible problems from the absent of ‘natural selection’. We are just about to enter the last phase of evolution – in which *we* will be in control and mmechanisms such as natural selection are no longer necessary.

    The only bad thing to this is, really, that it will probably only we available to the rich. But that is not a scientific problem, but a political.

  24. Kajen says:

    @Bear:

    I suffer from severe asthma myself (mostly allergic, but there are other triggers). When I was a kid I was hospitalized for to six times a year.

    My parents still let me do all the things that would not harm or instantly kill me (I never was – or will be – able to enter a hayloft without choking). Sometimes they nearly died of worry, but they never showed it while dealing with me. On the contrary, they encouraged me to do as much as I was able to do.
    They also refrained from overdosing chemical disinfectants.
    Nowadays I am on constant medication but apart from that I lead a fairly normal life (including exercises such as bicycling and swordfighting).

    When I moved to Germany and presented my case to a new doctor (a specialist for respiratory diseases), she told me that I’d probably be worse off if my parents had tried to shield me from everything or had kept me inside some hyper-hygienic bubble.

    So – we need the medication, but maybe we also need a little bit of dirt (and parents who are willing and able to check on their kids as well as mine did).

    [Edit:] Bad living condition (mouldy homes, polluted inner cities) DO NOT COUNT as “a little bit of dirt” and poverty…
    My family was able to afford good health care, maybe that’s why I lived.
    On that thought… there’s something to be said for the German health care system.

  25. Ozy says:

    NobleBear, facts do not have agendas. The only thing you have to take from this is that medicine causes an increased prevalence of genetic disorders, which is a natural consequence of evolution. Whether that is, in some sense, “bad,” is a matter of interpretation, although I’m sure most would agree that it is, at the very least, something of a problem, even if the positives outweigh the negatives for now.

  26. Chriss says:

    As someone who has asthma and has for a long time (as well as fibro, go figure), you have my deepest sympathies. You can always hope she grows out of it, or at least partly out of it. Speaking as someone who’s died from asthma a few times and (thankfully so far) been brought back each time, it’s not something to play around with. You might try asking your doctor for an Epipen to carry with you, and one to leave at your daughter’s school. It’s also important to remember that educating your daughter’s caretakers and school faculty is very important. Most people who don’t have asthma (and even some that do) don’t recognize early warning signs of an attack. And with over 5,000 Americans (just Americans! What about the rest of the world’s population?) dying from severe asthma attacks every year…and a large chunk of that being children…no school or anyone around children can afford to not know these things.

  27. roxysteve says:

    Is there any non-apochriphal evidence for the “cleanliness = death of civilization as we know it” school of thought? This sounds awfully like the McDonalds Wormburger to me.

    I recently heard someone repeating that old saw about Victorian women having ribs removed to accomodate the extreme corsetry needed for the wasp-waist then in fashion. Now as it happens I’d been re-examining that story myself as a mental exercise in scepticism, so I engaged the other person on the subject. It turned out that neither of us knew of an actual, recorded case of this process.

    I asked the person if it wasn’t more likely that someone from a later time, perhaps one where the Rubinesque figure was more the real-world standard, had looked at some old photographs and surmised that the only way that a body could be forced into that shape was by surgery.

    Consider that there was no real anaesthetic in the time the operation was supposed to be so popular.

    Consider that there was no agreed upon standard of hygene in hospitals either, and that post-operation death due to sepsis was common. Even elementary dentistry could kill a person.

    Consider that I have seen people who have managed to crush their bodies into much smaller configurations sans a surgeon’s help. Hey, I live in New York and worked on the fringe of Greenwich Village at that time. If it’s out there, it’s out there in the village.

    I haven’t been able to turn up a single verifiable case of this process being performed in the interests of Victorian Feminine Icon creation, and I’ve looked hard. I’m now of the opinion that this is one of the older Urban Myths rather than an object lesson in fashion haggism at any cost.

    So I say again, where’re the medical studies that support this cleanliness leads to athsma contention? I’m willing to give it a hearing, but not on the “everyone knows” level.

    As for cancer, I think it far more likely (but I’m not in a position to prove beyond doubt) that it can be traced to the casual pollution of the living space by industrial civilization. We dump stuff into the ground, water and air without a second thought for what happens in a dozen years from now. I never knew anyone with a thyroid problem until I moved onto Long Island. Now I would have a problem pointing to an acquaintence who doesn’t have a family member with a thyroid issue. My wife’s family has several members who’ve had hemithyroidectomies for Hashimoto’s disease. Of course, the reasons for that are simply my opinion, and only a fool would use my opinion to go to court.

    Show me the medical studies that support and oppose the contention, if there are any.

    Steve.

  28. Shamus says:

    Steve: I don’t think there has been a single study. Not any that I’ve heard of. Even after all these years, it’s still called the “Hygiene hypothesis“.

    It’s a devil of a problem to study. How do you set up a controlled test? There are so many variables in play that getting hard data from out of the noise would be nigh-impossible without a really large group. There is a lot more than just lack of dirt that makes our environment different from the one we lived in 200 years ago.

    Hygene can’t be the only issue, in any case. I was wheezing the day I came home from the hospital. I was what? A few days old? Hadly enough time for my immune system to go sideways from lack of “dirt”. Hardly enough time to blame it on anything but genetics. In a previous generation, I would have been one of those kids to die of an unexplained “lung infection” or some other mis-diagnosis.

    My post wasn’t designed to explain or refute anything. I was sort of pointing at the problem and saying, “Hmmmph. That’s a toughie.”

  29. Dana says:

    I have the suspicion (call it the “toxicity suspicion”) that it is more the simple growing toxicity of our environments that is causing the spike in both asthma and cancer (and god-knows how many other conditions). After all, I understand it to be a commonly-held belief (based upon what evidence there is) that both of these conditions (and others) are not simply genetic, but are HEAVILY environmentally-influenced. The body is going along fine (or at least managing ok) until something external intervenes and throws things off-kilter (or overwhelms our coping mechanisms).

    The way that the FDA (among others) studies the toxicity of environmental factors doesn’t seem to mesh with how we actually understand the body to work. They try to set “safe limits” of each toxic substance IN ISOLATION – that is, how much of that particular pollutant we can be “safely” exposed to, when there is no indication that our bodies deal with each pollutant IN ISOLATION, but that the SAME systems have to deal with ALL of the pollutants present, and with even (relatively) small amounts of THOUSANDS of different pollutants present (as I understand to be the case these days), then these systems can still become overwhelmed (and people can become sick).

    I believe that the FDA (and others) need to change their approach to one where they try to measure and assign an “average overall toxic resistance” measure for people and then try to measure the extent to which given amounts of various substances seem to (on average) tax this system. With this approach, we might be able to better see the harm that we are doing to our environments and ourselves and to find the political will to become much tougher on the rampant “pollution in the name of prosperity” that still goes on today (long after we should know better).

    I also believe the genetic issue to be something of a red-herring, although like you, I don’t have the studies to prove my understanding. I believe this for two reasons.

    Firstly, I understand that genetic change in slowly reproducing organisms like human beings is GLACIALLY slow, even in the face of fairly strong influences like that of modern medicine. If there are significant changes (or even SPIKES) that are being noted within the span of SINGLE HUMAN LIFESPANS, then these changes seem very unlikely to be caused solely (or even LARGELY) by genetic selection (or “anti-selection”, in this case).

    And secondly, I have been casually following the progress of modern medical science with regards to genetics, and it seems very likely at this point that within 20 years (or 30 at the most), anyone who wants to will be able to scan their own genome (this part of the service has actually, in limited form, ALREADY become available) and with that information (for small cost) change ANY base-pair substitution that is suspected to be dangerous or maladaptive in any way (in their own bodies or at least in their reproductive cells).

    I believe that we are going to start CONSCIOUSLY evolving our own DNA, and as far as I am concerned, this is a very good thing, not least of which because it can (theoretically) take the steam out of the people in the “we should be letting more people die” camp (not that I am saying in any way that Shamus is one of them, only that they seem to be out there).

    Evolution through “natural selection” seems a very powerful force, and it has apparently resulted in some almost unbelievably slick and beautiful and clever “designs”. But it also a terribly ugly force, one that seems to work extremely slowly through the very forces of pain, sickness, and suffering that we as human beings have (mostly) come to see as BAD and UNDESIRABLE things. And so I applaud the fact that we seem to be on the cusp of not NEEDING to evolve (at least exclusively) in such an ugly and cruel (not to mention slow and imprecise) manner any longer. :)

  30. roxysteve says:

    [Shamus] Sorry, the wrong tone came across it seems.

    I wasn’t howling at you. I have heard the hygene “hypothesis” many times recently, and was howling at the world in general to start asking for the question to be looked at properly. We are only a stonesthrow from having another “vaccination causes autism” situation boil over and we need real data before people stop teaching their kids to wash their hands after using the bathroom on the strength of a fallacy.

    Steve.

  31. roxysteve says:

    [Dana] Genetic changes in individual progeny lines is slow, but genetic drift in an organism’s genome as a whole is what mathematicians call a massively parallel process. The results out of such processes can be non-intuitively fast, and this one is no exception. Many example abound (coughs) TB (/coughs).

    The FDA doesn’t have any official interest in pollutants in anything but things we ingest as I understand it. The people you probably were thinking of are the EPA, a largely toothless organisation of late. Since I’m living and working in NY I have a very low opinion of the EPA that they have worked hard to earn, but I shall confine myself to that statement and not amplify in the interests of not sparking a flame war with anyone. I take your point though. In any event, such governmental bodies are reactive institutions, designed to come in after the fact and make sure it doesn’t happen again. They can’t, by their very design and mandate, be proactive. They rely on polluting organisations being “self regulating” (again, I won’t rant about the obvious problem here since the capability and willingness of corporations to self-police is a political platform issue) and ‘fessing up when things go wrong.

    The mechanical process of gene splicing is far from the model you suggest, in which individual base-pairs can be mixed and matched at whim. The mechanism used to achive gene reworking is a fascinating study, and anyone with strong views on gengineering owes it to themselves to get read up on it so they can assess for themselves the challenges and possibilities of the technology in the near future.

    I am strongly of the opinion that we should as a society move agressively to define the science and the moral code necessary to begin stamping out genetic defects such as propensity for spina bifida, diabetes, Parkinsons disease, Muscular Dystrophy, Downs Syndrome, Epilepsy, Congenital Deafness (hot potato, that), Cerebral Palsy – the list goes on and on and come on already! Why do our children still get born with this crap lurking in their bodies? (Sorry, hot button issue with me too).

    We all need to get the basic education in the genetic manipulation technology being proposed so we can discuss it from an informed standpoint. I’m not talking about going to college and getting a degree in the science involved, just understanding at a macroscopic level how the trick is done. Let’s not argue with each other endlessly anymore about stuff that is just not possible. I’m speaking of the world at large, rather than the comments section of 20-sided when I say that of course.

    Regards,

    Steve.

  32. Shamus says:

    Roxysteve: I didn’t take offense or think you were howling at me. We’re all good here.

  33. roxysteve says:

    [Shamus] I’m glad about that. Sometimes people don’t read my stuff in the voice I wrote it. Sometimes this is my fault.

    Steve.

  34. John says:

    Just my 2 cents as a final-year medical student:

    Asthma is one of those conditions where there are many effective forms of treatment available (ranging from a simple avoiding of trigger factors like pollen…to corticosteroid sprays and inhalers…to leukotriene inhibitors that target the inflammation in the airways at a molecular level) but the cause is not well defined.

    For some, it is straight-forward – previous exposure to an allergen (dust-mites, pollen, animal hair, etc) sensitises the immune system in their bodies to produce a particular type of antibody (IgE) that triggers the swelling and inflammation in the airways the next time one is exposed.

    Why do some people have this form of allergy, and others don’t? That is, why do some people’s IgE are activated by dust-mites, while other people aren’t? The answer isn’t clear, but what we do know about the cause comes from our understanding of immunology – how our immune system came into being, and how it works.

    We acquire the genes for our immune system from our parents, yes this is true. So it goes without saying that potentially asthmatics could pass on their tendency to develop asthma and other related allergic conditions (like hayfever, sinusitis, etc).

    However, how our genes shape our immune system is quite amazing and to do this, I’ll use the following analogy:

    Imagine we acquire the immune system genes in the form of four numbers (1,2,3,4) from our parents, (in real life, we acquire gene segments). So a person would have 1,2,3,4 from dad, and maybe 5,6,7,8 from mum (assuming the parents aren’t related in any way).

    These four dice would be the same in identical twins (since they have the same genome), but studies show that these twins don’t necessarily have the same immune response to diseases and allergens. Why?

    Well, babies get their immune antibodies from mum through the womb so they effectively have mum’s immune system for about 2-3 months until the antibodies break down (being simple proteins).

    when that happens, the body has had no exposure to diseases, yet 99.0% babies are able to fight off infections like the cold and flu despite this.

    Its because we then use these gene segments randomly to generate the unique signatures of the antibodies that will specifically bind to a particular object:

    e.g. the antibody binding to the flu virus would be, maybe
    1,1,2,3,5,6,7,5, while the one binding onto the measles is 2,3,5,3,2,3,5,3

    What your body does is say, “right, I know I’m gonna get attacked but i have no idea of what is coming so I’m gonna combine these genes fragments into as many combinations as I can, so I can get lucky and hit any potential invader”

    all of this is done, believe it or not, even before the baby is born….at the DNA level.

    So it explains why some people are naturally immune to the past panedemics like the plague or the Spanish flu, because they were lucky enough to have the exact combination of gene s to form the right antibody to fight off the infection.

    Naturally, then these people survive and pass on the gene fragments (not the combination) to their children:

    e.g. say the gene for combating the spanish flu that killed millions post-WWII is the number 10

    so anyone without the number 10 isn’t gonna survive very well because the other genes produce antibodies that don’t bind well to this flu virus (given enough time and support with non-curative medical treatment, the body may survive with its weakly-binding antibodies whose binding ability increases the longer u survive) – this is why kids who’ve had chickenpox don’t get it again, assuming the pox virus doesn’t mutate, but thats another story.

    so kids born from these surviving parents have the number 10 in their genes, so are more likely to survive an attack.

    unfortunately, the opposite can be true – that some combinations may prove harmful to people who carry them.

    Some combinations may actually target the body’s own cells, which happens in illness like rheumatoid arthritis and lupus (SLE), while others target common household things like pollen and mite-dusts, producing asthma.

    The story with asthma, however, is that only a minority of asthmatics are accounted for with this IgE pathway (that is, when we block their IgE production with drugs etc etc, they still get asthma).

    Theres still a ways to go yet before we elucidate the cause of asthma, but the common line you will get from medical texts on this is that asthma is a “combination of genetic and environmental factors” which is code for “we have some ideas, which has given us great treatments and stuff, but we don’t know enough to prevent it”.

    The role of external triggers in diseases like asthma and cancer is not clear, partly because of the way the clinical studies looking at them are done.

    e.g. some studies showed a relation between meat and bowel cancer, which people have interpreted as meat causing bowel cancer. Looking at the study more closely, we can see that what the studies did was to look at the people who got bowel cancer and those who didn’t…and looked back to see if they ate meat or not, and found that more of those who had the bowel cancer ate meat than those who didn’t.

    But the study couldn’t have accounted for all the other possible variables, like smoking or diabetes, if its looking backwards. I haven’t looked recently, but a more convincing study would involve following a set number of vegan kids and kids who ate meat over their lifetimes and seeing which ones got cancer or not.

    Lastly, our increasing knowledge in genetic diseases has indeed given us the potential to screen embryos of parents with a history of heritable illness (like huntingtons or cystic fibrosis) for these illnesses before implanting them back in the womb of the mother.

    There is no tampering with the embryo, just simply avoiding the embryo with a clear genetic anomaly. If this was made available to all such familiies, it is indeed possible to make such inheritable illnesses a thing of the past.

    As a student in the hospital wards encountering families with a member suffering from such conditions, it would be a great thing to know that the sufferings and pain that can come with coping and caring for such a child, as well as the fear that it may happen again with a future child, can be avoided.

    But unfortunately, most illnesses do not have a clear-cut “bad” gene involved – sometimes its many genes, and other times, no clear gene is implicated.

    The complexity of the issue is akin to playing with Lego – we now know ALL the Lego blocks in a set of Lego (i.e. the exact structure of the human genome) but we still have little idea, much less the tools and methods to replicate how they come together in the human body – i.e. how we can attach them together to build a toy model aeroplane.

    In short, we still can’t produce a fully functional human cell – like a nerve, muscle or skin – from the basic atomic elements. Until we get a better idea of how to, alot of the potential that gene therapy has will remain locked away.

  35. roxysteve says:

    Thank you for the explanation, John. You raised several points I hadn’t considered.

    The question “Why does it seem that there are so many more athsmatic people in the world today than when I was a kid?” still remains opaque to me, though.

    Steve.

  36. John says:

    There are a few ideas floating around, such as these days children are more overprotected in cleaner home and school environments, the so-called “bubble-wrap” generation, and so are exposed to allergens when they are older, and therefore when their body’s immune system are much stronger to yield a more severe allergic response. I haven’t yet read any clinical trials to support that idea though.

    One of the more substantiative theories, however, from numerous clinical studies following babies and mums over the years, is that breast-fed babies are less likely to develop allergies as they grow older, than formula-fed babies, though the reasons behind this are not fully understood.

    Looking at it from first-principles, breast milk contains human-based proteins that the baby’s body would not likely reject or attack with its immune system, while formula tends to contain cow or soy proteins which are essentially foreign. There are some reports to suggest that soy milk given to babies who are not intolerant to any food (often by well-meaning mums who want to avoid their children from being intolerant to cows milk) is more likely to result in food allergies.

    Breast milk, apart from its nutritional value, contains antibodies that may potentially “vacuum” out potential allergens before the baby’s own immune system responds to it, thereby preventing any allergic response occurring.

    Having said, not every kid who was breast-fed is free from asthma, but looking at large samples of populations around the world have shown marked reduction in numbers of allergic conditions like asthma amongst those who were breast-fed.

    So one idea is that, with more and more mothers choosing formula over breast milk for convenience and ease of feeding, as well as significant marketing from the manufacturers (they would likely make a huge financial loss should all mums use their own milk than buy formula), more and more babies lose that valuable immune protection from mum.

    Still, my brother had asthma, which was occasionally serious enough to force him to be admitted to hospital several times, but grew out of it at the age of 14. As of yet, I haven’t gotten a real good answer from anyone at my university as to why this happens, because most allergies (like peanut, cows milk) don’t just suddenly disappear.

  37. Boobah says:

    There’s also the hypothesis that some of the immune issues is a result of our immune systems being effectively over powered.

    The idea is that many parasites suppress their hosts immune system to a degree so it doesn’t kill them. If you’re susceptible to the parasite, and your immune system isn’t strong enough to keep most stuff at bay while suppressed, you die out. Therefore, once you stop the parasites, your now-tuned-for-parasite-suppression immune system is over eager.

    It’d be a fairly simple hypothesis to test; just grab a bunch of allergic people, stick a fairly innocuous parasite in ‘em, and see how their allergies go. I have no idea if anyone’s done any real testing on this; I’m especially unsure of how medical ethics boards would view intentionally setting parasites loose inside someone, leaving aside the ewwww! factor.

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