The worst disease ever in human history

[denverdoc]

IMO this discussion underscores Ivan's original point about addiction. Nicotine while not producing euphoria has the curious property of being among the most addictive substances known to man. The leader tho by quite a stretch in terms of addiction worldwide remains caffeine.

 

[Tsu]

And all of those have an extremely good chance of having smoking as their hidden cause.

Stomach cancer, high blood pressure and cerebrovascular disease could also have smoking as their hidden cause.

 

[rainbow93]

This list of the http://healthlifeandstuff.com/2009/11/the-10-worst-diseases-ever/" says Bubonic plague is the worst, as it killed 1/3 people in Europe at one point.

 

[mgb_phys]

This list of the http://healthlifeandstuff.com/2009/11/the-10-worst-diseases-ever/" says Bubonic plague is the worst, as it killed 1/3 people in Europe at one point.

Yes but the population then wasn't that big so it may have only killed 10M people.
So a disease today that kills 1% of the 6Bn population is a bigger killer.
Alternatively a disease like malaria that killed a large proportion of people every year for the last million years is also a contender.

 

[dimensionless]

I'm no expert on this subject but I would say smallpox. It killed 90% of the indigenous people in North and South America after Columbus arrived. Plus many people in Europe, Asia and Africa.

I would have said Bubonic Plague, but smallpox seems to have caused more damage.

 

[ViewsofMars]

Alternatively a disease like malaria that killed a large proportion of people every year for the last million years is also a contender.

I wasn't aware malaria has been around for the last million years. Source please. The History of Malaria, an Ancient Disease implies early mention of malaria in 2700BC.
http://www.cdc.gov/malaria/history/index.htm

As far as today goes' ischemic heart disease kills over 6 million individuals each year and is projected by the World Health Organization to be the greatest single-disease cause of death worldwide' according to Duke Clinical Research Institute.

Dis Markers. 2009;26(5-6):265-71.

Prognostic biomarkers in individuals with prevalent coronary heart disease.

Halim SA, Newby LK.

Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715-7969, USA.
Coronary disease is the leading killer of individuals worldwide and a leading cause of healthcare expenditure. On a global scale, ischemic heart disease kills over 6 million individuals each year and is projected by the World Health Organization to be the greatest single-disease cause of death worldwide by an increasing margin into 2030. Nearly 17 million Americans (7.6% of the population) have prevalent coronary heart disease, 8 million of whom have had a prior myocardial infarction. It is estimated that in 2009, 550,000 will die from coronary heart disease in the United States and that the direct and indirect costs from treating coronary heart disease will exceed $165 billion. Although patients with known coronary artery disease are among the highest risk patients for future cardiac events, not all patients with coronary disease will have an ischemic event (first or recurrent). Determining which of these patients will have an ischemic event is critical to the concept of personalized cardiovascular care. Increasingly, biomarkers that can be readily assayed from blood or other body fluids will be critical to risk stratification and effective application of secondary prevention strategies, just as they have played an increasingly prominent role in risk stratification of acute coronary syndrome patients.
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 

[denverdoc]

Impressive numbers, but still a drop in the bucket compared to addictive disease, which obviously causes a lot of heart disease. I couldn't easily locate US stats but here are some from Canada which in the year in question had a population of about 23 million. From the: Journal of Public Health, Vol. 89, Issue 3 385-390, Copyright © 1999 by American Public Health Association
This Article

Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada.

E Single, L Robson, J Rehm, X Xie and X Xi

Canadian Centre on Substance Abuse, University of Toronto, Ontario, Canada.


OBJECTIVES: This study estimated morbidity and mortality attributable to substance abuse in Canada. METHODS: Pooled estimates of relative risk were used to calculate etiologic fractions by age, gender, and province for 91 causes of disease or death attributable to alcohol, tobacco, or illicit drugs. RESULTS: There were 33,498 deaths and 208,095 hospitalizations attributed to tobacco, 6701 deaths and 86,076 hospitalizations due to alcohol, and 732 deaths and 7095 hospitalizations due to illicit drugs in 1992. CONCLUSIONS: Substance abuse exacts a considerable toll on Canadian society in terms of morbidity and mortality, accounting for 21% of deaths, 23% of years of potential life lost, and 8% of hospitalizations.

One stat I did find re the USA, 500 billion per annum direct and indirect costs, and that for EtOH alone!

 

[mgb_phys]

I wasn't aware malaria has been around for the last million years. Source please. The History of Malaria, an Ancient Disease implies early mention of malaria in 2700BC.

The malaria parasite is old, the family is possibly older than mosquitoes. It also infects a lot of other primates so it's a fair bet it infected early man as well.

It also infects people on the african savanna, most more modern epidemic disease are water borne or transmitted from domesticated animals so need the start of cities to become a problem. Malaria was always present for as long as you care to define people as people.

It probably wasn't mentioned before the invention of writing and civilization in the 3rd millennia BC for the same reason that nothing else is!

 

[ViewsofMars]

The malaria parasite is old, the family is possibly older than mosquitoes. It also infects a lot of other primates so it's a fair bet it infected early man as well.

It also infects people on the african savanna, most more modern epidemic disease are water borne or transmitted from domesticated animals so need the start of cities to become a problem. Malaria was always present for as long as you care to define people as people.

It probably wasn't mentioned before the invention of writing and civilization in the 3rd millennia BC for the same reason that nothing else is!

Well, I went exploring and found an absolutely incrediable website that pertains to nearly every aspect of "Malaria - History, Aetiology, Pathophysiology, Clinical Features, Diagnosis, Treatment, Complications And Control Of Malaria" by Dr. B.S. Kakkilaya. I highly recommend his educational website for those who wish to learn about Malaria.

History of Malaria Parasite And Its Global Spread


Time Line For Origin of Malaria

Half a billion years ago
Existence of pre-parasitic ancestor

150 million to 200 million years ago
Early Dipterans, ancestors of mosquitoes, appear

130 million years ago
Two-host life cycle in Dipterans and vertebrates evolves

130 million years ago
Divergence of the bird and mammalian malaria parasites

100 million years ago
Lineage of P. malariae, P. ovale, and P. vivax diverges

~5 million years ago
P. falciparum evolves

2-3 million years ago
Divergence of P. vivax from P. cynomolgi

4000-10000 years ago
Lethal strain of P. falciparum appears

4000-5000 years ago
Anophelines in Africa develop highly anthropophilic habits

Man and Malaria seem to have evolved together. It is believed that most, if not all, of today's populations of human malaria may have had their origin in West Africa (P. falciparum) and West and Central Africa (P. vivax) on the basis of the presence of homozygous alleles for hemoglobin C and RBC Duffy negativity that confer protection against P. falciparum and P. vivax respectively.

The ancestors of the malaria parasites have probably existed at least half a billion years ago. Molecular genetic evidence strongly suggests that the pre-parasitic ancestor for malaria parasite was a choroplast-containing, free-living protozoan which became adapted to live in the gut of a group of aquatic invertebrates. This single-celled organism probably had obligate sexual reproduction, within the midgut lumen of a host species. At some relatively early stage in their evolution, these "premalaria parasites" acquired an asexual, intracellular form of reproduction called schizogony and with this, the parasites greatly increased their proliferative potential. (This schizogony in the RBCs of humans causes the clinical manifestations of malaria). Among the invertebrates to which the ancestors of the malaria parasites became adapted were probably aquatic insect larvae, including those of early Dipterans, the taxonomic order to which mosquitoes and other blood-sucking flies belong. These insects first appeared around 150 million to 200 million years ago. During or following this period, certain lines of the ancestral malaria parasites achieved two-host life cycles which were adapted to the blood-feeding habits of the insect hosts. In the 150 million years since the appearance of the early Diptera, many different lines of malaria and malaria-like parasites evolved and radiated. The malaria parasites of humans evolved on this line with alternate cycles between human and the blood-feeding female Anopheles mosquito hosts. Fossil mosquitoes have been found in geological strata 30 million years old.

P. falciparum is found to be very closely related to a malaria parasites of chimpanzees, P. reichenowi and these two are more closely related to the malaria parasites of birds than to those of other mammals. The lineage of these parasites possibly occurred around 130 million years ago, nearly about the same time as the origin of the two-host life cycle involving blood-feeding Dipterans and land vertebrates. The separation of the lines that led to P. falciparum and P. reichenowi probably occurred only 4 million to 10 million years ago, overlapping the period in which the human line diverged from that of the African great apes. The modern, lethal strains of P. falciparum probably emerged about 4,000 years ago, after agriculture took roots in Africa.

P. malariae, P. ovale, and P. vivax diverged over 100 million years ago along the lineage of the mammalian malaria parasites. P. ovale is the the sole known surviving representative of its line and causes infection only in humans. P. malariae was a parasite of the ancestor of both humans and African great apes and had the ability to parasitize and cross-infect both host lineages as they diverged around five million years ago. P. malariae is found as a natural parasite of chimpanzees in West Africa and P. brazilianum that infects New World monkeys in Central and South America is morphologically indistinguishable from P. malariae. P. malariae, like P. ovale, is the only confirmed and extant representative of its line. P. vivax belongs to a group of malaria parasites like P. cynomolgi, that infect monkeys. The time of divergence of P. vivax from P. cynomolgi is put at 2-3 million years ago.

End of the last glacial period and warmer global climate heralded the beginnings of agriculture about 10000 years ago. It is argued that the entry of agricultural practice into Africa was pivotal to the subsequent evolution and history of human malaria. The Neolithic agrarian revolution, which is believed to have begun about 8,000 years ago in the "Fertile Crescent," southern Turkey and northeastern Iraq, reached the western and Central Africa around 4,000 to 5,000 years ago. This led to the adaptations in the Anopheles vectors of human malaria. The human populations in sub-Saharan Africa changed from a low-density and mobile hunting and gathering life-style to communal living in settlements cleared in the tropical forest. This new, man-made environment led to an increase in the numbers and densities of humans on the one hand and generated numerous small water collections close to the human habitations on the other. This led to an increase in the mosquito population and the mosquitoes in turn had large, stable, and accessible sources of blood in the human population, leading to very high anthropophily and great efficiency of the vectors of African malaria. Even though the practice of agriculture had developed throughout the tropics and subtropics of Asia and the Middle East up to several thousand years before those in Africa, simultaneous animal domestication in Asia probably prevented the mosquitoes from developing exclusive anthropophilic habits. In most parts of the world, the anthropophilic index (the probability of a blood meal being on a human) of the vectors of malaria is much less than 50% and often less than 10 to 20%, but in sub-Saharan Africa, it is 80 to almost 100%. This is probably the most important single factor responsible for the stability and intensity of malaria transmission in tropical Africa today.
http://www.malariasite.com/malaria/history_parasite.htm

It probably wasn't mentioned before the invention of writing and civilization in the 3rd millennia BC for the same reason that nothing else is!

You might enjoy reading "Malaria In Ancient Literature."
http://www.malariasite.com/malaria/history_literature.htm

Thanks,

Mars

 

[334dave]

well quite the discussion on noninfectious .. ugh... conditions or behaviors..
i would have to agree with the flu of 1918
but i would like to expand on what is the worse on the human condition
i/e the person?

rabbies ? leper loosing parts of his body?
loosing your mind or un-tolerable pain from parasitic infections?

yes.. that is a good expanshon of the OP's question
what is the worse or most horrible
Infectious disease on the person ...?

 

[denverdoc]

The Op's question never said word one about infectious etiology. I trust from your comments that you don't see addiction as a disease. You may not have enough information: the genetic contribution (at least with alcohol) is greater than both cardiovascular disease or Type II diabetes (which are felt to be highy inheritable diseases and also contain behavioral components). The course of the illness is uniform across cutures and and from what we can tell, time course. Not an infectious disease (role modeling and parental habits are of less prognostic importance than the history of the biologic parents, even in cases of adoption at birth), but a disease by every criteria.

 

[hamster143]

It seems reasonable to consider only those diseases which are likely to cause severe disability or death of a young person. Neither smoking, nor alcohol addiction, nor obesity fit this criterion. Smoking will make you more likely to die of lung cancer when you're 70 (instead of living till 80 just to have your consciousness wiped by Alzheimers). Excessive consumption of alcohol can result in stomach cancer or cirrhosis of liver, but once again not till you're into your retirement years.

We should not consider diseases that primarily kill infants and the elderly (such as most types of flu), and we should adjust for the population of the world (75 million killed by the 1918 flu pandemic in the population of 2 billion represent smaller impact on human society than 75 million killed by the 14th century plague pandemic in the population of 400 million).

From this perspective, it's probably a three-way tie between plague, smallpox and tuberculosis.

 

[denverdoc]

I would agree if you considered all generations equally important--i.e that the population was roughly constant with roughly the same proportion of individuals surviving childhood.

But if you look at total numbers afflicted, than I would disagree.

A rather sobering reminder that population numbers were virtually flat until say 1500 a.d. at which time sufficient numbers were living plenty long enough to suffer the ravages of addictive illness. BTW I have seen several die under the age of 30 to cardiomyopathy and cirrhosis, but recognize that most of these illnesses have their largest impact in middle age.

 

[Hurkyl]

population numbers were virtually flat

 

[denverdoc]

From the perspective that H. sapiens is probably about 200,000 years old, yes. So the classic 30 foot graph with a spike on the end is a better representation than the one shown.

 

[hamster143]

A rather sobering reminder that population numbers were virtually flat until say 1500 a.d. at which time sufficient numbers were living plenty long enough to suffer the ravages of addictive illness. BTW I have seen several die under the age of 30 to cardiomyopathy and cirrhosis, but recognize that most of these illnesses have their largest impact in middle age.

During most of the human history, alcohol addiction was not a significant health issue for a simple reason. It can't develop without access to cheap concentrated alcohol. During middle ages, distillation techniques were primitive and uncommon. Most modern distilled beverages (whiskey, cognac, vodka) date in their present forms no further than 1700. Since they were distilled manually in small batches from lower-concentration alcohol (for example, whiskey is made by distilling beer), they were expensive and mostly used for medicinal purposes. Commonfolk typically could only afford to drink homebrewn beer, usually no stronger than 4%, and, in the Mediterranean, diluted wine.

The real breakthrough came in the 1800's, when industrial mass production methods of cheap spirits were developed.

 

[denverdoc]

Interesting points re the history of distillation, and of course, the fact that either beer or wine requires a diversion of foodstuff, has limited access among lower classes--that and taxes which have been around for EtOH since 1690, and my guess is much sooner. Nevertheless history dating back to B.C. suggests that habitual intemperance was a social problem for at least some of the people and it can be fairly assumed that health effects were known. Certainly some intruiging evidence points to the decline of the Roman Empire as a result of ever more spirited drinking, though the real culprit may have been the lead which was used as a preservative.

Nevertheless your point re distillation and the production of copius quantities of cheap gin is well taken. But it is incorrect to assume that beer and wine are less potentially injurious than distilled spirits.

Given it is a pro responsible use site, I thought this was a fair source for some of the info.

http://www2.potsdam.edu/hansondj/controversies/1114796842.html

 

[hamster143]

But it is incorrect to assume that beer and wine are less potentially injurious than distilled spirits.

They are less potentially injurious (beer in particular) because you need large amounts to achieve comparable levels of intoxication. Your source puts beer consumption in medieval Bavaria at 300 liters/capita/year. That's 800 ml/day or just under 2 drinks (assuming 4% alcohol content). You need to drink nothing but beer all day, every day before cirrhosis and gastrointestinal cancers can become significant threats.

 

[denverdoc]

They are less potentially injurious (beer in particular) because you need large amounts to achieve comparable levels of intoxication. Your source puts beer consumption in medieval Bavaria at 300 liters/capita/year. That's 800 ml/day or just under 2 drinks (assuming 4% alcohol content). You need to drink nothing but beer all day, every day before cirrhosis and gastrointestinal cancers can become significant threats.

I'm not sure where you are getting the info for your conclusion--the threshold for increased risk of cirrhosis in men varies between 40 and 120 gm/day. If we take the middle value of 80 gm/day--this is roughly 7 standard beers per day. It doesn't seem to matter from what type of beverage.

There were some recent studies that drinking a large proportion of wine vs other types of beverages might mitigate the risk, but these findings are now in doubt.

For women, the risk of cirrhosis increases significantly with an average daily intake as little as 20 gms/day--or two beers per day.

I am not arguing that I think cirrhosis has been a major killer throughout the ages. What I am arguing is that beer or wine are less damaging. Alcoholics can easily put away a six pick of beer in a couple of hours. This is hardly drinking nothing but beer all day. Try to put aside the notion of the cirrhotic as the skid row bum. I used to work for a liver transplant team and they come in all sizes and flavors, but the vast majority were "functional alcoholics" meaning they were able to hold down jobs,marriages, etc for at least the vast majority of their drinking careers. Some even confined EtOH consumption to weekends and an occasional binge.

 

[hamster143]

the threshold for increased risk of cirrhosis in men varies between 40 and 120 gm/day. If we take the middle value of 80 gm/day--this is roughly 7 standard beers per day. It doesn't seem to matter from what type of beverage.

80 gm/day at 4% is two liters of beer. That's roughly the amount of fluids an average person consumes in one day.

I'm curious, is there data on relative risks of binge drinking vs. spreading the alcohol consumption? With most chemicals, consuming a lot at once is much more dangerous than spreading the same amount over some time. 20 cups of espresso over 2 hours will put you in the ER, 20 cups of espresso over 2 weeks keep you alert throughout your work day. 5 gray of whole-body radiation in one day will kill you, 5 gray over six months might increase the risk of cancer. It seems logical that hitting the liver with 7 standard drinks at once (a glass of vodka) would make more damage than the same amount spread over a day.

 

[denverdoc]

There are some data, most of it somewhat conflictual on this issue--say comparing cirrhosis rates in scandanavia vs those in the mediterranean. Actually higher in the wine drinking countries vs the vodka guzzlers. But they drink more.

Some new evidence points at daily consumption and drinking on an empty stomach as risk factors--the latter is speculated for the reason you cite--liver is deluged by rapid gastric emptying. The former is speculated to be because the liver has less of a chance to "heal". So the notion is if you give the liver a few days break to process the fat and repair cellular damage, the injurious effects are lessened and don't accumulate. Bottom line is the disease just doesn't seem to follow any clear cut rules at this point.