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Medical Treatment for the cause

  1. Sep 13, 2018 #1
    In many deficiency-related diseases doctors prescribe to supplement, that which is deficient.

    For example, if insulin is found deficient they replace with insulin. Similarly the case with vitamin deficiencies, calcium deficiency, thyroid deficiency etc.

    I have a few doubts on this regard,

    1) Have they ever try to ascertain why such deficiencies have occurred? How long can one keep on supplementing them? Why the cause of deficiency is never found out and treated?

    2) Has it ever occurred to them that this kind of deficiencies could have been the body's way of adaptation to deal with something else? It could have been a temporary armour against something. For example, it is found that the body intentionally brings down the iron level during fever. There may be some advantage to it. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938201/

    If so, supplementing deficient items may prove detrimental too. Unless the cause is analyzed, we can't blindly supplement. So I'd it right to supplement the deficiencies blindly?

    Is there any rationale behind my doubts?
     
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  3. Sep 13, 2018 #2

    Evo

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    I don't understand your post. Doctors here in the US do not just blindly hand out supplements. Actualy, they are probably opposed to supplements. Maybe that is the case in your country. The things you cited in 1 & 2 just don't happen here. You would need to cite medical sources.
     
  4. Sep 14, 2018 #3

    CWatters

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    Likewise here in the UK. They will ask you about your diet and possible causes before handing out pills.
     
  5. Sep 14, 2018 #4
    Yes. If you just google up the mentioned deficiency types one by one then (after brushing aside an unimaginable amount of crackpotry, diet advertisement and stupidity) I believe you will find satisfying amount of medical science.

    It is just that for some deficiencies the cause is exactly the low intake.
     
  6. Sep 14, 2018 #5

    Drakkith

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    The cause is usually found and treated. It's just that the cause is usually insufficient intake of a nutrient, which can easily be fixed by altering ones diet, or the failure of a particular organ to create enough of a hormone or other necessary compound. The latter is rarely able to be fixed short of replacing the organ, which is why supplements are given for disorders with the thyroid, pancreas, etc.

    That's not what we usually think of when we talk about a deficiency. The body still has plenty of reserves of iron, it's just temporarily altering the availability to combat a disease. These are short term effects that would only become a problem if you somehow weren't able to fight off the disease in short order. But in that case you're probably in far greater danger of dying from the disease before temporary iron 'deficiency' becomes a problem.
     
  7. Sep 14, 2018 #6
    Take, for example diabetes type 2. Here it is surmised that either the insulin is secreted less or it is ineffective.

    Hence steps are taken to 1) supplement it by insulin injection 2) prescribe sulfonylureas 3) GLP-1 agonists 4) Meglitinides 5) DPP4 inhibitors.

    All of these either directly or indirectly influence and enhance insulin production. In my view a supplement need not be a direct supplement like insulin injection.

    Without finding the cause (of diabetes) the effect is being treated by supplementing (insulin). I consider dpp4 inhibitors and insulin supplement as more or less similar. They both make more insulin available for action.

    I was trying to refer to this kind of supplement/replenishment.

    Another example would be hypothyroidism. Here (without finding the cause of less thyroid production) thyroxin is given. Is it not supplementing?

    I am not denying the effects (short term benefits) of such treatments. But we stop there. We do not try to find the cause of the problem and remove it.

    I am thinking is in the lines only. I want your comments. Thanks.
     
    Last edited: Sep 14, 2018
  8. Sep 14, 2018 #7

    Drakkith

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    We are trying to find the cause of the problem (or rather we usually know the cause, we just don't know how to fix it). Research into more effective treatments for diabetes, hypothyroidism, and other such diseases is ongoing. Right now we don't really have any other widely available options other than to provide supplements for many of these diseases.
     
  9. Sep 14, 2018 #8

    BillTre

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    I take thyroxin for hypothyroidism.
    In my case, it was noticed by my doctor that my throat felt weird to him during an exam.
    I went to a specialist and got it biopsied and it turned out to be Hashimoto's Thyroiditis, an autoimmune disease that is the most common cause of hypothyroidism.
    In my case, the thyroid gland was almost all gone.
    After that was figured out thyroid hormone measurements (and of the hormone that controls the release of the thyroid hormone) were done and the the hypothyroid condition was diagnosed.
    I then started taking the thyroid replacement (the levels were calibrated by measuring the levels of the Thyroid Releasing Hormone and adjusting the amount of thyroid replacement I took).

    So, in this case, it was not just prescribed blindly based on lacking thyroid hormone, but was a fix to a problem found through other means.
    A non-replacement treatment would seem to involve something like transplanting in a new thyroid gland (something I have never heard of and which could well be more expensive and involve greater possible negative health effects (operation, immune suppression drugs, etc.).

    Incidentally, I feel ripped off because one of the symptoms of hypothyroidism is supposed to be a lack of energy, but taking the thyroid replacement did not give me any noticeable power boost!
     
  10. Sep 14, 2018 #9

    CWatters

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    You picked the wrong problem to get :-) I had to be admitted to hospital twice at short notice due to Ulcerative Colitis They put you on IV steroids for 5 days. After 24 hours the steroids make you feel a million dollars.
     
  11. Sep 19, 2018 #10
    Yes, in general terms medicine is obsessed with identifying the causes of problems and building up a detailed picture of what is happening in the body. Several of your examples involve the loss of a capacity to produce hormones and if the cells that produce a hormone has died currently we don't have the technology to replace them, but this is also being investigated. Even when we know why cells have died we either don't know how to stop this or we discover the disease after the damage is done. Just knowing the cause as yet doesn't mean we can treat it and these hormones are given not just for short term benefit, they keep people alive.
    Its a common claim among alternative therapists that they treat the cause while western medicine simply manages the symptoms this is nonsense and many of these therapists haven't a clue about the underlying pathology and they have no requirement to test their ideas or in fact to even make sense. There is only so much that can be squeezed into a weekend course and that has to include marketing.
     
  12. Sep 21, 2018 #11
    On the one hand you are saying that knowing the cause a problem doesn't ensure resolution. On the other we are just replacing the insufficient hormones as treatment.

    For example, for t2DM our treatment is just insulin-specific (directly or indirectly). May be as a reaction, body produces more glucose through glycogenolysis or fat. This may lead to futile cycles.

    If we know why hyperglycemia happens, may be our treatment will become more effective?

    This is my essential question.
     
  13. Sep 21, 2018 #12

    Drakkith

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    There's no guarantee that we will develop better treatments, but the general trend for nearly all treatments has been that they improve over time as our understanding of the underlying disease increases.
     
  14. Sep 21, 2018 #13
    I understand your viewpoint. But I am just concerned that we are slowly ignoring a systematic approach, leaving everything to chances. I am afraid it may backfire at some point of time.
     
  15. Sep 21, 2018 #14

    Drakkith

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    I'm sorry but I don't know what you mean by 'leaving everything to chances'. Or 'a systematic approach'.
     
  16. Sep 21, 2018 #15
    No they are not ignoring a systematic approach, in fact in diabetes they know quite a lot about the variety of causes. In the same way the treatment approaches also vary based on the causes. None of the oral drugs are quite the same as insulin injections, they all rely on the body being able to produce at least some insulin. The oral drugs act in a variety of ways that might increase insulin production or increase the cells sensitivity to insulin a few have other useful actions as well. These are typically used in type 2 diabetes that tends to occur in later life. In type 1 diabetes which tends to occur earlier the pancreas looses the ability to produce any insulin so drugs to stimulate production have no effect that's why they need insulin and this is balanced against their diet. We have a great deal of experience with insulin and no one thinks its ideal but this isn't something we can chose not to do, before insulin was discovered type 1 diabetes was always fatal and still would be. If we stopped using insulin we would be looking at around 3 million children under 15 across the world , dying within a week or two. Both types of diabetes carry significant risks to people and in fact both types appear to be increasing. There have already been advances in treatments and lots of work in progress but in type 1 the only really good cure would be to replace the insulin producing cells and then keep them alive, as most of the diabetes in this group is caused by autoimmunity this is no easy task. A cure for diabetes would be an almost certain Nobel prize, people would love to discover one and there are many trying.
     
  17. Sep 21, 2018 #16
    I shall enumerate my points vis-a-vis type 2 diabetes or Hyperglycemia.

    We don't know the real cause (question of why) of the following conditions,

    1) What triggers insulin resistance, and why?
    2) Why renal threshold is rised?
    3) Why the same Islet of Langherhans produces less insulin but more glucagon.
    4) Why fat and muscle cells refuse to take in circulating glucose.
    5) What is the role of incretins in insulin resistance.
    6) How, high fasting glucose is related to insulin resistance. (Anyway what is the role of insulin, when you are not eating?)

    All of these effects combine to produce hyperglycemia. It is no longer just pancreatic insulin insufficiency.

    If we know the answer these questions, perhaps we will know why our treatment ineffective in the long run.

    The whole body viz pancreas, kidney, adipose/muscular cells, liver seem to contrive together to increase the circulating glucose. And we don't know why. The body seems to have a one point agenda of raising circulating glucose anyhow.

    Yet we never bother to understand why the body is behaving in this way. May be it has a point. May be it is an adaptation.

    True, we are extremely wary of the deleterious effects of long term hyperglycemia. Treatment is necessary. But do we know of the short term effects of our treatment? What are the repercussions of it? Our research is not oriented to include these things.

    Yet we treat hyperglycemia with sulfonylureas, dpp4 antagonists, incretin & ppar gamma analogues, SGLT2 inhibitors etc.

    I am not questioning/blaming the learned people. I am merely expressing my concern.

    What are the harmful effects of this treatment? (I am not referring to side effects) Do we have the agenda of researching into these?

    What if the insulin resistance itself is body's way of adaptation to something else. If so, we might have been treating it wrongly. This is certainly a rhetorical question only. Yet we must have an answer to rule out this possibility, in my view.

    But this is what worries me.
     
  18. Sep 21, 2018 #17

    Drakkith

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    Let's get this straight right now. As has been said multiple times already, we do bother to understand why. The struggle to understand how the body functions and what causes diseases comprises an enormous amount of time, effort, and money by the medical community. The fact that we don't yet understand something completely is not a sign that it is being ignored nor is it a sign that something has gone wrong in the scientific process.

    You can call it an adaption if you want, but because it is an often lethal detriment we call it a disease.

    Yes it is. It absolutely is. That's the entire point of drug trials (and other research). They may not be up to your standards, but they result in effective treatment for thousands or millions of people that would likely die otherwise. And that's the thing here. Sometimes the treatment also ends up hurting the patient. That's just a sad fact of medicine. But it is almost always preferable to an early death.

    I'm sorry but it doesn't sound to me like you have any idea how the medical process works. We don't try to understand the underlying cause of diseases? Well, yes we do actually. We don't try to understand how our treatments affect our patients? Again, we actually do. There are thousands of papers out there dedicated to these topics, and they form two large fields called pathology and clinical research:

    https://en.wikipedia.org/wiki/Pathology

    https://en.wikipedia.org/wiki/Clinical_research

    Please make at least a trivial amount of effort to look into this before you effectively accuse modern medicine of completely ignoring a large portion of their field.
     
    Last edited: Sep 22, 2018
  19. Sep 21, 2018 #18
    There is a great deal of information easily available about most of the issues you mention, There is a good overview on medscape, you can register for free.
    https://www.medscape.com/viewarticle/412682_1
    Its important to know that diabetes isn't really a single disease there are different ways that people can become glucose intolerant and this effects the treatment decisions.
    While insulin and glucagon are produced in the Islets of Langerhans they are produced by different cells the local high levels of Insulin inhibit Glucagon production, if Insulin can't be produced you loose this inhibition.
    Chronic hyperglyceamia increases the levels of the sodium-glucose cotransporter 2 which increases the renal threshold, that's why inhibitors can help bring glucose levels down.
    A lot of the effects are clearly adaptations but they are designed to bring glucose levels under control or control some other harmful effect.
     
  20. Sep 22, 2018 #19
    I wonder how that would be known without extensive research for the cause of the glucose intolerance?...
     
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