Comment by tialaramex
15 hours ago
Of course it depends on fractions. You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection. So knowing that all the plans towards eliminating this disease focus on HPV.
On the other hand most people with "flu" in summer months are not infected with Influenza, so an improved influenza treatment isn't going to make a big difference for them unlike in winter. We know other reasons you might get those symptoms which are more likely in summer.
Peptic ulcers are another well-known case, in which most (though not all) instances can be traced to a Helicobacter pylori infection. Other causal factors include NSAID usage, stress, and diet.
<https://en.wikipedia.org/wiki/Peptic_ulcer_disease>
<https://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disea...>
One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis.
Successful treatment and elimination of syphilis in patients and populations through antibiotics. As one of the few cases of near-total elimination of a class of mental conditions, this a useful reminder to the psychiatric profession that not all mental conditions have causes limited to the brain and its function, whether through its biochemistry or neural/behavioural processes.
<https://en.wikipedia.org/wiki/General_paresis_of_the_insane>
> One of the rare examples of a mental health condition being virtually completely eliminated is that of General paresis of the insane, a symptom of late-stage syphilis.
I think a better example is the very recent (i.e., in the 2000s) discovery of anti-NMDAR encephalitis which can very closely resemble schizophrenia [1].
In syphilis, there were at least other manifestations of disease that can (and were) known, unlike this totally unappreciated mechanism (which better resembles Barry Marshall and H. pylori).
1. https://www.ncbi.nlm.nih.gov/books/NBK551672/
> You can develop cervical cancer via some other route, but the vast, vast majority of cervical cancers are caused by HPV infection.
What are these other ways? There's an intuition that bodies are like computer programs that can fail in unpredictable ways, but this is usually false and belies a failure to see links between 'novel' and previously described mechanisms.
Computer programs always fail in predictable — but usually unpredicted — ways.
Human bodies, not so much, mostly because we lack the capability to monitor, measure and emulate the behaviour of such complex systems. As such, we gain medical knowledge using statistics, usually covering most common "failure modes" first, but we increasingly learn that those are never as clear cut either as our observation technology improves (as it does with science otherwise too — eg. Newtonian mechanics is completely true up to some error bars and constraints achievable in that period).
Spontaneous mutations? Which no matter how much you carve out modifiable risk factors will always be a thing. At least 5% of cervical cancers are HPV negative, so it's not even all the uncommon (not I would call "vast, vast" IMHO)
> Spontaneous mutations? Which no matter how much you carve out modifiable risk factors will always be a thing. At least 5% of cervical cancers are HPV negative
Random mutations causing cervical cancer essentially does not happen - as a sibling commenter writes, well-studied cases of this are so rare that they’re below our sensitivity of detection/technical error rates.
This is what I mean when I say we try to apply our intuitions to medicine - they’re not reliable and the truth is idiosyncratic.
Because our prior for cervical cancer being caused by HPV is so incredibly high, we would require overwhelming evidence to reject the hypothesis that any new case is due to HPV. There are ways to do this, and, should they be attained, would be published in a reputable journal based on their novelty.
Where did you see 5%? I'm not an expert (though I think I know one) but the study I'm looking at says 0.3% - hence my "vast, vast". That's 3 patients out of 1000.
In that study they take cancer cells and check for HPV, get about 7% negatives which I'm guessing is what you're describing too, but they take those negatives and PCR them to figure out, well, OK, what was wrong with these cells and when you take the cells to pieces very often your assay goes oh, these instructions are HPV. So, you know, the cancer cells aren't "infected" with HPV but well the genetics are just HPV, the replication has gone haywire and tangled parts of HPV with the human cell instructions and now it's cancer.
Crucially we can assume that if you don't get infected with HPV this wouldn't happen. So HPV was still causal.