Appendicitis is activated by inflammation and "not a problem" for most people. The Appendix organ hides in the body and waits to become inflamed to attack.
It's certainly in the realm of possibility EBV or other viruses have no benefit, but the history of medicine is harmful medical intervention after harmful medical intervention...
In defence of medicine, its history (of the last 100 years or so anyways) is filled with beneficial intervention after beneficial intervention. Never have humans lived longer and healthier, with such low rates of infant mortality and lack of disease.
It's almost certain that EBV has no benefit. We have a nice control group of people without EBV and as far as I'm aware absolutely no benefit is apparent.
Agreeing with you but it's crazy to see people hand-wave "EBV is fine".
Everyone seems to have to go through life the hard way where "nothing is a problem don't overreact" until suddenly it's destroying your life and then it's too late.
EBV can turn to mono and once your body is making auto-antibodies you are screwed for a long time, maybe the rest of your life because your quality of life is just gone. It will keep coming back every time you get weakened.
How about VZV turning into shingles? If you ever had a shingles attack it will change your whole perspective for life on illness and pain. If you could eradicate VZV from your body to prevent that you most certainly should, EBV too.
Indeed. It seems quite insane to me. That a virus that causes hundreds of thousands of cancers and many more debilitating illnesses every year could be reasonably expected to be fine, let alone beneficial is just baffling to me.
The non-carriers are not a control group unless we are 100% sure that the assignment is random. I find it hard to believe when the vast majority of population are carriers.
It's not random. More developed countries and richer people in more developped countries have a lower incidence rate. The chance of catching it increases with age. The part of the population that doesn't catch it seems to be avoiding it by luck, higher hygiene, and fewer vectors. See: https://academic.oup.com/jid/article/208/8/1286/2192838
The first recorded appendectomy is in 1880. Probably the first major study conclusively indicating adverse consequences was published in 2014.
It did hold for a long time, until it didn't because we found scientific evidence that said the opposite. Are you really so confident that no such evidence could ever be found for anything else? There is so much we don't know about the human body.
That's really not it. There is a heavy bias that the appendix is somehow beneficial because we evolved to keep it for some reason (though it could have been just a relic).
EBV is a virus. Our immune system does whatever it can to get rid of it. It causes significant illness. There is absolutely no reason to believe it is beneficial whatsoever.
If you think it is, you can prove it. We have literally hundreds of millions of people walking around that never got EBV. Go on, and find a statistically significant way in which EBV is beneficial for them. You have the burden of proof here.
If that bias is so strong, why did people believe the appendix was vestigial for a 100 years?
If the immue system does "whatever it can" to get rid of EBV, why is it happy to let EBV lie dormant in most people who have it?
Most of what you said can be said about bacteria too. It turns out bacteria can be helpful and blindly applying antibiotics is linked to the rise of numerous autoimmune diseases. It took quite a long time for us to figure it out.
I think the burden of proof is on the people who want to modify other people's bodies (i.e. prophylactic EBV vaccination). You can do what you want to yourself. But unless we want to repeat the mistakes of the recent past we should be ~really~ sure there is no reason the body keeps it around lying dormant. One could even say this is a larger "control group" than the one you are talking about.
Besides, correlational medical studies can't even determine if eggs and coffee are good or bad for you. If we really want to answer these questions adequately, we need better tools.
The immune system isn't happy to let EBV dormant. EBV infects the immune system in order to lie dormant. It hides inside long-lived B-cells in a way that is impossible for your immune system to see from the outside, so there is no way to mount an efficient response at that point.
Again, we knew about side effects for antibiotics from the get-go. It's link to autoimmune diseases specifically is recent because autoimmune diseases were misunderstood. We knew that bacteria could be beneficial and necessary from before we had the first antibiotic.
If we can't tell if eggs or coffee are bad for you, it's because there just isn't a strong correlation either way, and diet studies are not very good at deriving signal.
Thankfully, simply comparing people that are and aren't infected is a much clearer signal.
Again, this isn't hard. We've been able to associate dozens of negative outcomes to EBV infection. We would be able to figure out a positive outcome.
The idea that "the body keeps it around" just completely flies in the face of reality. The fact is, the body doesn't really have a way of preventing it from staying there.
> The idea that "the body keeps it around" just completely flies in the face of reality. The fact is, the body doesn't really have a way of preventing it from staying there.
This is a difference in semantics, not reality. The body also doesn't have a way of spontaneously ejecting the appendix. I would describe this as the body being happy to let it stay there. Of course, sometimes the body becomes unhappy with the existence of the appendix. I think the interesting question is why this happens and the proper treatment is to remove or mitigate these triggers. This is harder than removing the appendix.
We thought there were no serious consequences of antibiotics for a century. We were wrong. As someone living with autoimmune disease, I can assure you that we continue to misunderstand these diseases. I wish I could be so confident that we would never be wrong about anything else ever again. A few days ago there was an article where a virus was used to fight a bacterial infection [1]. How can you earnestly say it's impossible that any virus that makes its home in the immune system could play a role in the immune response? Proving negatives is really hard. Maybe if I saw a 10000 studies that showed no correlation for a wide range of different infections I could be convinced, but our system doesn't encourage publication of negative results so I'm not holding my breath. How many have you seen?
The problem with statistical medical studies is that in general samples are non-random (as you note in another comment) and cannot easily control for any of the 1M (lower bound) confounding variables. Our current methods here are mainly good for p-hacking publications, not uncovering causal relationships or complex effects. This is a discussion for somewhere else though probably.
>We thought there were no serious consequences of antibiotics for a century.
That's not true. We knew there were serious consequences and that microbiome was important from before antibiotics were even a thing.
>The body also doesn't have a way of spontaneously ejecting the appendix. I would describe this as the body being happy to let it stay there.
It has a way of doing so over evolutionary timescales, which is not true for EBV.
>A few days ago there was an article where a virus was used to fight a bacterial infection [1].
That is a bacteriophage. It is a virus that does not infect human cells, but only bacteria. We've known about them for decades.
> How can you earnestly say it's impossible that any virus that makes its home in the immune system could play a role in the immune response? Proving negatives is really hard.
I don't need to prove a negative, you have the burden of proof. It's absolutely certain that has an impact on immune response, we know that, it's just that every single effect we have seen so far has been negative.
> The problem with statistical medical studies is that in general samples are non-random (as you note in another comment) and cannot easily control for any of the 1M (lower bound) confounding variables.
There aren't 1 million confounding variables as far as sampling for EBV. You could feasibly account for all remaining variance, or enough of it to know that it doesn't have a sufficient impact.
We had some minor inklings of the microbiome, but we were not aware of serious consequences. Unless you are accusing the all the governments and medical bodies of the world of gross malpractice.
> It has a way of doing so over evolutionary timescales, which is not true for EBV.
Do you have evidence for this claim?
> That is a bacteriophage.
Do you really think nature has drawn a bright line between viruses than can affect humans and viruses that can affect bacteria? I'm not sure this lines up with reality. People are even seriously starting to talk about the "Human Virome" [1]
> I don't need to prove a negative, you have the burden of proof.
This is what they said about tobacco causing cancer and pesticides killing bees and carbon emissions causing global warming. How did that work out? I'd prefer a more proactive scientific framework than a reactive one. Maybe we could stop the next crisis before it happens.
> There aren't 1 million confounding variables as far as sampling for EBV.
There are 1M confounding factors in sampling outcomes. Not controlling for confounding variables is a great way to get weak conclusions.
> We had some minor inklings of the microbiome, but we were not aware of serious consequences. Unless you are accusing the all the governments and medical bodies of the world of gross malpractice.
That is not true. Microbiome treatments were proposed at the beginning of the 20th century.
I don't see how it would be malpractice. Pathogenic bacteria are a much worse problem than damage to microbiome in most cases. If your microbiome was damaged by evidently useless antibacterial treatments, it could be malpractice.
> Do you really think nature has drawn a bright line between viruses than can affect humans and viruses that can affect bacteria? I'm not sure this lines up with reality. People are even seriously starting to talk about the "Human Virome"
Yes, there is bright biological line between viruses that can infect humans and bacteria. And sure, the human virome could be thing, and certainly natural bacteriophages are important and so are many benign, transient infections important for the human system.
> This is what they said about tobacco causing cancer and pesticides killing bees and carbon emissions causing global warming. How did that work out? I'd prefer a more proactive scientific framework than a reactive one.
Certainly not. Tobacco causing cancer was the default because it is a foreign contaminant in the human body. Insecticides killing bees (insects) is also the default position. Global warming was theorized and predicted since the late 19th century, see Arrhenius, so yes energy companies had the burden of proof.
We already have the priors of EBV causing massive damage to the human body. You're saying that we must prove the negative that it causes nothing beneficial at all. That's akin to saying that despite we know that global warming has many negative effects, we have to show it has no positive effects.
> There are 1M confounding factors in sampling outcomes. Not controlling for confounding variables is a great way to get weak conclusions.
That isn't how statistics work. You can calculate a distribution of impact of every confounding factor onto the measured variance, and from then on you can know if you have controlled enough confounders or not. If you have 999,990 factors that alltogether account for 0.1% of variance, and 10 members that account for 99.9% of variance, you know it's enough.
> If your microbiome was damaged by evidently useless antibacterial treatments, it could be malpractice.
This is how I would describe the vast majority of applications of antibiotics. I'd like to be more charitable and say the people encouraging the use of antibiotics didn't realize the scale of the damage they were causing.
> Yes, there is bright biological line between viruses that can infect humans and bacteria. And sure, the human virome could be thing, and certainly natural bacteriophages are important and so are many benign, transient infections important for the human system.
The human virome ~is confirmed~ to be a thing, and includes bacteriophages. This bright biological line conclusively does not exist. Why would humans evolve to coexist with (or include) a large number of benign viral populations?
> Tobacco causing cancer was the default because it is a foreign contaminant in the human body.
If this is your argument, then what is the default for removing something that is benignly present in the vast majority of people? Surely it should be that it is potentially unsafe, like it is with the appendix and gut microbiome and frontal lobe etc. Anyway this is a historical argument. We've applied huge amounts of pesticides because there was 'no evidence they were harmful.' It turns out this was a bad idea. This framework is clearly very dangerous. Perhaps we should look harder for evidence of harm before we do things.
> That's akin to saying that despite we know that global warming has many negative effects, we have to show it has no positive effects.
Global warming is human-induced change. Removing EBV from the entire human population is human-induced change. The bar for causing change should be higher than leaving things as they are. A better analogy would be removing the appendix. There was no evidence this was harmful for 100 years! That doesn't mean it wasn't harmful!
> You can calculate a distribution of impact of every confounding factor onto the measured variance
In my experience, no one does this. And certainly never with the most important confouding varibables like diet and lifestyle.
>This bright biological line conclusively does not exist.
It does. Bacteriophages cannot infect human cells. They can only do it by changing our microbiome.
>If this is your argument, then what is the default for removing something that is benignly present in the vast majority of people? Surely it should be that it is potentially unsafe, like it is with the appendix and gut microbiome and frontal lobe etc. Anyway this is a historical argument. We've applied huge amounts of pesticides because there was 'no evidence they were harmful.' It turns out this was a bad idea. This framework is clearly very dangerous. Perhaps we should look harder for evidence of harm before we do things.
EBV causes millions of cancers, and it seems that it is likely to cause millions of cases of autoimmune diseases. It is known to cause vast amounts of harm. By the same logic. Beyond this, a large proportion of viral infections of EBV cause mono, which in and of itself is a great harm. You can't ask that every future intervention prove a negative.
> In my experience, no one does this. And certainly never with the most important confouding varibables like diet and lifestyle.
Is your theory that for some diets and lifestyles, EBV has beneficial effects? You can certainly design a study to account for this.
It's certainly in the realm of possibility EBV or other viruses have no benefit, but the history of medicine is harmful medical intervention after harmful medical intervention...