Are noncommunicable diseases communicable? (Finlay et al, 2020)

[rvallee]

I don't have a better title since I can't find the paper, the article doesn't have a link to it and Google (scholar included) doesn't turn out anything yet.

Paper: https://science.sciencemag.org/content/367/6475/250. Titled: Are noncommunicable diseases communicable? Thanks @Lisa108!

https://www.cifar.ca/cifarnews/2020/01/16/obesity-heart-disease-and-diabetes-may-be-communicable

A new paper in Science by B. Brett Finlay and a team of CIFAR fellows in the Humans & the Microbiome program proposes that “non-communicable” diseases may be transmitted between people through the microbiome.

“Non-communicable diseases” including heart disease, cancer, and lung disease are now the most common causes of death, accounting for 70 percent of deaths worldwide. These diseases are considered “non-communicable” because they are thought to be caused by a combination of genetic, lifestyle, and environmental factors and can’t be transmitted between people.

A new research paper in Science by a team of fellows in CIFAR’s Humans & the Microbiome program throws this long-held belief into question by providing evidence that many diseases may be transmissible between people through microbes (including bacteria, fungi, and viruses) that live in and on our bodies.

“If our hypothesis is proven correct, it will rewrite the entire book on public health” says B. Brett Finlay, CIFAR Fellow and professor of microbiology at the University of British Columbia, who is lead author on the paper.

 

[rvallee]

The last one is particularly interesting as it would essentially overturn current dogma over disease presentation, how it is assumed rare to have more than one disease (just world fallacy?), with comorbidities particularly easy to miss if every symptom is considered to be part of the early diagnosis. It would be particularly brutal to the foolishness of going straight to psychosomatic when patients present with too many symptoms, because of the belief that no one could possibly be this unlucky, and the common clinical approach of 1 consult = 1 symptom.

Bit like rediscovering the germ theory of disease on a whole other level. The microbiome is this massive germ colony we arbor and understand almost nothing about. And there's more than the gut, there are several microbiomes all over the body.

Honestly decent chance that this illuminates many dark corners of medicine. It makes 1 million times more sense than the nonsensical psychosomatic models that were created to just block those dark corners from view.

 

[Saz94]

How can stuff be transmitted between people through the microbiome? I don't understand.

 

[Ravn]

How can stuff be transmitted between people through the microbiome? I don't understand.

I don't either. Based on the below my guess - but no more than a guess - would be that you pick up a disturbed microbiome from others.

The authors base their hypothesis on connections between three distinct lines of evidence. First, they demonstrate that people with a wide range of conditions, from obesity and inflammatory bowel disease to type 2 diabetes and cardiovascular disease, have altered microbiomes. Next, they show that altered microbiomes, when taken from diseased people and put into animal models, cause disease. Finally, they provide evidence that the microbiome is naturally transmissible, for example: spouses who share a house have more similar microbiomes than twins who live separately.

My bolding - has anybody ever inflicted ME microbiomes on mice?

 

[Midnattsol]

How can stuff be transmitted between people through the microbiome? I don't understand.

Being close and personal (physically) with someone could cause exchanges of bacteria (I think this is also observed between animals and their owners). And I'm not taking about being unhygienic, like @rvalee says, we have many microbiomes and some are more accesible than others (for lack of a better term ). Adult microbiomes are more resistant to change than childrens, but if you live with someone for a while I'd be surprised if nothing changed.

Also, the gut microbiome can be influenced by environmental factors (diet, drugs, toxins) and such exposures may be shared. Sleep and sunexposure can also have an impact, and are things that might be shared by several individuals in a household.

I'm not familier with the concept of it being rare to have more than one disease though, I've always heard the opposite. Especially with many "non communicable" disease as they can be linked to many of the same lifestyle factors and exposures. Autoimmune diseases are another "if you get one it's likely you develop another" category. Maybe there is a change in how these things are taught to us students?

It's also not new, so I feel they are being a bit sensational on purpose..

Edit: fixed some typos.

 

[Forbin]

How can stuff be transmitted between people through the microbiome? I don't understand.

There are occasional outbreaks of Hepatitis A that are traced back to restaurants. It seems to follow the fecal-oral route. In other words, someone is not paying attention to the "All Employees Must Wash Their Hands" sign.
Other diseases, like polio, have the same mode of transmission.

 

[Lisa108]

Link to the paper published in Science here

Title is: Are noncommunicable diseases communicable?

 

[James Morris-Lent]

I'd say this is in the 'overhype' stage. The telltale signs being (1) speculating that this could be a big deal for literally every acquired non-infectious disease and (2) relying on a logical argument that is knitting together some correlative findings and animal 'model' findings in a very speculative and hopeful way.

It seems reasonable to study this sort of thing but hopefully people don't get caught up in all-encompassing pet theories.

 

[Arnie Pye]

The last one is particularly interesting as it would essentially overturn current dogma over disease presentation, how it is assumed rare to have more than one disease (just world fallacy?), with comorbidities particularly easy to miss if every symptom is considered to be part of the early diagnosis. It would be particularly brutal to the foolishness of going straight to psychosomatic when patients present with too many symptoms, because of the belief that no one could possibly be this unlucky, and the common clinical approach of 1 consult = 1 symptom.

Just to add to your comment - using hypothyroidism as an example - one of two things is likely to happen to people with hypothyroidism - a condition with lots and lots of possible symptoms. Either they are rapidly dismissed as being depressed and anxious attention-seekers who are mentally ill if they list all their symptoms, or they end up diagnosed with a very long list of conditions which are actually much more likely to be caused by low thyroid hormone levels. I've read of patients who are diagnosed with hypothyroidism editing and pruning their symptoms lists so that what they mention is not immediately dismissed by a doctor as signs of a mental problem.

It is known (or ought to be known by all doctors) that every cell in the human body needs adequate levels of thyroid hormone either all the time or at some point in its life cycle. The active thyroid hormone is T3, which doctors rarely measure in the UK. (Because they say it's "too variable to be useful", despite the fact that the measure they do use - TSH - varies substantially more than T3 throughout the day. Both TSH and T3 have a circadian rhythm.) If T3 (Edit: in the body) is in short supply then there is nothing to stop people having symptoms anywhere on or in the body, and yet doctors usually reject this.

This is the list of symptoms as described by NICE in the Clinical Knowledge Summary on the subject of hypothyroidism :

https://cks.nice.org.uk/hypothyroidism#!diagnosisSub

If people report having symptoms that differ markedly from the above list then they are told that their symptoms are "nothing to do with your thyroid", and you can bet that an offer of anti-depressants probably isn't far behind.

This is the symptom list as prepared by a hypothyroid patient.

https://hypothyroidmom.com/300-hypothyroidism-symptoms-count-how-many-you-have/

I find it hard to believe that there could ever be a meeting of minds between the authors of those two links.

 

[Mithriel]

Research into microbes dropped after the 70s once antibiotics became commonplace. We have lost all sense of living in a cloud of infections. Hygiene ideas are abysmal compared to when I was a child. We are much cleaner in a lot of ways but it doesn't get treated as life or death anymore.

PCR stimulated the field again and they have discovered that there is much more to the micro world than was ever suspected. It is structured and interconnected in a way that was never suspected. A lot of our ideas will be overturned.

Quite a long time ago now I read about an Indian researcher who found that chickens became obese after infection with a common virus.

 

[InitialConditions]

How can stuff be transmitted between people through the microbiome? I don't understand.

The microbiome is not just in the 'gut' but elsewhere including on/in the skin.

 

[rvallee]

How can stuff be transmitted between people through the microbiome? I don't understand.

The "stuff" itself is the microbiome, various germs we come in contact every day and changes all the time depending on what we touch, breathe or eat. Up until recently they were considered uninteresting since they are "benign", which somehow translated into having no known impact, but even that isn't entirely true (MRSA as an important example), it's just taken a lot of time to catch up to the idea that those trillions (quadrillions?) of microbes impact our health, not entirely surprising considering the gut microbiome is largely responsible for what nutrients make it into our body.

Interest about microbes has usually been about the bad ones that runaway into an infectious state. Medicine is catching up to the fact that "causes no known harm" isn't the same thing as having no impact.

 

[rvallee]

It's also not new, so I feel they are being a bit sensational on purpose..

The ideas aren't new but until recently they were largely dismissed as unimportant. So the paradigm sure is new, even though some people have been working on it for decades. History repeats itself because people like the rhyme. The germ theory of disease followed the same path but mostly focused on the nasties that replicate and break all the things, instead of the parasitic ones that low-key hijack our body to survive.