different mini-topic tonight, we cover a very interesting publication with the Great Doc adding his contribution to a research team's findings.We look at some research into the prevalence of OA then versus nowadays.
As always, please enjoy.
INTRODUCTION
If you are new to us there is one Doc. that we are very fortunate to have as a consultant working for us, on our side. What do I mean 'on our side'? While the FDA do work together with sponsors for drug approval, The Good Great Dr David T Felson has been working on the other side in the past, working for the FDA vetting out the candidates and sponsors like us! Yep, we managed to get him to represent us, to help us with the very important trial design.
He has never done this before, he has never worked with a commercial partner and taken their case to the FDA.
He is world renowned in the twin fields of OA and RA with not just a few dozen peer reviewed papers, he has had some 300 or so personally peer reviewed papers and has played a role in more than 480 papers.
His credentials read longer than the number of people involved in visual effects in the latest Marvel movie! (See Appendix A below). Here are three posts on the Good Doc for some background on his expertise if you are new to us at PAR HC and haven't read them (Single left click on the below hyperlinks):
GOOD DOCTOR 1...............................................................20/11/2019 GOOD DOCTOR 2...............................................................18/01/2020 GOOD DOCTOR 3...............................................................14/06/2020
Yes while we wait for the end of Sept, maybe the beginning of October...hopefully not as late as Mid October *blah* ...it's interesting to learn more about the disease we one day will address at some sort of scale, globally.
Are we there yet?
AN INTERESTING STUDY
So the researchers set out to find why is OA prevalence increasing over the ages.One could easily come to the conclusion that the answer to that is simple...
Increase in BMI
Increase in Longevity
While these factors can and do contribute, the researchers found that isolating those two factors out still did not completely account for a marked increase.
So what was the increase? Well the researchers actually compared very historic periods of time, namely:
How did these three sets of times compare with each other in terms of OA prevalence?
Surely Prehistoric times would have a greater OA prevalence due to all the manual labour? The digging...the toiling....the onset of Industrial time with it's machinery and mechanical aids should result in a lowering of OA prevalence, correct? Even today we should see the figures stabilise right?
Quite the contrary...rather than figures, lets look at pic! You know I love my pics:
Mate, quite the opposite, prevalence increasing over the ages! A) above, normalises the data for taking into account Gender. B) controls the data for Gender, Age, BMI and ethnicity.
Mozz speak? This means that B) shows a rampant increase over the ages factoring OUT things like Male/Female (sorry girls, but OA is more prevalent in females irrespective of any factors), your age and BMI. So we know the population is getting obese over time, removing this factor it means something else is driving these figures other than BMI (and Gender and Age etc). While things like Body weight and age etc may add to the numbers, it isn't the main driving force as a singularity.
Let me digress for one sec...There was a very comprehensive survey and analysis done some time ago that looked at the effect of the Great Depression (1929) and life expectancy rates. The researchers took figures and rates from before the Great Depression , during the Great Depression and after. The BIG surprise was that during the Great Depression when there were acute food shortages and most people had to cut back on food...well...the life expectancy during that time went.....UP2. Could we actually be eating too much as a population? I'm not at all suggesting that thats the only factor, there could've been a few factors such as less smoking and alcohol consumption etc...but that was from a peer reviewed publication. There are some merits in fasting as also documented by the famous Dr Mosely. 3 (Before taking on any diet or significant/material change to your diet/lifestyle always prudent to consult a Healthcare professional).
Right, let's get back to it...
What is the multiplier factor from age period to age period above?
"After controlling for sex, knee OA prevalence in the postindustrial sample was 2.6 times higher (95% CI, 2.1–3.4; P < 0.001) than in the early industrial sample and 2 times higher (95% CI, 1.3–3.3; P = 0.003) than in the prehistoric sample".
Now those are concerningly high factors for OA incidence increases over time.
WHAT'S CAUSING THIS?
The researchers found from prehistoric samples through to pre and early industrial eras through to the modern era that OA existed in low frequencies early on but "since the mid-20th century, knee OA has approximately doubled in prevalence, even after accounting for the effects of age and BMI" ... in other words the increase in OA in modern times cannot solely be accounted for by people simply living longer or as a consequence of more often having a higher BMI.
Now the researchers point out that BMI for the prehistoric and other samples are not easily determined, errors are possible and there are study limitations.
What rationale did they come up with?
Genetic predisposition plays some role in the results
"Recent environmental changes have played a principal role". They postulate that it is finally the load on joints that are causing this. It may be a change in load or a change in the strength (weakness) of structural tissues.
Factors such as footwear or walking on harder surfaces like concrete footpaths could play a role
One possible major contributor that warrants further study is the fact of physical inactivity "which has become epidemic during the post industrial era".
Chronic low-grade inflammation onset possibly by "modern diets rich in highly refined carbohydrates, and excessive adiposity" can further exacerbate the problem and "magnify and accelerate loading-induced damage to joint tissues and may also directly affect knee OA pathogenesis".
Jogging on Concrete? Might wanna try the dirt path or grass instead? (Shouldn't be construed as advice) (When can I tell my legal dept to go jump?)
How then does the factor increase look as a graph side by side?
This is a telling picture:
The above data has the BMI, sex and ethnicity factors adjusted, the shaded parts depict 95% confidence levels.
IN CONCLUDING
The researchers drew some parallels with other prevalent and increasing diseases."Intriguingly, other well-studied mismatch diseases, such as hypertension, atherosclerotic heart disease, and type 2 diabetes, that also have become epidemic during the last few decades are strongly associated with knee OA". This, as the researchers went on to state, suggests common causes and risk factors are more prevalent and a bigger risk factor in modern times. Physical activities in combo with diets would go a long way to addressing OA but at the end of the day how many patients will choose this more laborious pathway over a somewhat quicker and perceived easier route over a simple a prescription?
Certainly I see a vicious circle here in the case of a great percentages of folks. The less time they make for exercise and a good diet, the more OA becomes a risk. The more OA prevails, the more the perceived pain and thus less impetus to go on and fix it by taking on low impact exercise and making time to research, shop and plan better and more nutritious diets and lifestyles.
It requires effort. Another classic setup for iPPS.
DYOR
APPENDIX A
I find the Marvel Movies a very interesting story. Bought out originally for $4 billion in Aug 2009 by Disney, there were many at the time wondering if Disney had actually paid too much for this franchise? A franchise of comic fans that certainly weren't mainstream at the time. Even today, the actual numbers that follow marvel Comics aren't particularly noteworthy.
But, the same cannot be said of the Marvel Movies, they have been an incredible hit with MASS worldwide following. I somewhat liken their popularity hopefully to one day our own drug and how popular and just how broad based appeal it may one day have.It's not lost on me the bits of humour they throw in there which are not really at all distracting and add to the flavour. Isn't that somewhat a little like what we have.? We are dealing with serious science and it can get dry here, but folks like AF and Pool_Master and a whole host of others do keep us entertained as we wait. I'm not getting carried away and thinking this will happen in the next few years. I know these things take time to play out...but if it takes 10....if it takes 15 years...I will ensure I have more than just 100 shares left to enjoy it. (Not advice, can be unforeseen risks, ensure you understand the downsides, never ever rely on one poster no matter HOW enthusiastic and researched they appear to be, '100' is an arbitrary number).
No,@Absentfriend, this is not some random name generator (see below), they are the actual people involved in the latest Marvel film, Black Widow.3
(Note: I attempted to simply past all the names into HC but I actually exceeded the 50,000 word limit....the way around this was to screen capture...)
different mini-topic tonight, we cover a very interesting publication with the Great Doc adding his contribution to a research team's findings.We look at some research into the prevalence of OA then versus nowadays.
(20min delay)