Terrain Theory vs Germ Theory

[dann]

I respectfully disagree with this portion of your comment. IMHO terrain theory puts too much of the responsibility on the individual, in the sense that it implies that if you get sick, it is your fault. Some people are born with subpar immune systems (the genetic condition SCID comes to mind), and others become immunocompromised from lymphoma or other diseases. It also ignores the fact that new pathogens appear and old ones evolve. However, I would agree that terrain theory can appear reasonable on the surface. Nor do I disagree with the proposition that good nutrition and exercise are important components of good health.

It's a little more complicated than that, and it's important when people divide themselves and others into two groups: those with strong and those with weak immune systems. For instance when they are talking about COVID-19: 'I have a strong immune system, so I've got nothing to fear. I see no need to get vaccinated.'
You may have a pretty good immune system until you run into that new infectious disease that your otherwise strong immune system just doesn't handle very well even though it was able to tackle all the others. And unfortunately, that isn't something that you know until you run into it.

There are also immune systems that are so 'strong' that they react to innocuous stuff that would be harmless if it weren't for the (too) strong reaction to something that isn't even a pathogen, but may nevertheless kill them because of the immune response: Anaphylaxis (Wikipedia).

Sometimes COVID-19 may kill you, not because your immune system is too weak, but because its reaction to the infection is too strong:
Cytokine storm (Wikipedia).

 

[Chris_Halkides]

dann,

You make some valid points, but you did not directly address the issue that I hoped to raise; my phrase "subpar immune system" is vague enough to be unintentionally misleading. One type of SCID (severe combined immunodeficiency disease, a.k.a. boy-in-the-bubble-disease, from a television movie) is a genetic deficiency in the enzyme (deoxy)adenosine deaminase. Because of this hereditary deficiency, deoxyadenosine triphosphate (dATP) is found at higher concentration inside the cell than normal, and it binds to a regulatory site on the enzyme ribonucleotide reductase, the enzyme which produces the four critical precursors for the synthesis of DNA. When dATP inhibits ribonucleotide reductase, the slowdown of DNA synthesis prevents the rapid proliferation of specific cells needed for the adaptive immune response. My point is that one cannot reasonably blame a person who has SCID and who gets sick from an infection for poor lifestyle (diet, exercise, etc.) choices. I recall a rant from Del Bigtree about Covid-19 along these lines, but I don't remember where I read it. If a person suffers from SCID, the fault is in their stars.

 

[Chris_Halkides]

At Science-based Medicine David Gorski wrote, "You can see where I’m going with this in the age of COVID-19 and why pandemic deniers and minimizers might be attracted to the 19th century ideas of the “terrain” being more important than the “microbe,” namely for the same reason that antivaxxers so frequently lapse into germ theory denial and invoke Béchamp and/or Bernard. (Examples include Kelly Brogan and Andrew Wakefield) After all, if SARS-CoV-2 is not the “main” cause of COVID-19 and severe illness, then all those public health interventions, such as masking, “lockdowns,” and vaccines become superfluous and unnecessary, if not actively harmful. I’ll discuss this aspect more near the end of this post. I’ll also prime you by suggesting that, even if you’ve never heard of Claude Bernard, Antoine Béchamp, or “terrain theory” before, I bet you’ve encountered these ideas being invoked by quacks, antivaxxers, antimaskers, and anti-“lockdown” activists."

 

[Chris_Halkides]

Almost fifteen years ago at SBM Peter Lipson wrote an essay "Your disease, your fault," in which he stated, "Earlier this week, my colleague Dr. Gorski explored a common theme in alternative medicine: the idea that all disease is preventable. This implies that all disease has a discrete cause and that individual behavior can mitigate this cause." This week at SBM Scott Gavura returned to this idea as he discussed wearable monitoring devices: "As Peter Lipson pointed out so succinctly fifteen years ago, the idea that all illness is preventable isn’t new – it’s long been a cornerstone of alternative medicine. But under MAHA, this fringe, unscientific belief has moved into the mainstream. RFK Jr. and his allies are promoting a vision of health that’s not just about personal habits, but also personal virtue. If you’re sick, it’s not bad luck, or bad genes – it’s your bad choices." Mr. Gavura continued, "Miasma theory had moral overtones – lack of cleanliness was not only unhealthy, but a sign of failing or laziness...By tying health outcomes to individual choices and digital self-surveillance, MAHA policies risk making healthcare less equitable and overall, less effective."

Mr. Gavura identifies RFK, Jr as a believer in Miasma Theory, but I think that Terrain Theory is a closer fit. It has long struck me that there is an element of blaming the victim in Terrain Theory.

 

[Mojo]

"Miasma theory had moral overtones – lack of cleanliness was not only unhealthy, but a sign of failing or laziness...By tying health outcomes to individual choices and digital self-surveillance, MAHA policies risk making healthcare less equitable and overall, less effective."

And (at least as far as homeopathy is concerned) the 'miasma' can be inherited. It’s not just to do with being a bad person, it's to do with being the wrong sort of person.

 

[bknight]

Here's my problem with Big Snake-Oil; those who promote alternative meds are always 100% certain in the outcomes. Real medicine is rarely 100% certain. The alternative gang hasn't changed their tune in the 45 years with each sub-group pushing their miracle cures with the same lines of BS.

Meanwhile, medical science has evolved in those 45 years. In the 80s I had a rescue inhaler for my asthma attacks, and today I still have a rescue inhaler, but now I have another inhaler that prevents asthma attacks completely. Type-2 diabetics have a bunch of options for medications that aren't insulin. Last week I had chest x-rays and I didn't have to take my shirt off, and I was in and out in 4 minutes. And most of us old guys notice our younger doctors are all advising healthier diets, and exercise (which I guess they always did). Every aspect of medical science has evolved, and continues to evolve as new data emerges.

Type 2 for me and I use Metformin to control it. Works well for me.

 

[Chris_Halkides]

At Science Based Medicine Scott Gavura discussed germ theory denial and gave some helpful background on germ theory versus terrain theory. He wrote, "Terrain theory doesn’t just reject evidence: it rejects uncertainty. And in doing so, it offers an illusion of control: Live life purely and holistically, and you can avoid illness. But reality is messier. Disease can strike even the healthy. Through acknowledging the reality of germ theory, we’re also accepting a necessary truth: some aspects of our health are beyond individual control. Germ theory gave us something terrain theory couldn’t deliver: effective, lifesaving interventions like vaccination, antibiotics, sterilization and sanitation – together they have saved many millions of lives and are cornerstones of medicine."

 

[arthwollipot]

More importantly, Terrain theory claims that if you get sick it's because you didn't live purely and holistically aka. it's your fault.

 

[Blue Mountain]

More importantly, Terrain theory claims that if you get sick it's because you didn't live purely and holistically aka. it's your fault.

Two cousins of mine and a sister-in-law, hard-working individuals living healthy lifestyles (non-smokers, got decent exercise, in stable marriages) died of cancer in their fifties. Modern medicine would say they were unlucky. Terrain theory says they must have done something wrong. I'll side with medicine.

My father lived to 93. My mom died at 85 after being in care for the last five years of her life due to dementia. For the majority of their lives they had almost identical lifestyles and ate the same foods, which mom prepared. So what did my father do right that my mom didn't?

 

[a_unique_person]

One problem is that there were several diseases that were commonly caught by children. These kept them away from school and even killed off a few of them. Now vaccines have prevented most of these diseases.

The main problem is that the immune system has less to do and may cause trouble. So may we need to start giving it something to do.

The immune system is always active. We just aren't off that till we get a major infection.

 

[Chris_Halkides]

One aspect other Terrain Theory that may bear further exploration is what its ramifications are for society. At Unbiased Science Jess Steier quoted from the resignation letter of Dr. Demetre Deskalakis, who had worked at the Centers for Disease Control until this week. "we're heading toward 'a pre-vaccine era where only the strong will survive.'" A few months ago at Science-based Medicine Dr. David Gorski wrote about the soft eugenics of the MAHA movement.

 

[The Common Potato]

My next door neighbour used to refer his older sister as "The Germ!"

 

[Chris_Halkides]

At Science-based Medicine Dr. David Gorski discussed germ theory denial and genetics denial and quoted from an Op-Ed that appeared at the Wall Street Journal Journal. "Moreover, there is no incompatibility between germ theory and acknowledging that your general health, which is impacted by lifestyle, can modulate your susceptibility to disease. That, however, is not what terrain theory advocates are saying. Those who invoke terrain theory tend to emphasize “the terrain” über alles as the be-all and end-all of preventing infectious disease. What they are arguing is that pathogenic microorganisms and viruses can’t make you sick if your terrain is “clean” and “pure.”"

Dr. Gorski continued, "Perhaps the best example of how MAHA denies genetic predisposition to health conditions is autism. I’m just going to repeat it again right here. Autism is primarily, but not exclusively, genetic in nature. The evidence for this conclusion has been building for decades, and we’ve written about it a number of times here on SBM dating back to 2010. Indeed, we now know that the genetic contribution to autism and autism-spectrum disorders is approximately 65%-90%, perhaps as high as 80%-90%...While it is true that some antivax narratives suggest a “genetic susceptibility” to autism that is triggered by vaccines, I still consider this to be genetics denial, as in these narratives the primary cause is never genetic. Rather, it’s the vaccines in genetically susceptible individuals, which seems to be most children. Moreover, try as antivaxxers might, they have never actually identified specific genes that somehow predispose to vaccine-induced autism."

 

[Chris_Halkides]

At City Journal NIH Director Jay Bhattacharya and and assistant director Matthew Memoli provided a new pandemic playbook, writing in part, "We should learn from recent example: a metabolically healthy population, physically active and eating nutritious food, will cope far better in the face of a novel pathogen than a population facing a severe chronic-disease crisis…Ultimately, public health agencies encouraging people to take whatever steps they can to improve their health will have a dramatic effect during the next pandemic. Whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more, anything that makes the population healthier will prepare us better for the next pandemic. The best pandemic preparedness playbook for the United States is making America healthy again." At Science-Based Medicine Jonathan Howard responded, "That’s it! That’s the entire plan. It’s terrain theory all the way down. Like the GBD, Dr. Bhattacharya’s suggestion that Americans should be “healthy again” isn’t inherently wrong. It would be great if people smoked less and walked more. However, that’s hardly a brilliant insight, and it’s been tried before. Dr. Fauci made it a point to encourage exercise as early as March 2020, and unlike Dr. Bhattacharya, he led by example- Dr. Anthony Fauci Is an Avid Runner, Even When He Works 19-Hour Days."

 

[rjh01]

At City Journal NIH Director Jay Bhattacharya and and assistant director Matthew Memoli provided a new pandemic playbook, writing in part, "We should learn from recent example: a metabolically healthy population, physically active and eating nutritious food, will cope far better in the face of a novel pathogen than a population facing a severe chronic-disease crisis…Ultimately, public health agencies encouraging people to take whatever steps they can to improve their health will have a dramatic effect during the next pandemic. Whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more, anything that makes the population healthier will prepare us better for the next pandemic. The best pandemic preparedness playbook for the United States is making America healthy again." At Science-Based Medicine Jonathan Howard responded, "That’s it! That’s the entire plan. It’s terrain theory all the way down. Like the GBD, Dr. Bhattacharya’s suggestion that Americans should be “healthy again” isn’t inherently wrong. It would be great if people smoked less and walked more. However, that’s hardly a brilliant insight, and it’s been tried before. Dr. Fauci made it a point to encourage exercise as early as March 2020, and unlike Dr. Bhattacharya, he led by example- Dr. Anthony Fauci Is an Avid Runner, Even When He Works 19-Hour Days."

About the only thing missing there is to tell people they should be vaccinated. Then you have an extra layer of protection.

 

[Chris_Halkides]

About the only thing missing there is to tell people they should be vaccinated. Then you have an extra layer of protection.

They did not discuss vaccination in either the retrospective portion of their essay on Covid-19 or in their new pandemic playbook. Another thing not discussed in the new playbook is focussed protection, which was part of the Great Barrington Declaration. If one is a hard core terrain theory believer, neither is necessary. However, they did not give any specifics on how to get people to stop smoking, control hypertension, exercise more, etc.

 

[Jack by the hedge]

... Mr. Alexander goes on to write, "By shunning, censoring and removing alternative viewpoints from education and healthcare we have completely ignored the Terrain. As a result, the average US citizen is sicker than their counterpart in any other major industrialized nation.

Arriving late to this thread, I see this odd argument in the OP. He was saying health outcomes in the US are worse than other industrialised nations and implies this is because the US clings to germ theory over terrain theory. But so do all those other countries. The US isn't some weird Lysenko nation where medical science stops at the border and swaps itself for politicised magic.

Okay it wasn't. What the future holds I hesitate to guess.

 

[Chris_Halkides]

Dr. Mehmet Oz discussed influenza at Newsmax, and The Hill covered his remarks: "“Flu is always a problem. Every year there’s a flu vaccine. It doesn’t always work very well. That’s why it’s been controversial of late,” Oz said. “But like many illnesses, the best news out there is if you can take care of yourself, so that when you do end up running into the flu, you can overwhelm it...Things like getting sunlight, and you can’t do that in northern parts of the country, which is tough this time of year, take some vitamin D. Zinc seems to be effective as a basic supplement,” he added. “But fundamentally, the MAHA initiatives: Eat the right food, food that came out of the ground looking the way it looks when you eat it and consume it, and getting physical activity actually makes sense. But the most important tool of all is sleep."" This advice seems like a mixture of germ theory and terrain theory.

 

[a_unique_person]

He's doing that classic, disingenuous Trumpophile doublespeak.

 

[Mojo]

"But the most important tool of all is sleep."

Is that why Trump keeps doing it? Doctor's orders?