Advanced Maternal Age Associated with AIS?

[Ballet Mom]

Please explain genetically why the incidence of scoliosis would be decreasing (rapidly in genetic time-frames)?

[Dingo]

hdugger

OK, I know I promised I wasn't going to post anything else, but nothing I've read indicates that there *is* a relative worldwide constant rate for scoliosis.

I read a lot about this stuff and I don't recall a single disease with a worldwide, constant rate. If my memory serves me correct scientists found evidence that even the rate of Down Syndrome has risen and fallen over the past millenium. I just googled and can't find the story.

However I did find this...

Wiki: Down Syndrome

Current research (as of 2008) has shown that Down syndrome is due to a random event during the formation of sex cells or pregnancy. There has been no evidence that it is due to parental behavior (other than age) or environmental factors.

Environmental factors? Hmm...

Centers For Disease Control: Risk Factors for Down Syndrome (Trisomy 21): Maternal Cigarette Smoking and Oral Contraceptive Use in a Population-Based Case-Control Study

Younger mothers (<35 years) who smoke and have meiotic II error are at an increased risk of having children with Down syndrome. The combined use of cigarettes and oral contraceptives increased the risk even further.

[Pooka1]

http://www.scoliosis.org/forum/showt...hlight=kiester

So Dr. Kiester, an orthopedic surgeon doing research of scoliosis at UC Irvine, believes that the natural incidence of scoliosis is falling....he thinks due to obesity. I ran across a medical article that said the use of forceps in delivery had been falling over the past couple of decades. Perhaps hidden trauma associated with forceps births has been decreasing due to that and therefore the incidence of scoliosis in athletes is also falling. Interestingly, neither one of those ideas would be considered genetic. And why would a genetic trait be decreasing anyway?

I guess the alpha-scientists will need to show Dr. Kiester what's what and put him in his place for not following the accepted scoliosis research agenda these days.

Dr. Kiester) It is my belief that bracing does make adolescent scoliosis worse. It is very helpful for neuromuscular scoliosis, but it is rare that I would recommend bracing for adolescent scoliosis.

Don't you want to publicly correct Dr. Kiester on his erroneous view of bracing for AIS?

[Pooka1]

Please explain genetically why the incidence of scoliosis would be decreasing (rapidly in genetic time-frames)?

Reference?

[Ballet Mom]

Dr. Kiester) It is my belief that bracing does make adolescent scoliosis worse. It is very helpful for neuromuscular scoliosis, but it is rare that I would recommend bracing for adolescent scoliosis.

Don't you want to publicly correct Dr. Kiester on his erroneous view of bracing for AIS?

I am well aware of his belief in bracing. It seems to accord with your beliefs and should give him more credibility in your eyes. I still don't believe that bracing is harmful. It doesn't make everything he believes incorrect.

[Pooka1]

I am well aware of his belief in bracing. It seems to accord with your beliefs and should give him more credibility in your eyes. I still don't believe that bracing is harmful. It doesn't make everything he believes incorrect.

I don't judge results based on their content as is so popular around here. As I mentioned previously, I judge them solely based on how tight the methods and reasoning is.

Kiester's beliefs are bracing are neither here nor there. His methods used to come to that conclusion are what matters. The methods lend credibility, not the conclusion. This is why my advisor's advisor paged over to the methods section of his draft, read it, and chucked the paper in the garbage (lack of adequate controls). The point is if you can't get past the methods section then you do not have to read the rest.

I agree bracing is not usually physically harmful.

[hdugger]

I wanted a try a quick summary of the various arguments here, because I think the key points often get lost is murky language.

1 There is complete agreement that genetics play a role in scoliosis (as they do in virtually every human disorder).

2 Noone understands the exact mechanism of that role - nor does anyone know what exactly causes scoliosis

3 Because of 2, noone knows if understanding the genetics will in any way further our understanding of the disease. So, if the "heritable" part of the disease is a specific body type and hyper flexibility, that overlaps with things we know already just by observing the physical characteristics of people with scoliosis.

The point of departure between the various positions is that (as best I can tell) Pooka is arguing that genes *completely* determine the course of scoliosis, and that, therefore, absolutely nothing that will alter the course of the disease short of surgery. The rest of the participants are arguing that there are some other factors - prenatal environment, nutrition, bracing, and lots of others - that will in some way alter the course of the disease. Of course, medical research is too flawed to cast much light on either position, and experts in the field hold opinions which encompass all of the arguments advanced here.

So, again, the argument is not whether genetics plays some role, but whether it plays a completely deterministic role, or whether there is some intervention (short of surgery) that would in some way change the course of the disease.

[Pooka1]

I wanted a try a quick summary of the various arguments here, because I think the key points often get lost is murky language.

1 There is complete agreement that genetics play a role in scoliosis (as they do in virtually every human disorder).

Among the field experts, yes. Among the bunnies, no.

2 Noone understands the exact mechanism of that role - nor does anyone know what exactly causes scoliosis

Si.

3 Because of 2, noone knows if understanding the genetics will in any way further our understanding of the disease. So, if the "heritable" part of the disease is a specific body type and hyper flexibility, that overlaps with things we know already just by observing the physical characteristics of people with scoliosis.

I think genetics will necessarily play a role in terms of etiology though not necessarily the specific treatment given, "It's all genetic" per that one researcher and his listing of the top hypotheses. (Note I'm NOT saying or implying that no treatment can be had for genetic conditions. There is not reason to assume that conservative treatment can't succeed just because a reliable one hasn't been found yet.)

The point of departure between the various positions is that (as best I can tell) Pooka is arguing that genes *completely* determine the course of scoliosis, and that, therefore, absolutely nothing that will alter the course of the disease short of surgery.

No actually I have no thought to treatment when I mention that. I am simply saying the researchers in this field claim, "It's all genetic." That either is or isn't the case. My bunny guess about treatment is it will not include gene therapy just based on the trajectory of that field versus that of surgery let's say.

The rest of the participants are arguing that there are some other factors - prenatal environment, nutrition, bracing, and lots of others - that will in some way alter the course of the disease.

Again, if others are thinking in terms of treatment then that fact has escaped me. I thought we were talking about what the experts in the field are working on in terms of etiology, not treatment modes.

Of course, medical research is too flawed to cast much light on either position, and experts in the field hold opinions which encompass all of the arguments advanced here.

The etiology definitely includes genetics from what is known. This is the accepted consensus which is not to be confused with true. But it either is or is not the accepted consensus among the researchers.

So, again, the argument is not whether genetics plays some role, but whether it plays a completely deterministic role, or whether there is some intervention (short of surgery) that would in some way change the course of the disease.

Again, I have never had a single thought to treatment in these discussions. It is all etiology, all the time from my perspective. I am not so sure cracking the etiology will necessarily lead to an effective treatment. That is not a given.

And I disagree with you that all the bunnies accept that genetics plays at least some role. There are some here who seem to think that when researchers say "environment" that that is synonymous with "germ theory" of scoliosis. I don't believe that is what these researchers mean by that term. Straight genetic drivers have not been pushed off the table. Some claim there is a known polygenetic inheritance pattern at this point. There are environmental pathogens and intercalating agents and P450 triggers or whatevers that INTERACT with DNA (which is still "genetic" as I understand the usage by these researchers) but if you aren't running the appropriate genetic program that allows the scoliosis, they clearly aren't hurting folks.

Or maybe I'm completely wrong.

[rohrer01]

Okay, I just read the last page of this thread, but I can't help myself here. Even totally genetic or heritable diseases, even ones that are gamete malfunctions like Down's Syndrome can be affected by "environment". I don't believe I need sources for this line of reasoning.

Take a Down's child and give him or her "no treatment" and they will be totally helpless as adults. If you work intensely with that child with OT you will get varying degrees of results that will lend some of the Down's adults to lead fairly independent and productive lives.

Take a child with Cystic Fibrosis and leave them "untreated" and they will usually die very young. If you treat them with respiratory therapy and whatever medications they use (I'm not claiming to know) and they can expect to live much longer.

There are treatments for many other "genetic" diseases (I use that term loosely), such as Sickle Cell Anemia, etc. I'm not going to sit here and take up the time to think up a bunch. The point is that there are therapies that, while they don't cure the disease, do benefit the patient. Is it naive to think that Scoliosis is any different? (This is a purely rhetorical question)

In Pooka's defense, I'm sure she is probably well aware of this fact.

I will apologize in advance if I'm completely off topic here, as I did not read the entire thread, so if you screech me it is well deserved. I just couldn't help myself from interjecting at the thought that ANYONE could really believe that there are no effective therapies for most "genetic" diseases.

[Pooka1]

I will apologize in advance if I'm completely off topic here, as I did not read the entire thread, so if you screech me it is well deserved. I just couldn't help myself from interjecting at the thought that ANYONE could really believe that there are no effective therapies for most "genetic" diseases.

Hey Rohrer! Glad you're back.

I realize there are treatments for other genetic disorders. I was discussing etiology up until my last post.

The present treatment for surgical scoliosis is surgery. Maybe if they discovered the etiology there would be a better treatment. What I seriously doubt is the germ theory of scoliosis and that a vaccine will ever be developed that would avoid curve development as is advocated by certain bunnies because I don't think there is evidence for the germ theory of scoliosis. There is evidence for genetic theory and in fact that is the consensus of the researchers per that one article.

[hdugger]

I will apologize in advance if I'm completely off topic here, as I did not read the entire thread, so if you screech me it is well deserved. I just couldn't help myself from interjecting at the thought that ANYONE could really believe that there are no effective therapies for most "genetic" diseases.

No, you're directly on target, as best I can make sense of the discussion. The over-arching question, and it seems to appear in most non-surgical threads, is whether there's any point in further examination of any topic other than surgery, since the entire course of the disease is hard wired genetically.

I think that belief - that absolutely everything about the course of the disease is hard wired - is a minority belief amongst experts.

[Pooka1]

No, you're directly on target, as best I can make sense of the discussion. The over-arching question, and it seems to appear in most non-surgical threads, is whether there's any point in further examination of any topic other than surgery, since the entire course of the disease is hard wired genetically.

This issue never entered my mind in this thread. And I don't see how it follows from any of the discussion. Perhaps I've completely missed the boat. Unless it is strictly germ theory and a vaccine is developed, the treatment is going to require surgery NOW as far as anyone knows. Whether conservative treatments will ever work is orthogonal to this point as indeed to the entire thread from my perspective. Conservative treatments could work for a strictly genetic etiology and they can work for a strictly germ theory etiology. I don't think the relevance of the potential efficacy of conservative treatments is necessarily related to the etiology.

I am not sure why you injected treatments late in the discussion. It came out of the blue for me.

I think that belief - that absolutely everything about the course of the disease is hard wired - is a minority belief amongst experts.

That it is genetic is the consensus opinion. That is not to say they can't interrupt some biochemical pathway and avoid curvature. The two things are orthogonal.

[Ballet Mom]

No, you're directly on target, as best I can make sense of the discussion. The over-arching question, and it seems to appear in most non-surgical threads, is whether there's any point in further examination of any topic other than surgery, since the entire course of the disease is hard wired genetically.

I think that belief - that absolutely everything about the course of the disease is hard wired - is a minority belief amongst experts.

Might I add that the Scoliscore test could only be beneficial if all AIS cases are in fact genetically caused.

[Pooka1]

Might I add that the Scoliscore test could only be beneficial if all AIS cases are in fact genetically caused.

Scoliscore determines the risk of progression, not of incidence. But that said, I think the fact that Scoliscore can predict progression to <40* could be viewed as further evidence that AIS is genetic, in keeping with the consensus of the research community.

[Pooka1]

No, you're directly on target, as best I can make sense of the discussion. The over-arching question, and it seems to appear in most non-surgical threads, is whether there's any point in further examination of any topic other than surgery, since the entire course of the disease is hard wired genetically.

I think that belief - that absolutely everything about the course of the disease is hard wired - is a minority belief amongst experts.

It doesn't follow that the etiology determines the treatment like you are asserting and here's why.

Assume AIS is found to be entirely "hard-wired" (genetic) wherein some biochemical pathway is out of whack. A conservative treatment consisting of a drug could cure that or at least ameliorate it.

Now assume AIS is found to be entirely germ theory and caused by a virus. This does NOT fit the evidence in hand but let's just go with it for now. If it is like AIDS and seems to defy finding a vaccine then surgery, a NON-conservative treatment is the only option.

That's why you can't make the connection between etiology and treatment as you have.