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Comment by k__ | Hacker News Reader

"one million people with MS in the United States in 2022, and in 2020, about 2.8 million people were affected globally"

Is there a reason why the US is affected more?

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It doesn’t have to be affected more, just diagnostics in US might be better. People in outer parts of the world might not be getting diagnosed and cared for.

On the other hand, many other places have much more accessible health care with similar or better quality.

Definitely some selection bias in there, but not "the US vs the world".

My impression is that there's a lot of discretion in an MS diagnosis, that it's a set of symptoms with no other identified cause. I.e., it's like a process of elimination.

I don't know much about MS so I can't make any claim really, but it seems like there might be room for those symptoms to be interpreted very differently in other countries with different training and testing protocols.

This is likely measurement bias - a statistical distortion caused by more easily available or better-working diagnostics.

(for the same reasons, some countries want to reduce CoViD testing so it appears there are fewer cases, exploiting this distortion.)

And right next door, Canada is #1.

<rant> When you look at the geographic distribution of MS you would think there might be a pathogen involved. Clearly there are other factors (genetic, environment?) since not everybody gets it, but there is evidence on the map.

Modern DNA techniques should make it possible to search for a culprit but if you don't "believe" that a pathogen is a possibility you will never search for it.</rant>

Yes there is probably a particular virus that’s involved. It is EBV, unfortunately a very common virus that can get reactivated by COVID-19. The picture only got clear this year and there are no great therapies or vaccines yet. In this study from earlier this year, the chance of active military developing MS was 32-times (3,200%) higher for people who had EBV vs those that had other common viruses: https://www.science.org/doi/10.1126/science.abj8222

Thanks for the link. This put me on notice that EBV might also be responsible for other neuralgic disorders since it hangs around forever. It also points to investigating the rest of the Herpes family IMHO.

If we could acknowledge/prove that some of these viruses are dangerous long after initial infection, it might prompt the development of an EBV vaccine. Not sure if Herpes would respond to vaccines. Put it on the list with Human Leukemia/Lymphotropic virus Type 1.

If the link in this comment is accurate, part of it could be that Americans eat terrible food. https://news.ycombinator.com/item?id=33297849

I'm not American, but I doubt I would have gotten MS were it not for terrible diet, stress, lack of sleep, various deficiencies at the time of diagnosis but also during childhood. Also had a very bad bout of mononucleosis when I was 10 (while also being malnourished), so these things can go quite far. So I think my nervous and immune systems were always frail.

So sorry to hear. As of 2022 there is enough evidence for a causal link between EBV (the virus that also is behind mononucleosis) and MS later in life. The hope is that humanity will eventually have strong drugs and maybe a vaccine. Unfortunately, progress has been very slow until now. I hope things will move faster now that people could convincingly argue about this link between a virus and the disease.

Lots affected in scandinavia. The doctors claim scandinavian genetics predict higher incidence. But it could be a confounding factor.

MS is more common in rich countries. My speculation is that rich people spend more time indoors, away from the sun.

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