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Comment by tchaffee | Hacker News Reader

We are already there. The FDA has approved hematopoietic stem cell transplantation. And there are over 3000 clinical trials under way. We know already that we can effectively treat some blindness.

The reason I mentioned heart disease is because of how widespread it is and how dramatically it might increase average lifespan. For heart disease specifically it is indeed hard to tell how far away we might be from stem cell treatment being a success.

But stem cell treatment as a whole has already delivered.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367472/

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Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root?

Not to mention the quality of life improvements from never being sick in the first place.

organ systems are interdependent, and failure or pathology can cause nonlocal effects.

cardiac hepatocirrhosis is one example.

https://emedicine.medscape.com/article/151792-overview

https://www.sciencedirect.com/science/article/pii/S221317791...

in such a case isolated treatment of pathos may help but would not be a complete treatment, and would result in chasing subsequent sequelae, over a protracted therepeutic effort.

Not sure what the relevance of cardiac cirrhosis is to this discussion?

You’re talking about an uncommon end stage complication of chronic severe right heart failure.

To the parent comment’s question: yes, prevention is better. If you prevent right heart failure you will not get cardiac cirrhosis.

The old adage of “an ounce of prevention is better than a pound of cure” is still true.

>>Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease<<

preventive and corrective measures, in response to health issues should be instituted in the context of the whole organism[patient]

cardiac cirrhosis, is an example of secondary pathology related to a common set of disease conditions [heart disease].

correction of pathologic state of one organ via stem cell therapy, is a start but is not complete, heart disease is not always preventable by way of lifestyle choices, as genetic, and traumatic causes will effect occurence.

protracted illness often leads to secondary, or even, systemic issues concurrently presenting, at time of first examination.

any therapy must take this context into account.

The old adage of “an ounce of prevention is better than a pound of cure” is only true, when prevention is possible.

Cardiac cirrhosis is just a bad example, it’s difficult to estimate prevalence but it’s very rare and even then most cases don’t matter as it reflects a state of severe systemic dysfunction (i.e. patient is on deaths door for several other reasons). Fixing the heart at that point won’t accomplish anything with respects to cirrhosis. Right sided heart failure is also rare outside of advanced LHF or preventable causes of pHTN.

Congestive heart failure as a whole was attributable to preventable causes in something like 95% of cases in the NHANES cohort. The 5% of other cases is variable but sure, some are not preventable.

Point being that prevention is possible and remains the preferred approach for the overwhelming majority of people, as the parent comment was inquiring about:

> Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root?

Probably. Obesity also increases the risk of many types of cancers. This appears to be due to the chronic inflammation and immune system effects. In 20 years it will be interesting to see what cancer rates are in patients that have been taking GLP-1 drugs.

I think non-obese people still want effect treatments for heart disease.

Fully agree that we still need to develop treatments but from a prevention perspective if you maintain a healthy weight and diet (i.e. avoid metabolic syndrome) don’t smoke, and don’t use cocaine you should be doing really well from a coronary artery disease perspective barring some hereditary lipid disorder.

Throw on a statin at 35-40 for good measure (expert opinion, not strong evidence but many of my physician colleagues do it too).

Not all heart disease happens due to lifestyle choices. There aren't a lot of preventative treatment options for people who have a family history of heart disease.

Stopping obesity with ozempic might extend lifespan but it won’t fully correct loss of health span due to poor nutrition and lack of exercise. I don’t know if any drugs can correct for a poor lifestyle. They can correct for some major issues caused by poor lifestyle, but cardiovascular disease is only one slice of that miserable pie.

> I don’t know if any drugs can correct for a poor lifestyle.

Given their reputation for making people energetic (not having any interest I've never tried), I wonder if ecstasy and cocaine lead to exercise?

> We are already there. The FDA has approved hematopoietic stem cell transplantation.

Source? To my knowledge what’s approved is not iPSC.

Hematopoietic progenitors are a different challenge and “low hanging fruit”.

https://www.fda.gov/vaccines-blood-biologics/cellular-gene-t...

> But stem cell treatment as a whole has already delivered.

Clinical trials underway does not equal delivered. In the 3 years since your review article talking about future applications none of these hypothetical applications have been delivered yet.

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