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Comment by cubefox | Hacker News Reader

> We are thus left with a product, Lumina, that cannot guarantee the prevention of future caries

"Guarantees" are not strictly needed. What matters most is whether there is a substantial reduction of future caries, not whether it makes you totally immune to it.

Say, if Lumina/BCS3-L1 "only" reduces cavities by 50%, it is already half as good (arguably) as a drug which prevented 100%. This would already be large progress for such a massive global problem. The article author does not seem to recognize the potential of such a drug.

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I feel like this is a trend in online writing lately, and it's leading me to more and more withdraw from online discourse. Whenever someone introduces something that greatly helps with something, there are a bunch of people who start pointing out that, while the new solution is waay better than anything before it, it's not 100% perfect, and therefore "it's benefits are exaggerated" or similar. If the new thing is in the public eye for long enough, those "exaggerated" complaints start morphing into "it's a scam", and shortly after that the new solution to yesterday's problem is the villain that must be stopped.

It's really confusing, and quite tiring.

Perfect is the enemy of the good.

I think the bigger issue is not whether it has some efficacy, even if limited (which could be interpreted as a good thing), it's the potential for the bacterium to create a mono-culture, which would be objectively bad (remember, diversity is critical in populations, and for our oral health perhaps even necessary).

So not so much perfect being the enemy of the good, fluoride isn't perfect either, but it is good. This is potentially extremely harmful, and possibly even a source of something like a new AIDS pandemic...

I'm sorry but the last claim seems extremely exaggerated.

Well literally any change removes money from some to give it to others. Side effect may be that people are better off (see Ozempic) but oh boy are the people losing money going to muddle the water / for investors as well as to fight the change.

A similar thing happened when the media learned about Ozempic (semaglutide) a while ago. Multiple progressive outlets, especially the Guardian, published articles stating the drug was overhyped, playing down its value, citing overweight women from "fat studies" academia (basically activists against the stigma of being overweight saying that being overweight itself is not the problem), emphasizing all its downsides etc. Of course they couldn't stop the hype, because the drug actually works.

Yet another example: In early 2020, for a few weeks many news sites claimed that face masks don't help against coronavirus transmission because there was "no evidence" that they did. Of course this wasn't true (the evidence was just limited, and the protection wasn't optimal), and they changed their tone quickly once multiple non-Asian countries started to introduce mask mandates for visiting public places.

See also effectiveness vs efficacy. If condoms are 100% effective but used incorrectly 20% of the time, they have 80% efficacy. It’s a useful stat when determining where to best allocate funds, but not for individual healthcare decisions.

The tone of the article is for some reason very dismissive and derisive of alternatives to plain dental hygiene. As you point out, if a simple supplement in the form of harmless bacteria could improve caries reduction by even a small amount, it seems it would be a valuable option.

There is an existing 'probiotic' that has been around for years and works the same way, and promises the same benefits, as the one described in the article, it is called Streptococcus salivarius M18, there are quite a few studies that indicate it does work to some extent [1]. You get them in the form of lozenges that you put in the mouth while sleeping and they dissolve by themselves, so not a very invasive treatment if one wanted to use it.

[1] https://www.google.com/search?q=Streptococcus+salivarius+M18

The claim of the headline is also not supported by the evidence shared in the article. As just one example, the article notes that many different strains of bacteria are responsible for caries. This fact doesn't necessarily say anything about the effectiveness of Lantern's treatments - although it might shed light on the mechanisms that make it effe tive (or not).

That's what the clinical trials and studies on the early adopters are for. There's lots of interesting commentary on the early research, such as Scott Alexander's write-up, that are much better than this article.

> The tone of the article is for some reason very dismissive and derisive of alternatives to plain dental hygiene.

Yeah, emphasis on "plain". It's proposed as an addition, not an alternative, to conventonal tooth brushing.

Streptococcus salivarius M18 seems also interesting, but its results in preventing caries are much more limited, from what I can tell. It also has be taken continuously (once per day), instead being a one-time application like BCS3-L1.

> The tone of the article is for some reason very dismissive and derisive of alternatives to plain dental hygiene.

Putting my conspiracy theory hat on, the dental hygiene industry in the US is for-profit, like the pharmaceutical, and would rather sell you a treatment than a cure.

I tried to have a dialog with my child's dentist about nano-hydroxyapatite. I was interested in their thoughts about it, not as a replacement for fluoride based therapies, but in addition to them. Rather than having a discussion about the merits of both treatments or discussing any concerns about compatibility, the dentist adopted an attitude that was belittling and made me feel like I was an anti-vaxer. The suggested we could just not do any fluoride therapies at all.

It was very odd and alarming.

I would say the author has some more substantial problems raised in the article. From the article, it seems the people pushing lumina as that we accept something which is unlikely to solve the issue (mutans is not the sole or even the probable cause of caries, just one of many) and this strain of bacteria is likely to pickup the pathogenic genes over time for higher lactic acid production, and it is no less likely than its pathogenic counterpart to produce biofilms. So now you have a bacterium that is more stubborn, and is at best going to out-compete a narrow band of microbes, some of which might be pathogenic, until it itself becomes pathogenic at some point. Now you have the same problems, with extra moving parts introduced where things can go wrong. What happens if your body becomes sensitive to the toxin this strain produces and you end up with horrific gingivitis that cannot be readily cured?

That isn't a great sales pitch.

The article makes clear that a 50% reduction is likely massively optimistic.

You mean this quote?

https://news.ycombinator.com/item?id=41574918

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