by derefr | 2025-04-26 20:05:39+00:00
> The theory here is largely mechanical; and it’s not just psychiatrists like Scott who are weak at mechanical explanations; it’s doctors in general as well as medical researchers and biologists.

A tangent here, about not just "mechanical" explanations, but "mechanical" treatments —

IMHO, the insistence in modern medicine on treating recurrent bacterial infections purely with antibiotics is wrongheaded, and the cause of a lot of resistant strains of bacteria. Especially for topical/mucosal/epithelial infections, where the infected tissue is accessible without invasive surgery.

In a recurrent bacterial infection, the reservoir of the infection is one or more (almost always macro-scale) biofilms or plaques. And antibiotics just don't do much to biofilms/plaques. (If they could, you could spray Lysol on the walls of an under-ventilated shower that's developed "pink slime" biofilms — and all the slime would dissolve, or detach and run down the drain. But it doesn't do that, does it?)

Even if you kill most of the bacteria, the biofilm itself — the "fortress" of polymerized sugars which the bacterial cells have secreted to secure their position — is not destroyed by antimicrobal compounds. And the few bacteria that remain have a great position to regrow from.

What does work to clean a slimy shower wall?

Scrubbing. Scraping. Peeling. Together with targeted chemicals, that 1. get water out of the polymer (because these biofilm surface polymers are often lubricative when wet, and thus resistant to abrasion — but this effect breaks down when dry), and 2. rough up the surface of the biofilm/plaque a bit, to get a better grip on it.

Biofilms and plaques adhere to themselves — so, when you can break the biofilm or plaque into chunks, you can then get entire chunks out. (And also, by removing chunks, you create paths for antimicrobials to then get past the biofilm surface polymer. You're breaching the fortress.)

If you picture a strep-throat infection — spots on the tonsils and on the throat, etc — those spots aren't a symptom; they are "the enemy" you're trying to fight. Remove them — mechanically! — and you go from using antibiotics (picture tiny cellular infantrymen) to effectively "fight a war of attrition against an enemy with a secure position", to "a defeat in detail of an enemy with nowhere to hide."

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Interestingly, there are certain medical specialties that think mechanically about infection.

• Dentists, obviously, know that you must abraid dental plaque away. There's no chemical that you can put in your mouth every day that will keep plaque from forming, or reduce it once it has formed. (In fact, ironically, antimicrobial oral rinses [of e.g. chlorhexidine] accelerate plaque formation, because bacterial cells killed "in place" inside their biofilm fortresses will deposit and enrich the surface polymer layer of the biofilm — much as dead sea creatures deposit and enrich limestone sediment.)

• Audiologists know that there's ultimately nothing you can do with drugs or topical treatments to get an ear clear of wax+fat+dust+anything else trapped in there. You have to go digging. Chemicals can soften the wax, to make it easier to remove; but, due to the shape of the ear, and the lack of ability to "come in from behind" (there's an eardrum in the way!), the softened wax will never come out on its own.

• Dermatologists know that a cyst can't just be drained + treated with antibiotics. The body forms a defensive pocket around a cyst — but the inside surface of this pocket ironically provides the perfect medium for a biofilm to grow on, and thus for an infection to recur after drainage. Cysts are only considered well-treated if the pocket itself is removed — thus removing the biofilm.

...and yet, when you look at most other disciplines, you see completely the opposite.

• An ENT is very much not willing to abraid biofilms out of your sinuses or throat "if they can help it", despite those surfaces being accessible to an endoscope without breaking past any barriers. They will always try first to treat "pharmacodynamically", with e.g. oral antibiotics + an antimicrobial sinus rinse — presumably in the hopes that you'll accidentally do something mechanically in the process of treatment (e.g. snorting really hard to get the remnants of the rinse out) that will dislodge the biofilm. You have to go through years of back-and-forth with an ENT before they'll actually bother to look further up inside your sinuses than they can see with an otoscope/anterior rhinoscope. (And IMHO this is why so many people suffer from idiopathic chronic sinusitis, developing into nasal polyps et al. Nobody's ever been willing to go deep up their nose with an endoscope, find impacted biofilm plaques, and say "alright, let's clear those out.")

• Kidney stones, once symptomatic, are treated ultrasonically (lithotripsy); but the thinking on follow-up prevention is entirely about preventing accretion — not in removing the cause. [In many cases, the cause of (struvite or apatite) kidney and/or urinary stones, is very likely a bacterial biofilm within the kidney, spalling off bits of biofilm, which denature into plaques after exposure to the harsh pH of the kidney/uterer/bladder; get caught on some tissue; and then act as nucleation sites for mineralization (stone formation) as dissolved minerals pass through.] Once someone gets one kidney stone, they are generally thought to just be "prone to kidney stones", and will likely get them randomly for the rest of their life. A lot like the old — pre-infectious-origin — thinking that someone can be "prone to peptic ulcers"!