Actually yes we spend most of our time looking at healthy as well as ill. Infectious disease docs are the ones who spend most of their time looking at the ill. As I said I do agree with Paul about his get them in spawning condition as heathy as they can be. This why I also said I follow many of his nutritional strategies.
Much of the current work in the field suggests there is a break down that causes some disease, the host get weak some diseases then get a foothold, staph infections are good example of this. We also have this bug living on our skin and respiratory tracts and most of the time our immune systems keep it check. However polio, Ebola, and many of the other nasties don't follow this rule and can cause disease in heathy individuals.
I think there is some doubt as to the health of even non-sick people that eat typical Western diets. But after that, exposure to exotic germs is the main problem we are up against. (A side-effect of easy travel.)
What I didn't agree with is the suggestion that somehow our ancestors were better able to fight off disease because they exposed it all the time, and we are too clean and medicated. The data does not show this to be true. Most studies show children who are exposed to lots of dirties have lower rates of allergy and autoimmune disorders, not better resistance to pathogens. Really the data suggest we teach our immune systems not to overreact to everything which is what allergies are.
Am I misunderstanding or is there a contradiction or something here?
My understanding is that children who play in dirt - as in dirt on the ground outside - have less immune problems. I.e. They are more healthy. (BTW, all monkeys and gorillas eat dirt as part of their regular diet. Not accidentally.

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Pathogens are a different part of the picture, right?
Auto-immunity (from the invertebrates; arthropods) versus reactive immunity (from the quadrupeds; bony fish).
From an evolutionary perspective the weak die off and the gene pool that survives is better able to handle the diseases. However evolution only works at the level of populations not individuals and is about getting to reproductive age leaving as many progeny as possible before you die, generally to a pathogen, which for most animals leads to you being prey for a predator before the disease gets you this is why most animals in the wild appear healthy because predators take out the ones with disease, does not mean there is no disease in the wild. One can take the population approach, but it does come at the cost to some animals who just don't have the high fitness evolution demands to survive some disease no matter how well we feed and nourish them.
It sounds obvious to say given the topic, but that seems like a gross oversimplification.
Just looking at the lifecycle of infection for Ich in an individual fish suggests that it's a much more integrated and nuanced situation.
- Not even close to all infected fish succumb.
- The ones that don't succumb aren't simply survivors and they don't survive simply by developing immunity and wiping out the Ich.
- They become hosts to that that particular strain of Ich.
- That ich strain then has a leg up on the local ich population by having a stable breeding ground near other fish.
- Bonus to all the surviving fish's kin since they're now less likely to run into a strain of Ich for which they are not immune-capable.
- And bonus to that Ich strain cuz it didn't just get sloughed off into the void along with 99.99% of other pathogens.
So my perpetual question is: Is the fish getting infected even a bad thing, or is it a survival strategy?
At first blush it seems like there should be an easy answer to that.
As I said I think what Paul does from a get animals in top health is absolutely the right approach, but if there is signs of disease I also believe there is a time for medical intervention to help the individual survive.
Without doubt, treatments can help on a case by case basis.
Unfortunately there is a strong fixation by most folks on treatments and barely any discussion on the making of healthy fish.
As if there was no relation between
health and
lack of sickness.
Some folks have even confused treatments with the making of healthy fish.
Commonly, a treatment can have the opposite effect - making the subject even less healthy. It just happens to have an even more pronounced effect on the infection (hopefully killing it outright) - which is why we do it. This is especially true for antibiotics, but generally true of most treatments.
Last, even when treatment becomes the correct option, almost nobody actually identifies what they are treating. Because of this, almost all treatments you read about on forum sites like this are ill-advised.
Cheap microscopes are out there, but count how many conversations here involve one.
After treatment, fish that go on to receive typical care in a typical tank
never get healthy.
Then you hear a few months after treatment that (e.g.) a coral was introduced and killed multiple fish in the tank or caused a fish wipeout.
Healthy fish do not get sick like this.
Most of us don't have tanks with as complete an ecosystem as Paul, and what might work in his tank will not work in mine for 10 years, he may actually have critters in his tank that keep,disease at bay, predator of the predator so to say, or that his very mature micro fauna can outcompete crypto or velvet during part of their lifecycle so his outbreaks never get to those proportions that become lethal for his fish.[....]
Paul's tank is not as exotic as it sometimes sounds IMO. Feeding our fish better (live or frozen-whole foods preferred) and subjecting our fish to fewer environmental stresses (overcrowding, etc) will get us at least most of the way there.
If you read up on aquaculture and probiotics, you'll find they have been successfully reducing incidence of disease - using essentially the same ingredients as PaulB - for 20 to 30 years in the case of shrimping. (Access to paid journals needed for many of those articles though...)