Clusters

Lot’s of young people from the Detroit area move to Chicago, and I was one of them.  As a medical resident I worked with a fellow Michigander, an attending physician I’d known when we were younger.  One day he called me.  Did I know this woman from home? -Of course, sort of, why? -Because she’s in the hospital with something bad, and we have to find out what it is.

That story is long, and has a sad ending with bright moments in between.  But shortly after he called me again.  Did I know another talented young woman from back home? -Yes, better than the last, in fact. I was afraid to ask why.

She had something really bad, and that story ended badly, with few bright spots.  Some day I’ll dredge up the piece I wrote about it, but she was someone I knew only passingly well, but developed what was, at least to me, an unusual relationship, one between a person facing death and one who had seen a lot of it.  I’ll never know how she viewed it, of course, but I hope the friendship gave her some comfort.

A number of people from that particular part of town developed malignancies when young.  At least that’s what they say.  Many suspect a common factor, aside from geography and ethnicity, one that may explain this cluster of diseases. It’s never, to my knowledge, been investigated.

Disease clusters are a tough nut to crack.  Randomness does not describe a system where events are scattered evenly, but one in which there are voids and clusters without any unifying cause. It is the job of epidemiologists and public health officials is to figure out which clusters have a common cause and which are due to chance alone.

There is a cluster in the news right now.  In an Upstate New York community, several young women have begun to experience involuntary movements similar to the symptoms of Tourette’s syndrome. The tics that have been shown on TV are fairly complex tics, with stereotypic gestures and utterances.  The story has regained headlines because activist Erin Brockovich has become involved.

It has been reported that local neurologists have diagnosed the cases as “conversion disorder”, that is involuntary physical manifestations of psychological stressors.  Epidemiologists approach cases like this in various ways, identifying cases, commonalities, common exposures, etc.  They have to figure out if each individual case is physiologically similar, and if there may be a common cause, what it could plausibly be.  It’s a lot of work.

In this case it seems unlikely that Brockovich will turn up a valid environmental cause.  It seems more likely the underlying connection will be social, that is, a non-physical transmission of a disorder.  Disorders have been spread this way before, and will be again.  It doesn’t make them less real.  These young women are suffering, but from the evidence available, it appears their suffering is likely connected by knowledge rather than a traditional pathogen.  As they hear of someone else with symptoms, they begin to experience it themselves.

We don’t know exactly what makes people susceptible to such things, but they are very real.  The fact that they are not based on chemical exposures or bacteria makes them no less a problem.  But without the tedious gumshoe work of the public health community, it’s easy to blame something more sinister, like a landfill, or power lines, or foods.  These hypotheses, if found to be wanting, distract from the real cause, and real solutions.

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2 Comments

  1. What I find most interesting is how everyone says these girls are suffering from Tourrette’s like tics. As someone with TS, I and am sure many others, would not consider myself to be “suffering”.

  2. Agree with Nam. The way that the media has been handing the whole situation has been unfortunate. There has also been statements to the effect that “teenage girls are just prone to drama”. I hope that the doctors are actually being less dismissive about whatever is affecting these young people.

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