TIME: Almanac 1993/TIME Almanac 1993.iso/time/061091/0610350.000

Text File | 1992-08-28 | 9KB | 197 lines

                                                                                MEDICINE, Page 54

Stalking Who Done It At the White House


Did Millie or faulty faucets really lead the President and First
Lady to develop the same disease? Nonsense. But autoimmune
disorders can be strange.

By CHRISTINE GORMAN -- With reporting by Barbara Dolan/Chicago
and Andrew Purvis/New York


    Call it a case of plumbing panic. Within two years, the
President and Barbara Bush develop the same overactive thyroid
disorder, and best-selling pooch Millie suffers from a bout of
doggie lupus. Heightening the drama, doctors reveal that both
of these diseases hail from the mysterious realm of autoimmune
disorders, which occur when the body unaccountably begins
attacking itself. Pundits confidently calculate the odds of such
a coincidence at 1 in 3 million. Latter-day Clouseaus begin
looking everywhere for a culprit. Dan Quayle raises questions
about the ancient plumbing at the Naval Observatory -- the
official 100-year-old vice-presidential residence, which the
Bushes occupied for eight years. Suspicion spreads to other
sources of presidential water, which are tested for the presence
of toxic levels of iodine or lithium.

    While federal scientists raced to analyze their samples
last week, Americans flooded the White House switchboard with
a few theories of their own about whatdidit -- everything from
chemicals in the carpets to infectious pets. One citizen
counseled the President to slather lemon juice over his throat
and chest to soothe his hyperactive thyroid. Others admonished
him to eat his hated broccoli since it contains small amounts
of a naturally occurring substance that restrains the organ.

    Well-meaning advice to be sure, but utter nonsense.
"They're not going to find anything in the water," says Dr.
Lewis Braverman, chief of endocrinology at the University of
Massachusetts Medical Center. Lithium decreases the thyroid's
output instead of increasing it. As for iodine, a person would
have to consume at least 10 to 50 times the normal daily dosage
in order to trigger hyperthyroidism. "It's sort of a feeding
frenzy," says Dr. Charles Christian, physician in chief at the
Hospital for Special Surgery in New York City. "All the
attention is pressuring the people taking care of the President
to prove that something hasn't been missed."

    The fact that both Bushes developed the same rare disorder
may seem surprising, but it is not inexplicable. Just as
somebody always wins a lottery in which the odds are 3 million
to 1, so some couples are bound to suffer identical fates. "No
one made such a fuss over us when my husband and I both
developed Graves' within three years of each other," says Denise
Ploetz, an adult-education teacher from Newark, Ohio, whose
condition was diagnosed in 1976. "Our doctor just said it was
a coincidence."

    Although we may never know precisely what triggered the
Bushes' conditions, scientists have made extraordinary advances
in just the past decade in understanding what goes wrong in
autoimmune disorders such as Graves' disease. Their discoveries,
driven in part by the intensive study of the AIDS epidemic,
reveal that the immune system is not a single straightforward
defense system but many elaborate systems whose cellular members
constantly patrol the body looking for friends and challenging
foes. "The immune system is very like the brain -- it has to
recognize everything," says Dr. Howard Weiner, associate
professor of neurology at the Harvard Medical School. "Every
virus, every piece of dust, your body has to recognize as
foreign."

    Autoimmune disorders occur when the body engages in
"friendly fire" against its own tissues. This mistaken course
of action can either overstimulate an organ, as in Graves'
disease, or destroy tissue, as in multiple sclerosis, in which
the myelin sheath surrounding nerves in the spinal cord and
brain is attacked. Some immune diseases, like systemic lupus
erythematosus, whose signs include skin lesions and arthritis,
strike more women than men. Others, like ankylosing spondylitis,
which can fuse the spine into a bent-over position, predominate
in men. In all, 40 different maladies, affecting about 6% of the
U.S. population, are thought to be autoimmune in nature. Among
the most common: rheumatoid arthritis, in which the collagen
fibers of the joints come under assault, and Type I diabetes,
in which the immune system targets the insulin-producing cells
in the pancreas.

    One of the difficulties with sleuthing the causes of these
disorders is that so many factors are involved. Inheritance can
play a role: several genetic types have been found that confer
an increased risk of autoimmune disease. Dr. Christian, who has
been called in on the Bushes' case, plans to test the President
and his wife to see if they share the same markers for genetic
susceptibility as most people who have Graves'. However,
heredity is by no means the whole story. For example, if one of
two identical twins develops an autoimmune disease, the other
twin will get the same disease less than half the time.

    Clearly environment, life-style and medical history play
some kind of role. For years doctors have recognized that many
children who develop rheumatoid arthritis -- sometimes almost
overnight -- show signs of viral or bacterial infection just
before the onset of the disease. Some patients with rheumatoid
arthritis swear they can affect their disease through exercise
and diet.

    A growing body of evidence suggests that such ubiquitous
viruses as herpes, Epstein-Barr and cytomegalovirus may be
enough to push the immune systems of genetically susceptible
people into overdrive. The fact that George and Barbara
developed Graves' within two years of each other may point to
a common infectious trigger -- perhaps a cold they shared in
Helsinki or Kennebunkport.

    For some autoimmune conditions, researchers have begun to
decipher the intricate interplay between genetics and
environment that leads to disease. Much to the surprise of many
scientists, immunologists have discovered that in the process
of manufacturing millions of T cells -- the blood-borne infantry
of the immune system -- the body sometimes produces a few
treacherous double agents. Early in life the thymus gland,
located over the heart, acts as a checkpoint to weed out the
potential traitors. Sometimes, however, a few of these renegade
T cells get through to circulate in the body. Then it becomes
a game of chance. Invading viruses or bacteria may inadvertently
activate the errant T cells. That leads to the identification
of good healthy organs as targets for destruction.

    One of the greatest mysteries in immunology is why more
people do not succumb to autoimmune diseases. For example,
researchers now realize that nearly everyone harbors T cells
that will react against their own nerve tissue. Yet less than
1 person in 1,000 develops multiple sclerosis. What else is the
body doing to police its overly zealous defenders? Scientists
do not expect the uncertainties to persist much longer. "We're
at a point where we know when a child would be at a 50 to 100
times greater risk of getting a long list of autoimmune
diseases," says Stanford neurologist Lawrence Steinman. "For
several diseases we know the bacteria or viruses that can
trigger the illness in people with an underlying genetic
susceptibility." Improved treatments, reflecting this new
knowledge, are beginning to emerge from the lab.

    Fortunately for the Bushes, Graves' disease is relatively
easy to manage. But there is no sure way yet to stop the
progression of multiple sclerosis and numerous other autoimmune
disorders. Using an approach pioneered by Dr. Irun Cohen at the
Weizmann Institute of Science in Rehovot, Israel, researchers
are working on vaccines that help tone down overactive immune
systems by targeting rebel T cells. So far, American and Dutch
researchers have injected these experimental vaccines into a
handful of patients with rheumatoid arthritis and multiple
sclerosis. Because the diseases are long-term disorders that are
subject to spontaneous remissions, however, it is too soon to
tell how effective this approach could be. One potential
drawback: scientists may have to customize the vaccine for each
individual patient.

    Alternatively, researchers may be able to coax the body
into becoming a little more forgiving. Eating, for example, is
possible in part because the immune system does not mount an
attack on something that has passed through the gut. So
Harvard's Weiner has begun feeding small doses of myelin to some
multiple sclerosis patients in the hopes of increasing their
tolerance for the protein. Scientists are also supplementing the
diets of people who suffer from rheumatoid arthritis with tiny
doses of specially prepared collagen.

    The great White House plumbing puzzle of 1991 will
probably prove to be a wild-goose chase, but possibly it will
bring some benefits. Researchers in immunology hope all the
attention will heighten interest in their field and maybe even
produce more research funds. At the very least, it has raised
awareness of a category of diseases that, while commonplace,
have been only dimly understood.