Clusters

The world's oldest ER doc has survived another winter. Too much snow, leaking roofs, freezing temperatures and no Caribbean vacation made this a particularly onerous winter. The continuously rising ER census added to my SAD.

My beloved wife booked us for a three night escape in VERMONT. It snowed 12 inches the day after our arrival and I had extreme flop sweat driving home in an ice storm. We returned to the hacienda to find 6 inches of wet heavy snow. We did discover the joy of snowshoeing but a beach in Puerto Rico would have been oh so therapeutic.

What does this have to do with clusters? Nothing, I just needed to vent. Before getting to clusters, she, who is an exotic woman of indeterminate age, made a scheduling conflict. This deprived me of my one excuse to take the tuxedo out of mothballs. We missed the black tie charity ball. The upside was that our grandniece, along with her mother, grandmother and grand aunt, got to enjoy a sophisticated night of dinner and "Mary Poppins".

Epidemiology is the study of the spread and control of diseases. A cluster is a "pocket" of a disease or condition that is statistically aberrant. A person of my acquaintance recently pointed out that her neighborhood had a large number of young people with learning disabilities and or mental illness. The cause was not evident to her but she suspected that neurological Lyme disease might play a role.

The incident of a disease in a population can be easily enumerated. One in a hundred or one in 10,000 are derived from the number of cases of an illness in a given population. The geographic distribution of these cases may not be even, i.e., clusters. Clusters of cases may represent a local factor that contributes to the disease or be totally random.

Bacterial meningitis has a definable incidence in the US. The clustering of cases in military installations and college communities is real and represents the grouping of large numbers of potentially susceptible people in a small area.

When an an unusually rare disease suddenly appears in a narrow population, there is often a specific cause. Clear cell carcinoma of the vagina began to appear in young women back in the sixties and seventies. An epidemiological examination revealed that all the young woman had been exposed to DES in utero. Diethylstilbesterol was given to women at risk for miscarriage in the fifties and sixties. It did not prevent miscarriage but did induce abnormalities in the genitourinary tracts of the exposed children.

The virus that caused HIV was found after the disease AIDS was recognized. Unusual pneumonias, rare cancers, and early deaths sparked the epidemiologists to uncover the roots of the AIDS epidemic and led to the successful isolating of the HIV and the treatments that have prolonged the lives of these patients. Our blood supply is constantly being screened for transmissible diseases, thanks to the work of medical sleuths in epidemiology and medical research labs.

A disturbing trend among well intentioned parents, is to not vaccinate their children. The rationale for this dangerous decision is the belief that vaccines may cause autism. The facts are that the incident of children diagnosed with autism is climbing. There are any number of reasons for this rise in cases of autism. Better knowledge of the variety of conditions in the autism spectrum by physician and the general public accounts for some of the increase. The miasma of chemicals in our environment from PCB's, phthalates, hormones fed to animals, and industrial and agricultural run off, may all cause damage to developing nervous systems. There is no evidence that the MMR or other vaccination causes autism.

The human brain looks for patterns. Seeing the image of Abe Lincoln in a potato chip illustrates this phenomenon. The danger lies in not remaining scientifically skeptical in the pursuit of seemingly significant clusters of disease. Don't believe everything you read on the internet. This blogger tries to be accurate. I use information from peer reviewed scientific literature, not Wikipedia.

Stay informed, be skeptical.

I saw my first robin yesterday, and I heard the congaree of the redwing blackbird last weekend. Spring is here. Rejoice!