Disease cluster mystery
October 14, 2007

FOR MORE than 20 years, health officials have known about a puzzling concentration of the neurodegenerative illness known as Lou Gehrig's disease in the southeastern Massachusetts town of Middleborough. In the coming months, a study financed by the federal government and conducted by state environmental health scientists might answer the riddle of whether toxic waste from two Superfund sites in the town has caused the rare and usually fatal disease, which normally strikes just two of 100,000 people.

The state is also working to create a registry to keep track of the disease. In collaboration with the Centers for Disease Control and Prevention's National Environmental Health Tracking Program, such registries can build up the databases that researchers need to track diseases with suspected environmental causes. Democratic Senator Hillary Clinton of New York and Republican Orrin Hatch of Utah have called for a $100 million increase in the CDC program's budget to help the tracking program establish itself nationwide. Congress should approve the funding.

Besides being a potential site for a casino operated by the Mashpee Wampanoag tribe, Middleborough was home to a metal plating plant and a chemical plant. Their industrial waste became Superfund sites that still have not been entirely cleaned up.

The two best-known victims of amyotrophic lateral sclerosis (ALS) have been Gehrig, the baseball Hall of Famer who died of it, and the physicist Stephen Hawking, who has defied the odds by surviving with the disease for decades. Most of those afflicted die within two to four years. The disease deprives patients of the ability to control motion, speech, and finally breathing, although their minds remain clear. Besides environmental factors, scientists are also exploring genes and viruses as possible causes.

Researchers have studied other ALS clusters. Three men who played football for the San Francisco 49ers in 1964 were diagnosed with Lou Gehrig's. A possible cause was a fertilizer with high levels of the heavy metal cadmium that was used on the team's practice field. Residents of the western Pacific island of Guam have also had abnormally high rates of the disease. A possible trigger there was an edible bean, the cycad.

The CDC program for tracking environmental links to diseases was spurred by a 2001 Pew Environmental Health Commission report calling for such an effort. The program offers the prospect of integrating, under uniform data standards, the toxic monitoring and health surveillance efforts of a myriad of state agencies. Especially in the case of low-incidence diseases like Lou Gehrig's, such a nationwide tracking system could be of great benefit to scientists in identifying concentrations and pointing to causes. Congress should give the project the support it needs.

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