Health department to investigate local ALS cases
Review may show if Tuscaloosa County has unusual number of cases


By Sarah Bruyn Jones
Staff Writer


August 13, 2007


The Alabama Department of Public Health has taken the first steps in investigating deaths from Lou Gehrig’s disease, particularly in Tuscaloosa County.

A state epidemiologist is conducting a preliminary review of death certificates from the past decade to see if they show a higher-than-normal incidence of amyotrophic lateral sclerosis, commonly known as Lou Gehrig’s disease.

While the review may give some insight into whether Tuscaloosa County has an unusual number of ALS cases, interpreting the reasons for it may prove more difficult.

Observations

Unscientific observations such as reports of six cases of ALS within one church in Tuscaloosa have some people wondering if there is an increase prevalence of ALS in the county.

Dr. J.P. Lofgren, the medical epidemiologist performing the review, said it would be comforting if the evidence showed Tuscaloosa did not have a high rate of ALS.

“If it happens that Tuscaloosa doesn’t look unusually high, that takes some of the worry out [of the community]," he said, adding that the investigation will include about 900 records.

About 90 Alabamians die each year from ALS.

Among those who will be following the study is Dr. Eugene Marsh, a neurologist and dean of the University of Alabama’s College of Community Health Sciences.

He also is a member of First Presbyterian Church, where the six local cases occurred.

“I was seeing more people than I felt like I should, both in the community and especially at our church," Marsh said in May. “It wasn’t scientific, just observational."

Marsh asked the state to look into the matter. He has also tried to get the attention of the U.S. Centers for Disease Control and Prevention in Atlanta, but said he was told to start with the state government.

Though some research has suggested there are genetic and environmental factors that possibly contribute to ALS, the disease’s cause is unknown.

Interpretation

Using death certificates in the investigation is not fool-proof. There are a number of factors that could yield results that might appear falsely troubling or optimistic.

For one, Lofgren is reviewing deaths and not the current living population. That’s because searching death certificates is quicker, easier and less expensive than tracking down living ALS patients. But he said his review should be fairly accurate because the rate of death will approximate the rate at which people are contracting ALS.

But there are also problems with relying on death certificates to reveal the answers.

ALS is not a condition indicated on death certificates. That’s why Lofgren is reviewing all deaths caused or related to motor neuron diseases. ALS cases constitute 85 percent of motor neuron diseases, he said.

“It’s not the primary cause of death," said Sharon Matland, with the national ALS Association, based in California. “It’s not always listed as a contributing factor, so it can be a problem in identifying ALS deaths."

Typically, most people with ALS die from infections or respiratory failure. But, Lofgren said, those who maintain death certificates are trained to look for the underlying cause.

“So the cause of death may be listed as respiratory failure caused by pneumonia caused by ALS," Lofgren said.

Conclusions

Even if Lofgren’s review shows an increased rate of motor neuron disease exists in Tuscaloosa, he said there may not be a reason to be concerned.

“What is likely to happen, or what often happens when people say they’ve observed things like this, is they are often right," he said. “The rate may be higher, but that doesn’t mean that there is something special going on or something that is causing it.

“I always compare it to rolling dice. Sometimes you throw four sixes in a row. And the dice is perfectly normal, you just happened to throw four sixes in a row."

Reach Sarah Bruyn Jones at sarah.jones@tuscaloosanews.com or 205-722-0209.

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