Your Health This Week
Is chocolate bad for the bones? And more.
Research: Peter Kokkinos and colleagues compared the fitness level of almost 16,000 veterans with their mortality risk. The participants walked and ran on a treadmill designed to evaluate heart function until they needed to stop because they were tired, and then were assigned to one of four groups (low, medium, high, and very high fitness) based on performance. In this research population, blacks were little younger than whites but had higher blood pressures, a greater likelihood of smoking, and a higher probability of obesity. They were also more likely to have cardiovascular disease and diabetes or abnormal blood lipids. These differences between the black and white research subjects were taken into account. Most of the participants—white or black—were of the same relatively low socioeconomic level.
Findings: Once all the variables were controlled for, the results were remarkably similar across the racial groups. At a seven-and-a-half year follow-up, it was clear that as fitness level improved, mortality rate dropped. The relationship was pretty much linear and almost the same for blacks and whites
Conclusion: As usual, we have to be careful not to assume that the improved fitness was the cause of the greater life expectancy. (People could test poorly for fitness because of an underlying illness that's the real cause of lower life expectancy, though the researchers made efforts to correct for this effect.) The message: Fitness results, on average, improved life expectancy, and the effect applies whether you're black or white, rich or poor.
History: About 340 years ago, an English physician, philosopher, and collector of odd things, Sir Thomas Browne, described a strange illness he had apparently encountered years earlier in children in Languedoc, a region in the southeast corner of France. The illness began with coughs and convulsions—symptoms which resolved, Browne said, when "harsh" (coarse?) hairs appeared on the backs of the sufferers. The only other thing Browne related about this disease was its name—Morgellons.
Condition: Morgellons, or at least a condition given the same name, has now reappeared, in the form of an illness in which sufferers are tormented by the sensation that bugs are crawling under their skin. This is accompanied by itching, as well as the sense of being stung or bitten. Many sufferers find relief by scratching or picking. What binds this new condition to Browne's description is the appearance of red, blue, or black fibers or granules in the picked skin. Sometimes, when doctors examine under high magnification the sites of sensations, similar fibers are seen embedded below the skin's surface.
Effect: Morgellons disease makes people miserable. They are often intensely anxious and, understandably, strongly focused on finding a cause and effective treatment. They are sometimes reluctant to have contact with other people, including family members, for fear of passing on an infection. For the same reason, they sometimes get rid of furniture or clothing. They are often frustrated and deeply unsatisfied by their encounters with doctors. Many patients also describe being chronically exhausted and having joint or muscle pains.
Explanation: Most dermatologists consider Morgellons disease to be a variant of a well-known condition: delusional parasitosis—the sense of infestation of the skin by bugs—though they are quick to point out that no matter what the cause, patients genuinely and strongly experience the sensations they describe. Patients with this illness often have concomitant psychological problems, which would not be surprising no matter what the cause: A debilitating disease is as likely to be a cause of depression as the result of it.
Parallels: Are there are other conditions that might help clarify whether Morgellons is a collective delusion or a physical condition caused by some kind of parasitic invasion of the skin? Maybe. There are a whole collection of shared delusional illnesses—think "mass hysteria." One of the most famous is "koro" (also called "suo-yang"). It is a high-anxiety delusion, often shared simultaneously by many people, that one's genitals are shrinking inward. It is usually a male delusion, but sometimes women experience a similar sense that their nipples are inverting or that their vagina is closing. Epidemics of koro have been reported in China, India, Malaysia, Thailand, and Nigeria. Sufferers sometimes believe the shrinking organ was stolen from them, and this has led to the very real beating or lynching of the perceived perpetrator. Similarly, every year, groups (frequently of adolescents) experience collective panic, often with mass fainting and vomiting, when they imagine smelling a strange odor.
Conclusion: These examples make it easy to dismiss patients with Morgellons as victims of delusion. But I am compelled to point out that occasionally an epidemic of teenagers collectively smelling an off-odor and fainting has turned out to be the result of exposure to carbon monoxide from a defective furnace or to insecticide contamination. The CDC has now begun to look at Morgellons in a scientific way, so perhaps soon we will have a better handle on cause and treatment.
Sydney Spiesel is a pediatrician in Woodbridge, Conn., and clinical professor of pediatrics at Yale University's School of Medicine.
Photograph of chocolate by John Foxx/Stockbyte.