Everyone is, potentially, an amateur epidemiologist. You see something that, well, just seems odd. So you investigate further. You understand that something can be a coincidence, so one or two examples simply won’t cut the mustard. You also understand that something can be true even though we don’t understand why it is true. Or we might suspect a reason but be totally unable, through lack of resources, to prove it.
Take Dr John Snow for example, the doctor who investigated a cholera outbreak in London in 1854 – and by mapping it came to the conclusion that the source of the disease was a particular well in Soho. He closed the well and the cholera epidemic gradually died out. In doing this he became the father of epidemiology. Such anyway is the story.
Dr. Ignaz Semmelweis was not in such a fortunate situation. He was a lowly Hungarian doctor in a Viennese hospital. In the course of his work, it had come to his attention that the women who gave birth in the wards attended by doctors had a far greater incidence of puerperal fever (a deadly condition) than the wards attended by the midwives. He measured this situation over a lengthy period and the results were quite clear. But what could be the reason? Again, using simple observation, he noted that the doctors had a tendency – a macho tendency one assumes – of going from their female patients to the mortuary dissection rooms and back without, in the meantime, washing their hands. But unfortunately for Dr Semmelweis there was no microbial theory to account for this situation. When he pointed out his findings he was scorned and eventually driven out of the hospital. What proof did he have? sneered the medical authorities. It would be disastrous for the confidence of patients if it was believed that doctors themselves were the carriers of contagion. Any suggestion of this sort needed to be snuffed out at once. Semmelweis had a nervous breakdown and committed suicide.
But Dr Semmelweis was right. He had no explanation. He certainly had no proof. But he was right.
And then take the case of Kathy Downer. Unlike the other two examples, Mrs Downer is not a doctor but her lack of education has not robbed her of her common sense. Some years ago, I was given her number and told she had an interesting story to tell me – and she did. About 30 years previously, she had found herself in the unpleasant position of having a husband and a daughter who had both been diagnosed with cancer – different cancers but both diagnosed within a ten week period. So Mrs Downer asked herself a very sensible question: could there be some connection between the fact that her husband got cancer and then her daughter was also diagnosed within a very short time span? Was this a coincidence? Just plain old bad luck? Or was there a common cause? As she explained it to me: “You can’t fight if you don’t know what the enemy is. If there is a cause how can we defend ourselves if we don’t know what it is?” Two cancers in one family one after the other in a matter of months: What was the likelihood of that?
Mrs Downer recognised that this could just be a coincidence but her suspicion that there might be a common cause was also perfectly valid. So she decided to acquire more data. By asking around her neighbourhood she heard of other cases of cancer. She decided to visit these people and talk to them to see if she could build up a picture, a potential scenario that explained what was going on. And having visited a dozen or so households where there was cancer she was suddenly struck by a curious fact that a majority of these cases had in common.
Before I reveal what her discovery was, a discovery that she later tested against a much larger population and found to be still valid, I want to ask you, the reader, a question. Let us suppose the answer was something bizarre such as that a large proportion of them lived in, say, a cul-de-sac (a dead-end street). What would be the knock on impact of that fact being proven to be true and becoming public knowledge? Well, we can easily see that there might be a great deal of panic. Prices of houses in cul-de-sacs might plummet and so on. No government would wish for these consequences and so it is unlikely that they would support any move to clarify this fact. On the contrary they would deny, attack, bluster and obfuscate – the mass media would point out that such a suggestion was hysterical and unproven so large sections of the public would feel justified in sneering at any such suggestion on the grounds that it was alarmist, unscientific and unproven. And they might be right but there would be no fierce resolve to seek a definitive answer, especially if there were strong reasons to suggest that the explanation was – potentially – correct.
- So let us return to Kathy Downer. What exactly was it that she found to be the common denominator? It was this. Ten of the first twelve families that she visited lived in a cul-de-sac. The others lived next to a fire hydrant. Later, when she put forward these facts in her local newspaper, she ended up with figures that suggested that about 60 per cent of the cancer cases in her local area involved families living in cul-de-sacs.
Now, before we go any further, one can easily find that the way in which Kathy Downer acquired her facts was one that favoured self-selection. So the figure of 60 per cent is not one that we can depend on. But it is far higher than coincidence would suggest. Or is it? If 60 percent of all the houses in a local area were in cul-de-sacs, then so too would be the random distribution of cul-de-sacs. But I know of no town where there is such a high proportion of cul-de-sacs. So something might, just might, be going on. If so, what?
Well, let us discard any suggestion that there is anything about the shape of a cul-d-sac or the psychic energy distribution that might explain it. In fact, Kathy Downer quickly spotted the most likely issue – the water supply. She discovered that the water pipes supplying water to cul-de-sacs were similarly dead ends. She also discovered that cul de sacs previously had been regularly flushed through – as were the fire hydrants – but this practice had stopped a few years prior to the cancers affecting her family. When the pipes had been flushed this had always resulted in an unpleasant discolouration of the water – so something capable of discolouring the water was being shifted by the flushing process. This suggests the build up of something. Was it possible that this something was toxic and, by not being flushed out, remained and was capable of contaminating all the water that passed by? Well, it was certainly a theory.
We normally think of the tap water supply as being clean. Certainly most people are happy to drink it without a second thought. But Kathy Downer, using only simple common sense logic and the very limited resources available to her, came to the conclusion that drinking the tap water in her own house – which happened to be in a cul-de-sac – was unhealthy. As this was not an academic issue for her she immediately took action. She stopped her family from drinking tap water and put them on, initially, bottled water – any old bottled water. Interestingly she very soon got further evidence that her suspicions were correct. Her daughter was undergoing chemotherapy and so the state of her blood was being carefully monitored on a weekly basis. Within weeks it became clear that her daughter was showing a marked improvement in her ability to tolerate the chemotherapy. And it wasn’t just the blood tests. One of the impacts of the chemo regime she was on was that it stunted her growth. But now she was beginning to grow again.
So Kathy Downer, if she is correct in her suspicions that many cancers are caused by the toxic nature of unflushed water pipes, deserves a place alongside Dr John Snow and Dr. Ignaz Semmelweis. It is unlikely that she will be elevated to this pantheon in our lifetime but at some time in the future I very much hope that her contribution is recognised. In the meantime, if you live in a cul-de-sac, ring your local water supplier and ask them when was the last time the pipes were flushed. That goes too for those of you who live near a fire hydrant.
If you live in America, and you have heard of the Flint Michigan scandal in which a town’s water supply was switched to cheaper – but highly toxic – river water leaving many children with serious lifelong impacts, you will appreciate that the relevant authorities cannot always be trusted to provide the public drinking water you need. Research has also found that schools right round the country have water systems that have high lead levels. If this is true of schools it might also be true of hospitals (just saying).
When I mentioned this story to Jim and Debbie Broom who were caring for their grandson Connah, they went very thoughtful. “We were living in a cul-de-sac when Connah was diagnosed,” Jim told me. They had also switched to filtered water – refusing all other sources of water – while Connah was undergoing his second round of chemo. They almost immediately noticed that his ability to withstand the chemo had improved and his hair started growing again – so thickly and glossily that all the doctors commented on it.
As I write this there is a lot of concern about the negatives of bottled water – but, very likely the negatives of tap water should be taken even more seriously.