N.C. doctors begin belated study into health effects of Pfiesteria Skepticism accompanies epidemiological inquiry

November 16, 1997|By Douglas M. Birch | Douglas M. Birch,SUN STAFF

GREENVILLE, N.C. -- They arrived at the East Carolina University medical school here yesterday, cloaked in official anonymity, like the jurors in a celebrated criminal case.

But the people who underwent six hours of testing yesterday, and the others who will come here next Saturday, aren't being asked to pass judgment.

These 60 people are acting as witnesses against single-celled organisms, including Pfiesteria piscicida, the fish-killing microbe accused but not convicted of having made people ill along the tidal rivers that vein North Carolina's coast. These volunteers form the core of the most intensive study of Pfiesteria's health effects this state has ever launched, perhaps the most ambitious ever attempted.

It follows four years of state officials insisting that there was no evidence the microbe had ever made anyone sick in the wild.

"We tried to tell them about it, and wouldn't nobody listen," said Roy Rice, 45, a waterman from Morehead City, who said he is participating in the study. "Then Maryland found it. They did something about it. Our state wasn't doing nothing."

Dr. Stanley Music, North Carolina's chief of environmental epidemiology and director of the current study, said there was little reason for action until Sept. 29. That's when a team of Maryland doctors announced that they had evidence of a unique set of symptoms among 13 people exposed to fish kills on the Pocomoke River.

"Up until the Labor Day weekend, no one had found any credible environmental effects of Pfiesteria," Music said. Now, depending on the outcome of their study, North Carolina officials may be forced to admit having overlooked a major public health threat for the past four years. Or they may congratulate themselves on having not succumbed to Pfiesteria hysteria.

JoAnn Burkholder of North Carolina State University, who helped discover Pfiesteria and who was poisoned by the microbe's toxins in her laboratory in 1993, wonders if the study isn't a waste of effort.

"There are some good people on that medical team," she said. "But they have to work very closely with people who have done their best to downplay and bury this issue for years." She and some others here fear North Carolina is mainly interested in rebutting Maryland's findings.

Music, a former epidemiologist with the U.S. Centers for Disease Control and Prevention, said he is not only going to "conduct a first-class" study using "impeccable science," but is determined to go Maryland one better.

His study can't, he admitted, look for short-term, or acute, effects of massive exposure to the organism's toxins. Pfiesteria season ended weeks ago, and the state hasn't experienced any massive blooms since 1995.

So Music and the 25 physicians he's directing will look for chronic effects or long-term symptoms.

The Maryland medical team is conducting follow-up studies to look for long-term effects in the 37 people it has found with what seem to be Pfiesteria-related symptoms. But, at least initially, symptoms seemed to fade within days or weeks of exposure. Finding chronic effects of exposure to toxins can be tricky and requires carefully designed research.

Debbie Crane, spokeswoman for North Carolina's Department of Health and Human Services, said about 10 of the test subjects were culled from people who called the state's Pfiesteria hot line. Music said callers were asked to complete questionnaires.

Based on this information, he said, he and other scientists identified 10 people who might suffer from an illness similar to the one discovered in Maryland.

A second group of about 20 people are state workers selected because they work on the water.

About thirty others are controls. They were chosen based on their similarity to the first two groups, but they have had little contact with the water.

The groups will be melded, and the 25 physicians and others conducting the study won't know who is in which group.

Scientific studies are routinely "blinded" in this way to protect against unconscious bias.

Maryland's study was done on an emergency basis: Everyone knew that the people being studied claimed to be sick. Maryland's team selected and examined controls only after it looked at the initial batch of patients. And Maryland didn't know what to look for.

Music said the physicians working for him will use the CDC's case definition, which is based on the Pocomoke River cases.

Maryland's team did have some advantages over North Carolina's. One was seeing people with recent exposure to the toxins. Another was that they generally had the trust and cooperation of the people they were asked to examine.

David Jones, a 53-year-old North Carolina waterman, may be the most profoundly disabled of any of Pfiesteria's suspected victims, suffering from slurred speech and mental confusion. A physician wrote in February that his condition was "possibly" related to Pfiesteria.

Jones said he was invited to participate in the study. But he refuses, angered over previous comments by state officials casting doubt on health claims.

"It would be very, very foolish on my part," he said. "It would mean that one of my three live brain cells had collapsed. I really don't think they want to find anything."

Rice, the Morehead City waterman, sometimes finds himself driving down a road, with no idea where he is, or where he is going.

"You just have to stop and wait, and wait, until you figure out something," he said.

He has agreed, he said, to participate in the study despite his distrust of the state.

"I want them to find out something," Rice said. "If they get lucky and find out something, that's great with me."

Pub Date: 11/16/97

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