Stalking: Who Done It At the White House

By Christine Gorman

Call it a case of plumbing panic. Within two years, the President and Barbara Bush develop the same overactive thyroid disorder, and best-selling pooch Millie suffers from a bout of doggie lupus. Heightening the drama, doctors reveal that both of these diseases hail from the mysterious realm of autoimmune disorders, which occur when the body unaccountably begins attacking itself. Pundits confidently calculate the odds of such a coincidence at 1 in 3 million. Latter-day Clouseaus begin looking everywhere for a culprit. Dan Quayle raises questions about the ancient plumbing at the Naval Observatory -- the official 100-year-old vice-presidential residence, which the Bushes occupied for eight years. Suspicion spreads to other sources of presidential water, which are tested for the presence of toxic levels of iodine or lithium.

While federal scientists raced to analyze their samples last week, Americans flooded the White House switchboard with a few theories of their own about whatdidit -- everything from chemicals in the carpets to infectious pets. One citizen counseled the President to slather lemon juice over his throat and chest to soothe his hyperactive thyroid. Others admonished him to eat his hated broccoli since it contains small amounts of a naturally occurring substance that restrains the organ.

Well-meaning advice to be sure, but utter nonsense. "They're not going to find anything in the water," says Dr. Lewis Braverman, chief of endocrinology at the University of Massachusetts Medical Center. Lithium decreases the thyroid's output instead of increasing it. As for iodine, a person would have to consume at least 10 to 50 times the normal daily dosage in order to trigger hyperthyroidism. "It's sort of a feeding frenzy," says Dr. Charles Christian, physician in chief at the Hospital for Special Surgery in New York City. "All the attention is pressuring the people taking care of the President to prove that something hasn't been missed."

The fact that both Bushes developed the same rare disorder may seem surprising, but it is not inexplicable. Just as somebody always wins a lottery in which the odds are 3 million to 1, so some couples are bound to suffer identical fates. "No one made such a fuss over us when my husband and I both developed Graves' within three years of each other," says Denise Ploetz, an adult-education teacher from Newark, Ohio, whose condition was diagnosed in 1976. "Our doctor just said it was a coincidence."

Although we may never know precisely what triggered the Bushes' conditions, scientists have made extraordinary advances in just the past decade in understanding what goes wrong in autoimmune disorders such as Graves' disease. Their discoveries, driven in part by the intensive study of the AIDS epidemic, reveal that the immune system is not a single straightforward defense system but many elaborate systems whose cellular members constantly patrol the body looking for friends and challenging foes. "The immune system is very like the brain -- it has to recognize everything," says Dr. Howard Weiner, associate professor of neurology at the Harvard Medical School. "Every virus, every piece of dust, your body has to recognize as foreign."

Autoimmune disorders occur when the body engages in "friendly fire" against its own tissues. This mistaken course of action can either overstimulate an organ, as in Graves' disease, or destroy tissue, as in multiple sclerosis, in which the myelin sheath surrounding nerves in the spinal cord and brain is attacked. Some immune diseases, like systemic lupus erythematosus, whose signs include skin lesions and arthritis, strike more women than men. Others, like ankylosing spondylitis, which can fuse the spine into a bent-over position, predominate in men. In all, 40 different maladies, affecting about 6% of the U.S. population, are thought to be autoimmune in nature. Among the most common: rheumatoid arthritis, in which the collagen fibers of the joints come under assault, and Type I diabetes, in which the immune system targets the insulin-producing cells in the pancreas.

One of the difficulties with sleuthing the causes of these disorders is that so many factors are involved. Inheritance can play a role: several genetic types have been found that confer an increased risk of autoimmune disease. Dr. Christian, who has been called in on the Bushes' case, plans to test the President and his wife to see if they share the same markers for genetic susceptibility as most people who have Graves'. However, heredity is by no means the whole story. For example, if one of two identical twins develops an autoimmune disease, the other twin will get the same disease less than half the time.

Clearly environment, life-style and medical history play some kind of role. For years doctors have recognized that many children who develop rheumatoid arthritis -- sometimes almost overnight -- show signs of viral or bacterial infection just before the onset of the disease. Some patients with rheumatoid arthritis swear they can affect their disease through exercise and diet.

A growing body of evidence suggests that such ubiquitous viruses as herpes, Epstein-Barr and cytomegalovirus may be enough to push the immune systems of genetically susceptible people into overdrive. The fact that George and Barbara developed Graves' within two years of each other may point to a common infectious trigger -- perhaps a cold they shared in Helsinki or Kennebunkport.

For some autoimmune conditions, researchers have begun to decipher the intricate interplay between genetics and environment that leads to disease. Much to the surprise of many scientists, immunologists have discovered that in the process of manufacturing millions of T cells -- the blood-borne infantry of the immune system -- the body sometimes produces a few treacherous double agents. Early in life the thymus gland, located over the heart, acts as a checkpoint to weed out the potential traitors. Sometimes, however, a few of these renegade T cells get through to circulate in the body. Then it becomes a game of chance. Invading viruses or bacteria may inadvertently activate the errant T cells. That leads to the identification of good healthy organs as targets for destruction.

One of the greatest mysteries in immunology is why more people do not succumb to autoimmune diseases. For example, researchers now realize that nearly everyone harbors T cells that will react against their own nerve tissue. Yet less than 1 person in 1,000 develops multiple sclerosis. What else is the body doing to police its overly zealous defenders? Scientists do not expect the uncertainties to persist much longer. "We're at a point where we know when a child would be at a 50 to 100 times greater risk of getting a long list of autoimmune diseases," says Stanford neurologist Lawrence Steinman. "For several diseases we know the bacteria or viruses that can trigger the illness in people with an underlying genetic susceptibility." Improved treatments, reflecting this new knowledge, are beginning to emerge from the lab.

Fortunately for the Bushes, Graves' disease is relatively easy to manage. But there is no sure way yet to stop the progression of multiple sclerosis and numerous other autoimmune disorders. Using an approach pioneered by Dr. Irun Cohen at the Weizmann Institute of Science in Rehovot, Israel, researchers are working on vaccines that help tone down overactive immune systems by targeting rebel T cells. So far, American and Dutch researchers have injected these experimental vaccines into a handful of patients with rheumatoid arthritis and multiple sclerosis. Because the diseases are long-term disorders that are subject to spontaneous remissions, however, it is too soon to tell how effective this approach could be. One potential drawback: scientists may have to customize the vaccine for each individual patient.

Alternatively, researchers may be able to coax the body into becoming a little more forgiving. Eating, for example, is possible in part because the + immune system does not mount an attack on something that has passed through the gut. So Harvard's Weiner has begun feeding small doses of myelin to some multiple sclerosis patients in the hopes of increasing their tolerance for the protein. Scientists are also supplementing the diets of people who suffer from rheumatoid arthritis with tiny doses of specially prepared collagen.

The great White House plumbing puzzle of 1991 will probably prove to be a wild-goose chase, but possibly it will bring some benefits. Researchers in immunology hope all the attention will heighten interest in their field and maybe even produce more research funds. At the very least, it has raised awareness of a category of diseases that, while commonplace, have been only dimly understood.

CHART: NOT AVAILABLE

CREDIT: TIME Chart by Joe Lertola

CAPTION: AUTOIMMUNE AILMENTS

With reporting by Barbara Dolan/Chicago and Andrew Purvis/New York