Case Study
An Inexplicable Disease
Unfortunately, what follows really happened. The information you will be receiving in this case is the same information that a group of researchers had to work with.
Case Background
Its March, 1957. You travel to a remote island region to study a strange disease affecting the indigenous people. The people are hunters and farmers without written language or any modern technology. Despite being vicious warriors, they are extremely friendly and want your help. They believe they are being killed by sorcery. Healthy individuals will suddenly develop a strange walk, followed by slurred speech, facial ticks, and uncontrolled fits of laughter. You notice, however, that while they lack the physical ability to control their speech, they remain intelligent and coherent.
Within only 3 months, they will become completely incapacitated, unable to move or eat. In a cruel twist, however, they remain conscious, and, sadly, fully aware of their own suffering. Most die of starvation or dehydration due to the inability to swallow. Some face a possibly more merciful, early death from secondary infections, such as pneumonia (due to inability to cough). Once the first symptoms occur, death is certain, with 100% dying in 3-6 months. Treating the symptoms and secondary infections only prolongs patient suffering.
You decide that you must discover the cause of the disease, and quickly, as one person in the tribe dies every three days, and the illness appears to be spreading, especially among children. You plan to do research and report your findings at an international conference. You have 2 years to gather as much information as you can before then.
Task
Students will assume the role of a specific type of researcher (physician or anthropologist). I am assigned to Physician.
You will be given initial information about the disease and options for further research. You must decide which investigations to pursue (each takes time). The goal of your investigation is to determ
ine the cause of the disease as soon as possible. In this scenario, you have a total of 24 months to collect data.
Remember that you are not trying to guess what the disease isyou are trying to determine its cause. Specifically, the question you are interested in answering is:
Is the disease infectious or non-infectious? If it is non-infectious, is it genetically inherited or environmentally caused?
Observations:
Your group is made up of well-trained physicians. Here are the additional observations you have made:
The disease is specific to a tribe of ~12,000 people that live in several distinct villages. The tribe is socially isolated from neighbors with little inter-tribe marriage.
Despite occasional violent and non-violent contact, neighboring tribes are not affected nor have any medical workers become ill, thus the disease does not appear to be airborne.
Every village within the tribe is affected with an annual death rate of about 1% and increasing annually. Despite being in every village, the disease appears to affect specific families; some families are completely unaffected while others have multiple members who are sick.
The disease almost exclusively affects women and children. In most families where one woman is sick, other women of the same family and their children eventually develop the disease. This fact has strained relations between men and women in the tribe; the women believe the men are attacking the women and their children with sorcery. Men suspected of being sorcerers are being murdered by men who have lost their wives.
As physicians, you know that all infectious diseases cause an immune response, typically in the form of inflammation, however, when you examine the sick, no inflammation is present. In fact, no evidence of any immune response whatsoever can be found, but without an autopsy you cant be certain.
The disease does not respond to any common drug treatments you try, including antibiotics, steroids, and vitamin treatments.
Possible Investigations: