Researcher seeking clues behind clusters of disease in tiny town

NORTHPORT, Wash. – Rose Kalamarides was in her early 20s when she was diagnosed with ulcerative colitis.    Her older brother also got the debilitating disease. So did one of her childhood friends, her third-grade teacher and a former classmate at her elementary school.

At the kitchen table of her mother’s home in Northport, Kalamarides noted a common thread in each diagnosis: People who got sick were from families who were downwind and downstream from a smelter in Trail, B.C., that funneled pollution through the narrow canyon of the Columbia River.

“When we were kids walking to school, we could smell it in the air,” said Kalamarides, now 56, who grew up about 15 miles from the smelter’s stacks.

The disease cluster in this tiny border town of 296 people has caught the attention of a Harvard Medical School researcher, who thinks it could provide clues for solving a medical mystery.

About 1.4 million people nationwide have ulcerative colitis or Crohn’s disease, a similar inflammatory bowel condition. The illnesses affect about one in every 200 people. Both diseases are believed to have environmental triggers, but despite extensive research the causes have never been identified.

Last year, 119 current and former Northport residents took part in a health survey designed by Dr. Josh Korzenik. Seventeen had confirmed cases of either ulcerative colitis or Crohn’s disease.

“That’s about 10 to 15 times what we’d expect to see in a population the size of Northport,” said Korzenik, director of the Crohn’s and Colitis Center at Brigham and Women’s Hospital, one of Harvard Medical School’s teaching hospitals. “I’m not aware of any other cluster like it.”

Researchers have long suspected that environmental toxins play a role in Crohn’s disease and colitis, which have symptoms including abdominal pain and diarrhea. Both illnesses emerged after the Industrial Revolution, when exposure to pollution from coal-fired factories and vehicle emissions became a part of many people’s daily lives.

Northport might help provide some answers.

Korzenik has ruled out a genetic influence in the town’s cluster: Few of the individuals were related. Seven of the 17 cases were people who lived along Mitchell Road, where sulfur dioxide emissions from the smelter killed farmers’ crops in the 1920s and 1930s, leading to an international lawsuit.

For a century, the smelter now owned by the Canadian mining company Teck Resources also dumped millions of tons of waste laden with heavy metals into the Columbia River.

Korzenik plans to expand the health survey to gather information from other communities near Northport. He’s also interested in pursuing funding to explore possible pollution exposures, including looking into whether the smelter’s emissions may have played a role in disease rates. An earlier study he worked on in England showed a mild correlation between rates of inflammatory bowel disease in young adults and certain types of air pollution.

“It’s important for the people of Northport to understand why this is happening – if there’s a particular exposure that’s leading to this extent of the disease in their community. It’s also important for the larger community,” Korzenik said. “Does this hold an important clue? … Then it may hold answers for many other people out there.”

Local residents say Korzenik’s initial findings confirm what they’ve long suspected: that rates of inflammatory bowel disease are uncommonly high in their small town.

“It’s a validation, but it’s a sad validation,” said Clifford Ward, a Northport resident who lives several miles from the smelter.

Two of his three children have had digestive tract problems, though neither has been diagnosed with Crohn’s disease or colitis. One is still a teenager. “There are 30 to 40 times per year when I can still see and smell smoke from the smelter,” Ward said.

David Godlewski, vice president for Teck American, the U.S. subsidiary of the Canadian company that owns the smelter, declined to comment for this story. In past interviews, however, Teck Resources officials said that ongoing plant upgrades have reduced the Trail smelter’s air and water emissions by 95 percent.

People in Northport are eager for answers.

“It’s not a very nice disease,” said Bob Jackman, a Northport resident whose wife was diagnosed with ulcerative colitis in her 40s. She often swam in the Columbia at a beach across the river from the Mitchell Road property where Kalamarides grew up.

Her parents moved there in the 1950s, thinking the 150 acres would provide a wholesome setting to raise their six children, said Kalamarides, who now lives in Alaska. Her father was a truck driver. Her mother tended a large garden and the family raised chickens, hogs and cattle for meat.

“My mother’s grocery bill in the summer was less than $5,” said Theresa Finnigan, Kalamarides’ twin sister.

“We irrigated out of that river,” Kalamarides said. “You can’t see the pollution coming up with your lettuce.”

In the 1980s, the state of Washington placed air monitors on the family’s farm. They detected elevated levels of arsenic and cadmium.

A few years earlier, Kalamarides had been diagnosed with ulcerative colitis. At age 28, she had her colon removed.

The surgery followed severe bouts of the disease. Internal bleeding made her anemic. Even with regular blood transfusions, she was frequently fatigued. Maintaining her weight was a struggle; it slipped to 90 pounds. As slight as she was, her face was puffy from powerful prescription steroids she took to help keep the ulcerative colitis in check.

“You’re in pain every day,” she said. “Your life starts to revolve around the disease.”

As a young woman, Kalamarides found ulcerative colitis embarrassing to discuss. Removal of her colon cured her symptoms but required her to wear a bag – and later a catheter – to eliminate waste.

Now that she’s in her 50s, Kalamarides finds it easier to talk about the disease’s impact on her life.

She finds it disturbing, however, that diagnoses of Crohn’s disease and colitis are still occurring in Northport.

“We need to understand what’s happening,” she said, “or this could go on forever.”