The Bush Health Mystery

As President George Bush wound down from a quick 18 holes of golf one afternoon last week, he added a little flourish. Pulling into the clubhouse at the Cape Arundel Golf Club, near Kennebunkport, Maine, the president suddenly spun his cart around and charged back onto the links. "I hate to tell you this," he exulted, "but we've accepted the challenge for another nine holes!" In truth, the president frolicked at slightly less than full throttle during an extended Memorial Day retreat. But he looked heartier than he had in weeks, and he'd regained eight of the 13 pounds he lost after doctors used radioactive iodine to control his hyperactive thyroid. As his vigor returns, though, the mystery surrounding his illness only deepens.

Bad news comes in spurts, but rarely does it spurt so symmetrically. Just 18 months ago, Barbara Bush learned she had Graves' disease, a condition in which the immune system attacks the thyroid gland, sending it into perpetual overdrive. Then came word that First Dog Millie had developed lupus, a related autoimmune disorder. This spring, when the president himself was hospitalized for an irregular heartbeat, not even conspiracy theorists perceived a pattern. Yet there was a pattern. Against extraordinary odds--the estimates run from one in 10,000 to one in 3 million--the president had the same disease as his spouse.

What's going on here? Is there a mysterious contagion in the White House? Did the Bushes drink bad water during their years at the Vice Presidential Mansion, as Dan and Marilyn Quayle now worry? Or is this mini-epidemic just a fluke? Baffled, but wanting to do something, White House doctors announced last week that they were looking for a culprit. Investigators analyzed water samples from past and present family quarters--the White House, the Kennebunkport estate, Camp David and the Vice Presidential Mansion--while combing old medical records for clues. The effort may reveal nothing about the causes of autoimmune disease--that mystery has baffled researchers for more than a century--but it will surely enliven the search. "The beauty of having the First Family as your patient," says White House physician Burton Lee, "is that you can mobilize a lot of high-level brain power."

Last week's first tests-to determine whether lead, iodine or lithium had contaminated the family's drinking water-were little more than a formality. In Graves' disease, the immune system unleashes antibodies resembling a natural chemical called thyroid stimulating hormone (TSH). When these antibodies attach themselves to the thyroid gland, they provoke flurries of metabolic activity. The results can range from agitation and sleeplessness to weight loss, eye problems (Barbara Bush's complaint) and the irregular heartbeat that plagued the president. Iodine and lithium can inflame the thyroid, causing similar symptoms, but neither substance has been implicated in Graves' disease. So no one was surprised last week when the water tests came up dry.

While toxicologists look for other possible poisons, Dr. Charles Christian, director of medicine at New York's Hospital for Special Surgery, will review the medical and family histories of the president, Mrs. Bush and Millie. Though autoimmune diseases don't normally turn up simultaneously in couples and their pets, they do tend to run in families. Studies have shown that blood relatives of Graves' patients are at increased risk not only for Graves' disease but also for other autoimmune disorders (the Bushes' son Marvin suffers from one called regional enteritis, a chronic intestinal inflammation). Moreover, the errant antibodies involved in Graves' disease are sometimes discernible in patients' relatives, suggesting a genetic predisposition. Yet heredity is not the whole story. As Christian says, "Lots of people who would seem to have the predisposition don't get the disease." The question is what triggers the illness in those who are susceptible.

Psychological stress is one possibility, though not a very compelling one. People with overactive thyroid glands often have trouble concentrating, maintaining relationships, performing on the job, even driving a car safely. But those problems could all be products rather than precursors of the disease. "It's difficult to know which is chicken and which is egg," says Dr. Paul Ladenson, director of endocrinology and metabolism at the Johns Hopkins School of Medicine. "No solid study has demonstrated that patients with Graves' suffered more stress before the illness."

Viruses are likelier triggers. When tested for the AIDS virus (HIV), people with autoimmune diseases often yield false positives. Moreover, people with HIV infection often develop autoimmune symptoms. Intrigued by such connections, researchers have studied autoimmune patients to see if they might harbor an unknown bug from the same family as HIV (a retrovirus).

They haven't been disappointed. In 1989, researchers in London analyzed thyroid tissue from five patients with Graves' disease and found that, unlike healthy tissue, it contained a specific DNA sequence normally associated with the AIDS virus. Their conclusion: "a distinct human retrovirus, closely related to HIV-1, might be involved in ... Graves' disease." The same year, researchers at Philadelphia's Wistar Institute found retroviral DNA sequences in tissue taken from multiple sclerosis patients. More recently, a team at Tulane University in New Orleans recovered what appears to be a novel retrovirus from the salivary glands of patients with Sjogren's syndrome, another autoimmune disease. "We haven't proved that the virus causes the disease," says Robert Garry, the researcher who headed the team, "but we've drawn a strong connection."

None of this bears directly on the First Family's well-being. Whatever caused the Bushes' maladies, the symptoms appear well under control. Nor is the White House investigation likely to bring any big surprises. "The overwhelming possibility is that we will come up with nothing," says Lee. "This is a document for the future."

What--or where--were the culprits? Theorists wondered about bad water in the Vice Presidential Mansion, or strange viruses inhabiting the White House.