The Best American Travel Writing 2014 Read Online Free PDF

fraught with wars, revolutions, genocides, and totalitarianism—all of which have hampered research and medical record-keeping. Today, BEN is a budget-straitened side project for most scientists who study it. A disease that affects only middle-aged Balkan farmers isn’t exactly a magnet for international funding.
    Â 
    My father began studying BEN in the 1980s, but his work was interrupted by the Yugoslav wars. Last fall, he returned to the Balkans for the first time in years, and I went with him. We began our trip in Timişoara, the largest city in western Romania, where we met Calin Tatu, a researcher who has been studying the disease with the U.S. Geological Survey for more than a decade. Tatu, who is in his 40s, and has a buzzcut and a close-trimmed beard, holds a medical degree in immunology but prefers working in the lab to seeing patients. He was wearing tinted glasses and a cargo vest, and had spent the previous week climbing Mont Blanc. At lunch, over two double espressos and two Coke Zeros, he told us about his research.
    For the past 10 years, Tatu has been investigating the Pliocene lignite hypothesis—a theory developed by a geologist who noticed that the map of the endemic villages closely shadows the locations of Pliocene-era coal deposits. It isn’t clear exactly how the coal would make people sick, but Tatu believes that toxic compounds may be leaching from the coal into the groundwater. At his lab, he showed us a machine capable of reducing 20 gallons of groundwater to a few teaspoons of brown sludge. He says that he has found unique organic compounds in water samples from the region, but he doesn’t yet know whether they contribute to BEN .
    In recent years, Tatu has been testing another theory as well: poisoning by aristolochic acid, a toxin found in plants of the
Aristolochia
genus. This theory, which has recently gained wide acceptance, was formulated thanks to one of those grievous human misfortunes described by scientists as “a natural experiment.” In Brussels, in the 1990s, a number of otherwise healthy young women suffered end-stage kidney failure, requiring dialysis or transplants. It turned out that they all belonged to the same diet clinic, where they had taken a Chinese herbal slimming blend containing aristolochic acid. About half of them later developed the same rare upper-urinary-tract cancer found in BEN patients. Researchers soon made the connection with BEN , particularly since a species of aristolochia—
Aristolochia clematitis,
or European birthwort—is common throughout the Balkans.
    In 2007, an American pharmacologist named Arthur Grollman analyzed kidneys from BEN patients and found molecules derived from aristolochic acid bound to the patients’ DNA. In further studies, he identified aristolochic acid’s mutational signature in DNA from patients’ tumors. According to Grollman, these findings prove that the cancers were caused by aristolochic acid, which he suspects was ingested after seeds from the plant got mixed with wheat and ended up in the villagers’ bread. Other researchers have built on these findings, and many now favor the term “aristolochic-acid nephropathy” over “Balkan endemic nephropathy.” Grollman believes that the mystery has been solved.
    Yet questions remain. Some researchers have been unable to find the same molecules, either in the Belgian women or in BEN patients. Others have drawn attention to the differences between the Belgian women’s disease and BEN ; notably, the Belgian women tended to become sick within 12 to 18 months, rather than 20 years. Perhaps the biggest puzzle is why aristolochic acid would make people sick only in certain areas, given that it grows throughout the Balkans, as well as in much of the rest of Europe and the Middle East.
    The aristolochia theory is strong precisely where the Pliocene theory is weak, and vice versa. Pliocene coal is found throughout the