“People don’t need more time with the doctor,” Varlamova tells me softly in Russian. “They’re not as motivated to take part in scientific investigations. They have more important problems in their life.”
Then there’s the Russian bureaucracy. All the samples taken for the study have to be analyzed in the same Finnish lab for consistency. But just as Knip’s study was taking shape, Russian legislators passed a law requiring special permission to export human tissue samples. (Some lawmakers argued that foreigners might use the samples to develop biological weapons targeting Russians.) As a result, Varlamova explains, thousands of study samples from Petrozavodsk had to be individually reviewed by three ministries, including the dauntingly named Federal Agency for the Legal Protection of Military, Special and Dual-Use Intellectual Property, before being exported. Finally, though, samples going all the way back to 2008 and filling two industrial freezers crossed the border into Finland last December, along with a 30-pound stack of paperwork.
Early results are pointing to different immune system challenges during infancy in the study regions. Russian children, Knip says, spend the first years of their lives fighting off a host of infections virtually unknown in Finland. The Russian kids, as other studies have shown, have signs of regular exposure to hepatitis A, the parasite Toxoplasma gondii and the stomach bug Helicobacter pylori. “Helicobacter pylori antibodies are 15 times more common in children in Russian Karelia than in Finland,” says Knip. “We did expect more microbial infections. But we didn’t expect such a huge difference.”
Identifying important differences may lead to a Type 1 diabetes prevention strategy, for kids in Finland and the rest of the developed world. “If one could identify specific microbes, you’d have to consider whether you could expose children—in a safe way—to those microbes,” Knip says.
Such an intervention could prime the immune system much like a vaccine, but might use a collection of bacteria rather than a specific microbe.
Knip’s in a hurry to find out: Living laboratories don’t last forever.
Von Mutius, for her part, says she might have missed her chance to prove her hypothesis that crowded daycare centers, not pollution, protected kids in East Germany. Leipzig’s coal pits have been flooded and turned into lakes ringed with beaches and bike paths. “We cannot go back—the East and West German phenomenon will remain an enigma,” von Mutius says.
In Russia, Karelia’s living standards, though they lag behind those in the most developed nations, have been rising slowly—alongside cases of Type 1 diabetes, celiac disease, hay fever and asthma.
If Knip and his team can identify the culprits soon enough, perhaps Karelia, and other developing regions, can enjoy the upsides of modernity without some of the disorders that have accompanied economic advancement elsewhere in the world.