In places where living conditions resemble this “pre-hygiene” past—rural parts of Africa, South America and Asia—the disorders remain uncommon. It can be tempting to dismiss the differences as genetic. But disease rates in the industrialized world have risen too fast, up to 3 or 4 percent a year in recent decades, to be explained by evolutionary changes in DNA. “You can see quite clearly in a pre-hygiene situation you don’t see allergic disease,” says Thomas Platts-Mills, an allergy specialist at the University of Virginia. “Move to a hygiene society, and it does not matter your race or ethnicity—allergy rises.”
These findings don’t mean that people should eschew basic hygiene. Its benefits are clear: In the past 60 years or so, our overall life expectancy has continued to rise. The trick for scientists is to determine exactly which early life exposures to germs might matter and identify the biology behind their potentially protective effect.
That’s one big way Knip’s research on the Finland-Russia border can contribute. The accident of geography and history playing out there offers a chance to work in what Knip calls a “living laboratory.”
“It’s really an exciting opportunity,” says Richard Insel, chief scientific officer for the New York City-based Juvenile Diabetes Research Foundation.
Just a few hours after we arrive in Petrozavodsk, I follow Knip and his team to a morning meeting at the Karelian Ministry of Health. Russian officials on the other side of a long conference table explain through an interpreter that they haven’t recruited as many study participants as their Finnish and Estonian colleagues. Parents in Petrozavodsk are unfamiliar with the practice of conducting medical studies, reluctant to submit their babies to what they see as painful blood tests and too stressed to fill out long surveys on diet and family history.
If Knip is frustrated, he hides it well. The recruitment phase of the study was supposed to end in 2012. He’s trying to buy his Russian colleagues another year to conduct their work, he says, smiling and shaking hands before heading to a taxi waiting outside. “It’s turned out to be a lot more complicated than we expected,” Knip tells me later. “Cultural differences have been a big learning process for us.”
The next stop is Petrozavodsk Children’s Hospital, a building on the city’s outskirts surrounded by concrete apartments. While Knip gives a pep talk to pediatricians charged with gathering study samples, I sit down with Tatyana Varlamova, a young doctor in a thigh-length white lab coat and black pumps. Varlamova’s drab exam room is a world away from Knip’s gleaming lab in Helsinki. It’s equipped with a plug-in space heater and particleboard desk. Wilted potted plants sit next to an open window. In a long corridor outside are wood benches filled with exhausted-looking parents and children edging toward tears.
Varlamova is clear-eyed about the differences between Russian Karelia and Finland. “Karelia is poorer,” she says, “there’s no hysterical cleaning of apartments and a lot more physical activity.”
Conducting the study in Russia has been a struggle, she says. While extra attention from doctors encourages Finnish and Estonian parents to participate, that’s not the case in Russia. Babies here are already required to visit a pediatrician once a month in the first year of life, more often than in Finland. Enrolling young children has also been challenging. Since 2008, doctors have seen 1,575 children in Espoo, a suburb of Helsinki; 1,681 have been sampled in Estonia, where the diabetes rate falls between that of Finland and of Russian Karelia. But after three years, researchers had recruited only 320 Russian children.