Press Release for Hound of the Baskervilles Article

To appear in the Christmas Issue of the British Medical Journal

Embargo Date: Thursday, December 20th, 4 p.m., Pacific Time

Media Contact: Dolores Davies, 858.534.5994 or David Phillips 858.534.0482

In the well-known Sherlock Holmes story, The Hound of the Baskervilles, by Arthur Conan Doyle, Sir Charles Baskerville dies from a heart attack brought on by extreme psychological stress. Findings from a new medical article by University of California, San Diego Sociologist David Phillips suggest that people can indeed be scared to death, both in fact as well as fiction.

Phillips's research, published in the Christmas, 2001 issue of the British Medical Journal, may provide the most persuasive evidence to date linking psychological stress and fatal heart attacks. In the study, Phillips, a well-known authority on mortality statistics and on social and psychological factors affecting them, collaborated with UCSD Mathematics Professor Ian Abramson and UCSD students George Liu, Kennon Kwok, Jason Jarvinen, and Wei Zhang.

"I have often wondered if people could indeed die by fright," said Phillips, "and if so, how this could be investigated quantitatively. I recalled that in The Hound of the Baskervilles, Sir Charles Baskerville dies of a fatal heart attack, apparently because he is frightened to death by the hound. Arthur Conan Doyle was a physician as well as an author. I wondered if his story was based on medical intuition or on literary license, i.e. were fatal heart attacks and stress linked in fact as well as fiction?"

"Although numerous laboratory studies have shown cardiovascular changes following psychological stress," said Phillips, "for obvious ethical reasons only mild, non-fatal stressors can be studied in the laboratory, and one may not be able to generalize beyond these mild stressors to determine if, in the real world, fatal heart attacks are precipitated by extreme stress."

"The challenge was to find a way to test this hypothesis that would circumvent the ethical problems of the laboratory experiment and yet would retain some of its rigor," explained Phillips. "The best solution seemed to be to find a natural experiment that met three criteria:

First, we needed to identify a real-life event that has distressing psychological effects on one segment of the population but not on others.

Second, although the real-life event is psychologically stressful for one segment of the population, it should not actually be a dangerous occasion; it should only be perceived as such.

Third, the real-life event should not be linked to any changes in the quality of medical services.

If cardiac mortality increases during this real-life event for those who are distressed by the event, and does not increase for those who are not distressed, then we would have preliminary evidence suggesting a link between cardiac deaths and psychological stress. If the event indeed met the three criteria listed above, one could not easily ascribe the increase in cardiac mortality to such things as a degradation of medical services."

"It is not easy to think of a real-life event that meets these three criteria, but we think we found one. The event we chose is connected to a Chinese and Japanese superstition. In Mandarin, Cantonese, and Japanese, the words 'death' and 'four' are pronounced nearly identically, and consequently the number 4 evokes discomfort and apprehension in many Chinese and Japanese people. Because of this, the number 4 is avoided in floor and room numbers in some Chinese and Japanese hospitals, and in some Chinese and Japanese restaurant telephone numbers. In addition, the mainland Chinese airforce avoids the number 4, but uses other numbers, to designate its military aircraft, apparently because of the superstitious association between 'four' and 'death'."

The study by Phillips and his co-authors finds that cardiac deaths peak on the fourth of the month for Americans of Chinese and Japanese descent, and that this pattern is not seen among whites. The study used computerized U.S. death certificates to examine more than 200,000 Chinese and Japanese deaths, and 47,000,000 white deaths, from 1973 to 1998.

Conan Doyle suggests that Sir Charles Baskerville was particularly susceptible to a stress-induced heart attack because he had a chronic heart condition. If Doyle's medical intuition was correct, deaths from chronic heart disease should display a particularly large fourth-day peak. Sir Charles Baskerville's superstitious fear of an avenging spectral hound was shared and reinforced by his neighbors. Similarly, Chinese and Japanese superstitious fears are likely to be stronger where they are reinforced by large Chinese and Japanese populations.

Phillips's evidence supports both of these expectations: For U.S. Chinese and Japanese, there are 13% more cardiac deaths than expected on the fourth of the month. This fourth-day increase is still larger (27% above expected) in California, where Chinese and Japanese populations are concentrated.

Phillips and his co-authors tested nine, alternative, non-psychosomatic explanations for their findings, for example, the possibility that, on the fourth, Chinese and Japanese might change diets, increase alcohol consumption, refuse medicines, or overstrain themselves. Phillips and his co-authors concluded that their data suggest a link between psychological stress and heart attacks. "Our findings are consistent with the existence of psychosomatic processes, with the scientific literature, and with a famous non-scientific story. The Baskerville effect seems to exist both in fact and in fiction, and suggests that Conan Doyle was not only a great writer, but a remarkably intuitive physician as well."

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