The mystery of sudden deaths
Eng Chee Koon
Wed, Jan 17, 2007
AsiaOne
First, the good news. Doctors say the 10 cases of sudden deaths reported in the last four months are not abnormally high. So, there is no need to be unduly alarmed.
And the bad news? Researchers are no closer to unravelling the mystery of sudden deaths.
While the frequency of the recent sudden deaths has been a worrying trend, experts say this is just a coincidence and it does not signal a looming epidemic.
Professor Edmund Lee from the National University of Singapore's (NUS) Department of Pharmacology told AsiaOne: "There is no epidemic. And it is important to have a perspective of this matter."
In the last fortnight, there were three such deaths - that of NUS don Ananda Rajah who died on Jan 9, 30-year-old Singaporean William Loo last Sunday, and a 29-year-old Malay deliveryman who was found dead in bed on Monday morning.
According to Prof Lee, the number of sudden deaths reported by the Health Sciences Authority (HSA) every year averages about 300 cases. This figure includes both men and women aged between 18 and 60 years old.
Still, it is disturbing to read of otherwise healthy individuals who simply die with no apparent cause. Statistically, this is within expected norms. To many members of the public though, it is scary to know that death can strike one suddenly, like playing a game of Russian roulette.
Nonetheless, several possible explanations have been offered by doctors and experts for this phenomenon.
One theory thrown up is that the victims carried a genetic mutation, which affected the flow of their hearts' electrical activity. In a nutshell, this could result in a situation where they may possibly suffer blackouts, palpitations, or even death if the heart's electrical activity was disrupted.
Called Brugada's Syndrome, this condition was later attributed as the cause for sudden deaths among Thai workers here between the 1980s and 1990s.
Based on this assertion, it goes that the underlying cause of sudden deaths can be pre-diagnosed through DNA tests and an electrocardiogram (ECG). However, Prof Lee warns that this may be fallacious.
"The idea that you can genetically test and pick up the majority of these cases is fallacious. You can, at best, pick up a small minority of people who might go on to have a higher risk of sudden death," he says.
He explains to AsiaOne: "For many cases, it is hard to prove that just because there is a mutation, that it is the cause of death."
Over the past three years, Prof Lee and his team has built up a case file of about 50 people who had died mysteriously with no apparent explanation. This was done in collaboration with the Centre of Forensic Medicine at HSA.
He noted that many of the sudden deaths could also be attributed to a previously undetected heart condition. When the condition manifests as cardiac arrest, the victims succumb but this would be difficult to detect post-mortem because the heart looks normal when examined.
However, he agreed that the research so far has only helped to identify the problem and experts are still far from understanding the cause of sudden deaths.
While that might be of no comfort to those who have lost loved ones to this unexplained occurrence, it is important that the statistics be viewed in a wider context.
Given that we have an average of 300 sudden deaths annually out of a population of four million, the rate of occurrence is extremely low - less than one in 10,000 people.
When this figure is compared with more than 4,200 deaths in 2005 from cancer - Singapore's top killer disease - we can see how it is important to maintain some degree of perspective regarding sudden deaths.
Ultimately, it is important to bear in mind that the probability of sudden death occurring on a scale of epidemic proportions is remote. That fact, in itself, is probably also the reason why the public is shocked and alarmed whenever such cases hit the headlines.
