Fake News

One of the more dangerous catchphrases of the last four years has been the outcry of ‘fake news’. By sowing seeds of doubt into the recesses of readers’ psyches whenever a public statement is at odds with a powerful figure’s own determined narrative, trust in those charged with bringing truth to the populace is undermined. Norms are eroded, emotions heightened, conspiracy theories watered and fed, and communities find themselves in an anarchic state of dizziness and unknowing, harbourless when it comes to the truth.

The concept of ‘fake news’ as a political tool is not, however, new. But we shall return to that in a moment, as this is primarily a medical column. We will permit Marie Antoinette to bridge the gap for us.

There is a profusion of medical conditions attributed to stress. For today’s slightly unusual palette of pathology, we will consider a single severe stressor with its firestorm of adreno-sympathetic chemicals; an outpouring of epinephrine and other neuroendocrine messengers. Several columns ago we explored the role of catecholamines in traumatic brain injury, and the mercurial cardiovascular profile it causes. We know that subarachnoid haemorrhage can manifest on ECG with plunging inverted T waves (so called cerebral T waves) purportedly related to a sympathetic surge and widespread subendocardial ischaemia. The classic myocardial pathology in response to a blast of unexpected stress is Takotsubo cardiomyopathy, that octopus pot ballooning of the heart apex, with its regional akinesia.

Now let us welcome Marie Antionette. Apocryphal as the story may be, it is said that Louis XVI’s Austrian wife, she of the exquisite but ultimately traitorous dress collection, porcelain-skinned beauty, and penchant for elaborate patisserie items, on the night before her beheading in a climactic chapter in the French revolution (which one could imagine to be at least moderately stressful) found her hair turned suddenly, strangely, white. Thus, the sudden greying of hair, in response to stress, has been dubbed the Marie Antoinette syndrome.

Can this happen? Is it nonsense, a device for fiction and bad movies? Or is there some physiological basis behind it?

Hair colour is, of course, derived from melanocytes, which produce a range of pigment combinations, occurring just under the skin. The melanocytes (which produce the melanin) arise from a different part of the hair follicle, in the imaginatively named ‘bulge’, developing from melanocyte stem cells. These stem cells slowly deplete with age, causing normal greying. The bulge is innervated by tiny sympathetic neurons, which assist in normal activation of the stem cells in order to differentiate into melanocytes with hair regrowth. In the presence of a massive sympathetic outburst, however, all the stem cells are activated at once and they migrate en-masse out of the bulge, leaving none to go on with the cyclical process of giving colour to the hair. We know all this only because poor lab mice, once again, have had to suffer the indignity of being bred with a variety of receptors, and given a whole number of stressors (it doesn’t do to imagine them), to explore how natural, and unnatural, greying occurs.

But can it happen overnight? It has certainly been recorded over weeks, in the wake of unquestionably stressful events, and in our mice, three to five hair growth cycles.

Is this relevant for emergency medicine? Perhaps not, but it is worth knowing that both acute, and chronic stress, can have vast and wide-reaching consequences in the human body, in every system, every organ, and should not be dismissed in considering a holistic history.

Marie Antoinette, however, gets the last say here. Her history was brief and ferocious. Married off to the dull Dauphin when she was fourteen, she was, as Hilary Mantel quoted, ‘a virgin in a nest of vipers’. Her enemies were not just among the people of France, but court as well, and she was constantly under attack. As her reign went on, and disapproval of Marie grew, scandal mongering pamphleteers and gossipers began to circulate printed material, accusing her of all sorts of crimes, from the hideous to the sexually bizarre. They were the equivalent of the Daily Mail or perhaps your National Enquirer with a little bit of Fox news thrown in. When the palace tried to counter with factual information it was decried as fake, and political. Denouncement on either side left the rabble unsure of the truth, and once the rabble became hungry, well you know what happened next.

Perhaps Marie Antionette Syndrome is, itself, fake news, but the sooner this phrase is retired, the sooner we can return to more a more cautious weighing up of the information we read.