MJ asked Mark Alpert:

I'm new to your works (read about "The Six" in the July edition of Goodreads YA Newsletter) and wondered what made you choose Muscular Dystrophy as your character's plight? I have a form of Muscular Dystrophy called Spinal Muscular Atrophy so am always intrigued when authors use it in works of fiction.

Mark Alpert Very good question! As you know, there's a whole spectrum of conditions of this type, and even among people with my main character's form of muscular dystrophy -- Duchenne -- there's great variability regarding symptoms, prognosis, etc. However, one thing is fairly consistent among people with Duchenne Muscular Dystrophy -- they typically lose the ability to walk by age twelve. I wanted my protagonist, Adam Armstrong, to be a teenager who loves football but can't play it except in his virtual-reality game. I also wanted him to have a very poor prognosis -- that is, less than six months left to live -- and as I make clear in the text of THE SIX, this kind of prognosis is NOT typical of teenagers with Duchenne anymore, because over the past few decades researchers have made tremendous strides in treating this kind of muscular dystrophy (through better techniques in breathing assistance, etc.) thus enabling most people with Duchenne Muscular Dystrophy to live into their twenties and thirties (and there are even some cases of life expectancy to the 40s and 50s). But unfortunately in some cases the breathing and heart muscles are severely affected at a relatively young age, and in those cases the prognosis is much poorer. This is Adam's situation, which is why he's facing death before the age of eighteen. I hope this makes sense! Is there anything else you'd like to know?

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