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Listed below are links to weblogs that reference CSI MEDBLOGS: FRAUD IN VIENNA! YUSHCHENKO’S NEW HOLIDAY MOVIE: “A ZIMPFER FOR CHRISTMAS” :

» Code Blue Blog: Top 10 Reasons Why Yushchenko Wasn't Poisoned from The Big Picture

Dr. Boyle at CodeBlueBlog raises "good questions":http://codeblueblog.blogs.com/codeblueblog/2004/12/csi_medblogs_fr.html suggesting that Yushchenko may not have been poisoned: bq. 3. Being fat-soluble, Dioxin would be absorbed by man... [Read More]

» Was Yushchenko Poisoned? from Jay Reding.com
CodeBlueBlog takes a look at the evidence and concludes that there's something fishy going on with the dioxin poisoning story. Indeed, the evidence presented does seem to warrant that conclusion. If someone were going to try to kill Mr. Yushchenko, why... [Read More]

» Yuschenko and Dioxin - yes, no, maybe, who knows? from Hyscience
Both discussions are very interesting, with Medpundit providing us with a description of acute dioxin poisoning which she believes fit Yushchenko's symtpoms "to a tee," and CodeBlueBlog providing us reasons why he doubts that dioxin is behind Viktor Yu... [Read More]

» Viktor Yushchenko Poisoning—Is It All A Fraud? from OpinionBug.com
I just read Dr. Boyle's column refuting the Rudolfinerhaus clinic's assertion that Viktor Yushchenko was poisoned with dioxin. Dr. Boyle's refutation of their claims is simply stunning. It looks as though we're back to square one: CodeBlue... [Read More]

» Re: Yushchenko from Solomonia
You know, the guy with the face. The guy at CodeBlueBlog isn't buying the dioxin poisoning thing. Like I know. Interesting, though.... [Read More]

» CBB still skeptical from blogs for industry
Dr. Boyle smells a rat, but not dioxin. I'm still evaluating the data. Mostly I'm finding the quality of the science reporting to be maddenly poor. Background: This weekend, Doctors associated with Viktor Yushchenko's treatment in Vienna annouced th... [Read More]

Comments

rhodeymark

"However, increasingly, with all the questions (especially regarding alcohol consumption)"
I thought it was bad sushi, comrade. Stick to the real script, eh? Must be some nasty Wodka to give that sudden chloracne after a presumed lifetime of tippling. Methinks you bang your drum (while operating hi-hat with armpit and blowing kazoo) a little loudly at this stage of the game. Your "debunking" has the same stench of bad theater you claim to be sniffing out.

Eric Wilner

A couple of quibbles, offhand...
First, while I don't know what dioxin smalls like, I do know that not all chlorine compounds smell anything like chlorine... nor like anything for that matter. Saran wrap, prior to the recent reformulation, was actually made fron saran, which is primarily polyvinylidene chloride -- and it's pretty odorless (though noted for not dissolving in soup). Chlorofluorocarbons (Freons) tend to be nearly odorless, too (at least, the ones that used to be in common use).
Second, just because something is hydrophobic doesn't mean it can't be hidden in soup, as long as the soup has some fat content; the existing oil slicks in the soup could contain any fat-soluble substance. (Hiding a fat-soluble poison in the fat in a soup might imply more than casual access to the soup during preparation.) The last bowl of chicken soup I ate certainly had little fatty oil slicks floating around on the surface, and I didn't find this alarming.

CodeBlueBlogMD

rhode:

If you scroll back a little, I spend a lot more time in previous posts describing the link with alcohol ingestion via pancreatitis.

As I have said many times, if you take the end known results (the signs and symptoms of the illness) and combine those with the known clinical course -- as we've been given -- and attach probabilities as to the CAUSE, then poisoning is low on the list of differential diagnoses.

Pysicians face these kinds of "mysteries" every day in the ER. If Yushchenko walks in and has pancreatitis and says he was out at a big dinner last night and then develops multiple complications, you would be committing malpractice to diagnose him with and treat him for Dioxin poisoning. Until we have data. They say they have data. If they would just SHOW us the data I would say: "Okay, an unlikely thing occurred to cause this illness." I have no problem with that.

But this past weekend's performance was strictly a put-on, make no doubt. Yushchenko went all that way and created all this media attention to GET HIS BLOOD DRAWN for a supposed "new" test to show Dioxin poisoning. His blood could have been drawn anywhere -- they shipped it OUT to Amsterdam!

CodeBlueBlogMD

Eric:

The points I raise are holes in the story. A story that is AT LEAST partly concocted and staged. Maybe a fistful of greasy Dioxin smells like tomoatoes and goes down like butter, but there are too many inconsistencies and contradictions.

Besides, Katerina smelled it on his breath HOURS LATER, right? So it had to have some lasting aroma and flavor!

Mango Dreams

Hmmm. You're a radiologist (so you say). Not a toxicologist, not an ER doc. A radiologist. And this makes you an expert on dioxin poisoning how?
Dioxin is nothing like chlorine, comrade. Not in taste, odor, consistency, or any other characteristic. It dissolves in fat, so that a fat-based soup or any other fat-based food might serve.
Your diagnosis of rosacea is good for comic relief.

You may be a great guy in real life, smart and wise, but on the blog you come across as something else.

CodeBlueBlogMD

People are pretty hung up on the chlorine and fat- soluble issues, I see. Those really are minor points, come on. I threw them in there really because of how casually Zimpfer just assumes one can get Dioxin into someone's dinner, and that was juxtaposed with the ridiculous claim by Yushchenko's wife that she smelled "poison" on her husband's breath hours later.

Not many people have complete expertise in everything, but I have thousands upon thousands of hours of study in science, multiple degrees (the equivalent of 2 PhD's), twenty years of experience -- and I did the research, so what else do you want from a blogger, eh?

As for Rosacea, you can laugh at me, but right back at ya -- becuase you're wrong. It certainly could be rosacea (as I have explained many times in previous posts) which can come on in explosive fashion and be extremely disfiguring.

Most importantly, my friend, it is a COMMON problem and there is an old saw used for those who simply do not know enough math to understand statistics and probabilities and it goes like this:

It is MUCH MORE LIKELY that you will see an uncommon manifestation of a common disease than a common manifestation of an uncommon disease.

Thanks for stopping by.

nikita demosthenes

The symptoms of "chloracne" from dioxin poisoning are consistent with Yushchenko's condition.

Many commentators have been saying this for close to a month now.

The fact that it took doctors a long time to come out and actually announce this is consistent with my experience with ... doctors. (And would be especially true in a case of the attempted poisoning of a public official in the midst of an election battle - like this case).

For the symptoms of "chloracne" from dioxin poisoning, see, for example, here:

http://nikita_demosthenes.blogspot.com/2004_11_28_nikita_demosthenes_archive.html#110186226265596130

(Scroll down for the medical description of "chloracne" from dioxin poisoning).

CodeBlueBlogMD

Acne is a SIGN not a SYMPTOM. Signs, in medicine are end-results. Because of this, they can be deceiving when trying to make a diagnosis -- becasue many pathophysiologic pathways can lead to the same signs.

I saw those Google images of chloracne a long time ago and I never thought that the blackheads and pimples shown in those images resemble Yushchenko's facial lesions.

Pardon my saying this again (I said it above) but:

It is MUCH MORE LIKELY that you will see an uncommon manifestation of a common disease than a common manifestation of an uncommon disease.

So I look for COMMON reasons for whatever I find FIRST. Then, if data prove me wrong, I move to the unl;ikely diagnosis.

I AM NOT SAYING YUSHCHENKO COULD NOT HAVE BEEN POISONED WITH DIOXAN.

I AM saying it is -- and remains -- unlikely...a position one is FORCED to take by logic, especially when you have to treat patients.


ali

i think one can logically deduce from Dr. Boyle's summary at the top that the poisoning is a hoxa. 3 and 4 disprove it and 2 shows they are doing a song and dance routine to avoid the issue. Even if commenters here are correct about one point, the other nine seem to build a tough case against the dioxin poisioning.

nickpicker

Here's another angle - the Yushchenko posse (incl. bought-off medics at the Rudoflinerhaus, if not for the 15 minutes) claims "they" wanted to poison him. To what effect? To kill him? To disfigure his face? Given the largely varying opinions on the lethality of dioxin we have at least two options: (1) "They" wanted to kill him, but failed. (2) "They" wanted to disfigure his face, and succeeded. But wait, what about other options? (3) "They" took into account killing him, but a disfigured face is nice as well. (4) "They" wanted to let him die later, but unfortunately the disease broke out prematurely.

In whatever way you turn it, the whole setup smells like a beweisorgie. There's just too much signs hinting at evil, dark forces *cough* Yanukovich *cough* that you better believe the opposite. Russian intelligence, Ukrainian intelligence, Putin and gang causing that much noise to take Yushchenko off the track? Give me a break.

Hyperias

I followed a link here hoping to pick up some info on this situation, but I only made it halfway through the post before I gave up. You've got some kind of axe to grind - personal or political - I don't know. The post reads like something I read on Daily Kos that "showed" the CBS Bush National Guard memos were "probably" genuine. Make a big deal out of minor inconsistencies and omit a couple of facts and bingo! -- you've got yourself a new conspiracy theory.

I do however agree with your old saw that an uncommon instance of a common problem usually beats a common instance of an uncommon problem - but I think you've got your definitions mixed up. Dioxin poisoning from the envirionment is surely uncommon -- unless you happen to live in an environment where somebody might want to poison you with dioxin. That changes the odds. And that's the issue, isn't it? We're not talking about some kind of naturally occuring life style disease here, although that may turn out to be the case. The charge is attempted murder or disability. Your uncommon/common old saw doesn't cut that wood.

michael edelman

Ah, the comedy that ensues when amateurs try to play medical detective...

Yushchenko’s symptoms mirror what's been seen in thousands of cases of dioxin poisoning from industrial sources.

Dioxin doesn't smell like chlorine.

And even a freshman chemistry student knows how to suspend a hydrophobic compound in water by using a surfectant.

JR

It might be of interest in this connection that the amazing Dr. Zimpfer, who the MSM has largely implied is in charge of medical matters at the Rudolfinerhaus clinic, was at least until late in fact the president of the clinic's supervisory board: that is, in effect, an administrative officer. The actual medical director was until last Thursday one Dr. Lothar Wicke. One day before Viktor Yushchenko arrived for the latest alleged round of tests that miraculously seem to have resolved the medical mystery that two earlier visits to the clinic at the height of his illness could not, Dr. Wicke resigned. Since Viktor Yushchenko first checked in to the Rudolfinerhaus in early September, Dr. Wicke has persistently maintained that the diagnosis of poisoning is scientifically unfounded. For his trouble, he has by his own account been the object of threats coming from Yushchenko's entourage - in at least one case apparently relayed by Dr. Zimpfer - designed to encourage him to keep quiet or retract his opinion. In October, he was assigned an armed guard by the Viennese police. For more on "The Strange Case of Dr. Wicke", see here:

http://trans-int.blogspot.com/2004/12/strange-case-of-dr-wicke-or-questions.html

Pythagoras C

In further evidence supporting CBB and refuting his detractors, the clinical data on chloracne appearing in Nikita's own blog strongly argues against the hypothesis that the condition could have arisen one day after eating the contaminated food:
"Chloracne is a rare acne-like skin condition caused by certain toxic chemicals including the dioxins. It develops A FEW MONTHS AFTER swallowing, inhaling or touching the responsible agent." (quote from http://nikita_demosthenes.blogspot.com/2004_11_28_nikita_demosthenes_archive.html#110186226265596130 ; capitals are mine)

Pythagoras C

Some of CBB's detractors (such as Hyperias above) appear to imply that VY's constellation of signs & symptoms is a common presentation of dioxin poisoning. VY's primary diagnosis, however, in September was ACUTE PANCREATITIS, a condition NOT known to be associated with dioxin poisoning. How do supporters of the dioxin theory account for pancreatitis?

Truth Teller

This quote from the last book of the Tanach may be relevant to this case. It is related to corruption by politicians and leaders seeking power without an accompanying faith in a higher force.

Malachi 2:3

"Behold, I will corrupt your seed, and spread dung upon your faces..."

Edward Teague

1. So dioxin poisoning only produces chloracne effects on the the face, ears ? Nowhere else?
2. I haven't been poisoning anyone recently but if I did, I really do believe that there are a few easily obtained, relatively untraceable chemical routes I might just consider.
3. If they wanted to kill him , why didn't they just shoot him - that's the usual method in those parts.

xox

hi..
well if it s not dioxin, what was?

dabrick

Let me take a bit of time to dispute some of your arguements.

As an expert on dioxin formation in comubustion systems, I have been involved in numerous scientific studies on the chemistry, formation, analysis, and effects of dioxin on living systems and the environment. So let's take a couple of your arguements step by step.

YOU SAY "Dioxin is a chlorine-based fat- soluble compound."

FACT: True so far.

YOU SAY: "Chlorine stinks.....(Dioxin is)..a chemical that .....stinks like Limburger cheese left all day in the dry sauna."

FACT: Dioxin has no odor. First, in order for a compound to have an odor, it needs to have some degree of volatility (volatility, simply put, is the ability of a compound to turn into a gas, allowing it to reach our nose and be smelled), and dioxin has is non-volatile. Second, although I doubt any odor studies have been performed (or can be performed due to its non-volatility), the structure of the compound would not be conducive to sensitivity by our odor receptors.

Lastly, just because something is cholrinated does not mean it going to smell like your swimming pool - think about table salt (sodium CHLORIDE), which has no odor. Plastics made from PVC (after residual vinyl choloride has leached out)have no odor, and somebody else mentioned Saran wrap has no odor.

YOU SAY: "Dioxin doesn’t dissolve in water... chemical that stands out in water like an oil slick."

FACT: You're right to an extent on solubility in water, however, solubility is a matter of degree. Dioxin is very slightly soluble in water, just as are other chlorinated compounds like PCBs, PVCs, etc. However, it's water solubility is not the issue. An account in the "Australian" (which I found by Googling "Yushcenko", "dioxin" and "soup") said the dioxin was "probably given to him in a creamy soup". Creamy soup. Hmmmm... cream, fat, fat-soluble, duh!!

Also, we're not talking massive quantities here. I haven't done the math, but from the accounts I've read, I suspect the amount of dioxin administered is in the miligram range (a miligram is 1/1000th of a gram, or about a couple of grains of salt) so indicating it would form a slick indicates your lack of knowledge of the subject.

YOU SAY: "Rudolfinerhaus had to send the blood samples to another hospital/clinic in Amsterdam to get the answer" I believe your implication was "how come they couldn't do it themselves?"

FACT: Dioxin analysis is a highly specialized field, requiring specialized equipment (i.e., high resolution gas chromatograph/high resolution mass spectrometer), as well as the expertise to conduct the analysis. There are only a handful of labs in the world that can conduct this analysis, and even fewer that can conduct it well (there is not much call for dioxin analysis and the capital investment is high, so it makes no commercial sense to open a lab on every corner). So, it would make perfect sense for any clinic or lab to send their samples to one of these handful of labs to conduct outside dioxin analysis.

I'm not going to attempt to research any of your other points - but I can speak as an expert on the above. But the fact that you've gotten these so wrong leads me to doubt the credibility of your other points.

Next time, do a bit of research before you start posting.


Pythagoras C

dabrick, you are correct on some chemical aspects of the story. Yes, TCDD is indeed odorless, and Katerina Yushchenko, who "smelled poison on his lips", should be kindly informed about this. Also, yes, TCDD can be dissolved in a fatty soup. However, since you are so critical of CBB and you claim to "...have been involved in numerous scientific studies on the chemistry, formation, analysis and effects of dioxin on living systems", here are some questions for you:
(1) Are there any reported cases of acute pancreatitis (which VY had) due to TCDD poisoning?
(hint: don't spend too much time searching for this)
(2) How long after TCDD poisoning is chloracne starting to appear? Could VY have developed it next day after the Secret Service soup?
(hint: for the case of highest TCDD blood levels reported, see
http://ehp.niehs.nih.gov/docs/2001/109p865-869geusau/abstract.html?section=environmental )

dabrick

Let me take them backwards --

(2) "How long after TCDD poisoning is chloracne starting to appear? Could VY have developed it next day after the Secret Service soup?"

Obviously (and furtunately) exposure to high TCDD levels is rare. The exception to that is the accident that happened in Seveso, Italy in 1976, where an industrial accident exposed the town to high dioxin levels.

According to several accounts I've found by Google'ing "seveso" and "chloracne", some immediate effects were noted, particularly in children:

-- (from http://www-unix.oit.umass.edu/~envhl565/hot/hot/seveso.html) -- "The chloracne was the only adverse health reaction documented immediately following the accident"

--(from http://www.getipm.com/articles/seveso-italy.htm) -- "The first sign of health problems, burn-like skin lesions, appeared on children a few hours after the accident."

So yes, effects can be noted immediately after exposure. Keep in mind, the Seveso exposures were inhaled, not ingested, and were not as severe as suggested here.

(1) "Are there any reported cases of acute pancreatitis (which VY had) due to TCDD poisoning? (hint: don't spend too much time searching for this."

I won't, because I know the body of knowledge on dioxin exposure is, fortunately, quite limited. With good reason, we generally don't expose people to high levels of poisons, then conduct epidemological studies to note effects.

Are there reported cases of acute pancreatitis due to TCDD poisoning? I'll agree - quite possibly not (BTW - no matter what Google, Inc. wants you to think, the whole body of scientific knowledge can't be found by plugging some terms into Google). However, how many cases of ingested dioxin poisoning are on record? You noted one in the reference you provided (although the route of exposure was indeterminate, and I'm having trouble comparing levels since the news reports I can find on VY don't provide enough detail to allow comparisons). If there were 50 more cases, would pancreatitis be noted in any? I don't know, neither do you.

Note one thing, however. Although there does not appear to be proof of TCDD pancreatic toxicity, there is at least one case of pancreatic carcinoma after exposure, poteitially indicating at least some accumulation in that organ. At Seveso, a 55 year old woman "died from pancreatic adenocarcinoma 7 months after the explosion" (http://www.cdc.gov/mmwr/preview/mmwrhtml/00001310.htm). Obviously, this is VERY annectdotal (it's a single case and who's to say it was the dioxin that caused the cancer?), but if we want to stretch our imagination......

kyan gadac

The diagnosis of pancreatitis may have nothing to do with dioxin poisoning. Pancreatitis commonly occurs after a large meal and a bout of drinking. Precisely the reported activity of VY on the night in question. The smell that his wife detected on her husband's breath may well have been a result of keto-acidosis, a symptom of high sugar levels seen in diabetes. Diabetes is a common sequelae of acute pancreatitis (the pancreas is the source of insulin) .
However AFAIK pancreatitis does not produce acne like rashes. So the diagnosis of pancreatitis does not rule out dioxin poisoning. It may in fact be a perfectly reasonable primary diagnosis in this case.

I'd also note that dabrick's reference(above) to accounts of acute dioxin poisoning states that both patients had 'non-specific gastro-intestinal symptoms'. Which leads me to conclude that the diagnosis of pancreatitis may be wrong, rather than the diagnosis of dioxin poisoning. Which also explains why it took months to reach a 'correct' diagnosis.

Pythagoras C

Thanks to dabrick for a thoughtful post. I am here responding on the issues he discusses on chloracne temporal profile and on pancreatitis.
Thanks to CBB for brilliantly developing an exciting theory for VY's ailments. I am here summarizing and building on his hypothesis.

CHLORACNE TEMPORAL PROFILE
Halogenated chemicals such as TCDD can generally cause 2 types of skin reactions: photocontact dermatitis and chloracne. The former can develop very fast, does not look greenish and is apparently the type of rash observed acutely after TCDD poisoning. Chloracne, which appears as reddish and greenish skin lesions, is slow to develop because it requires keratinocyte hyperplasia, hyperkeratosis and abscess formation, processes that generally take at least weeks to develop.
(For comprehensive discussion, see article by Yamamoto & Tokura, linked at pubmed: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12850300 )

VY reportedly developed a rash with greenish areas only days after his alleged poisoning on Sept. 5. I cannot totally rule out that chloracne took such a clinical course, but it would certainly stretch the limits of biological plausibility, something that should at least be critically addressed by medical experts and legal investigators.

The other problem with VY's "chloracne" is that its exact appearance changes by the day. See, for example, a good collection of recent VY photos at: http://cnn.netscape.cnn.com/ns/news/photosearch.jsp?cap=Yushchenko .
Significant daily changes are incompatible with the histopathology of chloracne and my guess is that they would not be observed clinically in a TCDD case.

A much more plausible explanation for the apparent rapid changes in the color characteristics of VY's rash is that they do not represent changes in chloracne but are the result of make-up applied to cover a reddish-looking rash (which could have any among a variety of causes, including alcohol-related rosacea).

PANCREATITIS
Everyone apparently agrees that acute pancreatitis is not a recognized complication of TCDD poisoning. Although an atypical case cannot be totally ruled out, the fact remains that pancreatitis argues against the diagnosis of TCDD poisoning.
As for the reported case of death from pancreatic cancer 7 months after TCDD poisoning, the time interval is incompatibly short with the natural history of cancer and it can safely be assumed that the cancer predated and was not caused by the poisoning.

MOST LIKELY DIAGNOSES, ASSESSMENT AND SUGGESTED PLAN
(1) Pancreatitis, most likely due to excessive alcohol use, and
(2) Rosacea (prominent, as expected, in nasal and malar areas) due to a combination of stress and alcohol.
Both diseases are common and their relation to alcohol (not necessarily at overtly intoxicating levels) is well established, as CBB has correctly pointed out.
A greenish make-up would be a logical choice to cover an embarrassing reddish rash. Allegations of poisoning would be an obvious tactic for a campaigning politician keen to turn an embarrassment into a powerful political weapon in a crucial election. As soon as somebody suggested "dioxin", all that the VY entourage had to do to "prove" poisoning was to find a little TCDD and add a drop in a blood sample collected by his private doctor.
There are 2 simple medical measures to resolve the puzzle:
(1) VY must be examined by independent doctors. Most importantly, it must be determined whether the greenish color represents skin lesions or is the result of make-up.
(2) VY must give new blood samples for TCDD levels, to be collected and handled by independent and reliable medical personnel.

Pythagoras C

kyan, you raise excellent diagnostic points. Note, however, that there is publicly available data convincingly showing that VY had pancreatitis. See the medical certificate from his first visit to Rudolfinerhaus:
http://www.razom.org.ua/en/news/2357/
Of particular note:
- lipase 125 (normal 7-29) (amylase not given)
- Spiral CT: "pancreas intermittently massive without clearly defined edges".
The #1 diagnosis he is given is: "Acute pancreatitis with interstitial swellings, II degree". I see no reason to doubt it.

Now if the diagnosis of alcohol-related pancreatitis is correct, we still have to explain the rash. Rosacea, which can produce a variety of (reddish) facial lesions, is a well recognised complication of excessive alcohol intake. Stress (which VY undoubtedly had) is considered a triggering factor for rosacea. Whereas I am not aware of the frequency of simultaneous pancreatitis and rosacea, both are common sequellae of alcohol. As for the greenish appearance of VY's rash, I believe (as I wrote above, see photos at http://cnn.netscape.cnn.com/ns/news/photosearch.jsp?cap=Yushchenko ) that it is more compatible with make-up application rather than chloracne.

dabrick

Some excellent deiscussion!! Much more thoughtful and logical than the initial posting here!! Thank you.

I will let you MD-types argue the other potential causes for the symptoms shown by VY - I'm not an MD nor do I play one in a Blog. I'll try to stick to the dioxin side of the discussion.

I'll repeat myself on the body of knowledge on acute and extreme dioxin poisoning - it is EXTREMELY limited. Dioxin is formed in combustion sources at very low levels (pg/m3), and it's presence in the environment is quite low (that's not to say it is of no concern). Consequently, most studies conducted to date have focussed on long-term, low level effects.

One thing I'll completely agree on - if you want to kill somebody, poisoning with dioxin is about the dumbest way to do it. It's persistance in the body makes it amenable to analytical techniques, once you know what to look for. There just aren't many sources of dioxin for such use, expediting tracking its acquisition. It's never been known to be fatal (at least not immediately).And finally, handling it can be dangerous to the poisoners.

But there are dumb criminals out there (see www.dumbcrimninalacts.com for some entertainment). One of the articles that Pythagoras C referenced (the highest dioxin levels recorded in humans) indicated that while this woman's exposure route could not be determined, it was possible that she was poisoned deliberately.

Have at it guys!! Keep the discussion thoughtful.

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