CodeBlueBlog: CSI Medblogs: Poison, Yushchenko, and the Birth of a New Ukranian Comedy Duo

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CSI Medblogs: Poison, Yushchenko, and the Birth of a New Ukranian Comedy Duo

A New Martin and Lewis?

Victor Yushchenko was treated for his "poisoning" at Rudolfinerhaus, one of Austria's "finest clinics," and press releases continue to emanate form this clinic that brags about having "the atmosphere of a five star hotel."

I guess the staff is reading this blog because yesterday they amended their previous news release where they said, so definitively (italics and bold mine):

This is no longer a question for discussion,” Dr Korpan said. “We are now sure that we can confirm which substance caused this illness. He received this substance from other people who had a specific aim.

In today's backtrack, the Rudolf House comedy team of Korpan and Zimpfer back off their irritated call for an end to questioning and admit that, well, maybe there still is room for discussion:

"We are still investigating the hypothesis of poisoning," Zimpfer said. "However, we have not found any indication that a chemical or biological substance has been employed."

Illogical Regressions

Oops. Is that a retraction? Or a backtrack? The poisoning diagnosis has regressed from a conclusion to a hypothesis. Are they watching their words here? Probably. Let's look at the meaning of "Hypothesis":

Hypothesis:

A tentative explanation or idea about how things work

A hypothesis guides you in further work to get a better answer

Not very sure any more, are they? There's more:

Korpan, appearing at the news conference yesterday with Zimpfer, said doctors were working on three poisoning theories, including one involving dioxin. All theories being pursued involved poison, he said, adding, however, that "we don't have any evidence of what caused the illness."

Uh-oh we've lost more ground here. Now, they admit, they don't have any evidence of what caused the illness. Hmmm...Maybe that's how they teach it in Austrian medical school. You know...start with the least probable mechanism (for which you admit having NO EVIDENCE) to explain the data (like pancreatitis) and work backwards to try and make your guesswork fit the clinical data.

Unfortunately, Yushchenko isn't making it any easier on the team of Korpan & Zimpfer. Newsday says:

Making the mystery even more difficult to solve was Yushchenko's refusal to let doctors take biopsies of his facial tissue - he reportedly said he did not want to have his face bandaged while campaigning

Now all those who accuse me of "slandering" Yushchenko with the diagnosis of alcoholism: can any of you explain the obviously untrue--even ridiculous--refusal of a skin biopsy? A biopsy that might put all the speculation to rest and prove once and for all exactly what his skin condition is???

A Scarlet Letter?

As I've said before, a skin biopsy is the size of a pencil eraser and can be covered with a small, flesh-colored bandage. I guess Yushchenko figures that if someone sees the bandage they'll think something is wrong with him?

So more comical interludes from the gang at Rudofinerhaus -- what does Rudolfinerhaus mean in Austrian anyway...Comedy Club?

Posted by Doctor CBB on December 09, 2004 at 05:48 AM | Permalink

Comments

Doctor,
There is nothing comical about not having any evidence yesterday and having it today, if I get your chronology correctly. Secondly, when I compare the two Yushenko pictures three months apart, and someone tells me that the reason for that is alcoholism, guess who sounds like a clown?

Posted by: Ivan Lenin | December 09, 2004 at 03:52 PM

Mr. Lenin:

It isn't my chronology. On December 8th The U.K. Times reported:
MEDICAL experts have confirmed that Viktor
Yushchenko, Ukraine’s opposition leader, was
poisoned

This unsupported asseveration was carried as fact by the media and press worldwide and many blogs then picked it up and proclaimed that the mystery was over. Yushchenko had indeed been poisoned.

Closer reading of the article revealed no evidence or proof. On December 9th the same MD's who made the statement on December 8th said:

there's no conclusive evidence about what
caused the ailment

I cited Newsday, above, for the story on the 9th, but it was widely reported. Oddly,however, none of the media or the bloggers (who were quick to agree the case was closed and that V.Y. had been poisoned) followed up today to point out that the docs in Austria retracted their previous assertions.

Are the docs being coy? Or were they chastised by their superiors for stating facts where none existed? You got me.

I think the way the story has come out of Rudolfinerhouse is extremely comical. It certainly makes no sense to me, as a physician, and I can't imagine doctors getting away with so much nonsense in the U.S., say, if it had been John Kerry who had suffered a similar problem.

My impression is that everyone REALLY wants to believe that Yushchenko WAS poisoned. I guess it fits nicely in an Oliver Stone way.

Of course the real world hardly ever works that way (conspiracy, intrigue, poisoning, Mission Impossible scenarios...). There is almost always a logical, less flamboyant explanation.

It is still true, and I admit it in several places, that Yushchenko COULD have been poisoned nonetheless. There is NO evidence, and there are no cogent cases out there, that I have seen, that can explain how V.Y.'s ailments came about through a poisoning. But it surely is possible. Just highly unlikely. But unlikely things have happened before, and I don't bat an eyelash when they do.

Because I am trained to take the medical data (signs, symptoms, and diagnostic exams)that exists and then list, IN THE ORDER OF LIKELIHOOD, FROM MOST LIKELY TO LEAST LIKELY the possible reasons for the illness I am faced with.

It is only in this way that one is able to employ the therapeutic methodologies that are most likely to help the patient. Anything else is malpractice.

What I did was to take all the information I could find, in the given reports, and try to put everything together into a most likely scenario.

Your statement about looking at the pictures of V.Y. and KNOWING (by what authority and training?) that this was not caused by alcoholism, is, to me, part baffling and part frustrating.

I realize that the way my blogs are written creates, sometimes, a redundant, overlapping and crosshatched story; however, if you read all my posts you would see that I did not say alcoholism caused V.Y.'s facial grotesquery.

I said that drinking alcohol is the most common way to get pancreatitis (which he had) and that alcohol consumption can also set off explosive rosacea (see my photos)that, when covered with pancake make-up, could explain V.Y.'s disfigurement.

I also said that if I were a secret agent having V.Y. over for dinner, and I wanted to kill him, I think that that LAST method I would employ would be to lace his food with poisons -- almost ALL of which can be traced right back to the baked potatoes.

And, HE DIDN'T DIE. If I were really DUMB enough to poison the man I WOULD HAVE POISONED HIM. At least he would be dead -- I mean I'm going to get caught anyway.

But Viktor is alive. And he won't submit for the skin biopsy that would solve the big mystery. And his doctors sound like they don't have a clue.

Look, I realize that there is going to be one monster plate of crow out there for me to eat if someone comes out with a tissue diagnosis that shows V.Y. was indeed given a Dioxin turkeyburger; however, I would make the same diagnosis tomorrow if presented the same evidence, because when you bet on the favorites you win more frequently. And in medicine, in the U.S., that means your patients do better -- and you get sued less frequently.

Thanks for visiting my site.

Posted by: | December 09, 2004 at 05:16 PM

I hope you are a better physician than you are a lawyer. First of all, in order support the claim that someone "backtracked", it would have to be the same person making both statements, and it was not. It was Dr. Korpan who said Yushchenko was poisoned conclusively, and it was Dr. Zimfer who said they were still exploring the hypothesis.

Second, if the hypothesis is still being explored, then obviously that means poisoning has not been ruled out. The fact that they don't have the evidence to support the poisoning does not mean he was not poisoned. If they said "the invesigation was thorough and complete and we were unable to find any evidence of poisoning", that would be one thing. But they didn't say that. What they said was, they were not finished with the investigation. Therefore, the fact that they did not have evidence at that point in the investigation to support poisoning means nothing more than they aren't finished investigating, and that it is entirely possible they will still obtain the evidence.

Additionally, they can only obtain evidence of poisoning if they do the right tests in order to obtain the evidence. If I remember the article correctly, they said that dioxin testing had not been done initially, because his symptoms weren't that bad. So, had he been poisoned with dioxin, they wouldn't have the evidence because they didn't test for it. I saw nothing illogical in any of the articles or statements, only in your blog.

Having said that, and not being a physician myself, I am not saying he was poisoned. Looking at his list of symptoms, I guess to a lay person like me, it could sound consistent with alcoholism as well. So, Mr. Physician, let me ask you something on the one thing that you should be an expert on, which is obviously not logic. Are you telling me that alcoholism would produce the severity of these symptoms in a mere five months? That a nice looking man like Yushchenko would have a totally lesioned face with poc marks so as to make him unrecognizable within only five months? I would be interested to know. I never heard of it happening so severely so quickly. I hope I can count on you medical analysis more than your logical analysis or your legal analysis. I look forward to your answer.

Posted by: Deborah Weiss | December 10, 2004 at 01:34 AM

Also, now that I read your comment, it's funny how you are are quick to point out that people should read your blogs and language with precision, so as not to confuse your ideas or blur them together. Yet, when you read other people's articles and statements, you smush them altogether as though everyone is one person being hypocritical. And, you also took things out of context, which you obviously object to people doing when citing you.

Second, when you say that poisoning doesn't happen in the "real world", I take that to mean that you think your world and only your world is the "real world". You are very fortunate: you live in a free country, I presume. However, in the Ukraine and in old Russia, which is what Putin is trying to make the Ukraine again, it was NOT uncommon to be poisoned.

Are you a surgeon? I believe different types of professions attract different types of people, and different specialties within professions, too. It's a generalization, but most surgeons I know are very narcisstic and think they are the center of the universe. Sorry to be so mean, but I am forever shocked by people who think that their perceptions, experiences, thoughts, feelings or beliefs constitute either "THE TRUTH" or "REALITY".

Posted by: Deborah Weiss | December 10, 2004 at 01:51 AM

Ms. Weiss,

Korpan said "we don't have any evidence of what caused the illness."
Sounds like a backtrack to me, at least from how he is quoted in the first excerpt.
Not a backtrack to the point of eliminating poison, but from certainty.

I don't think Dr. B. is claiming absolute truth, and I'm sure he'd agree that he's speculating in a way that would be completely irresponsible to do diagnosis on one of his own patients based on a couple of pictures from newspapers reproduced at 72ish dpi on the web plus the press releases of the people who had actually seen the patient, which may well have been mangled by at least one round of translation into English plus the fine job of transcription we expect from the press.

However, speculating from a distance COULD lead someone to consider an alternative hypothesis - and then do the appropriate tests - if they are open to the possibilities. As I understand the situation, the suggestion of dioxin (which strikes me as unlikely, but I'm not an MD either) was also made long distance based on similar sketchy information.

Posted by: Jim Hu | December 10, 2004 at 03:56 AM

An ex-pat Austrian myself, I am happy to say that in my mind the Rudolfinerhaus is _the_ go-to place should I ever need a discreet abortion. :) It is also perfect for other treatments where privacy is desired: disreputable diseases, crazy aunt Helen's predilection for mother's little helpers, and the like.

Had I an actual health problem, I would prefer, say, the U of Vienna's teaching hospital (for most things), or the Lorenz-Boehler (trauma, accidents), and so on.

A few years ago, the Rudolfinerhaus had the reputation of a Betty-Ford-clinic for the affluent, with an add-on wing for the yearly check-ups of rich oil sheikhs. Unless that rep has experienced a sea change since then, I must ask: Why would someone who claims to have been poisoned check into the place when the AKH is a stone's throw away?

Cheers,
Felix.

Posted by: Felix Kasza | December 10, 2004 at 05:25 AM

Would you care to comment on this article?

http://www.msnbc.msn.com/id/6697752/

Posted by: Richard Carrillo | December 11, 2004 at 11:02 AM

First of all I would like to say thanks to the author (sorry I haven't found his name yet - just came here from google search). This is the first place in the net where I see common sense. I disagree with the author about alcoholizm diagnose. But the rest of his logic is correct. And when I "looked" at who "experts" are I have only one question left. How much does it cost to get dioxin (or whatever) poisining diagnose in this "world class" Rudolfinerhaus? :)))

As to the question of Ivan Lenin about clowns ... well I can say that only clown can call himself Ivan Lenin :) Не так ли, Ваня?

Posted by: Plohish | December 11, 2004 at 03:57 PM

Richard C.,

I've added some comments on that and other reports from today. See the trackback Why dioxin? and other recent posts on my blog. Short version: CBB and I may have overestimated the intelligence of the poisoners.

http://dimer.tamu.edu/simplog/archive.php?blogid=3&pid=761

Posted by: Jim Hu | December 11, 2004 at 03:57 PM

The finding of dioxin in VY's latest blood sample(s) (as reported on Dec. 11) is unconvincing. By far the most likely scenario is that his people added some dioxin to the blood samples. Thus both the VY people and the Austrian doctors appeared so certain of "poisoning" already by Dec. 7 (i.e. before the tests), as reported in the ... prophetic London Times article: 'Who poisoned Yushchenko?' http://www.timesonline.co.uk/article/0,,3-1393172,00.html
CBB's theory of alcohol-induced pancreatitis, rosacea, mildly immunocompromised state and viral-induced (possibly Herpes) Bell's palsy is medically rock-solid and continues to be the most plausible in this case. No serious arguments have been presented against this hypothesis either here or elsewhere. Fans of the "dioxin poisoning" hypothesis must also explain VY's severe pancreatitis, a condition never before associated with acute or chronic dioxin poisoning.
VY must undergo new blood tests, with venipuncture, sample handling and lab testing independently supervised in a different, less "private" hospital. Dioxin stays around for years and would be detected if present.

Posted by: Pythagoras C | December 12, 2004 at 09:42 PM

Well, congrats, Doc. Looks like the controversy sold well, and you got your Weblog award. Your hypothesis would have looked more credible, though, if your narcissism had not been so obvious. I am sure you're qualified to find a good shrink who will help you with the problem. I commend you on trying to revolutionize the commonly accepted opinion, but on the authority vested in me by my Party and my People, I recommend more discipline and less adulation by medical students.

You, Plohish, need to get some penis. First, you pick on my misspelling of a city, and now you start with names. Speaking of which, only a sad pedrilo will call himself Plohish, so stick it :)

Back to the question of poisoning: it could be bogus, and it could be faked by Yushenko himself: none of those people are angels. It could be an illness that somehow coincided in time with the election. However, if somebody wanted to do something nasty to him, they've succeeded, despite VY being alive - just like our Doctor succeeded at getting attention, despite failing to prove his claim. Who said they (whoever that is) wanted to kill him? If you are a politician with good looks, making your face look like that is bad enough.

If Yushenko did it to himself for the sake of power, then he deserves it. If it is a coincidence, it's a pretty damn weird coincidence. And if a power hungry stooge did it, there's nothing to be surprised about.

Posted by: Ivan Lenin | December 14, 2004 at 11:43 AM

Ivan...

Believe me I laughed outloud while reading your comment. Thanks. I needed a humerous interlude.

I'll try to find some help. I think I know the answer though...I'll just stop reading the news (and the comments!) because most of the reports about people's illnesses and accidents raise questions for me.

Gotta go with the common opinion. I'll try to remember...

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