CodeBlueBlog

CSI MEDBLOGS: AMERSTERDAM SAYS IT'S SO: YUSHCHENKO IS DIOXINIZED

It Was a Zebra After All?

A toxicologist at the Free University in Amsterdam reports tonight that his analysis of Viktor Yushenko's blood reveals:

100,000 units of dioxin per gram of blood fat

And there is widespread talk this may be the highest level ever recorded -- although why that is headline news everywhere is a mystery.

However, toxicologists are baffled -- as was this blog -- as to why any assassin would use Dioxin as a murder weapon. As CodeBlueBlog said, right from the beginning, if we are to assume that there were someone whose intention was to kill Yushchenko, or even disfigure him, in no way could he depend on Dioxin to do either. Said Jean-Francois Narbonne, a professor of toxicology at the University of Bordeaux:

...dioxin -- although a highly dangerous poison that could be administered in tiny amounts -- would not be the assassin's natural weapon of choice

If they wanted to kill him, cyanide or a poison derived from a plant or bacteria would have been far more effective...

When you want to kill someone quickly, you use neurotoxins, substances which attack the tissues of the central nervous system, paralysing the target and stopping respiration and heartbeat.

This announcement does not change, by one iota the way I would approach this case or diagnose this case -- nor should it change the way any reader approaches a similar case or any similar situation in life.

Beginning tomorrow, I am going to show you why. Because the truth is, a diagnostician is obligated to adhere to the most likely diagnosis until that diagnosis is either proven wrong or diminishes in statistical relevance related to the next most likely diagnosis.

If people could learn THAT lesson, they would make better choices in their lives and live better lives. Because Viktor Yushchenko's diagnosis is a Lottery diagnosis. By that I mean that it's like seeing someone on television win the lottery and then going out and spending everything you have on lottery tickets. What happens? You lose all your money.

So I will explain MORE tomorrow -- after I give you a SERIOUS update on the Mary McClinton story. A story I will be getting back to with a sledgehammer, and I may fly to Seattle to confront the doctors at Virginia Mason Medical Center. If you have time tonight read about it here and here. Because I have NEW Information. Information culled by personal investigation. And it is going to get exciting, I think.

What happens if the next time you see a similar case you START from the proposition that this is poisoning? The patient dies from his much more likely disease.

Ducks, Gills, Syphilis, and the Homunculus: The Tangled Bank # 18

Ducks, Gills, Syphilis, and the Homunculus -- what do they have in common? The Tangled Bank!

It is our pleasure to have you at The Tangled Bank, the biweekly sampler of science, medicine, and natural history blogs. Put on your pith helmet and load your neocortex, we're going exploring...

I know you won't believe this, but I have, more than once, wondered what the hell the thyroid and parathyroid glands are doing packed in the impossibly crowded apex of the thoracic inlet. Haven't you? PZ Myers efficiently pieces together the puzzle at Pharyngula, finding the solution in the homology with... fish gills.

If the discontinuities in the brain's homuncular map have kept you up at night, you may finally get some sleep as Tom Stafford at Mind Hacks deals with the distorted little man in all our heads.

10,000 birds singles out a trio of mergansers from that crowd, and now, after reading another entertaining and informative piece on this blog, I can finally answer the question: where do only scoters and eiders dare to tread? You'll have to read to find out. And keep reading.

If you didn't know, there are some who would reintroduce elephants in America (sounds like a new Tony-winning play). Thoughts From Kansas wonders if the Pleistocene species wouldn't feel out of place in a WalMart parking lot -- and by the way, how would the the parking lot feel about underlying elephants instead of Lexus massivus?

Are you feeding your dog a species-appropriate diet? I don't want to shame you, but Christie Keith might, over at Dogged Blog. Well, not shame you, but make you think real hard about tying your affection for science and knowledge of evolutionary principles to the diet of your canis lupus familiaris.

Coturnix takes us on an exegetical voyage (for a blog) meant to reinvigorate the relevancy of the Darwinian methodology. It is well worth reading -- all four parts -- and is quite successful, in my mind, connecting the threads...read it here and here, here and here.

Dr.Jennifer Forman Orth of the Invasive Species Website links everyone's attention to the culling of the  mute swan, a phenomenon which has now seen barriers to eradication "suddenly (and quietly) removed."

I want to personally thank my friends, the medical bloggers, for showing up here  this week -- and we hope they spread the word and return often.

Sumer leaves us with an interesting abstract regarding ultrasound simulators -- a training aid that helps doctors and technologists learn how to recognize important rare fetal anomalies.

Enoch Choi at Medmusings writes about drawing the line on the ledge before getting on the slippery slope. He defends another physician's blog that argued against aggressive euthanasia.

Kevin, M.D. gives us a behind-the-scenes look at a recent press release about an unfortunate executive. It's informative and educative. It's called blogging!

Dr. Charles lets us into his examining room to help diagnose his own...medical paranoia. It's a fate doctors are burdened with, always thinking they just contracted the next horrible disease (the curse of knowledge!).

Consumer-based comparative evaluations of pharmaceuticals make sense. Trapper, at isemmelweiss agrees and shows us one way this is being done.

Luckily, I got a last minute email from Sharon Howard, in the U.K., who was kind enough to grace us with this post that guides as through a brief but highly entertaining and enjoyable tour through the history of medical anatomy art (has anyone written that book yet?).

Our science is punctuated, finally, by fancy -- but it may be as good an explanation as any for the weather in Scotland. Ratty's Ghost spins us the tale.

Due to the blessed intervention of holidays during the upcoming month, the next Tangled Bank will be held in roughly four weeks, on January 12th, 2005, at Coturnix. Forward submissions to [email protected] or [email protected]

And when will YOU host The Bank? Collect important links! Get your name up in lights! Promote science! Link to the cerebral cortex of the net. Visit the Tangled Bank web page for more information.

CSI MEDBLOGS: ATTACK OF THE PUNDITS...CODEBLUEBLOGMD DEFENDS HIS THEORIES

Attack of the Pundits

With a reference by Instapundit yesterday, my post about this past weekend's events at Rudolfinerhaus in Vienna got widespread attention -- and that's okay -- however, many visitors read that one post (or read that and skimmed others) and came away with the wrong message as to my explanation of this case.

I've been posting about Yushchenko's mysterious disease since 11/30/04, before there was much talk about anything except "poisoning."

Since I've taken a few shots by people picking out points and sub-points (and I've even been accused of amassing circumstantial evidence towards conspiratorial theories!) in my discussion, let me summarize my position as I posted it, from the beginning.

Treat This Patient

If you are a physician, in the Emergency Department, and a man comes in saying he has bad abdominal and back pain, how do you approach this as a physician? You take a history, examine him, do the lab work, and then draw up a list of possibilities (in medicine we call this list the differential diagnosis) in order of likelihood from most likely to least.

That's how I approached this case on 11/30/04. Here were the data available:

• 50ish male out for a long dinner develops severe abdominal pain next day
• Four days later the pain forces him to the clinic and now he also has back pain
• Labs show elevated white blood cell count
• CT shows "swelling and inflammation" of the pancreas and liver (as a radiologist, to me this means enlarged liver and pancreatitis)
• He has a malar (cheeks and nose) eruption (see my original post, the eruption was less severe, earlier in his course)

Now, this 50ish male is a well-known figure and HIS proposal to me, as the ED MD, is that he was poisoned. The brief history is all you get -- that's all I got.

Doctors? What is your differential diagnosis starting with the most likely diagnosis first? Answer in unison, please. Alcoholic pancreatitis. No doctor worth his or her examining glove would say anything else as the first choice. You'd put down an NG tube (naso-gastric tube through the nose into the stomach) and admit him. There can be no argument about this.

65-75% of pancreatitis cases are caused by alcohol or gallstones. There is no mention of gallstones in the history or work up. Pancreatitis can be brought on by chronic over-consumption of alcohol or by binge drinking. For the nonmedical people, here is one description of the presentation of acute pancreatitis:

Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant--just in the abdomen--or it may reach to the back and other areas. It may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Other symptoms may include

• swollen and tender abdomen
• nausea
• vomiting
• fever
• rapid pulse

Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.

What I have said, since the beginning is that: Yes, Viktor Yushchenko may have been poisoned, and I would not hesitate to investigate that hypothesis, test it, and believe it; however, until I have documentation, or quantifiable information that I trust, and that indicates otherwise, I am diagnosing and treating this patient for pancreatitis, and my assumption is alcoholic pancreatitis. In MY mind, to treat this patient any other way, given this scenario, would be wrong.

There have been very few revelations in this case that move me off that diagnosis except the report of ulcerations throughout the GI tract, which I stated, without hesitation, does not typically fit my diagnosis.

What About That Face?

As for rosacea, I disagree with all those who have said that it does not look like what Yushchenko has and that rosacea does not progress this rapidly. Rosacea can be explosive, and extremely disfiguring -- and it can be triggered by even one alcoholic drink. In five years of work at major inner city hospitals in Manhattan, I saw several such cases. Again, if you look at Yushchenko's face early on (see here), his disfigurement was much less severe. He had a spidery, red, malar eruption.

I agreed that Yushchenko's face has since transmogrified into something quite unusual and my first suggestion is that he was coating the eruption with pancake make-up; however, for anyone to adduce his facies as proof of poisoning, I would accuse that person of a logical error in trying to make a diagnosis from a clinical SIGN, which can be a common endpoint of many different pathophysiologic pathways.

As I have mentioned several times to commentators on my site, an important maxim for medical students is this:

You are much more likely to encounter an uncommon presentation of a common illness than a common presentation of an uncommon illness.

Chloracne or Rosacea? It's a straight-forward choice for me.

Opera Bouffe

Which leads to the farce this past weekend. I have been rebuffed for being hard on Dr. Zimpfer at the Rudolfinerhaus clinic this past weekend. However, I was expecting him to tell us what test they did and the results. And what did he say? It's poison. Case closed.

I gladly would have written a post describing the mystery, now revealed, as Dioxin poisoning (and a case for the annals, indeed); however, Zimpfer really just kicked us all out of his private clinic with no more quantifiable knowledge than we had when Yushchenko arrived.

And why did Viktor even go to Rudolfinerhaus this weekend? To have his blood drawn? They certainly had no time between Friday night and Saturday morning (when they said they had results to be announced at 1400) to do skin or visceral biopsies and analyze them appropriately. As it is, in that short time, they sent Yushchenko's blood to Amsterdam for some new test that diagnosed Dioxin poisoning (although they implied that his blood levels are normal).

These obvious subterfuges, coupled with Katerina giving press conferences about tasting the poison on Viktor's lips... and the children's choir singing in the background as Yushenko says he doesn't want any of this investigated right now -- I don't know, it just seemed like there was a need for parody.

So, I'm sticking with what makes sense to me, until I have some believable proof that the most likely diagnoses are knocked off their pedestals by the freakish and improbable. But I can accept that if it happens. Capita!

See:  Medpundit

        RangelMD

Last Call for Tangled Bank Submissions -- Medicine, Science, and Natural History

Closing deadline for submissions to the next Tangled Bank (think Carnival of the Vanities for science) is 8 P.M. tonight.

Science, medicine, and natural history -- or anything you have that is intersting and in the evolutionary ballpark, I'm looking at...so send me your links!

If you haven't  seen some of the great science blogs out there start out with Pharyngula or The Panda's Thumb, or the Tangled Bank site itself (click on icon below).

If you remember, send me:

• The trackback
• URL
• Permalink
• Title and a quick sentence about the piece

 

CSI MEDBLOGS: FRAUD IN VIENNA! YUSHCHENKO’S NEW HOLIDAY MOVIE: “A ZIMPFER FOR CHRISTMAS”

A Zimpfer For Christmas -- Directed By Michael Moore?

This past weekend saw the advent of a new Christmas blockbuster short film. The feature involves the hastily set-up and staged visit of Ukrainian presidential candidate, Viktor Yushchenko, to the private Austrian clinic Rudolfinerhaus, where he came to be quickly diagnosed as POISONED -- a diagnosis that previously eluded doctors for months. The morality play was a nauseating piece of frivolity designed to take the heat off Yushchenko who was, at first, dealt with sympathetically by all for many recent medical problems. However, increasingly, with all the questions (especially regarding alcohol consumption) about Viktor's true medical condition, the Ukrainian leader was determined to get this topic off the public’s radar as a new election looms.

CODEBLUEBLOG        STAT            SUMMARY

If you don’t want to read the whole post

Top Ten Reasons Why This Weekend’s Yushchenko Diagnosis is a Fraud:

10. It is hard to believe that while Viktor was acutely poisoned (with poison everywhere in his blood, sputum, sweat, and semen); they missed the diagnosis but now, MONTHS later they make the diagnosis in twelve hours (they say someone fortuitously developed a new test recently to make the diagnosis).

9. A real expert in poisoning says this would be a unique case in the history of forensic toxicology.

7. There are many major medical institutions and hospitals throughout Europe; why does Yushchenko keep going to this private clinic (it’s actually a keep-away clinic for the rich and Euro-famous -- you know the type) if he’s really concerned about getting help – did Bill Clinton go to a hideaway hospital for his bypass?

6. Rudolfinerhaus had to send the blood samples to another hospital/clinic in Amsterdam to get the answer (they did that fast, didn’t they?) Why didn’t Viktor just go to Amsterdam himself?

5. Viktor’s wife was brought in to tell some egregious and laughable tales, like “I just remembered... I tasted the poison that night when I kissed him.”  As my daughter would say: OH… MY… GOD!

4. Dioxin is a chlorine-based fat- soluble compound. Chlorine stinks. And Dioxin doesn’t dissolve in water. So the brilliant spies are trying out a new way to poison someone with a chemical that stands out in water like an oil slick and stinks like Limburger cheese left all day in the dry sauna --- is that likely?

3. Being fat-soluble, Dioxin would be absorbed by many organs – especially the liver – and these organs would contain that fatty compound for months, at least, if not years. Yet Zimpfer says there are no traces of Dioxin in Viktor’s liver or pancreas. He also said Yushchenko’s Dioxin levels “have returned to normal.” That is not possible.

Research shows without doubt that Dioxin remains in humans – in their fat and liver – for many years. The half life of Dioxin in humans is seven years. So, if Yushchenko’s Dioxin levels are normal – then he was never poisoned!

3 a. Zimpfer cannot know #3 unless they did a large core liver biopsy this weekend, which they could not have done. And these biopsies take days to fix, stain and analyze.

2. The doctors in Austria have not offered even one shred of quantitative data (for perusal) to back up their claim. Not one lab test or pathology result. They didn’t even mention (oops!) which tests they did! They simply said the tests were positive for Dioxin. They have not produced any documents or other doctors who have SEEN the results. Only Zimpfer. And he’s a shill – that’s already proved.

1. Yesterday Yushchenko announced that he does not want any official investigation into his “poisoning” until after the elections. Ha! Why? Because he says he doesn’t want it to affect the outcome. Hasn’t it done that already? He means he doesn’t want it to affect the outcome the wrong way!

The Whole Christmas Story

Lights!

 

The Cast Arrives

Filming done, Viktor Yushchenko will go on with the Ukrainian presidential election today, after he and his Rudolfinerhaus claque (or quacks?) acted out a poorly scripted passion play this weekend manufactured solely to prove – for once and for all – that Yushchenko had been poisoned. With widespread and immediate acceptance by the entire world – including every single media outlet – this bold and silly Holiday movie may spawn a new round of reality television programming or even a return to cinema verite.

Did any one fall for this? I hope not. I certainly expect that readers of this column were more skeptical of the ridiculous sequence of events this weekend.

Four days after announcing he would not return to Rudolfinerhaus -- the Viennese medical clinic that couldn’t diagnose Viktor’s disease the FIRST time he was there -- the Ukrainian presidential candidate showed up, unexpectedly, on Friday afternoon in dramatic fashion.

He returned – whisked in by a black motorcade of limousines -- for the “blood and tissue tests” that doctors assured us they NOW could handle.

Because Your Kiss is on My Lips!

They hustled Viktor into the clinic and left his wife, Katerina standing outside for an interview, at which time she gave a performance that not even Marlene Dietrich in her prime could have topped. Passionately, Katerina breathlessly spoke to spellbound reporters, delivering this set-up line:

"I know in my heart that he was poisoned and it will be medically established today,"

Oh really? What Katerina didn’t tell the reporters is that her statement was not said with prescience; rather, it was said with advance information. No time for that, however, as Katerina was not done playing the opening act of this weekend’s gig. She had one little zinger to add. Speaking of an embrace she had with Viktor the night he was eating with the Ukrainian Secret Service she blurted out something I’m sure I read in Anna Karenina:

I smelled the poison on his kiss

As my daughter would say OH… MY… GOD!!! She just remembered this? Did the reporters start CHOKING? You smelled the poison on his breath? Are you sure? I mean, he did have sushi, right?

Who wrote this script anyway, the Brothers Grimm?

Camera!

Bing Bang Boom – Case Closed

Saturday morning – twelve hours later -- Rudolfinerhaus releases a statement saying they will tell the world the answer to the poisoning question at precisely 1400. That’s a pretty good prediction for a team that has admitted the case is baffling, difficult to solve, and one that may not have an answer. I mean it was just a couple of months ago when they had Yushchenko in their clinic for an extensive stay during the acute illness (when the poison would have been EVERYWHERE detectable in his system – in his blood, urine, sputum, semen) and yet they were stumped for all those weeks – and NOW he returns and within twelve hours they are giving an exact time for the diagnosis.

Time arrives for the announcement (Stage Left: bring on the dancing girls):

Rudolfinerhaus’ director, the frequently confused, double-talking Dr. Zimpfer straightens out his pince nez and clears his throat. The amazing Doktor, in the weeks since Yushchenko’s discharge, has become an expert in Dioxin and Dioxin poisoning.

Before I let the Zimpferisms spin your head, let’s get a few things straight about Dioxin.

Oily, Stinky, and Unknown – Borscht?

Dioxin is an unintentional breakdown product formed in many industrial processes involving chlorine, such as waste incineration, chemical and pesticide manufacturing, and pulp and paper bleaching. So, it’s a chlorinated compound – and chlorine products generally STINK (take a whiff of the pool cleaner some time).  In an EPA dioxin report, they refer to dioxin as hydrophobic (water-fearing) and lipophilic (fat-loving). This means that dioxin will not mix with water – only fat-containing substances—so, in order to poison someone with Dioxin you need to mix the Dioxin in with fat. NOT soup (what kind of soup are they eating?).

Asked what he thought about the details of trying to poison someone with Dioxin, a real expert, British toxicologist John Henry threw up his hands:

We've never had a case like this — a known case of large, severe dioxin poisoning

And You Thought Yogi Was Quotable?

With this preface, let’s examine some Zimpferisms that came out of the press conference (my replies in italics):

“If this dose had been higher, it may have caused death”

No one knows how much Dioxin it takes to kill someone – even nefarious spies, apparently, eh? So, how do YOU know what the dose was and that more would have been fatal?

“It would be quite easy to administer this amount in a soup”

What amount? See above.... being hydrophobic, Dioxin would stand out in soup like an oil slick

If they did dose his soup with the chlorinated poison, don’t you think Yushchenko would have sniffed it out – I personally HATE the taste of chlorine in MY soup; and, didn’t his wife smell it on his breath HOURS later? So what did it smell like IN THE BOWL? Maybe Viktor had a cold.

(Zimpfer …added) it is impossible to determine exactly how the poisoning took place

So the soup thing is a guess? Is this something Austrian doctors regularly do in tough cases?

The hospital believed it had been a deliberate act of poisoning; “We suspect a cause triggered by a third party”

I thought it was “ impossible to determine exactly how the poisoning took place?”How do you work backwards from that to deduce a third party?

Besides, what new high-technology test indicated this? A motiveometer? These doctors are GOOD.

Zimpfer said it would take years for Yushchenko's body to rid itself of the dioxin

This is one correct thing Zimpfer said. Fat-soluble compounds (especially poisons) will remain in the liver (especially) and other organs for months or years or a lifetime

Doctors said dioxin levels in Yushchenko’s liver have now returned to normal and he is expected to be released from the hospital in the next few days

Oops! A bad contradiction. Zimpfer cannot know the concentration of Dioxin in Yushchenko’s liver unless they did a large core liver biopsy this weekend, which they could not have done in this time frame. And these biopsies take days to fix, stain and analyze.

Yushchenko was in satisfactory condition and his dioxin levels have returned to normal

So if Yushchenko’s Dioxin levels are normal now, that means he was never exposed to the agent! Here’s a small sampling from the literature:

The extreme persistence of dioxin in humans means that, once exposed, we continue to receive low doses from our body fat

Men have no ways to get rid of dioxin other than letting it break down according to its chemical half-lives

Dioxin's "half-life" in the human body is about seven years.  In other words, it takes about seven years for half of the dioxin in your body to be removed

Dioxin binds very strongly to intracellular receptors in the nuclei of animal and human cells throughout the body.  So dioxin can easily get into the nucleus, where the cell's DNA is located

Researchers from four countries across Europe, supported by one of the EU's research programmes, have produced further evidence of the multiple, long-term effects of dioxin on human health. Follow-up of 159 workers in the Austrian chemical industry who were exposed to dioxin shows that these effects can be detected more than 20 years after exposure. The findings have just been published in the international scientific journal, Environmental Research. The extremely long half-lives of dioxins in humans means that exposure can still be assessed in blood fat many years after the event.

ACTION!

Confused? Don’t worry, they are too

This whole little drama was staged because Yushchenko’s poisoning was starting to work against him. People were more interested in what was wrong with Yushchenko than in the election itself. So he had to put the whole thing to rest. Viktor called up the accommodating Dr. Zimpfer, briefed his wife (who probably ad-libbed the melodrama kiss part much to the director’s chagrin), and sped away to the private little clinic where they made quick work out of a diagnosis that previously had stumped the world, and now everything is OK and Viktor is going to be OK and the Dioxin will GO AWAY and let’s not talk about this anymore, OK?

A Frank Capra Denouement

And if you don’t believe that this was all staged ask your self two questions:

1. Why has not anyone at any time this weekend – in all the fanfare and all the pomp – given us ONE IOTA of quantitative evidence to examine? WHAT tests were abnormal? SHOW us a test result or a slide or SOME OTHER expert (who Zimpfer is not, by the way) who says he has SEEN the results and they are DISAGNOSTIC. None. Nobody. Nothing

2. Yesterday, Yushchenko said that he does not want anyone looking at any of this Rudolfinerhaus poisoning work-up carefully because he does not want it to affect the election! His words:

"This question will require a great deal of time and serious investigation. Let us do it after the election - today is not the moment."

Tell you what, Viktor, just show us one lab slip that has the box: Substance Confirmation: Dioxin checked on it.  Show us one computer print out. Let us hear from one lab expert or pathologist who saw the quantitative data and agrees: this is definitely, no doubt, absolutely, Dioxin poisoning.

In a scene that was hokier than Jimmie Stewart finding  Zuzu’s petals in his pocket, Yushchenko spoke, with his wife, to the press on Sunday, as he left the triumphant Rudolfinerhaus clinic – a children’s choral group singing in the background! Yushchenko addressed the world thanking the Zimpfer-lead team:

And I want to thank their team. They've spent many days and nights with me. I am very happy to be alive in this world today. And I thank these people for this.

I would thank them too, Viktor.

Cut! That’s a wrap.

It's Official: CodeBlueBlog Wins 2004 Weblog Award for Best in its Category

A Race to the Finish

Starting out in last place, CBB moved to fifth place in the first week of the contest. A move to third place in the last four days of the voting turned out to be just the beginning of a sprint to the finish as this blog received support from a wide range of medical professionals, readers, family and friends. By the evening of the last weekend of voting, CodeBlueBlog captured first, and held on to win by a few percentage points. See the official poll results here and the full results here.

Wizbang Wizardry

Thanks are again given to all those who voted and to the amazing Kevin Aylward at Wizbang for running the whole show, including the pursuit and capture of cheaters and spammers.

Thanks to everyone and STAY TUNED

More Thanks From CodeBlueBlog

As It turns out, it wasn't JUST the medical students who turned out en masse down the stretch for this blog in the voting for the 2004 Weblog awards. It was also:

*faithful readers, friends, and family*

*all of Greenwich Connecticut*

• *my buds in the CV clan  (www.cvclan.com) -- Awesome Halo Heavy Weapon Masters!
•      thank you Neph, and Big Ed, and BeoWolf and everyone else!*

*The Francis's and Stantons*

*Boyles and Minicuccis*

Thank You All for your efforts...

Check in tomorrow when I tell you why the Yushchenko "diagnosis" over the weekend was a fake and a fraud and NO ONE in the media got it...except me

Thanks .....

CodeBlueBlogMD

MEDICAL STUDENTS RALLY FOR CODEBLUEBLOG

The Student Body

In the last two days there has been a huge wave of support for CodeBlueBlog in the 2004 Weblog awards, driven by medical students and premedical/preprofessional students. Their voting has driven this blog to second place in the running -- and closing on the leader!

Apparently, a lot of the medical students and premedical/preprofessional students inhabit the Student Doctor Network (SDN) where they picked up on CodeBlueBlog, and they have been coming out to support it.

I want to thank everyone from SDN who has visited my site and taken the time to vote. I'm deeply pleased, because you are one of the main groups of people I'd most like to reach. I was thinking about ways to show my gratitude, and I had several different ideas.  Let me know which you think would be most helpful/fun:

1. Weekly advice column (you send me your questions about health care/being a physician, etc. and I answer them every week in a special column)

2. Case of the week (radiology cases; could be contest format; follow-up with teaching points)

3. A weekly medical puzzle . The idea would be, most times, to contain a small teaching point.

4. A weekly student blog column where you get to be a guest blogger on my site to talk about whatever you want

If the SDNers  are reading this, click on comments below and let me know what you think. Will it fly?

In any event, thank you, and keep voting! The contest ends December 12th and everyone can vote here once a day.

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?

"Physician Blogs Rock!"

That's What They're Saying...

...at this week's Carnival of the Vanities (the enduring creation of Bigwig -- and Grand Rounds is an offspring). Go visit the weekly blogospheric storm today at The Big Picture where Doctor Charles, The Madhouse Madman and CodeBlueBlog are all represented.

That's How They're Voting

And then go over and VOTE for The Examing Room of Dr. Charles HERE AND CodeBlueBlog HERE in the 2004 Weblog Awards... as medical blogs continue to create a stir and draw attention by altering the woof that is drawn across the warp of the internet...