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I am certain readers here know, Mr. Yushchenko was reported to have
high levels of dioxins in his blood. This appears to be relatively preliminary information from a medical standpoint. Mr. Yushchenko has levels (tissue?, blood?, etc.) that are reported to be a thousand times higher than some reference population. The reference population is not clear. It is not clear if any of his compatriots have higher levels since some might have been expected to eat the same food or have been in the same environment. It seems that the poisoner would have to be someone who was trusted to provide food or drink beyond suspicion. Salo or sushi could be carriers of dioxin. He could have been fed salo from a specially bred (poisoned) pig or contaminated fish. I doubt that dioxin is commercially available. It could have been mixed with sour cream, heavy cream, or full milk. I do not know why the doctors mentioned soup. Perhaps they thought of borscht with sour cream. The diagnosis came on the following day after Mr. Yushchenko's arrival in Vienna for a third visit. This leads me to believe that the diagnosis had been made earlier and that Mr. Yushchenko traveled to Vienna for related matters or for the appearance's sake. The blood tests were made in Amsterdam and Dr. Korpan appeared to know several days before that evidence for poisoning was already at hand. It is also possible that the diagnosis was known some time ago and Mr. Yushchenko wanted to wait for the opportune moment to announce it. Dioxin is rarely measured in the lab, but it is possible that it appears on spectroscopic methods so it could have appeared before. It is possible that blood testing was done on blood left in Vienna or mailed from Kyiv. I do not know. A toxicologist in London suggested chloracne on a BBC website forum. He apparently diagnosed it from photographs several weeks ago. It is clear that Mr. Yushchenko suffers from other health problems. It has crossed my mind that he could have received dioxin by injection since he has been receiving opiates through an epidural shunt for serious back pain. Given that this case, if it is dioxin poisoning, is virtually unique, attribution of Mr. Yushchenko's other symptoms (besides chloracne and perhaps hepatitis) is purely speculative. That is dioxin is not a cause of all his medical problems. It is also clear that the release of information has often been poorly organized, not chronological, and often not persuasive. The Rudolf---- Clinic was not prepared for such a case. Mr. Yushchenko's team often seemed to be behind his opponents in dealing with the ramifications of hisillness. That is they were not making their own case. Having read an official report (on www.ukrpravda.co.uk) of the first visit of Mr.Yushchenko to Vienna, it is clear that poisoning was not a concern at the beginning. The first reports seemed to point to alcohol as a toxin. That is the term was "...substances not usually considered normal nutrients .." That and other statements seemed to be euphemisms for alcohol. Blood tests and imaging tests supported these findings. A variety of tests were done un-necessarily. That is the doctors did not pay attention to diagnosis and the face at all. They acted as surgeons seeking to intervene rather than as diagnosticians. The perception was that Mr. Yushchenko was suffering from an abdominal surgical emergency. Some diagnoses appeared to have been played up by Mr. Yushchenko's staff: sarin, bioterrorist agents, endotoxins. Even today Mr. Yushchenko's team talked of "yellow rain" and T2 which are totally different toxins. "Yellow rain", a mycotoxin is not "agent orange", a dioxin, though the two colors may be similar. One Yushchenko staff member stated that the liver was twelve times as big as normal. That is a physical impossibility. It is not at all clear that dioxin "kills". Perhaps, the purpose was to make Mr. Yushchenko appear grotesque slowly. Dioxin poisoning is established by total body burdens and not by blood levels. That is because dioxins are a family of organic compounds which are fat soluble. That is one has to establish a total body burden from samples primarily in fat tissue. There are several formulae to do this (by estimating the amount of fat in the body) and the mechanisms/formulae used are not clear that this has yet been done. Dioxins are a by product of several human activities such as fires or pesticides. Use of dioxin as a poison is virtually unknown. A report in the Sunday edition of the Washington Post states that the Soviet secret services considered using dioxins in their chemical weapons campaign. The only direct problem they cause is chloracne which is a pustular acne like rash with a green tinge of color. Acute poisoning has occurred in industrial settings or accidents such as Seveso usually through inhalation. Other side effects are largely tangential. There seem to be minor increases in some cancer and in infant malformation. Mr. Yushchenko has had an evolving illness or illnesses since September. His facial appearance has changed over the last few months. It has become quite characteristic. In the initial visits the doctors made the diagnosis of rosacea which can appear quite similar. I have not seen chloracne in the past but his lesions appear more granulomatous than pustular. But it is quite possible that he is wearing make-up in his public appearances to smoothe the pustular lesions. Some doctors have questioned the diagnosis of chloracne. Bioxin is present in the skin involved for long after intake. Despite what the hospital doctors state, I think that it is impossible to state the date of poisoning. Dioxin occurs primarily in fatty food: milk, beef, fish, and oils. It can also be inhaled. Since it is fat soluble it takes a very long time to build up and a long time to decline. Tissue levels take time to build up. There is no medical literature on one dose intoxication through food intake. All people have some levels dioxin in them since it is in the background. It is not clear what are the usual levels of dioxin in similar persons in Ukraine. The half life of dioxin is listed as seven years which means that it will take seven years or more for Mr. Yushchenko's body burden to decline by fifty percent (if there is no further intake of dioxin). I know of no treatment and this condition is rare enough that I doubt that there is a mechanism of treatment. If it is found primarily in his fat so there is no clear mechanism for it to enter his blood stream and thus leave the body. Using decision analysis, the prior probability of Mr. Yushchenko's being poisoned, especially in light of a strange illness and in a country with an unstable and criminally infected political system, was high. One does not need a lot of evidence to increase such probability. The presence of greatly increased dioxin levels seems to tilt the probability of Mr. Yushchenko being poisoned to highly probable. It is possible that Mr. Yushchenko underwent other dirty tricks with reference to poisoning. One poisoning that I had considered was isopropyl alcohol. This alcohol is sickening but then is metabolized and leaves little trace. It makes the person appear vulnerable to alcohol and thus not manly in the Ukrainian sense of the world. It could be an ingredient of samohon. The stress of this could have made Mr. Yushchenko more vulnerable to a herpes virus the cause of facial palsy. I do not think that we have heard the last word on the poisoning and illnesses of Mr. Yushchenko. There is a need for a forensic and criminal investigation. Bohdan Oryshkevich, MD, MPH
Posted on the EurasiaHealth mailing list. EurasiaHealth Knowledge Network |
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