IRIS Blog

Due to the services of a pioneering neurologist with a hobby of investigative medical detective work, IRIS made news by publishing an accurate assessment of Ariel Sharon's stroke eighty times faster than the first report in the mainstream media.

Now he is at it again, so I will be publishing any of his insights into the medical case that could determine control of the Senate. Caveat: This entry will only be updated when medically significant information is released, which may be quite slow. During the Sharon case, most of the medical reporting was noise: insignificant, recycled or inaccurate.

Dec. 14 (11 am Eastern):

It sounds like he was suffering from the arteriovenous malformation shunting blood away from part of his brain to the point that part of the brain was not working. It sounds like no brain cells were lost in the incident while on the telephone, so one could argue this was a transient attack rather than a stroke. However, worse episodes can develop and the doctors were probably right to intervene.

He may do fine, he may have some impairment, he may die. We just don't have enough information to know.

By the former Director of the CIA, James Woolsey:

-The approach Israel is preparing to take in the West Bank was tried in Gaza and has failed utterly. The Israeli withdrawal of last year has produced the worst set of results imaginable: a heavy presence by al-Qaeda and Hizballah; street-fighting between Hamas and Fatah and now Hamas assassination attempts against Fatah's intelligence chief; rocket and mortar attacks against nearby towns inside Israel; and a perceived vindication for Hamas, which took credit for the withdrawal. This almost certainly contributed substantially to Hamas' victory in the Palestinian elections.

-Before his massive stroke last year Ariel Sharon repeatedly said he would not replay the Gaza retreat in the West Bank. With good reason: Creating a West Bank that looks like today's Gaza would be many times the nightmare. How would one deal with continuing launches of rockets and mortars from the West Bank into virtually all of Israel? A security barrier does no good against such bombardment.

-How does moderate Jordan, with its Palestinian majority, survive if bordered by a West Bank terrorist state? Israeli concessions will also make the U.S. look weak because it will be inferred that we have urged them.

-Three major Israeli efforts at accommodation in the last 13 years have not worked. These three accommodations have been based on the premise that only Israeli concessions can displace Palestinian despair. But it seems increasingly clear that the Palestinian cause is fueled by hatred and contempt.

-Israeli concessions indeed enhance Palestinian hope, but not of a reasonable two-state solution - rather a hope that they will actually be able to destroy Israel. When they speak of "ending Israeli occupation," they mean of Tel Aviv. Under these circumstances it is time to recognize that the Israeli-Palestinian issue will likely not be the first matter settled in the decades-long war that radical Islam has declared on the U.S., Israel, the West, and moderate Muslims.

-Someday a two-state solution may become possible, but it is naive in the extreme to believe that this can occur while the centerpiece of the radical Islamic and Palestinian agendas is maximizing Jewish deaths.

American doctors, among them senior neurologists, have joined the chorus of criticism of the medical care given to Prime Minister Ariel Sharon by physicians at Hadassah University Hospital, Ein Karem, and his personal physicians at the Sheba Medical Center, Tel Hashomer.

The negative assessment appeared in an article in the latest issue of Neurology Today, the official journal of the American Academy of Neurology, in interviews with four leading experts in stroke care and prevention.

Neurology Today is not really a journal - it is the newsy publication of the American Academy of Neurology, the major organization of neurologists in the US. They also publish the real journal Neurology.

The experts said they were not personally familiar with Sharon's case. However, on the issues raised in the article with regard to Sharon's treatment, the experts said treatment other than that given the prime minister would have been preferable.

Now, senior U.S. medical figures are weighing in on the matter. "One striking part of Mr. Sharon's saga is that he was taken in an ambulance for a trip to an emergency room more than one hour away," said Dr. Stephan A. Mayer, associate professor of clinical neurology and neurosurgery and director of the neuro-intensive care Unit at Columbia University Medical Center. Mayer added that he hoped Sharon's tragedy would would help inculcate that "if you have signs of a stroke, call 911 and go to the closest ER."

Mayer said Sharon's treatment was "something we call the 'VIP Syndrome' where you do things with famous people that you wouldn't do with ordinary people."

IRIS' neurologist enabled me to report on the ironically negative implications of VIP Syndrome on the day that the story first broke, scooping the first mention anywhere in the world press by a day. It should be emphasized that most of Sharon's tragic outcomes (including the fatal delay in reaching an emergency room and the heroic lifesaving efforts that were responsible for his current state of diminished consciousness) were probably largely caused by his VIP treatment. Of course Kadima's systemic corruption was likely a factor as well (for example, in the documented proactive dissembling to the public on the part of Sharon's doctors which was probably indirectly responsible for precipitating his brain hemorrage), but it is difficult to say for certain given the ongoing coverup and stonewalling.

As was reported, after his first stroke, Sharon was treated with a powerful blood thinner to prevent the recurrence of a cerebral blood clot. However Dr. David Greer, an instructor in neurology at Harvard's Massachusetts General Hospital in Boston expressed doubts about the type of drug, given Sharon's acute condition, calling it extremely controversial and certainly unproven.

To see complete coverage, in which most of the above points were either raised first or properly reported in their medical context on the IRIS Blog, click here.

This week Mahmoud Abbas (a.k.a. Abu Mazen) made two important statements:

-In addition to the dozens of terrorists he suddenly released from the Jericho "prison" allegedly supervised by the US and UK, he is planning to release the murderer of Israeli Minister Rehavam Ze'evi.

-He hopes Olmert wins as Prime Minister:

Likud spokesman Ronen Moshe said, "Even Abu Mazen understands that Kadima is more left-wing than Labor. Even Abu Mazen, who entrusted the formation of a PA government in the hands of Hamas and enables the release of the murderers of Minister Ze'evi, understands that Ehud Olmert will make great concessions for nothing in return or Palestinian obligations."

Recent reports have alleged that the US demanded of Abbas to delay the formation of a Hamas-led PA government so as not to negatively impact the electoral support of Ariel Sharon's Kadima party, led by Olmert since Sharon's massive stroke....

Labor expressed anger at Abu Mazen. Labor sources were quoted as saying that it was "unacceptable" to make this statement after Labor chief Amir Peretz had taken the trouble to meet with him. Labor leaders later issued a correction, saying they were not angry at Abu Mazen.

As the world's most dangerous terrorist organization takes power of a government, the mainstream media is furiously spinning the tale that this is nothing to worry about. There is now enormous attention focused at this moment on Israel's response, which would have the effect of advancing Israel's interests. Anything Israel would say would be broadcast worldwide at no cost.

What is Olmert's message? He "ordered the ministers in his government not to discuss publicly the developments in the PA." He is instead conducting meetings to figure out what to do.

Apparently he only began consultations on what to do a few days ago. Clearly, there was no decision made even on a simple statement in the event of a Hamas victory.

This is looking very similar to the utter negligence by Sharon's inner circle in:

-crafting a plan for handling the predictable Sharon brain hemorrhage,
-planning the Gaza disengagement, and
-preventing terrorists and weapons from entering Gaza.

Of course, Olmert has other priorities.

Update: Netanyahu is out doing Olmert's job. He just made the case against the terrorism of Hamas and Iran on American radio. His key line was one I had considered using today, that the lesson of the Holocaust is that if someone says he wants to annihilate you, believe him.

This is an explosive addition to the confirmation of the coverup charge I made the day after Sharon's first stroke, disputing the "clean bill of health" diagnosis:

After First Stroke PM's Doctors Concealed his Condition

The general medical condition of Prime Minister Ariel Sharon was more critical than his doctors and advisers have reported since his first stroke on December 18, 2005. In addition to the heart problem they disclosed, Sharon was suffering from cardiac and cerebral diseases that the doctors kept from the public....Haaretz's inquiry shows that Sharon also suffered from more serious, life-threatening heart problems, including a large aneurysm in the septum. This is known to be a source of cerebral blood embolisms, and indeed led to the blood clot that caused Sharon's first stroke, senior doctors at Hadassah University Hospital, Ein Karem believe.

However, Sharon also suffered from other heart diseases. These include a shunt that causes blood to flow spontaneously through the hole in the septum from right to left - the wrong direction - which is dangerous. Sharon also had other conditions in the cardiac septum that created further risks of blood clots that could wind up in the brain.

Senior doctors said this usually requires early treatment with blood-thinners and cardiac catheterization, as the cardiologists and neurologists at Hadassah had recommended.

But they said it also required closer surveillance, because the blood thinner Sharon had received could have been extremely dangerous, due to the additional disease discovered, cerebral amyloid angiopathy (CAA), which is liable to make cerebral hemorrhaging extremely hard to treat - as was the case.

The CAA diagnosis, which Haaretz revealed some two weeks ago, was also concealed from the public.

Senior doctors said the dangerous heart disease Sharon had raises several other questions about the partial and vague information that his doctors gave the media and the public under the guise of "full disclosure."

Another senior doctor said the doctors were stuck between a rock and a hard place. The cardiac disease created the danger of an embolism, but the medicine to prevent this increased chances of cerebral hemorrhaging.

There had to be a reason they treated with anticoagulants and nothing we'd seen earlier provided such a reason. This does provide a justification. This is an unusual heart problem and assuming it is true that CAA was detected after the first stroke--it is still not clear how that was done--there was indeed a hard decision. Keeping the problems secret was misleading; letting him go to the Negev and not operating soon were needless risks. This latest revelation underscores what I stated immediately after the second stroke. The lack of preparedness for what to do in the event of the likely risk of a hemorrhage was negligence on the part of Sharon's inner circle. As Haaretz emphasizes:

If Sharon had arrived even half an hour earlier at Hadassah he would have been saved, or at least the brain damage would have been a lot less significant.

Incidentally, some may mistakenly claim that my neurologist source overemphasized the poor judgement aspect of the story. As I have emphasized all along, major questions still cannot be answered because the actual medical records have been withheld and at times misrepresented. What my neurologist source has done is an analysis of the existing data while emphasizing where the holes are. For example:

Since they have not released information to suggest a substantial clot risk requiring aggressive (heparin) anticoagulation it remains questionable why they chose such a course of action that at least in retrospect clearly contributed significantly to his deterioration.

Much of the information that has been released is only in response to precisely the kind of medical detective work that IRIS has been in front of. We have emphasized all along that:

There is one way to stop the controversy: come clean and release the medical information as promised. Stop releasing sufficient information only about the attempt to keep him alive in a debilitated state and explain the treatment leading up to his massive brain hemmorrage.

Click here for all of IRIS's Sharon coverage.

Haaretz editorial:

Most of the questions raised about the quality of treatment given to Prime Minister Ariel Sharon are essentially medical, but beyond that, there are other questions of public concern. Who, for example, decided to conceal from the public the truth about the blood vessel disease diagnosed after Sharon's first stroke? And did doctors issue the partial medical report in good faith, or in consultation with Sharon and his advisers?....Sharon's doctors, including the director of Hadassah Hospital, gave the misleading impression that they were giving the public a full and detailed report, sometimes too detailed, while in fact they were concealing the cerebral amyloid angiopathy....The existence of such deposits characterizes Alzheimer's disease. This information is relevant to the question, whether the prime minister is capable of dealing with another term in office.....On December 26, eight days after Sharon's first hospitalization, his doctors held a news conference at which they appeared to provide the entire medical findings. Professor Bolek Goldman said at the time that "with the prime minister's consent, we are at your disposal to provide full disclosure of the prime minister's condition following his hospitalization."

See here for full coverage of the Sharon medical debacle.

A senior physician who is an expert in intensive care and comas told Haaretz on Sunday that, according to reports by doctors treating Sharon, if the prime minister's condition persists into next week - he is still unconscious and connected to a respirator - he may be defined as being in a vegetative state.

One can come out of a long coma and be fine but that is typically due to brainstem injury, not cortex injury as is presumed to be the case here. However, it is difficult to say this with great certainty since the scans have not been released.

A senior Health Ministry official told Haaretz on Sunday that he thought the cabinet should establish a commission that will investigate the treatment Sharon has received at Hadassah University Hospital, the functioning of his two personal physicians and various governmental, public and medical questions.

The senior official said the matter of the non-disclosure of some of the information about Sharon's condition should be examined, along with: the decision to administer blood thinners to the prime minister, despite the vascular disease in his brain; the controversial decision to perform a catheterization to repair the hole in his heart; his release from hospital and quick return to work after his first stroke; and the fact that he stayed at his home in Sycomore Ranch in the Negev, far from Hadassah.

Another leading expert has now spoken out on the opinion IRIS expressed fifteen minutes into the story:

Sharon's comatose state and the fact that he is undergoing the tracheotomy do not bode well for the prime minister's future, said Dr. Philip Stieg, chair of neurosurgery at the Weill-Cornell Medical College in New York.

It is becoming more probable as time passes that Sharon will either remain in a vegetative state or have low abilities to think and reason, said Stieg, who is not involved in Sharon's care.

'It suggests that the brain damage is as serious as we thought it was based on earlier reports and now its all playing out,' Stieg said. 'He's not turning the corner, he's not waking up...they're having to do more things to keep him alive.

Nevertheless, a highly suspect decision with potentially enormous political implications has been made by the Attorney General to rule that Sharon is temporarily (not permanently) incapacitated. The result of that ruling determined that Ehud Olmert would be the acting Prime Minister and therefore the leading contender for Prime Minister in the upcoming election. Olmert was elevated from political obscurity by this twist of affairs. In the last Knesset election he was in the 33rd position on the Likud list.

Three days ago, I paraphrased my neurologist's assessment of Sharon's apparent treatment following his first stroke as "hopelessly contradicted by medical norms." A neurologist is as likely to prescribe aggressive anticoagulants (e.g. Heparin) for a stroke victim diagnosed with CAA as he is to advise a cobra resolve a home mice infestation. Both are technically adequate, but present bigger risks than they solve. For example, one causes brain hemorrhages.

Two articles now present neurologists who share this assessment. Here is one:

Meanwhile, a prominent neurologist yesterday joined the chorus that has been questioning the prime minister's treatment ever since Haaretz reported that Sharon suffered from Cerebral Amyloid Angiopathy (CAA), a disease affecting the blood vessels of the brain.

Dr. Steven Greenberg, Associate Professor of Neurology at Harvard Medical School in Boston, said that CAA constitutes a "central risk factor" for the development of a cerebral hemorrhage. He also said that blood thinning medicines of the kind that Sharon received could cause a small hemorrhage to turn into a large one and a catastrophic stroke.

Here is the other who specifically recommended aspirin in this situation, confirming IRIS's entry of December 21.

Additionally, there is now convincing evidence of IRIS's accusation that part of Sharon's mistreatment can be explained as a textbook example of "VIP Syndrome."

From Haaretz:

The controversy surrounding Sharon's medical treatment and the transparency of his physicians continued unabated Wednesday.

Additional criticism was heard of Sharon's physicians for concealing the diagnosis of CAA after the prime minister's first stroke, despite their declaration of "full disclosure of [Sharon's] condition in the wake of his hospitalization."

Chico Menashe of Israel's Channel 10 reported Wednesday that a doctor involved in Sharon's treatment said the information was concealed "for political reasons," out of fear that if made public, it would be used for propaganda purposes against Sharon and his Kadima party, particularly in light of the fact that CAA has often been associated in medical literature with Alzheimer's Disease.

This confirms the charge I brought the day after Sharon's first stroke. I disputed the "clean bill of health" diagnosis and demonstrated disinformation on the part of his medical team. I also stated that it was clear that the team was focused on preventing the public from understanding the obvious point that I wrote after the first stroke: that his poor and precarious health "is the key to the current election. Ariel Sharon is nearly 78, very much overweight and not likely to change."

Click here for complete IRIS Sharon medical coverage.

Unfortunately, since Ariel Sharon's first stroke in December, there has been almost no source other than IRIS to turn to for an accurate overall assessment of his medical condition. While the media is now focused on the very slight developments in his climb from near-death, I have been documenting some of the extraordinary misimpressions that have been given. Essentially, there has been little substantive change in his overall condition since I first reported 15 minutes into the story that his political career was finished and that there was some question over whether he could be kept alive in a severely debilitated state.

Here are the current details by my neurologist source:

Everything we've seen from the recovery and heard from the scans suggests major damage to the right hemisphere and less damage to the left hemisphere. At the minimum there will be some serious paralysis and sensory receptive problems affecting the left side of the body and probably some interference with reasoning ability. It is possible that speech production and reception may be relatively intact, and it is even possible that vision in the entire visual field may be okay.

On the poor side of expectations is the possibility that he might not survive the next few weeks because of complications related to impaired consciousness and paralysis.

Click here for complete IRIS Sharon coverage.

Tom Gross has written another important piece:

Compared to past international media coverage of Ariel Sharon, which on a number of occasions in recent years has gone beyond personal demonization to outright anti-Semitism, the reporting on Sharon since he suffered a massive stroke last week has been relatively benign. Sharon, the butcher, the bulldozer, the war criminal, the "successor of Hitler," has suddenly been humanized in several usually hostile quarters, such as the BBC.

But only up to a point. Even amid this improved coverage, as Sharon lies fighting for his life, many articles in the Western media have retailed untruths, almost in passing, as though they were incontrovertible historical facts: Sharon initiated the second intifada, Sharon ordered the Sabra and Shatila massacres, and so on.

According to a Google search, there were over 24,000 articles published on Sharon in the 24 hours following his stroke last Wednesday night. But it was only four days later, in Monday?s Washington Post, that there was the first mention of Sharon?s protracted and successful libel battle in the 1980s against Time magazine for its inaccurate suggestion that he had encouraged the Sabra and Shatila massacres.

Sharon's successful proof in court that Time lied about his involvement in the massacre has been incredibly reported by the mainstream media as an inversion of the truth. This because Sharon could not prove intention to defame by lying.

A note for sophisticated students of media bias: the MSM will sometimes portray their adversaries nicely in situations of personal tragedy such as this, but they will almost never allow facts to be publicized which might cause people to agree with "politically incorrect" policies. For example, Gross brings the example of al-Jazeera showing Sharon looking grandfatherly around Hanuka candles. Another common example is to praise him for having converted from a "bad nationalist soldier" to a "good uprooter of Jewish settlers." Conversely, the MSM may criticize their heroes to appear objective, but it will always be at the personal level. For example, Jay Leno's monologues chide Bill Clinton for his personal vices, but criticize Bush for policies that enrich his oil friends.

There is now official confirmation of IRIS's contention from fifteen minutes into the Sharon stroke story that the aggressive anticoagulant Heparin likely caused his brain hemorrage:

In an interview recorded for the Channel 2 program "Fact" Wednesday night, one of Prime Minister Ariel Sharon's surgeons, Professor Felix Umansky, said that the hemorrhaging Sharon suffered when he had a second, massive stroke last week was likely caused by blood thinners prescribed after his first stroke on December 18.

For all of IRIS's coverage of this story, see here.

After the explosive leak earlier today that the diagnosis of CAA had been missed in the treatment for Prime Minister Sharon's first stroke, the medical team's spokesman appears to be peddling misinformation, saying that the CAA diagnosis is nothing new. The implication is that this was diagnosed after his first stroke. Unfortunately that would contradict their December press conference in which Sharon was given a clean bill of health after a complete recovery. IRIS challenged that press conference at the time and was later dramatically vindicated.

As I detail below, it is also hopelessly contradicted by medical norms. The PR situation is now a complete mess, so therefore I cannot see any alternative than that the medical team will end up denying the statement.

Source: Doctors Knew of PM's Brain Disease after First Stroke

Physicians at Hadassah University Hospital, Ein Karem knew during Prime Minister Ariel Sharon's first hospitalization in December that he suffered from cerebral amyloid angiopathy (CAA), a disease of the blood vessels in the brain, a medical source told Haaretz on Tuesday.

Prescribing anticoagulant drugs to patients with CAA could increase their chances of suffering a cerebral hemorrhage, like the one Sharon experienced last week. In spite of this, the source said, Sharon recieved the blood thinners.

Without specifically mentioning the Haaretz report, Hadassah director Professor Shlomo Mor-Yosef said Tuesday afternoon that, "A report in one of the newspapers today is incorrect. Hadassah physicians were aware of the brain diagnosis, and no new diagnosis has been made during the current hospitalization." In his statement, Mor-Yosef did not deny that the CAA diagnosis had been made....Ron Krumer, Hadassah's external affairs director, said in response "We are busy treating the prime minister and fighting to save his life. We are not dealing with anything else."

Knowing of CAA and prescribing the aggressive anticoagulant (heparin) seems incredible, because a major brain hemorrhage is a textbook risk and is precisely what occurred.

Additionally, IRIS has found another medical error stated by Mor-Yosef, which should have been noticed by the New York Times, which printed it:

Soon afterward he started breathing on his own, though he remains connected to a respirator as a precaution, the doctors said.

"This is the first sign of some sort of activity in his brain," said Dr. Shlomo Mor-Yosef, the director of the Hadassah hospital.

As an update to the IRIS scoop proving the reports of Sharon's brain death last week were a hoax, I quoted none other than Mor-Yosef:

Mor-Yosef said that said Sharon's pupils were responding to light, "which means the brain is functioning"

Click here to see all of the IRIS Sharon coverage.