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Are Arafat’s doctors withholding information?

Blood tests and scans can diagnose most diseases in 48 hours. But two weeks after Yasser Arafat was admitted to a hospital, there's no diagnosis. The most likely explanation? Experts say doctors know what’s wrong but aren’t allowed to disclose it.
/ Source: The Associated Press

Zoning in on a diagnosis for ailing Yasser Arafat should be a fairly straightforward task, medical experts say.

Blood tests, urine samples and scans can diagnose the majority of diseases within 48 hours, and 10 days is usually more than long enough to hit on the right cause of illness.

But nearly two weeks after the 75-year-old Palestinian leader was admitted to a French military hospital, no diagnosis has been revealed, raising questions over whether his doctors are baffled by the illness or whether they have a diagnosis but are not making it public.

The most likely explanation, experts say, is that doctors know what’s wrong but aren’t being allowed to disclose it.

There is a slim chance that Arafat has simply been too unfit for definitive tests, but some medical experts say that is unlikely.

Bits and pieces, but no real picture
“Today’s machinery and imagery can provide a living autopsy, and his blood and urine is still going to give them the core diagnoses,” said New York-based brain expert Dr. Eric Braverman. “I think you can be confident that the doctors have a diagnosis and they are not releasing it.”

Snippets of information have emerged, but not enough for a clear picture.

By the time Arafat arrived in Paris on Oct. 29, Palestinian doctors had already said he had a low blood platelet count — a condition connected with a variety of maladies from major bone marrow malfunction and cancer to infection and poisoning.

Since then, French doctors have disclosed Arafat has a high white blood cell count, that leukemia has been ruled out, that he is in intensive care, his condition has become more “complex” and that he is in a coma.

Confidentiality rules
French doctors are bound by patient confidentiality rules, as are physicians in many other countries. When giving briefings to the media, the hospital spokesman has noted that the information was being released with the consent of Arafat’s wife.

A delegation of high-ranking Palestinian officials in Paris to visit Arafat gave a media briefing Tuesday after talking with their leader’s doctors.

Speaking for the delegation, Palestinian Foreign Minister Nabil Shaath told reporters “we don’t have a full understanding of why his status has deteriorated, which means that we don’t have a full diagnosis.”

Experts say it is plausible, but unlikely, that doctors don’t know what’s wrong.

If the problem were poison, for instance, “you’d think by now that they’d be able to detect every possible poison,” said Dr. Simon Karpatkin, director of hematology at the New York University School of Medicine. “It’s surprising that they don’t have a diagnosis and it suggests that possibly they are withholding information.”

Besides the issue of patient confidentiality, there may be many reasons why doctors, or the Palestinian officials, are concealing Arafat’s diagnosis.

Embarrassment possible?
It is possible his illness might embarrass the Palestinian Authority, said Rory Miller, an Arab studies expert at King’s College at the University of London.

That doesn’t necessarily mean the illness itself is an embarrassment, he said. “It could be a chronic illness that they have known about for years but played down and that might raise questions of why they didn’t do anything about it before,” said Miller.

“Arafat has been such a one-man show that it’s not impossible that as long as he could function with a time-bomb condition, he wouldn’t let anyone deal with it and now it has come to a head.”

Doctors say a few ailments seem consistent with the little information that is known. At the top of many lists is a condition known as disseminated intravascular coagulation, or DIC — where the body consumes platelets. In elderly people, the underlying problem is usually a severe infection or a cancer.

“That has got to be a possibility,” said Dr. Trevor Baglin, a hematologist at Addenbrookes Hospital in Cambridge, England.

Other conditions raised by experts are chemical toxicity; a rare blood condition called thrombotic thrombocytopenic purpura that can be triggered by an infection or cancer; and a pre-leukemia bone marrow problem called myelodysplasia.

“They must have a working diagnosis, otherwise how do they know how to treat him?” asked U.S. gerontologist Dr. Tharakam Ravishankar.