Retrodiagnosis is the practice of reexamining medical diagnoses from the past. With the help of current medical information, taking a fresh look at old, or even ancient, cases may confirm a historical diagnosis; if a different conclusion is reached, this may shed new light on our interpretation of history. Currently, investigators are looking again at a more recent death: that of Palestinian leader Yasser Arafat. If the cause of death is found to be poisoning, as some parties believe, the outcome could have a similar effect on history, though it risks a much more profound political impact. Finding that line between historical study and modern political intrigue is important for the interesting exercise of retrodiagnosis.
In 2004, Yasser Arafat was dying. In 2012, some are trying again to find out why. Eight years ago, the compound of the Palestinian Authority’s president was being bombarded when, suddenly, he fell gravely ill. He was brought to France, to the Percy Military Hospital near Paris, but doctors were unable to save him. Arafat died on November 11, 2004, officially of a stroke linked to a blood disorder that stemmed from an unidentified infection.
Doubt has always remained in certain circles, however, over whether this mysterious illness was due to the causes stated, or even to 100% natural causes. Cirrhosis of the liver, cancer, AIDS have all been proposed. Another theory suggests that Arafat was poisoned. Last July, Al-Jazeera television released a documentary on the latter hypothesis, an investigation carried out in cooperation with Arafat’s widow, Sufa, who provided some of his personal belongings.
Samples from his clothing containing various bodily fluids were tested over nine months at the Institute of Radiation Physics in Lausanne, Switzerland. The results suggested the presence of elevated levels of highly radioactive polonium-210. Polonium is extremely rare in nature, but can be produced in a nuclear reactor. Whether the element was introduced directly into his body (as was the case for former Russian spy Alexander Litvinenko, killed by Po-210 poisoning in 2006), these analyses could not say. A statement from the Institute of Radiation Physics, stated that despite the surprisingly high levels of the radioactive element found on Arafat’s belongings, “the clinical symptoms described in Arafat's medical reports were not consistent with polonium-210” and that the poisoning claim could not be confirmed by their analyses of Arafat’s clothing.
Historical deaths get a second opinion
The practice of reexamining the health conditions and cause of death of historical figures, armed with modern medical knowledge, is not new. And since 1995, the University of Maryland School of Medicine has even hosted an annual conference devoted to retrodiagnosing, a famous patient of the past. This Historical Clinicopathological Conference (HCPC) is inspired by the traditional CPC, a medical school teaching tool in which a particularly challenging case study of a patient is presented to participants for examination. They assess the patient’s symptoms, decide on a diagnosis, and come together to discuss their reasoning and conclusions as a group. Historical CPC founder Philip Mackowiak, an epidemiologist and professor at the University of Maryland School of Medicine, first surprised attendees of these discussions by revealing that the patient being considered, for whom a more sensational diagnosis of rabies had come to replace the original cause of death linked to alcoholism, was none other than Edgar Allen Poe.
In May 2012, the Historical CPC featured the case of Vladimir Ilyich Lenin. Popularly believed to have died from a stroke brought on by a syphilis infection, this diagnosis was reexamined with the help of two speakers invited to share their specialist’s expertise. Dr. Harry Vinters, Chief of Neuropathology at the David Geffen School of Medicine at UCLA, brought his expert opinion on strokes, while Lev Lurie, PhD, a Russian historian based in St. Petersburg, provided insight on Lenin’s life. Details from his autopsy were considered, along with his risk factors, family history, and way of life.
The conclusion of the 2012 Historical CPC was that Lenin had, indeed, died of a massive stroke, but that the evidence was inconsistent with the theory of syphilis as the trigger. What else could cause such a dramatic medical event in a man of only 53, lacking some of the classic risk factors, like high blood pressure or smoking? (He did, in fact, possess other pertinent risk factors, like atherosclerosis, hardening of the blood vessels.) Pointing to the seizures suffered by Lenin in his last days – uncommon in stroke victims, but frequently seen in poisonings – Dr. Lurie hypothesized that Lenin could have been finished off by his successor, Joseph Stalin, rising in power as Lenin was dying. If true, the historical implications of this would be significant, although gathering evidence for this hypothesis could prove difficult, this far removed from the events in question.
Regarding the Historical CPC, Philip Mackowiaksaid in a University of Maryland press release that “It is fascinating to consider how far medicine has come in fewer than 100 years, and interesting, indeed, to ponder how the course of history would be changed had Lenin lived.” The death of Yasser Arafat, however, is recent enough that reexamining his death would likely go beyond an interesting intellectual exercise to have broad political implications. Should this be a reason to pursue testing, or a reason to let the dead lie?
Poisoning and Politics
Stalin saw Lenin as an obstacle to his rise, making him a plausible candidate for the proposed poisoning. If Yasser Arafat were poisoned, and it remains a total “if” for the moment, the suspects would be multiple and belong to different camps. Sufa Arafat seems to think the suspicion of polonium poisoning is enough to warrant further investigation: in July, she requested that a murder investigation be opened in France, against an unnamed perpetrator. At the end of August, given the delicate diplomatic nature of the situation, French authorities agreed.
Dr. François Bochud, director of the Institute of Radiation Physics that found polonium on Arafat’s clothing, had stated that the only way to confirm the results would be to exhume the body and test it for polonium directly. In July, it was reported that these tests would indeed be carried out. However, on September 9, the Palestinian Authority released a statement saying that, already sufficiently confident that Arafat was poisoned, it saw no need for such actions to be taken. One can only speculate what motivations are at play for the different parties in this case. What is sure is that any polonium will continue to decay (the element’s half-life is about 4.5 months), eventually reaching undetectable levels. If these tests are to be carried out, they will have to happen soon.
Ethical dilemmas diagnosing the past
In contrast to the official investigation of a relatively recent death, some historians are opposed to the exercise of retrodiagnosis. Even when the patient is long-since deceased, ethical questions do arise, writer Sam Kean reports in Science. The Chicago History Museum, for instance, turned down all requests to test samples of Abraham Lincoln’s blood in search of genetic disorders. One reason is that parts of the artifacts are destroyed to carry out these tests; another is privacy issues. In such cases, genetic health problems might be revealed to descendants who would not have chosen such tests for themselves, or uncomfortable questions of paternity could come to light. With retrodiagnoses, the “patient” is not present to give consent.
Still, it is difficult to imagine who would be affected by investigating the cause of death of Alexander the Great or King Herod, whose cases were examined by the Historical CPC in 1996 and 2002, respectively. The investigation into Yasser Arafat’s demise clearly falls into the realms of politics and justice, as opposed to these leaders of the ancient past. Knowing where to draw the line – at what point in history or for which figures the exercise of retrodiagnosis moves from medico-historical interpretation to something with serious present day implications – may be a delicate task for practitioners. As long as they walk this line with care, the HCPC can be a useful clinical tool, and then some. As Dr. Mackowiak has said, "The historical CPC is cross-disciplinary. It links medicine to art, music, literature, and history in a special way that gives the liberal arts greater relevance to clinicians."
Find out more: Polonium-210: a deadly element http://www.rsc.org/chemistryworld/Issues/2007/January/Polonium210.asp Swiss Institute finds polonium in Arafat’s effects http://www.reuters.com/article/2012/07/03/us-palestinians-arafat-idUSBRE8621CL20120703 Timeline: Litvinenko Death Case http://news.bbc.co.uk/2/hi/uk_news/6179074.stm Retrodiagnosis: “Tutankhamun’s death and the birth of monotheism”, on New Scientist http://www.newscientist.com/article/mg21528812.400-tutankhamuns-death-and-the-birth-of-monotheism.html?DCMP=OTC-rss&nsref=health