Friday, December 17, 2010

The Middle East is critically ill

The verdict is out and you may have already heard it. The Middle East is critically ill. The Americans unwillingly reminded us of that recently, when one now-very-famous Australian leaked out some of their widely known so-called secrets. One of the leaked documents told us how some U.S. senators met with the doctor of Damascus last year and how he clearly advised them that the way to deal with the question of Middle East peace is similar to how a doctor treats a cancer. One has to treat the cancer, the doctor alluded, in order to "cure" the patient. Treating the symptoms alone won't cut it.

One very clever Israeli historian agrees with this expert medical opinion. Although he does not diagnose the illness as a cancer (he admits he's not a physician), he does agree that treating the symptoms only will not cure the patient:

"There is no demonstration against Zionism, because the European Parliament even regards the demonstration against Zionism as antisemitism. Imagine in the days of Apartheid South Africa if you were not allowed to demonstrate against the Apartheid in South Africa, but only against the Soweto Massacre. And this is still a great Israeli success, and Germany plays a very important role in this success, that the main problem and the main reason for the criminal policies, is not analyzed, is not discussed, is not touched upon, only the symptoms. I'm not a doctor, I'm not a physician, but I know that if you deal with the symptoms and not with the cause of the illness, you don't cure the patient". 

So as you see, our patient is very ill, and everyone seems to be scrambling to find a way to treat the symptoms of the illness, rather than the cause of it. But... is it really a cancer?

Well, here is what we know. We do know that the illness is deadly, and that it causes a lot of bleeding. When you look at some of the artistic depictions of the illness from the last century, you may think that it was a violent assault that resulted in a stab wound.

[Photo credit: Joseph Morris, shared by a Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic licence]

But that would be one heck of a recalcitrant stab wound that does not heal in 63 years! It's very hard to believe it was only a stab wound, but if you insist, some of the things that could cause non-healing in a stab wound like this are, secondary infection and/or persistence of a foreign body in the wound. While both of these complications are plausible explanations, there may be more to the story of the illness than that.

One alternate theory points to the fact that there is some evidence to suggest that an organ transplantation procedure was performed on the patient some time in the last century (around 1948), as per a prescription that was issued decades earlier by a British doctor whose name was Balfour. It is very likely that the illness is related to complications that resulted from that procedure. For the first time ever in the history of organ transplantations, they did the procedure not because the patient needed it (there was actually a clear contraindication to doing the procedure), but because, they said, it was essential for the survival of the transplanted organ ( i.e. the graft) itself.

Before an organ is transplanted, doctors suppress the immune system of the body so that the body does not reject the graft. The body was partially suppressed by its caretakers in this case, before the transplantation (in an attempt to ward off a rejection), but as everyone should have predicted, the body did severely reject the foreign graft. There was also severe trauma from the surgical procedure, and moreover, cells of the graft itself started to violenty attack the rest of the host body (they call this graft-versus-host disease or GvHD, for short).  It was another first in the history of organ transplantations that the graft-versus-host reaction actually started long before the transplantation procedure, and many doctors believe that was a reason why the rejection was so severe. And then, there was another very bad complication in this case, and which can occur in situations like this. It was the development of a cancer in the graft itself (they call this post-transplant lymphoproliferative disorder, or PTLD for short, and it happens because the immunity in the body is suppressed). The cancer took over some nearby areas of the body (with significant and sudden growth in 1967) and the attacks by the graft continued unabated on the neighboring organs since that time. And they continue to this very day.

Post-transplant lymphoproliferative disorder (PTLD): sudden growth in 1967
[Photo credit: Supreme Deliciousness, shared by a Creative Commons Attribution-ShareAlike 2.5 Generic license]

This is not to say that doctors did not try to treat the illness at various points in time. There was an attempt by the Arabs at one point, for example, to use some kind of "chemotherapy" in 1973, but the effects of that treatment were short-lived.

The patient has been admitted to the intensive care unit many times so far since the beginning of the illness, but no good doctors have been allowed to take over the case. The doctors who have presided over the case have been incompetent. One of the recent ones goes by the name of George Mitchell, and he has been very incompetent in even treating the symptoms, let alone the core cause of the illness.

Everyone seems now to be waiting for some miracle to happen to cure the patient and everyone seems to be giving up, one way or another. This is because all involved parties utterly lack the credibility or the courage to suggest and pursue the therapy that could effect a cure. And just so we are all on the same page, the treatmet in this case does not, and should not, include radiation therapy. It is funny though how there is some evidence to suggest that cells of the graft are emitting some radioactivity themselves, as they attack the neighboring organs (and this is yet another first, in the world of transplantation medicine).

One piece of sad news is that a daughter of our patient and who goes by the name, Peace Process (born some time around 1991) had died, many believe, several years ago. Some believe she was stillborn, while others think she only died recently. Doctors in the West have denied (and will continue to deny) her death, but that denial is becoming more and more untenable as the days go by.  The British newspaper The Guardian, published a euology yesterday saying in it that Peace Process was dead, but that she has not been buried yet. I'll add and say, that an autopsy has not actually been requested on this case, because, as you might have guessed, the cause of death is known, and an autopsy would be redundant. Many are left wondering how the passing of Peace will affect our already critically ill patient.