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by John Helmer, Moscow 
  @bears_with

The mystery of what the Berlin doctors treating Alexei Navalny discovered in his bloodstream and urine tests in Germany has deepened after the Russian Foreign Minister Sergei Lavrov publicly referred last week to the clinical findings of a Swiss-based neurologist, Vitaly Kozak. Kozak has been reporting for several weeks that the biomedical data tables published in The Lancet in December reveal evidence of cholinesterase inhibition effects of poisoning by the drug lithium which Navalny was taking himself before his collapse on August 20.

That’s pathological self-medication – an overdose, not a Kremlin poison plot.

What then can be the reason the editors of The Lancet, Richard Horton (lead image, 1st left) and Astrid James (2nd left), have refused to publish a clinical commentary in the form of questions from  Kozak?  

There’s more to the mystery than that. Horton and James also refuse to answer questions about the circumstances of their publication of Navalny’s data records separately from the case report authored by Navalny’s chief treating doctors in Berlin, Kai-Uwe Eckardt (right) and David Steindl.

Eckardt and Steindl have now been asked to clarify the circumstances of the publication of their case report on Navalny and the separate biomedical data. They do not answer.  Because of the contradiction between the evidence in their data records and the intepretation widely given to their case report in the press and by NATO officials, Eckardt and Steindl were asked to say if the title of the report they wrote, “Novichok nerve agent poisoning”, was their choice of title, or The Lancet’s in London. Eckardt and Steindl will not say.

When medical doctors allow their science and their clinical practice to become part of a political scheme, based on fabrication of evidence and falsification of diagnosis, they violate several terms of the 2,500-year old Hippocratic Oath. They are intending to do harm;  cause injustice;  ignore one deadly drug;  fabricate evidence of another;  and as the ancient Greek text declared, “keep far from all voluntary wrongdoing  and other corrupting behaviour”. Horton, James, Eckardt,  and Steindl have all sworn the Hippocratic Oath when they qualified as practising physicians. When asked to confirm that now, they won’t respond.

Horton’s current title is editor in chief of The Lancet, the British medical profession’s standard- setter for the veracity of medical research around the world. He first graduated in medicine at the University of Birmingham in 1986. He didn’t practise for long; he joined The Lancet in 1990.  James, titled deputy editor, first qualified in medicine from University College London in 1986. She then practised as a doctor in the National Health Service for five years, before becoming a medical writer in 1988. She joined The Lancet in 1993.

On December 22, they agreed to publish the Navalny case report by the group of doctors who had treated him at the Charité hospital in Berlin, starting from August 22. The case report can   be read here.  

Read slowly and carefully, and it will be discovered that the authors admitted they did not detect organo-phosphate poisoning in Navalny’s blood, urine,  or on his skin; they tested no water bottle or clothing evidence which had been brought to Berlin by Navalny’s staff on the evacuation aircraft.  They also acknowledged they did not know what might have caused “severe poisoning with a cholinesterase inhibitor” until the German armed forces laboratory in Munich reported the Novichok allegation “2 weeks later”.  Read the analysis published on December 23.  

The evidence the German doctors said they relied on for the title of their report and for the conclusion that Navalny’s low cholinesterase scores had been caused by a Novichok attack came from press releases and press leaks from German government officials. These were amplified in the western media. But the evidence of the German army laboratory has never been reported, and no doctor there has signed his name to the subsequent  interpretations by officials and media of what the laboratory found.

An identical process of disinformation by press release subsequently occurred at the Swedish state defence laboratory and the Organisation for the Prohibition of Chemical Weapons (OPCW). Without anticipating it, however, these organisations ran into a problem with the data records published by Eckardt, Steindl and their colleagues at Charité. On the days when the Swedes and OPCW say they  took their samples of Navalny’s blood and urine, the German record shows his cholinesterase scores were so close to normal, it was impossible for Swedish defence officials, the OPCW, the French and the German governments to claim they had evidence of a Novichok attack perpetrated by the Russians, on order of President Vladimir Putin.

The dossier of this evidence can be followed, point by point, here.

The telltale signs of Navalny’s overdose of lithium and several benzodiazepine drugs cannot be disputed. It was published by the Charité doctors in what The Lancet editors, Horton and James, called a “Supplementary Appendix”. In fact, there are four separate appendices, tagged S1 to S4.

Source: https://drive.google.com/ These were first published on this website on January 12, with detailed clinical observations of the data by specialist pharmacologists, physicians and toxicologists. There was a powerful attack by an unusual method on the website after this article appeared; for several hours the publication was not accessible on the internet.  

A medical psychiatrist specializing in the benzodiazepines added his comments in a new report, published on January 17. These experts (none Russian) concurred on what would happen if the cocktail of benzodiazepines and lithium (possibly alcohol too), reported in Navalny’s test records, had been quaffed on the evening of August 19 or in the early morning of August 20, collapse day.

The “Supplementary Appendix” was not directly attached to the December 22 case report, as would normally be the case in the publication process at the journal; and as the authors intended it to be by their references to the appendix inside the text of their report.  It was also not easy to find the appendix after clicking to open the report; “See Online for appendix” is noted in small print on the first page. Why then did Horton and James of The Lancet decide the data tables should be posted with the advisory: “This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors”?   

 Why does their separate publication lack a date when the data were posted online? And how was it possible for  Horton,  James,  and the special “peer reviewers” of the appendix to fail to notice that the data do not corroborate the conclusion of the case report’s title; indeed, can the editors have noticed the contradiction and attempted to reduce its visibility or suppress it altogether?

The record which Vitaly Kozak made when he communicated with The Lancet in the second half of January confirms that Horton and James were made aware that the data allowed a quite different interpretation of what had caused Navalny’s collapse from the political one the Lancet editors appear to have accepted in their titling of the Berlin doctors’ report.

Kozak’s story first surfaced in German on January 11.

This is the English translation of the original German. Source: https://www.world-economy.eu/

The German publication also provided the text of Kozak’s comment which he had submitted to The Lancet in London.  “I would like to provide some interesting comments on the Publication and highlight some points, which, in my opinion, require explanation. First of all I have to disclose my conflicts of interests. I write these comments on the solicitation of the Editors of World Economy Wirtschaft & Finanzen Newsreport at no honorarium. As clinician and scientist I stay as equidistant as possible.” Read the full text here.  

Kozak concentrated on two clinical points revealed in the case report and appendices. The first was the evidence of Navalny’s consumption of lithium, and the possibility, already reported in other research, that there is “a toxicity burden… associated with lithium… Firstly, it is worth mentioning the potential role of lithium in the cholinesterase inhibition. There is evidence that lithium inhibits cholinesterase activity in blood.”

The second point was a symptom of Navalny’s which appears in the case report. According to Kozak’s comment to The Lancet, “in the Publication it is mentioned that 31h [hours] after symptom onset the patient had ‘wide pupils non-reactive to light’, which is contrary to cholinergic toxidrome;  unfortunately the authors provided no explanation of this finding in their discussion. The wide pupils are hardly explained by an assumed complete nerve impulse transmission blockade or effects of the assumed therapy with atropine, because wide pupils were combined with bradycardia and hypothermia (obviously as a results of severe diaphoresis).”

Kozak’s  expert credentials as a neurologist have been substantiated in the international medical research literature, and in his Swiss doctoral thesis. Kozak was more qualified to comment on Navalny’s clinical data than the neurologists in the Charité hospital team who listed themselves as co-authors of the December 22 case report and its appendix – Wolfgang Boehmerle, Franziska Scheibe, Katharina Demin, and Matthias Endres. None of them has the number of publications listed for Kozak, nor a comparable PhD.  In the cases of Boehmerle, Scheibe, and Demin, the Navalny case report was their first professional publication.

Notwithstanding, Kozak’s observations and inferences from the data tables appear to have been rejected for publication by Horton and James; they took this decision sometime between January 11 and January 22.

Kozak’s notes were also observed by medical specialists in Moscow. On January 14, for example, several specialists were asked by a Russian reporter to comment, not only on the Berlin doctors’ report, but also on the results of computer scan tomography (CT) and magnetic resonance imagery (MRI) for Navalny undertaken and recorded at the Omsk Hospital where he was treated between August 20 and 22.   This Moscow publication claimed that sources in direct contact with Navalny’s personal doctors had identified pre-existing medical conditions which were triggered by his drug intake prior to his collapse on August 20. The diagnosis reported was that “in addition to the main diagnosis — a violation of carbohydrate metabolism — the media did not mention such complications in Navalny AA such as: water-electrolyte disorders syndrome, lactic acidemic coma, dysmetabolic encephalopathy (severe course), myoclonic status, acute respiratory failure.” Chronic pancreatitis was also reported.

The results of the CT and MRI tests were reported to indicate a pituitary adenoma or tumour in Navalny’s brain affecting his hormone production, and also liver function damage. Source: https://zavtra.ru/

Debatable though Kozak’s and the Moscow clinical comments may have been, the evidence presented by The Lancet is not. The Omsk hospital data, including the blood and urine tests, as well as the CT and MRI results, have not been published yet.

On February 1, in a detailed timeline and dossier published by the Russian Foreign Ministry,  it was reported that “the conclusions of Russian doctors, who had not found any traces of toxic agents in the samples collected from Navalny, were immediately denounced, without any substantiation, as false and biased.” This was a warning from the Russian Government that the Omsk data might be released.

A week later, on February 8, Foreign Minister Sergei Lavrov made public  that he had received a letter from Kozak detailing the same observations which Kozak had sent to The Lancet. It is clear that even after Kozak had been dismissed by Horton and James, Russian government officials realised that his testimony would more likely be accepted internationally than the Omsk hospital evidence. This has not happened,  but Lavrov made the attempt.

Source: https://www.mid.ru/

“I appreciated,” said Lavrov to a television interviewer, “Doctor Kozak’s very detailed open letter addressed to me on January 22, 2021, in which he expressed his expert opinion on the available publications on Alexey Navalny’s treatment at the Charité clinic in Berlin. As I am not an expert in chemistry, biology or medicine, I cannot give you a professional comment on the analysis he has carried out, but having carefully read his considerations, which point to contradictions that have emerged, I agree that any questions and reasonable doubts regarding this case necessarily require clarification.”

Lavrov was emphatic that on the technical issue of this “clarification” depended the entire international allegation that a crime had been committed against Navalny. “The doctors at the Charité clinic, where the patient was immediately taken at his wife’s insistence, did not find any chemical warfare agents either – just like in Omsk – (so, according to the above logic, the Charité doctors could also be suspected of complicity). Those combat agents were not found until later at the Bundeswehr Institute of Pharmacology and Toxicology, as ‘announced’ by the German government. And that gave rise to peremptory accusations against the Russian state along with demands that it admit its ‘guilt’ and investigate the ‘crime’.”

Lavrov wound up: “Since the questions that Mr Kozak raised in his open letter from a purely scientific standpoint, as a specialist in medicine and biology, directly touch upon the issues that the West carefully avoids in its foreign policy dialogue with us, we plan, if he doesn’t mind, to draw the attention of the top officials from the OPCW Technical Secretariat, as well as Germany, France and Sweden, to his analysis, and ask them to comment. I also consider it important to support the doctor’s idea that other independent specialists in biomedicine also comment on the above facts. I hope they will hear Mr Kozak and, as honest professionals, provide their comments on the questions he has formulated.”

Lavrov’s remarks were not reported at the time by the international media. When the full interview was broadcast on February 12,  the Kozak case was ignored in the press reporting. Lavrov had accused the German Army doctors of lying: “I mean the Bundeswehr doctors. They are doctors as well. We have pointed out on numerous occasions that if the Omsk doctors did not find anything, and the Charité doctors didn’t either, then the Charité doctors can also be accused of concealing evidence of Navalny’s poisoning. A great deal has been said about the Bundeswehr. This does no credit to Germany as a country with a responsible attitude to its international commitments.”

What can have happened at The Lancet, first to publish the data tables as evidence that Navalny had not been poisoned by a nerve agent; to ensure that the data were peer-reviewed as an extra precaution for their veracity; and then to prevent Kozak from challenging the contradictions in the evidence?

Horton and James were sent emails, which were then followed up by telephone. They were asked these questions, which were acknowledged by their press spokesman, Jessica Kleyn:

1. What was the date on which the “Supplementary Appendix” was published?

2. What was the reason for separating it in time and in print from the December 22 report?

3. What was the reason for the separate peer review of the data tables and your notice that you ordered that done?

4. When did you receive a letter of professional comment on the data and the December 22 report from Dr Vitaly Kozak?

5. Dr Kozak says he requested publication as a comment — is that correct?

6. Dr Kozak says publication was refused — is that correct?

7. Was this refusal the culmination of a decision of The Lancet’s editorial management? by peer review? by a combination of editors, peer reviewers, others? 

8. Dr Kozak’s letter asks questions to follow up the scope of the interpretations of the data tables which have been published. What is your reason for not publishing these questions?

When telephoned at their office in London, they were also asked to confirm when they took the Hippocratic Oath. Horton and James will not answer.

At the Charité hospital in Berlin Eckardt and Steindl were asked a similar list of questions:

1. What was the date on which the “Supplementary Appendix” was published?

2. What was the reason for separating it in time and in print from the December 22 report?

3. What was the reason for the separate peer review of the data tables? 

4. Was the title of The Lancet report over your name,  “Novichok nerve agent poisoning”, your choice of title?

5. Are you aware of the letter of professional comment (neurological) on the data and the December 22 report from Dr Vitaly Kozak?

6. Dr Kozak says he requested publication as a comment in the form of several questions regarding the cholinesterase inhibition impact of the lithium you reported in your data tables. Dr Kozak also says his letter was rejected for publication. Do you know the reason for the rejection?

7. As a practising physician have you sworn the Hippocratic Oath? 

They too refuse to acknowledge or reply. The last point is significant but it is easy to forget. Even when doctors write and publish their case reports, they are still bound by the Hippocratic Oath. This is not less binding for Eckardt, Steindl,  and their colleagues in Berlin today, than it is for Horton and James in London. Journalists swear oaths, but they aren’t ethical ones. Horton and James were medical doctors, not journalists, and they were bound by their Hippocratic Oath when they published the December 22 report on Navalny; when they composed the Novichok allegation in the title of the report; when they published the appendix of data records separately; and when they refused to publish Kozak’s commentary.

Kozak was contacted by email and telephone.  He does not know why the data tables in the appendices were published separately from the case report. He would not disclose the “internal messaging between me and the journal.”  

The history of Hippocrates, the revolution in ancient Greek medicine associated with his name, and the details of the case method for medical analysis which the Greeks around Hippocrates invented was recently published by the English classical scholar, Robin Lane Fox. He has translated the full text of the oath at page 79 of the book. He provides the most exhaustive evidence yet uncovered of what Greek medical ethics and scientific method were in the fifth century BC.

The errors of the ancient Greek doctors, concludes Fox, “about germs or contagion, women’s bodies or even the benefits of nosebleeds were to be obstacles, not creative mistakes. [Their] approach, however, was not. It rested on observation, humanity and caution about harmful interventions. It also rested on a belief that similar cases would recur and could then be knowledgeably treated. [They] are possessions for all time, the first practical texts in the invention of medical science”. Source: https://www.penguin.com.au/

The Berlin doctors and The Lancet editors were doctors when they composed their case report on Navalny for publication to other doctors. Whether they acknowledge it now or not, all of them were bound by the Hippocratic Oath.

The alternative medical ethic – the antithesis of the Oath, as the Germans realise —  is the one dictated by command of state agencies which is intended to do harm and does so in outcome.  This was practiced in recent German history;  notoriously,  it has come to be associated with the name of Josef Mengele (lead image, 3rd from left), the German Army (SS) officer and physician who spent most of the war practising at the Auschwitz concentration camp.  When Lavrov said in his television interview last week that it had been the German Army, the Bundeswehr Institute of Pharmacology and Toxicology, which had been the initial source of the German state’s allegation of Novichok poisoning, he was implying that the ethics of the German Army are not those of the doctors whose names are signed to The Lancet report.

In the presentation of their case evidence, Eckardt, Steindl,  and the others do not claim that their four tabulations of Navalny’s biochemical records substantiate the Novichok poisoning allegation. That started with Navalny’s staff and was amplified through the Bundeswehr in the  mouth of the chancellor, Angela Merkel. However, by maintaining their silence to the questions put to them, and by ignoring the questions posed by Kozak, the German doctors are complicit in the Navalny campaign waged by their state, and by Germany’s western allies. In this campaign, the silence of Horton, James and The Lancet speaks even more loudly.



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