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Last Updated: Sunday, 8 January 2006, 14:06 GMT
Row rages over Sharon treatment

By Martin Asser
BBC News website in Jerusalem

With doctors at Jerusalem's Hadassah Hospital discussing the fate of Ariel Sharon, a dispute is raging in the medical profession over the treatment the prime minister has received.

Jerusalem's Hadassah hospital
Ariel Sharon has been in a coma since he arrived at the hospital
Some Israeli doctors are saying anyone else in Mr Sharon's condition would have been allowed to die peacefully last Wednesday night when he was rushed to hospital with a massive stroke.

And, they are asking, would he be in the medical situation he is in now if the treatment had been different?

But Ron Krumer, the director of external affairs at Hadassah Hospital, has stood by the treatment the Israeli prime minister has received.

"All the medical decisions taken regarding the treatment of the prime minister were necessary according to his medical conditions," he said.

Hole in heart

The debate is front-page news in Sunday's Israeli press, although some doctors have called the speculation "distasteful" as the medical team fights for Mr Sharon's life.

A senior UK-based cardiologist told the BBC News website the fundamental question concerns possible misdiagnosis after the prime minister suffered a first minor stroke on 18 December.

Sharon suffers minor stroke on 18 December 2005
Doctors discover small hole in heart, schedule operation for 5 January
Sharon rushed to hospital one day before scheduled surgery with major stroke
Undergoes two operations overnight on 4/5 January, followed by third on 6 January

After that incident, doctors found that Mr Sharon had a birth defect, a patent foramen ovalis (PFO) or hole in the heart, which they planned to close with a catheter operation. Doctors said the hole was thought to have contributed to the minor stroke.

But, in the light of subsequent developments, the cardiologist believes it created a blinkered, over-rosy picture, which allowed Mr Sharon to keep up his punishing work schedule at a time of high political importance.

Small bleed

"A PFO is a condition that 20% of people suffer from, but it's extremely unlikely to cause a stroke in a man in his 70s," the cardiologist said.

"If it's going to affect you it'll happen when you're in your mid-30s, not in your 70s."

Shlomo Mor-Yosef, director of Jerusalem's Hadassah hospital
Doctors at the Hadassah insist Ariel Sharon has received the best care
Instead of the congenital defect, Mr Sharon's first minor stroke was, the cardiologist said, more likely to have been caused by obesity, lifestyle or the severe stress that he has been under, with Israel at a political turning point and his son Omri embroiled in a corruption scandal.

His doctors prescribed anti-coagulation medicine as he awaited catheterisation and Mr Sharon brushed off the crisis, refusing to take the month or more's rest that most doctors would have ordered.

The UK doctor says the blood-thinning treatment would alleviate his condition as diagnosed but could prove "catastrophic" in another scenario, if, for example, Mr Sharon had suffered an undetected haemorrhagic stroke, or "small bleed" in his brain.

"It is very bad medical management to use anti-coagulant drugs in a case like this, because in the event of a small bleed it will make matters much worse," he said.

'World-renowned specialists'

Professor Martin Rabbai, a senior Israeli neurosurgeon agrees with this view, in quotes in Sunday's Haaretz newspaper.

If any other major political figure had suffered massive strokes and bleeding in the brain, this would be predominantly a 'messages of sympathy' board - let's not forget that first and foremost Sharon is a man and show a bit of humanity
Alex Harvey, UK

The heart catheterisation was "not recommended," the paper quotes the doctor saying, since it had not been proven that the stroke was caused by a blood clot crossing the hole in Mr Sharon's heart.

"On the contrary, it is advisable not to touch it," for someone in Mr Sharon's condition, Professor Rabbai said.

However the hospital director, Mr Krumer, defended all the treatments administered to Mr Sharon.

"These decisions were taken after consultation among senior staff at Hadassah hospital and with world-renowned specialists outside Israel," he said.

One neurologist told Haaretz he believed Mr Sharon was a victim of "VIP syndrome" - over-treatment given to prominent figures that is unnecessary, or even damaging, to their health.

Doctors say that, even if he survives, the condition is likely to have left him severely impaired physical and mentally.

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