Cry Wolf Blitzer

I was just telling a friend that the medical blogosphere hasn't had it's first Rathergate or Trent Lott effect yet -- there's been no story where medical blogs broke news or dictated mainstream media coverage.

Then I read CodeBlueBlog's take on Clinton's thoracoscopy (two posts):

If Clinton's pleural problem is secondary to his bypass surgery then either they failed to do appropriate follow-up and MISSED it for six months (unlikely); or, they have been hiding his problem while they exhaust all nonsurgical treatment options; OR ... Bill Clinton's exudative pleural effusion is from something else.

CBB suggests the possibilities: malignancy, bacterial infections, and HIV, among others.

Sensational stuff, right? Well, CBB's case flows logically, and is a good primer on the pleura. But it's based on two premises: 1) Clinton's looking pretty old and 2) we're just hearing about this effusion now. To me, it seems very likely that noninvasive workup proceeded quietly for months, the effusion persisted, and now the surgeons are going in.

As for his appearance, who knows? Some people look a little frail when they've lost a good amount of weight in a hurry, and Clinton's changed his habits. Comparing today's photos from a decade ago (as CBB has done), or even a few years apart, is a recipe for errors -- even for a radiologist.

Look at Clinton's contemporary, Michael Douglas -- in pictures from ten years ago, and now. Throw in a surgery and some weight loss, and ask yourself, is this really a conspiracy?

Sometimes CBB can sound like one of Douglas's directors, Oliver Stone. But when and if we see a medical coverup (whether it's Ukranian poisonings or pepper-balled Red Sox fans), I expect Code Blue Blog will be the one to break it. And that will be a great day for journalism, especially in this age of Martha and Michael.

Until then, I'll keep waiting for Sanjay Gupta tp patiently explain Light's Criteria for pleural effusions to an eager television audience.