A cunning way to kill a man that needs no expertise
The Times (London) - March 14, 2006, Tuesday

By: Dr. Thomas Stuttaford

We have known for years that Milosevic had a bad heart, with hypertensive heart disease associated with coronary heart disease and myocardial ischemia. As a result, the blood supply to his heart was inadequate and I'm surprised that he lived as long as he did.

He should have been considered for a coronary bypass or angioplasty (unblocking of the arteries). The problem here is that if someone suffers from severe heart disease, their heart may no longer be strong enough to take a better arterial blood supply.

I have not heard of rifampicin being used to mask the effects of another drug, but the mechanism by which drugs can interfere with one another is known as the "grapefruit effect", because grapefruit interferes with the metabolic pathways of many drugs. Imagine the route that a drug takes into the body as a series of alleyways. When one drug is taken to interfere with another, it is like sending a lorry down a narrow highway, preventing other traffic from reaching its destination.

In this case, rifampicin was apparently used to block the pathway for heart medication. This would have built up behind, like traffic building up on a congested road. With the drugs unable to reach the liver, they would go round and round in the blood supply -building up to dangerous levels and potentially causing terrific damage -but with their effects entirely negated.

You don't have to be terribly skilled to establish which drugs interfere with others. They are listed in a reference book called Martindale's and any would be poisoner could have looked up the pharmacology of the drugs that Milosevic was being prescribed and discovered those that used the same pathways.

The interaction of drugs is a constant worry in medicine. I never heard of anyone deliberately using this to poison a patient, but it is unquestionably a cunning way of doing it.

SECTION: OVERSEAS NEWS; Pg. 33

Copyright 2006 Times Newspapers Limited
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