核心提要：尼罗河在《证据！远程诊断追查铊毒真凶》一文中证明贝志城展示给央视记者的“专家电邮”是伪造的，构成他涉嫌朱令案的第一证据环节。这里，尼罗河根据Robert A. Fink医生的文章揭示贝志城涉嫌朱令案的第二证据环节：所谓美国医生Robert A. Fink和John W. Aldis在北京时间1995年4月12日之前提出了铊中毒诊断是撒谎。这两个证据环节相互印证，直接指向一个重大疑点：贝志城从一开始就知道朱令是铊中毒！

尼罗河《证据！远程诊断追查铊毒真凶》首次揭示了贝志城伪造专家电邮，构成贝志城涉嫌朱令案的证据链上第一个环节。随后尼罗河查证的焦点集中在这样一个问题上，是谁，在什么时间第一个作出铊中毒的诊断，或者非正式地第一个提到铊中毒的诊断。

贝志城在东方时空《朱令的十二年》电视访谈中说：“十号发了那是个周一，周三我就给朱令他爸爸打电话，看到提问里还有说是铊中毒。”。 “周三我就给朱令他爸爸打电话，”，也就是北京时间1995年4月12日，贝志城就明确发布了铊中毒诊断信息。那么我们查证的目标就缩小到从北京时间4月10日到12日两天时间。

在The First Large-Scale International Telemedicine Trial to China: ZHU Ling’s Case 网页上列出了84名专业人员作出了正确的诊断。其中，在4月12日之前作出正确诊断的人名单如下 （原始文件拷贝见附件1）：
1. Steve Cunnion, MD, PhD, MPH, the Uniformed Services University of Health Sciences
2. Frank Bia, MD, MPH, Professor of Medicine, Yale University
3. Dr. Neil Kay
4. John M. Friedberg, M.D., Neurologist, Berkeley, CA 94705
via Robert A. Fink, M. D., F.A.C.S., Neurological Surgery
5. Dr. Martin Wolfe, Tropical Medicine Consultant.
via John Aldis, M.D, MPH, FACS, U.S. State of Department
6. Dr. Aldis, M.D., AAFP, MPH & Tropical Medicine, U.S. State Department
7. Prof. Leslie H Bernstein
via Carole Shmurak
8. Jacquie Heller

根据贝志城们的记载，美国加州神经外科医生Robert A. Fink作出正确诊断的时间是4月11日。尼罗河查到了一篇Robert A. Fink医生本人撰写的文章《The Tao of the Internet》（全文拷贝见附件2）。从文章中可以清楚地看到，美国太平洋夏令时间4月11日也就是北京时间4月12日，他才在他的网络邮箱中看到从北京大学发出的求救信。

On April 11, 1995, I found in my Internet mailbox a message, in “fractured” English, from a young graduate student at Beijing University in China. It was a message of desperation. It concerned the plight of a fellow graduate student in chemistry, a 21-year-old woman who lay in the Intensive Care Unit of the University Hospital of Peking Union Medical College (PUMC).

那么Robert A. Fink医生看到这封信后采取了什么行动，他又是在什么时间作出了铊中毒的诊断呢？这封信上说得很清楚。

One of the earliest possible diagnoses which came to the mind of the author (and several others of the “outsiders”) was that of heavy metal poisoning (the alopecia was the “clue”). We asked if tests had been performed for heavy metals and were assured that such had been done early on. We later discovered that these consisted only of a screen for arsenic!
笔者（还有其他几个外界人士）最早想到的可能的诊断是重金属中毒（脱发是线索）。我们询问是否对患者进行了重金属检测，很确切的被告知这种检查早就做过。后来我们发现只查了砷！

接下来，Robert A. Fink医生的文章里出现了一个具体的时间点，美国太平洋夏令时（PDT）1995年4月12日（April 12, 1995）也就是北京时间（CST）1995年4月13日。

By April 12, 1995, the patient’s condition had not changed, and a repeat lumbar puncture revealed an elevated protein (248 mg.%) and 6 leukocytes. The impression of Guillain-Barre syndrome was reinforced, despite messages from the “outsiders” that this picture was not consistent with Guillain-Barre.
直到1995年4月12日，病人的状况没有改变，重复了一次腰穿发现脑脊液蛋白升高(248mg%)和6个白细胞。这再次加强了格林巴利综合征的印象，尽管来自外界人士的信息认为病人表现与格林巴利不符。

那么Robert A. Fink医生究竟是什么时间想到铊中毒的，文章接下来写道：

At about this same time, the author and John W. Aldis, M.D., a physician working in the U. S. State Department, and formerly the Embassy physician in Beijing, conceived of the idea of thallium poisoning, this after Dr. Aldis was sent an article by Rose Miketta, M. D., a physician with Searle Pharmaceutical Company, explaining the neurotoxic effects of thallium. We again suggested that the patient be checked for thallium poisoning. This recommendation was further backed by others, including Dr. David Bullimore (4/26) at St. James’ Hospital in England, and several other physicians in the United States.
大概就是这个时间，笔者和John W. Aldis医生，一个为美国国务院工作的内科医生，前任北京美国大使馆医生，想到了铊中毒。此前，在Searle药物公司工作的内科医生Rose Miketta给John W. Aldis医生发来一篇文章解释铊的神经毒性。我们再建议给病人作铊中毒检测。这一提议得到了其他人的支持，包括英国St. James医院的David Bullimore医生（4/26）和其他美国医生。

从这篇文章我们可以看到Robert A. Fink医生对朱令诊断的行动时间表，北京时间4月12日看到求救信，中间想到过重金属中毒，4月13日与协和医院的医生进行了沟通又倾向考虑格林巴利（多发性神经根炎）。真正考虑到铊中毒的时间是在这个时间点之后而且是经过专业人员的内部沟通之后。很明显，贝志城们撒谎了。Robert A. Fink和John W. Aldis医生并没有在4月12日之前作出铊中毒的诊断。

回到贝志城的这句话：“十号发了那是个周一，周三我就给朱令他爸爸打电话，看到提问里还有说是铊中毒。”。“提问里还有铊中毒”既是口误也是事实。尼罗河在《再论贝志城伪造专家电邮》一文指出，贝志城发求救信是两次，第一次是4月10日，而第二次是北京时间4月12日5点48分。第二次求救信主题栏中除了与第一次一样有Urgent!!! Need diagnostic advice for sick friend，加上了(?thallium poisoning)——?铊中毒。从4月10日到12日早上5点48分之间的时间里，贝志城为什么会提出这样的问题？

有人也许要解释说，协和医院神经科某位主任医生第一次给朱令看病怀疑过铊中毒，贝志城有可能得到这个信息所以知道去问外国专家。这种可能性确实存在，但是已经被贝志城本人否认了。贝志城在《朱令的十二年》电视片中明确表示，他一开始根本就不认识Thallium这个英文单词。贝志城说：“英文叫Thallium，我们拿回宿舍就查了字典，怎么还冒充这么一个东西来”。他连thallium都没有听说过，又怎么会根据协和有人怀疑过铊中毒在4月12日早晨5点48分第二次发出的求救信中将铊中毒正确翻译成thallium poisoning？

Robert A. Fink医生的文章还提供了两个与朱令案情相关的线索。第一点，美国医生不是神仙，他们和全世界各国的医生一样遵守循证医学的原则，首先要获取他们需要知道的进一步检查结果，而不是仓促发表自己的诊断意见。基本可以肯定，没有医生在看到求救信的第一时间就作出铊中毒的诊断，除非事先受到提示。第二点，Robert A. Fink医生的文章证实，协和医院的医生完全有能力与美国医直接交流。例如美国医生给协和医院传真有关论文，John W. Aldis医生本人直接认识协和的医生。所以贝志城发动同学大张旗鼓翻译专家电邮完全是“此地无银”的诡异表演。

尼罗河在《证据！远程诊断追查铊毒真凶》中证明贝志城展示给央视记者的“专家电邮”是伪造的。构成他涉嫌朱令案的第一证据环节。这篇文章，尼罗河根据Robert A. Fink医生的文章揭示了贝志城涉嫌朱令案的第二证据环节：贝志城公布的美国医生Robert A. Fink和John W. Aldis在北京时间1995年4月12日之前提出了铊中毒诊断，不是事实是撒谎。贝志城第二次发出求救信直接询问是否铊中毒将这这两个证据环节链接在一起相互印证。正是因为第一封求救信发出后两天之内，贝志城收到的回复邮件中没有人想到铊中毒，不得已才在第二次发出的求救信中直接提出了铊中毒的问题。最后又不得不造假把美国医生Robert A. Fink和John W. Aldis作出铊中毒诊断的时间点移到他通知朱令父亲的时间之前。他在央视电视片中不出示“专家电邮”原件，就是因为害怕观众看出日期上的问题。所有证据直接指向一个重大疑点：贝志城并不是根据专家电邮向朱令父亲打电话报告铊中毒诊断的消息，而是一开始就知道朱令是铊中毒！

尼罗河揭示的双重证据已经逼近了朱令铊毒案的真凶。每一个关心朱令案的正直善良之士，如果你亲自查证尼罗河提供的事实无误，如果你认为尼罗河根据这些事实得出的结论符合常识和人类通用逻辑规则。请把尼罗河的文章转载出去，把真相告诉更多的人。一起推动中国警方重启朱令案司法调查。

附件1：
The First Large-Scale International Telemedicine Trial to China:
ZHU Ling’s Case
http://web.archive.org/web/20000816192018/http://www.radsci.ucla.edu/telemed/zhuling/
The following is a list of 84 persons who made the correct diagnosis by themselves or by their friends who were consulted in the order of being received by Beijing University students between April 10 and April 26, 1995.
4/10        Steve Cunnion, MD, PhD, MPH
the Uniformed Services University of Health Sciences

            SWEET@utkvx.utk.edu

4/11        Andi/Cleveland State Univ. Ohio
            Frank Bia, MD, MPH, Professor of Medicine, Yale University
            Dr. Neil Kay
            John M. Friedberg, M.D.,  Neurologist, Berkeley, CA 94705
                via Robert A. Fink, M. D., F.A.C.S., Neurological Surgery
            Dr. Martin Wolfe, Tropical Medicine Consultant.
                via  John Aldis, M.D, MPH, FACS, U.S. State of Department
            (Dr. Aldis, M.D., AAFP, MPH & Tropical Medicine, U.S. State
            Department, was the doctor for U.S. Embassy to China 1989-93.
            He knew many doctors personally at PUMC and he actually saw
            Zhu Lingling at PUMC in March. He has been highly involved
            in the case and coordinated some of the international efforts.)

            Prof. Leslie H Bernstein
                via Carole Shmurak
            Jacquie Heller

附件2：
The Tao of the Internet
by Robert A. Fink, M. D., F.A.C.S.
On April 11, 1995, I found in my Internet mailbox a message, in “fractured” English, from a young graduate student at Beijing University in China. It was a message of desperation. It concerned the plight of a fellow graduate student in chemistry, a 21-year-old woman who lay in the Intensive Care Unit of the University Hospital of Peking Union Medical College (PUMC). PUMC is a medical school established by the Rockefeller family in the early part of the twentieth century, and, as the model for Abraham Flexner’s seminal report on medical education, perhaps, “the most American of non-American medical schools”. A reconstruction of the young woman’s case history to that date is as below:
In early December, 1994, the patient complained of abdominal pain, cramping, and extremity pain. Extensive tests, including autoimmune studies, thyroid tests, pelvic and abdominal untrasound, skull x-rays, and bone marrow examination were all normal. It was noted that the patient had some abnormalities of her nails, but this was not reported further. She was treated with “traditional Chinese medicine” and was discharged, improved. She subsequently returned to work (in a chemistry lab); we still do not know what chemicals she was working with. An “afterthought” was listed in the report, this a piece of data which was to become critical in the diagnosis of this woman’s condition; and that was the fact that, shortly after the onset of the abdominal symptoms on December 8, 1994, the patient’s scalp hair fell out, and she “became bald”.
After a period of improvement (and some re-growth of hair), the patient returned to the hospital with signs of peripheral neuropathy in the extremities, rapidly progressive disturbances in sensorium (and recurrent alopecia), developed multiple cranial nerve palsies, became comatose, and required a ventilator. She also showed muscular spasms, described as “oculogyric crises”, and a tracheostomy was performed. Lumbar puncture and MRI studies of the brain were normal, and studies for viruses, including Lyme Disease, were negative. The patient was treated with “shotgun” antibiotics with no improvement.
At that point, the author corresponded with the sender of the “distress message”. I learned that a number of other physicians, including people from the United States, Canada, Great Britain, Singapore, Thailand, Indonesia, and other countries, were also communicating with the student-sender and several other students at the University. The students in China have Internet connections but, (as we later learned), hospitals and physicians do not. We were forced to engage in our later communication with the medical professionals either by facsimile, which is tightly controlled by the Chinese Government; or by sometimes circuitous person-to-person connections. Information transmitted over the Internet to the students often did not reach the medical professionals who were treating the patient. This was due to the complex hierarchy of the Chinese culture, in which accepting information from “students” is almost as alien to Chinese professionals as is dealing with “outsiders”. This lack of direct communication has proven to be the most significant negative factor in this equation.
One of the earliest possible diagnoses which came to the mind of the author (and several others of the “outsiders”) was that of heavy metal poisoning (the alopecia was the “clue”). We asked if tests had been performed for heavy metals and were assured that such had been done early on. We later discovered that these consisted only of a screen for arsenic!
By March 16, 1995, the patient had been in coma for several weeks; and, despite normal cerebrospinal fluid findings, a diagnosis of Guillain-Barre syndrome was made by the Chinese physicians. By April 12, 1995, the patient’s condition had not changed, and a repeat lumbar puncture revealed an elevated protein (248 mg.%) and 6 leukocytes. The impression of Guillain-Barre syndrome was reinforced, despite messages from the “outsiders” that this picture was not consistent with Guillain-Barre.
At about this same time, the author and John W. Aldis, M.D., a physician working in the U. S. State Department, and formerly the Embassy physician in Beijing, conceived of the idea of thallium poisoning, this after Dr. Aldis was sent an article by Rose Miketta, M. D., a physician with Searle Pharmaceutical Company, explaining the neurotoxic effects of thallium. We again suggested that the patient be checked for thallium poisoning. This recommendation was further backed by others, including Dr. David Bullimore at St. James’ Hospital in England, and several other p hysicians in the United States. Yet, two weeks passed before the Chinese physicians decided to perform the thallium study. It required an intervention by personnel at the American Embassy in Beijing, and personal contacts between Dr. Aldis and several o f the PUMC doctors (whom Dr. Aldis had known from his days in Beijing), and faxes of articles directly to the hospital, before the test for thallium was finally run. The results were striking. The patient had levels of thallium in blood, urine, cerebrosp inal fluid, hair, and nails which were more than 50 times higher than “normal”! As to the source of the thallium, this remains unknown; but certain laboratory chemicals contain thallium; and, in the Orient, there are several industrial compounds (including several brands of rat poison) which contain thallium (its use is generally outlawed in the western world).
Once the diagnosis was established, the next problem was encountered. Several of us, using the Internet and other online databases, searched the literature for the optimum method of removing thallium from the body. A number of methods were cited; but to xicologists at the New York and Los Angeles Poison Control Centers felt that the most effective treatment was that of administration of the dye Prussian Blue (ferric ferrocyanide) and renal hemodialysis, with addition of potassium chloride. Then came the problem of obtaining the Prussian Blue (a common industrial chemical which was eventually found in China). Underlying this difficulty was the fact that, once again, advice from “outsiders” was suspect by the Chinese.
Finally, after many phone calls, faxes, and other communications (the doctors at PUMC would not deal with the students, who had Internet connections), including the involvement of the patient’s family (several of whom were known political figures locally) , the Prussian Blue-hemodialysis regimen was started on May 5, 1995, this almost one month from the initial proposal of the diagnosis of thallium intoxication and some forty days after the patient had lapsed into coma and had become apneic.
I wish that I could report a “happy ending” here. The patient responded rapidly to the treatment, and, within 15 days after the institution of treatment, the patient’s thallium levels in blood, urine, and cerebrospinal fluid had decreased to near-zero (although certain other tissues, such as nails and hair, will retain the metal for many weeks and will slowly “leach out”). Sadly, the patient’s neurological condition has not improved to a significant degree. She now has been partially weaned from the ventilator, and seems to recognize her parents; but she does not as yet have full consciousness, nor does she exhibit much in the way of voluntary or purposeful activity. The long period of brain intoxication in this case appears to be the reason for her lack of further progress to date and the prognosis for recovery remains guarded.
In recent years, there has been geometric growth in the use of online communication in medicine. The new field of “Telemedicine” is rapidly being advanced in the developed countries, with computer review of case histories, imaging studies (many of which are digital in their native form), and other medical data becoming almost “routine” in making judgments, for example, as to the transport of seriously ill or injured patients to tertiary medical centers. In our own area, patients are transported on a daily basis, from small facilities out in the “hinterland” to major urban medical centers. Physicians at outlying hospitals have, through a simple computer/modem connection, access to specialists and centers with advanced technology. The growing use of ISDN (Integrated Services Digital Network) telephone lines has made the transfer of complex information, including full-resolution MRI and CT scans, into a rapid and seamless procedure. The global Internet renders such “connectivity” a relatively inexpensive reality to be enjoyed by health care professionals and patients throughout the world.
Despite this availability of technology (and, in the case of this unfortunate student), however, the finest advances in global communication cannot surmount centuries of tradition and cultural differences. In this case, the cultural differences delayed implementation of the large volume of collective knowledge which was brought to bear on behalf of a young woman; and sadly in this instance, was probably “too little and too late”. As with other problems in this world, it still comes down to the “human factor”.
As we advance the cause of “Telemedicine” and other interactive technologies, we must never lose sight of the fact that, behind these wonderful machines are the minds and hearts, and prejudices, of the human beings who run them. It is in this “human arena” where we need to place our educational emphasis, so that the marvels of the modern digital age can be used for the advancement of our species and of the world as a whole.
AUTHOR’S NOTE:
This paper is dedicated to Zhu Lin, the 21-year-old student who is the subject of the case report. Acknowledgement is also gratefully made to John W. Aldis, M. D. (U. S. State Department); Xin Li (telemedicine fellow at UCLA Medical Center); Dr. Ashok Ja in (USC Department of Emergency Medicine and Los Angeles Poison Control Center); Dr. R. Hoffman and his colleagues (New York City Poison Control Center); Dr. David Bullimore (University of Leeds, England); and the myriad other people who labored on behalf of a young woman, critically ill halfway across the world.
http://www.rafink.com/tao.php