In the days of the Soviet Union, the opacity of the Kremlin gave rise to the specialty of Kremlinology. The tools of the trade were politics and personality. The health of the subjects was addressed in the most general terms.

The new Kremlin affords more access to all but the most guarded sanctums. Yet Kremlinologists ply their old trade, taking advantage of only part of the new cornucopia. One obstacle remains;  Kremlin players now wear masks of concealment. Simon Sebag Montefiore’s book,  Stalin: The Court of the Red Tsar, quotes Beria at the death couch of Stalin. “Comrades, I have saved us all!” anticipates scenes of what may soon occur.

On May 30, I wrote Is Putin Seriously Ill? Then regarded as almost baseless speculation, his illness has gradually migrated towards respectable opinion. On July 25, Parkinson’s disease or Parkinsonism was identified as possible in CIA Bill Burns (Putin) & CNN (NY Polio).  Since then, visible motor problems are indicative of actual Parkinson’s disease.

Yet this has little play among Kremlinologists and the media. Among  practitioners, illness is something that happens to you. When it does, you consign your fate to physicians. Among physicians, it is strongly taboo to diagnose without seeing the patient and ordering standard-of-care tests. This results in severe bias of exclusion among historians, and their contemporary counterparts, analysts.  Ebola, Rats, Lice, and History, and Hans Zinsser Part 1, provides a capsule of Zinsser’s thought:

Historians seem to keep within the perspectives of personal comfort; no successors have taken Zinsser’s mantle. Disease is merely noted as coincident with events political and economic, when more than occasionally, it has been the prime driver. Disease has driven civilizations into decline, and exterminated primitive populations.

In a YouTube video, a British analyst, noting that Putin recently drove the Kerch bridge, pronounced his health adequate for the annual year-end media events. Having disposed of health, he offers conventionally political reasons for his disappearance, reprising the error of historians. His medical judgement is wrong. He should have found an oncologist willing to give an anonymous opinion.

The media bias replicates the above, with an addition. Juridical circumspection is a linchpin  of a respectable free press. It is misapplied here. Putin is not protected by HIPAA, due process,  right to privacy, or presumption of innocence. He is the valid subject of the almost-facts that dominate intelligence work. Here’s one: Putin is dying. This estimate is based entirely on public video.

What is he dying of? The tabloid press is full of contradictions. It is impossible to extend the estimate based on contradictory purported diagnoses. One new symptom, coughing, suggests wide metastasis of whatever it is. Metastasis to the tissues surrounding the lungs frequently results in malignant pleural effusion.

During his disappearance, Putin may receive a variety of treatments, some temporarily disabling, advisable only for a ruler for whom there is no alternative:

• If  the tumor is in fact solid, in contrast to a blood cancer, repeated laparoscopic surgery to debulk and remove obstructions.
• Pleural aspiration.
• Intensive chemotherapy.
• External beam radiotherapy.
• Radioactive implants.
• Nerve blocks.
• Coley’s toxins.

Unlike infectious disease, every cancer is unique, the result of the myriad forms of genetic damage, unique to the individual.  The cough, if confirmed, collapses the timeline. Previously, the WAG was 3 years. Now, 6 months.

The Kremlin players, with masks of concealment, have a difficult choice, to watch and wait, or hasten. They are not friends; they are rivals.  When they drop their masks, they may be unrecognizable. Who strikes first has the best chance of neutralizing the others, but at a price.

What price legitimacy?