Usama bin Laden long ago died of kidney failure, or so I had thought.
In January 2002, former Pakistani President Pervez Musharraf claimed bin Laden required two dialysis machines. He speculated bin Laden likely died somewhere in Afghanistan without them.
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"I think now, frankly, he is dead for the reason he is a...kidney patient," our supposed ally had claimed.
These words conjured ghastly mental images of a multimillionaire terrorist in a cave with his blood churning through sophisticated medical devices. At least until maybe one day when his power generator ran out of gasoline, leaving him to die of renal failure.
Or maybe, in the alternative, bin Laden finally hacked a kidney or two from a compatible, young al Qaeda recruit, but the surgery, performed in a cave, left to him die of a mass infection.
Finally, a world without adequate health care had come to some good.
"Ever since 9/11, there has been talk in the nephrology community that he had been on dialysis," said Dr. Robert Provenzano, a prominent nephrologist and chief strategy officer of DaVita Inc. (NYSE:DVA), one of the largest kidney-care companies in the U.S. "But I don't know that anybody actually had proof."
There's no word if the compound where bin Laden finally met his 72 virgins was medically equipped, but it had been a safe place for dialysis sessions.
"It is very common in Pakistan and India for well-to-do people to have their own private dialysis," Provenzano said. "They just buy the machine and hire a technician."
That's what's known as hemodialysis, or the filtering of the blood. There's another process called peritoneal dialysis that involves a surgically implanted catheter and a bag of a solution to drip into the abdominal cavity. After an initial surgery, peritoneal dialysis requires no machinery, electricity or running water.
"People who talked about him being on dialysis talked about him being on this type of dialysis," Provenzano said. "That could have been performed in a cave."
"In the U.S., a doctor would have had to write a prescription, and it would be delivered to your home or wherever you wanted it," Provenzano said. "Those rules are less stringent in Europe and almost nonexistent in Pakistan."
Provenzano counts 410,000 people in the U.S. on dialysis, but of those, only about 10% are on peritoneal dialysis. While it's cheaper and doesn't involve machinery, it has to be done every day, as opposed to just two or three times a week for hemodialysis.
Still, when you're the target of a global manhunt, it is the way to go. Then, once you're established in a posh mansion compound, you can go back to hemodialysis. It hasn't been revealed whether bin Laden had a catheter in his belly. But wouldn't it be interesting to know?
"I'm hoping somebody looked before they tossed him overboard," Provenzano said.
It must have been like playing three-dimensional chess, running from the world's greatest military power, organizing terrorist attacks and all the while keeping up dialysis.
Mere decades ago, anyone with kidney failure could start planning a funeral. Today, they get dialysis for $65,000 to $80,000 a year until they can get a $120,000 kidney transplant. A Saudi multimillionaire can afford this. So can anyone on Medicare.
It is one of the things driving medical costs. But when faced with death, these costs are relative. More people need dialysis because more people survive heart attacks, cancers and other ailments that eventually take tolls on the kidneys.
"It is amazing considering how sick these people are, how well they actually do," Provenzano said.
Bin Laden could have kept up a dialysis regiment all these years, no problem. And if it kept him alive so that America could finally enjoy the pleasure of pumping a bullet into his head, it's a wonderful technology. Imagine our eternal despair if he'd died and his body was never recovered.
Bin Laden, of course, also reportedly had an enlarged heart, chronically low blood pressure, osteoporosis and two missing toes from fighting the Soviets in Afghanistan. Some news reports attributed to the Central Intelligence Agency said he didn't need dialysis, he just had kidney stones, and that he was actually a bit of a hypochondriac. But it won't hurt if bin Laden becomes a poster child for dialysis.
"We embrace AIDS, breast and prostate cancer, you name it, but mention you have kidney failure and people look at you like you're from Mars," Provenzano said. The stigma, however, isn't any worse than slogging through dialysis treatments several times a week.
"When our kidney patients complain," said Provenzano, "we can say, "Geez, if Usama can do this in a cave, you certainly can do it at home.'"
(Al's Emporium, written by Dow Jones Newswires columnist Al Lewis, offers commentary and analysis on a wide range of business subjects through an unconventional perspective. Contact Al at email@example.com or tellittoal.com)