28 March 2005

Advice for Andy Ho: Don't write what you don't understand

Advice for Andy Ho of the Straits Times:
Don't write about what you don't understand

"Dr" Andy Ho is a "senior writer" of the Straits Times. He is apparently their science and ethics columnist. He has an MBA from Yale and a PhD from MIT and an undergrad medical degree, I think. Apparently all that education taught him nothing.

In this opinion piece, Ho weighs in on the case of Terry Schiavo. His usual dedication to in-depth research and literature review is displayed to the world once more...

Ho writes:

Let us be clear about Mrs Schiavo's condition.

She is not brain-dead. She is a living, breathing person in what doctors call the permanent vegetative state, a term first invented in 1972.

At the risk of stating the obvious, the assumptions of both the lack of awareness and its permanence are not medical facts but merely, by their very nature, unprovable guesses. That is, there are no scans, blood tests or any other technology that can confirm such a diagnosis.

Strike one: Much of Terri's brain is dead. If Dr Ho had gone one step further to check which portion of her brain is dead, he would've stumbled upon this:

For comparison's sake, this is what a normal brain looks like under a CT scan:

And once again, especially for "Dr" Ho, who thinks there is no scan that can confirm the lack of awareness and its permanence:

The dark blue bits in Mrs Schiavo's CT scan - in the centre and elsewhere - are spinal fluid. That is to say, after her heart attack, much of Terri's brain died and turned into gooey fluid. Repeat (with apologies to Mrs Schiavo): She has NO BRAIN.

For the medically-savvy, Terri has no cerebral cortex. I would appreciate if Dr Ho would occasionally do proper research and refer to his medical texts, which state from the vantage of accepted neuroscience, that the

cerebral cortex is the seat of all our higher brain functions. Without a cerebral cortex, it is impossible for a human being to experience thought, emotions, consciousness, pain, pleasure, or anything at all; nor, barring a miracle, is it possible for a patient lacking a cerebral cortex to recover.

In case we didn't notice, Dr Ho wrote: the assumptions of both the lack of awareness and its permanence are not medical facts but merely, by their very nature, unprovable guesses...

Strike Two

"Dr" Ho did do lots of research! He discloses that he got his information from www.Terrisfight.org. Amazing. There's a 4 minute video that shows how lucid and responsive she is. She laughs and smiles to stimuli. She opens and closes her eyes in response to commands issued by a doctor.

All very well. If only Ho actually did proper online research, instead of visiting a biased pro-lifer site that shrilly announces "Treating convicted murderers better than Terri"? I mean, there are much better medical resources on the internet that may provide the relevant information for his assertion that Terri is fully sensate.

Like the University of Miami website that's tracking all medical, legal, and ethical issues linked to the case.

If Dr Ho had bothered to do his research, he'd find that

1. The 4-minute video of an apparently responsive and sensate Terri was formerly submitted to the Florida court and rejected, because...

2. The video was heavily edited from a 4-hour recording.

3. Mrs Schiavo would respond to commands, only after more than 10 or 20 minutes after they were issued, and other commands had been given in the intervening period - and then she'd respond randomly and sometimes repeatedly. It's very bad science to claim that she's therefore aware of the commands and following them. It's intellectually dishonest to edit out the intervening time period and leave out these facts.

4. It is normal for patients in similar persistive vegetative states to laugh, sigh, moan, articulate vowels randomly.

Advice to "Dr" Andy Ho: you need to do better research before you write on medical issues. Other bloggers have caught your biased and uninformed articles on strokes, homosexuality and AIDS, drug prescriptions, and a whole host of other booboos.

1 comment:

eastpaw said...

Hi there. I came across your blog while looking up Andy Ho: I'd just read an article by him and was curious about his educational background.

Anyway, you might be interested to know that your blog post here contains a couple of pieces of incorrect information.

Firstly, it is pretty much impossible to prove anything in science. The investigative method we use involves the statistical falsification (provisionally) of a stand antagonistic to the one we suspect is true, through which process of elimination we gain evidence (not absolute proof) that our hypothesis is likely to be correct. Due to a number of factors, not the least of which is limited human perspicacity, our hypotheses may grow stronger but may never quite become certain. In other words, there is no such thing as scientific proof. It may sound like I'm splitting hairs, but this is really quite important.

Secondly, your CT scan does not show that the patient has "no brain" or that she has no cerebral cortex. The lateral ventricles do clearly show up as enlarged in the scan, which is indeed indication that she has lost neural tissue. There is also obvious atrophy in the lateral, rostral, and caudal cerebral areas. However, she has retained significant brain tissue both in the forebrain and outside it, and furthermore responds (though inconsistently) to external stimuli, and therefore of a certainty fails to meet current medical criteria for brain death.

You're probably right to say she's not about to get better though. Adults just don't rebound from such profound neural loss.