November 25, 2009

Man In Coma For 23 Years Not In Coma

i want to believe.JPG

Story: Man in "coma" for 23 years,

Then a neurologist, Steven Laureys, who decided to take a radical look at the state of diagnosed coma patients, released him from his torture. Using a state-of-the-art scanning system, Laureys found to his amazement that his brain was functioning almost normally.
My first instinct was to dismiss this.  "Radical" and "state-of-the-art" are terms that describe technology that has been essentially unchanged for ten years.  Either the old doctors missed it, or Laureys has better technology at his disposal.

Belgian doctors used an internationally-accepted scale to monitor Houben's state over the years. Known as the Glasgow Coma Scale, it requires assessment of the eyes, verbal and motor responses. But they failed to assess him correctly and missed signs that his brain was still functioning.
So there's one answer: they didn't bother to scan him in the first place, or at least update the scans over time.  They relied on a behavioral measure.   It happens-- complacency, routine... patient gets offloaded to a nursing home never to be heard from again.  It happens.

The moment it was discovered he was not in a vegetative state, said Houben, was like being born again. "I'll never forget the day that they discovered me," he said. "It was my second birth".

And there the science ends, and the politics begin.


What do you want this story to be about?

Many people thought this was a hoax, but not because of what I've described, but because of this:

"I had dreamed myself away... I screamed, but there was nothing to hear," he said, via his keyboard.
Here's a video, but the screen cap tells enough:

houben hand.JPGThat's a therapist's hand guiding his hand along the keyboard.  "Facilitated communication" is controversial.  Is it Ouija board stuff, or for real?  The Amazing Randi  and one quasi-famous bioethicist say FC is a fraud.  Debate on TV and message boards all focus on FC.

But that's not what the actual news stories are really about.  The articles don't even mention Facilitated Communication.  And Dr. Laureys doesn't mention it in any of  his scientific papers I've read.  Even if FC is a hoax, even if this patient isn't really communicating via FC, it doesn't mean he's not conscious.  Isn't that really the issue?

That's the hijack: Randi, and Caplan, and the public, can't interpret MRI scans.  So instead they'll interpret and argue what they can-- news videos.  That's politics.


What does Dr. Laureys want to be true?

I'd like to tell you I looked at the case write-up, but there isn't one.  That's very suspicious, but also completely besides the point, because for Laureys, the point isn't about Houben.  That's why he didn't even write it up.

What he wrote about, however, was better/newer applications of technology to detect consciousness.  We can debate whether fMRIs are really novel or just appropriate practice,  but what he is really doing is asking the European governments to pay for it.  From Laurey's perspective, he wants to change standard of care to regularly employ this technology.

Following this, it's no wonder the British press keyed in on it.


What about the Americans?

"We have to re-evaluate cases like Terry Schiavo."  Actually, we don't. 

For U.S. doctors the application of "high tech" scans is hardly novel, even getting Medicaid/Medicare to pay for it isn't such a struggle.  But the comparison to Schiavo's case  isn't correct: Terry Schiavo was scanned with an MRI, people just disagreed with what it said.  The Houben debate is whether we should be scanning in general.


For my money, the case is suspicious but:

The spectacle is so incredible that even Dr. Laureys had doubts about its authenticity. He decided to put it to the test.

"I showed him objects when I was alone with him in the room and then, later, with his aide, he was able to give the right answers," Professor Laureys said. "It is true."

Laureys would have to be insane to make up a lie of this giganticality, but anything is possible.