Thursday, March 24, 2005

Actual facts in the Schiavo case UPDATED REPEATEDLY

Interrupting an emotional debate with real science.
March 24, 2005

It is always bad manners to interrupt an emotionally charged discussion with facts, but forgive me. Peggy Peck one of the country's best and most-respected medical writers, has covered the Schiavo case for years. In a discussion on the list serve of the National Association of Science Writers (NASW), Peggy put to rest several rumors and misstatements, many of them circulated by the yahoos who have intervened in this sad family matter for their own political purposes. With Peggy's permission, read on:

I've been writing about this for years. First, Michael Schiavo is her husband, not her ex-husband.

Second, the evidence from neurologists--with the exception of the bariatric chamber fan--is that she is in a persistent vegetative state, not a minimally conscious state. Here is an excerpt from one of my articles that explains the criteria for minimally conscious state:

What has confused many in the public--and a fair share of politicians--is the term "persistent vegetative state", says Joseph T. Giacino, PhD associate director of neurology, JFK Johnson Rehabilitation Center, New Jersey Science Institute, Edison, New Jersey. Dr. Giancino says this confusion is fed by a news media that uses the terms persistent vegetative state and coma interchangeably.

He notes that the three major disorders of consciousness are coma, vegetative state and minimally conscious state.

Terri Schiavo's parents, Bob and Mary Schindler, went public with a video tape of that appears to show Mrs. Schiavo responding to her mother. Her husband, on-the-other hand, claims the tape snippet that has been widely broadcast is actually a single event edited down from hours and hours of video tape.

Dr. Giacino cautioned against jumping to conclusions based on the video evidence. The only way to confirm a diagnosis of minimally conscious state, is with bedside examination by two examiners who can confirm the presence of four key criteria, one of which must be met before the diagnosis can be made. Moreover, those criteria should be reproducible during a single assessment.

First, the patient should be able to reproduce a simple command such as "Raise your hand" or "Stick out your tongue". Other criteria include the ability to speak one word, even if the word is spoken out of context and evidence of communication, which can include subtle signs such as eye movements. Finally, the patients should demonstrate a behavior that shows a relationship to an environmental event. For example, if a patient cries when shown a family picture.

Finally, the signs of minimally conscious state should be clear and unambiguous, Dr. Giacino said. He said there is no evidence that Schiavo has met these criteria in the last 15 years. " Chances are that is the way it will continue and another week or two is not going to make her better," he said.

You can read more of her work here and here. [It's a University of Pennsylvania site and free and relatively harmless registration is required].
And for an excellent story on the ethics of doctors who diagnose via videotape and reason through religion (including, apparently, the Senate Majority Leader/transplant surgeon) see Schwartz and Grady in the New York Times.
For more on the religious differences, see Watanabe and Stammer in the Los Angeles Times.
For a fine story on what's terribly wrong with that videotape the networks show ad nauseam, try Kennedy in the New York Daily News.
Every television news director in the country should be strapped to a chair and read that story aloud into their ears before running that tape again.

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