Thursday, November 26, 2009

coma coma coma coma coma chameleon

Here's a little exercise in scepticism and critical thinking for you, just to demonstrate how important it is, and how it is in fact the only way to find out anything about anything. If you want to limber up first, check out the pixie dust/magic finger story from a while back.

You may have seen the various articles (in the Daily Mail and Guardian, among others, and on the BBC website) about Belgian man Rom Houben and the apparent miraculous discovery that he is, inside his crippled and useless body, actually conscious and coherent after 23 years in what doctors had previously thought was a vegetative coma.

So, if you've got your critical thinking hat on straight, the first thing you think is: wow; how did they find out that he was conscious? And the answer seems to be: initially by some brain-scanning technique of an unspecified nature that might be something like fMRI or CAT, but might equally well be something else. The Mail alludes to "new high-tech scans" and "state-of-the-art imaging", but gives no details, nor does it describe how the results of a brain scan can be interpreted to determine "consciousness" or its absence. The Guardian mentions a "state-of-the-art scanning system", but that's about it.

But, hey, none of this should really matter, because the main thing is that he's able to communicate with the outside world, right? Well....the Guardian mentions that he is able to make simple yes/no signals with his foot, which seems clear enough, but in all the pictures, all the video footage and most of the articles he's communicating via a touch-screen keyboard interface with the assistance of another person.

Again, if you've got your critical thinking hat on straight this should set alarm bells off all over the shop. What appears to be happening here is something called "facilitated communication", whereby a "facilitator" guides the patient's hands around until they feel a "twitch" or something similar which they interpret as the patient selecting a letter. The trouble with this is that, bluntly, it doesn't work. Why it doesn't work, and has been proven not to work repeatedly in properly constructed tests, but appears to, is down to fascinating things like the ideomotor effect (the thing that makes ouija boards "work") and the observer-expectancy effect (also, more amusingly, known as the Clever Hans effect after the famous horse that could supposedly do arithmetic).

The sceptical blogosphere has been a-buzzing with indignation over a) blatantly pseudoscientific nonsense being passed off as medical science and b) the hopelessly credulous and unquestioning attitude most of the press and online media have taken in response. The only sceptical mainstream media article I could find (and I should point out I haven't exactly spent hours looking, so there may be others) was this one on MSNBC; significantly it's by an actual science-y doctor type rather than the usual pig-ignorant drunken hacks. In contrast plenty of sceptical and scientific blogs chewed over the story in a more critical way; here's PZ, Orac, the Amazing Randi and the Skepchicks just for starters, but there are plenty more.

It's easy to have an instinctive emotional reaction to what is a pretty tragic story of a life cut short, so here are a couple of disclaimers: no-one is suggesting that either the doctor (Steven Laureys of the University of Liège) or the facilitator operating the keyboard are anything but sincere; the whole point of facilitated communication is that it requires no conscious collusion from anybody. Equally, no-one is suggesting that Rom Houben may not in fact really be just as conscious and lucid as people are claiming he is, just that the "evidence" provided so far provides zero information one way or the other.

Most of the articles, critical or otherwise, have drawn the parallel with the story of Jean-Dominique Bauby, author of the book The Diving Bell And The Butterfly (later filmed). It's been suggested that Houben may be suffering from "locked-in syndrome" just as Bauby was. This seems unlikely given the differing nature of their injuries - Houben was in a car accident, Bauby had a stroke, which seems to be the usual trigger for LIS - but it's not impossible, I suppose. Again, until some proper tests are carried out no-one will ever know.

The other obvious parallel that some people have drawn is with Terri Schiavo, whose case was something of a cause célèbre in the USA in the early 2000s. Schiavo suffered some mysterious brain injury (over which there is still much speculation) in 1990 and then fell into a coma from which she never recovered until her death in March 2005. The legal furore surrounding her husband's bid to allow her to die, and her parents' demands that she be kept alive (with, bizarrely, interventions from Jeb Bush, governor of Florida), dragged on for many years. When you add loony religious notions like "the soul" into a mix already rich (and understandably so) in wishful thinking and denial then you've got a recipe for disaster. I predict the Houben case will be hijacked by some loonies banging on about the sanctity of human life and wanting some retrospective re-evaluation of the Schiavo case any second now. Oh, wait.

Many of the news articles have made use of some variant of the "silent scream of anguish" trope, which makes me think they've probably been reading too much science fiction. Or possibly listening to too much Metallica.

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bathmate said...
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