Battling Junk Science in the Schaivo Case

Glenn Reynolds posts an excerpt from a column today on TechCentralStation. The column is by Dr. Elizabeth Whelan of the American Council on Science and Health. It’s a pretty convincing column, assuming you didn’t know a lot about the Schaivo case.

I, as you might expect, have issue with it on both factual and non-factual grounds. I’ll make my case and you can judge for yourself. Dr. Whelan makes this statement.

The medical reality of Ms. Schiavo’s case is this: She has been in what is medically referred to as a “permanent vegetative state” for the past 15 years, ever since her heart temporarily stopped (probably due to the severe effects of an eating disorder), depriving her brain of oxygen.

That’s not quite true. Terri has been diagnosed as being in a “permanent vegetative state” but that was not her initial diagnosis, as the doctor says “ever since her heart temporarily stopped”.

That’s not how “permanent” is decided, though. The Multi-Society Task Force, quoted in a paper here, denotes the difference between “persistent” and “permanent”.

A wakeful unconscious state that lasts longer than a few weeks is referred to as a persistently vegetative state. … A permanent vegetative state, on the other hand, means an irreversible state, which like all clinical diagnoses in medicine, is based on probabilities, not absolutes. A patient in a persistent vegetative state becomes permanently vegetative when the diagnosis of irreversibility can be established with a high degree of clinical certainty – that is, when the chance that the patient will regain consciousness is exceedingly small.

That definition is further refined to note that there is a process. A patient is first diagnosed as being “persistent”, then “permanent”.

On the basis of these probabilities, a persistent vegetative state can be judged to be permanent 12 months after a traumatic injury in adults and children; recovery after this time is exceedingly rare and almost always involves a severe disability. In adults and children with non-traumatic injuries, a persistent vegetative state can be considered to be permanent after three months; recovery does occur, but it is rare and at best associated with moderate or severe disability.

At best, following these strict guidelines, Terri wold have been diagnosed as being in a permanent vegetative state three months after her heart temporarily stopped, not immediately, as the doctor said.

I do not know where Dr. Whelan got her information. It could be that this is just a typographical mistake, but it’s a critical error to make. As the quotes make clear, a diagnosis of permanence means that she was persistent for at least three months and that she was subjected to a comprehensive series of tests to determine that she had an almost nonexistent chance of recovery from that condition.

That leads me to my next point. Dr. Whelan excoriates Senator Frist and Dr. Cheshire for what she considers intemperate statements that Ms. Schaivo does not appear to them to be in a PVS.

Thus it was shocking that Sen. Bill Frist — a heart surgeon before becoming Senate majority leader — went to the Senate floor twice last week to argue that Florida doctors had erred in saying that Terri is in a “persistent vegetative state.” How did Frist arrive at this diagnosis? From watching the family videotapes.

Frist’s comments were picked up by journalists, including FoxNews’s Fred Barnes, who cited Sen. Frist as an authority in a debate with Morton Kondracke on “The Beltway Boys” last week.

Yesterday, there was another public challenge to Ms. Schiavo’s well-established diagnosis: Florida governor Jeb Bush announced that a “very renowned neurologist,” Dr. William Cheshire, had concluded that Terri had been misdiagnosed and that she was really only in a state of “minimal consciousness” rather than a persistent vegetative state. He used this “new diagnosis” to argue that “this new information raises serious concerns and warrants immediate action.”

As it turns out, Dr. Cheshire is not “renowned” as a neurologist — his limited publications focus on areas including headache pain and his opposition to stem cell research. Dr. Cheshire never conducted a physical examination of Ms. Schiavo, nor did he do neurological tests. Dr. Cheshire is director of biotech ethics at the Center for Bioethics and Human Dignity, a nonprofit group founded by “more than a dozen leading Christian bioethicists.” Everyone is free to be guided by a personal agenda — and it is clear that Dr. Cheshire has his.

Both of these physicians seem to have exactly the same information that Dr. Whelan has and have reached a different decision than she has. To be exact, they seem to have reached out for more information since they, at least, have reviewed the videotapes and I’m not sure that Dr. Whelan has.

There is a lot here, though, that Dr. Whelan has not said, though. First, she notes that “dozens of experts” have examined Terri over the years have reached the same conclusion. What she does not tell you is that some doctors who have examined her have not come to that conclusion. She does not tell you that the three doctors who initially examined Terri spent a relatively small amount of time doing so and their conclusion differed from the other two doctors who examined her at the same time.

Dr. Whelan harshly criticizes what she sees as an agenda on the part of Dr. Cheshire, but she fails to point out that Dr. Cranford (one of the initial doctors on this case and the most outspoken about Terri’s condition) is a noted and very outspoken “right to die” physician who has already been involved in some sketchy diagnoses of PVS.

Let’s be clear here. Both Senator Frist and Dr. Cheshire have been very clear about the basis on which they’ve made their statements. They have not hidden that they have only been able to use the viddeotapes and court statements of other physicians. They have openly admitted that they don’t have enough evidence to make a fully-informed conclusion (Dr. Whelan’s insinuation notwithstanding). Their agenda is hardly hidden and whether you agree with them or not, you don’t have to search very hard to find out their affiliation and their objectives here. Dr. Cranford, though, hasn’t been quite as forthcoming but he seems to have escaped Dr. Whelan’s ire.

What she hasn’t done is what I think any prudent physician would want done in this case. Ackowledge that there have been doctors without apparent agendas who disagree on Terri’s disgnosis and ask for a comprehensive examination to decide the matter once and for all.

Doing this one thing would almost immediately quell most of the debate. Only the fringes of either side would argue on. After all, if after such an examination, Terri’s diagnosis was confirmed, who could reasonably argue that she could feel pain, or even that she could want to remain alive in such a state. If the diagnosis changes, who could reasonably argue that she should die?

She closes with this.

Let’s call tripe when tripe is served. All of us are entitled to our own personal views on the Schiavo case, what her fate should be, and who should make decisions for her. But all of us should be united in rejecting politically-generated junk science.

I couldn’t agree more, which is why I’m calling “tripe” on this column. I don’t doubt her sincerity but I do doubt her objectivity, at least as far as this column is concerned. Dr. Whelan’s science, insofar as she’s introduced it, isn’t much more accurate than the statements she’s criticizing. I’d expect more from someone who wants us not to remain silent about the “outrageous misrepresentation of scientific facts about this case ” and to reject junk science.

No related posts.

Category: The Good Old US of A