In the wake of the discovery (reported in last week's BioEdge) that a brain-damaged woman in the UK in a persistent vegetative state was responding to stimuli, other stories about recoveries from irreversible comas are emerging in the press. While many doctors are sceptical, the possibility that some therapies may restore some consciousness in some cases threatens to overthrow a consensus on how to deal with patients languishing in hospitals and nursing homes.
Bioethicist Joseph Fins, of Cornell's Weill Medical College, says that ever since the Karen Ann Quinlan case in the US in the 1970s, doctors have been abandoning brain-damaged patients too readily. As a result, fewer patients improve and the statistics get worse. Then families and doctors give up and researchers stop pursing new treatments. It becomes a vicious circle which Fins dubs therapeutic nihilism. "We've spent a long time allowing people to die," he says. Maybe they deserve more intellectual, diagnostic and therapeutic engagement than we have acknowledged."
One simple therapy which has produced remarkable results comes from South Africa: a sleeping pill. A family doctor near Johannesburg discovered that when some severely brain-damaged patients are given zolpidem they emerge from their comas and begin to communicate. No one understands why, but it appears that the damaged brain cells are not dead, in some cases at least, but only hibernating. The drug may wake them up.
A journalist for the UK Guardian met several patients who emerge from a persistent vegetative state after taking zolpidem. The degree of recovery varies, and lasts only about two and a quarter hours, but some of the recoveries appear remarkable. Papers describing what happens have been published in the journals NeuroRehabilitation and the New England Journal of Medicine and a British company, ReGen Therapeutics, is carrying out clinical trials.
Another therapy is electrical stimulation of the brain. An American doctor, Edwin Cooper, claims that people given electrical stimulation emerge from comas more quickly and regain functions more quickly than if they are given only traditional treatment. His work has not attracted much attention in the US and was even denounced by the recently deceased expert witness in the Terri Schiavo case, Ronald Cranford, as "junk science".
However, in Japan, electrical stimulation is far more common. Doctors there implant electrodes directly into the spine. The results are not spectacular, but they are significant. About 40% of patients move from a persistent vegetative state to a minimally conscious state. Small as this may seem, relatives regard it as a blessing.
Even if these treatments are only experimental, if they can be verified, their implications for end-of-life treatment are enormous. If a persistent vegetative state is no longer a hopeless and irreversible condition, it will become more difficult to justify withdrawing life support from patients. ~ Wired, Sept 6;
Guardian, Sept 12
BRITONS ADDICTED TO COSMETIC SURGERY
Nearly 20% of Americans would like to have cosmetic surgery, according to a survey released by the American Academy of Cosmetic Surgery. Although only about 6% have actually had it, far more are interested. This seems to be fuelled by an overwhelming conviction that personal appearance is the key to professional success in the US.
Across the Atlantic, a darker message is being relayed to the profession: that their work is addictive for some patients. Dr Adam Searle, president of the British Association of Aesthetic Plastic Surgeons, has warned his colleagues that some patients are suffering from "imagined ugly syndrome" or "body dysmorphic disorder".
Plastic surgery is booming in Britain, with the number of operations in 2005, including Botox, up 35% on 2004. But often these operations may be unnecessary. "People can become addicted to the anticipation, the excitement and the attention they receive," says consultant psychologist Eileen Bradbury, of Manchester. "There is a short-lived result of feeling fabulous. But the post-procedure high fades, life goes back to normal and all the mundane problems come back so you need to go for another fix." ~
London Times, Sept 17;
HealthNewsDigest, Sept 18
AUSTRALIAN EUTHANASIA DEBATE FLARES UP AGAIN
A powerful voice in the Australian government has called for the legalisation of voluntary euthanasia. Although Federal Parliament quashed a euthanasia law in the Northern Territory back in 1997, Senator Amanda Vanstone, the minister for immigration, wants the states to "have another go". "I am in favour of us developing sane, sensible and humane euthanasia laws," she told the media. "And I think it's inhumane not to do so. Most people take their loved pet to the vet so it doesn't have to go through terrible agony in the last few days or hours of its life, but we can't find a way to arrange that for humans."
Senator Vanstone and two other Federal politicians will speak at a conference organised by euthanasia activist Dr Philip Nitschke later this week on the occasion of the 10th anniversary of the passage of the Northern Territory's bill in 1996. In the nine months that it was in force, four people died, all with the assistance of Dr Nitschke.
The anniversary is also being used to publicise a book, Telling It Straight, by a man who helped another patient of Dr Nitschke's to die in 2002. Nancy Crick took a lethal cocktail of barbiturates in the presence of 20 supporters in the state of Queensland. Assisted suicide being illegal there, police investigated, but no charges were laid. However, in the book author John Edge has detailed how he disposed of some potentially incriminating evidence. Police may now reopen the case. ~ news.com.au, Sept 17
SCIENCE DENOUNCES ANIMAL RIGHTS TERRORISM
The editor of the prestigious journal Science has denounced terrorist" tactics used by some animal rights organisations to intimidate scientists. Editor Donald Kennedy highlighted the case of Dr Dario Ringach, a neurobiologist at the University of California, Los Angeles, and a sometime contributor to Science. He was harassed so viciously by the Animal Liberation Front as a "vivisectionist" that he resigned his post. Kennedy was exasperated by the slow response of the UCLA administration to Ringach's troubles.
Kennedy says that intimidation by activists is one of the most serious issues facing US scientists -- and one that is largely ignored. "Scientific progress depends on experiment," he writes, and in the life sciences that usually entails the use of live animals." He supports strongly the Animal Enterprise Terrorism Act, which would prohibit threats against researchers and their families, establish penalties for financial damage and intimidation. It would also ban targeting people who have dealings with animal researchers. ~ Science, Sept 15
TEXAS DEBATES FUTILE CARE LAW
Legislators are having second thoughts about a controversial futile- care law in Texas. This stipulates that if a hospital review committee feels that further treatment of a patient is futile, it must give a patient's family 10 days to find another facility to care for them. Otherwise the hospital can end treatment -- even if family members object. Texas Right to Life, the state's leading pro- life group, originally supported the law as a compromise between the rights of families to protect their loved ones and the right of doctors to withhold treatment which will not benefit patients. However, several high-profile cases have turned the law into a battleground.
Recently, legal action kept Memorial Hermann Hospital from pulling the plug on a severely brain-damaged woman, Kalilah Roberson-Reese. Now she has regained some consciousness, responds to familiar voices and can sit upright in a chair. "Nobody has the right to determine whether my daughter should live or not," says her mother, Cynthia Deason.
As Chicago Tribune reporter Howard Witt comments, the debate echoes the right-to-die debate of the 1970s and 80s, when patient advocates pressed for the right of the terminally ill to refuse burdensome treatment. But now hospitals have been empowered to withdraw the treatment against the wishes of their advocates. The director of Right to Life, Elizabeth Graham, says that decisions may sometime be financially motivated. "The hospitals will say it is not, of course, but it does seem that the majority of patients or families calling us for help are either uninsured, underinsured, or they have Medicaid."
Disability groups also oppose the law. "People who don't see the value of living with a significant disability are determining whether your life is a burden and treatment is futile," says Colleen Horton, of the Texas Center for Disability Studies. ~ Chicago Tribune, Sept 17
DESIGN BRIEF FOR DESIGNER BABIES
The well-educated are significantly more open to the idea of "designing" babies than the poorly educated, according to a new study by psychologists at the University of East Anglia in the UK. They also found that there are gender, age and socio-economic class differences in what is deemed desirable and that many prospective parents would be prepared to manipulate their babies in ways that are at odds with moral orthodoxy.
Although the study was based on several small surveys, the results are intriguing:
- The better educated prospective parents are, the further they are prepared to go to improve their children's IQ.
- Women interpret certain interventions in child rearing as "design acts" more readily than men and people over 50 more readily than people under 25.
- Because of "parental uncertainty" -- the idea than women know for certain if a child is their's whereas men do not -- men show a significantly greater preference than mothers for their children to inherit their own characteristics.
- Parents see different physical, social and intellectual characteristics as desirable depending on the sex of the child.
- Older women and childless women are significantly more willing to "improve" the physical, social and intellectual characteristics of prospective children.
- Both men and women see genetic engineering as acceptable primarily for medical applications. ~ Eureka Alert, Sept 5
"SLIPPERY SLOPE" MAY BE REAL IN EMBYRO SELECTIONS
Slate's biotechnology columnist William Saletan has suggested that there really is a "slippery slope" in bioethics -- at least for designer babies. He points out that parents have moved from screening embryos which will certainly have terrible and incurable diseases at birth to screening them for genes which might possibly predispose a person to a curable disease late in life. Some clinics urge screening to prevent not just the disease but "cancer predisposition syndrome". The idea is that no child should be required to go through life burdened by the fear of developing cancer at some stage later in life.
A survey by the Genetics and Public Policy Center has found that of the American IVF clinics which offer pre-implantation genetic diagnosis, 28% have used it to target genes which do not strike until adulthood. And 42% have used it for non-medical sex selection. "If PGD were evil, it would be easy to head off such abuses by banning it," writes Saletan. "But it's not. PGD prevents hellish diseases. In those cases, you have to say yes. And once you start saying yes, it's hard to say no. That's why they call it a slippery slope," write Saletan. ~ Slate, Sept 16
IN BRIEF: Dignitas; Vatican
Dignitas: Four Britons have ended their lives in Switzerland, with the help of the Zurich's Dignitas clinic, in the past six weeks. So far, 54 people from the UK have died there. The head of Dignity in Dying (formerly the Voluntary Euthanasia Society) said that she was shocked and saddened by these deaths in a distant country, but the ultimate cause was the UK's failure to legalise assisted suicide. ~ Scotland on Sunday, Sept 17
Vatican: Pope Benedict XVI has given his strong support to adult stem cell research, saying that the Catholic Church has always backed "research aimed at the cures of illnesses and at the good of humanity". However, on the controversial topic of destructive embryo research, he said that "there can be no compromise or prevarication". History "has condemned such science in the past, and will condemn it in the future". ~ CWNews.com, Sept 18
