Year 12s: what will be the first way you research your future options? >>

Vegetative patient says 'I'm not in pain'

Source: http://www.bbc.co.uk/news/health-20268044

A Canadian man who was believed to have been in a vegetative state for more than a decade, has been able to tell scientists that he is not in any pain.

It's the first time an uncommunicative, severely brain-injured patient has been able to give answers clinically relevant to their care.

Scott Routley, 39, was asked questions while having his brain activity scanned in an fMRI machine.

His doctor says the discovery means medical textbooks will need rewriting.

Vegetative patients emerge from a coma into a condition where they have periods awake, with their eyes open, but have no perception of themselves or the outside world.

Mr Routley suffered a severe brain injury in a car accident 12 years ago.

I think the experiment they used is a little unreliable and the questions they asked such as imagaining himself playing tennis are the wrong ones to be asking. If I'd been stuck in a vegatative state that long the first question I'd want to be asked is 'do you want to die?'

I'm a bit skeptical in general of what this shows - it could just be a coincidental correlation (especially since it was only 1 in 5/1 in 10) and how can they possibly be talking about 'rewritting medical textbooks' already when they don't even know if this can apply to anyone else in a vegatative state? I think they're just jumping at the first thing they've found because they want it to be true, as pessimistic as it sounds.

Thoughts?

Reply 1

Good bloke

Original post by Kiss

If I'd been stuck in a vegatative state that long the first question I'd want to be asked is 'do you want to die?'

Put yourself in the place of such a person who doesn't want to die. The first thing you are asked is whether you want to die. If that were me I'd instantly think Aarrgghh! They want to kill me! and my morale would take a big dive.

What a ridiculous suggestion! I'd want to hear the plan for getting me back on my feet.

Reply 2

Kiss

Original post by Good bloke

Well it's a mere question. And if they, from their assertions, are able to answer it then there you should be no problem at all. And I said 'If I', not 'If they'.

Reply 3

Grad_UK

I remember listening to a podcast about something similar a while back, i think from the ABC website. There's certainly something in this -advances in scanning technology are allowing clinicians to communicate with patients where this previously was not possible. Quite remarkable science and of course impossible to imagine what how the patient must be feeling in such a situation. I can't play the video at work, is this where they describe the tennis experiment??

Assisted suicide is illegal so it would be unethical for a researcher to ask that particular question (at least according to an ethical review board).

I'd be interested to read the peer reviewed paper of this work if there is one. Does anyone have the link?? I might do a quick search.

Edit: link to paper http://www.nejm.org/doi/full/10.1056/NEJMoa0905370: older but similar research.

(edited 11 years ago)

Reply 4

Good bloke

Original post by Kiss

Well it's a mere question.

No. It is a loaded question, and highly improper.

Reply 5

Kiss

Original post by Grad_UK

Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment.

These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition.

The results from the experiment do reflect to show some signs of an active brain, but these are not conclusive and are a minority. That doesn't disregard their findings entirely, but I think the news and Dr. Young have been waaaaaaaaaaaaaaaay too eager in describing this as a form of communication when there is not significant enough evidence to suggest he was communicating effectively; that has only been shown through patterns. And they are getting ahead of themselves in saying medical textbooks should be re-written/this can revolutionise everything since this has 1. only been found in a minority of cases and 2. does not mean it can be applied to everyone who is in a similar vegatative state.

I'm sorry if I'm putting a downer on people's hopes, but I don't think they should be jumping at the first thing which has fallen through until there is more evidence.

Reply 6

besomebody

I'm not really sure which part of this you have an issue with.

Most research starts with case studies, anecdotes, etc. Then you (hopefully) get funding for bigger studies. I don't think anyone is suggesting that the findings can be generalised to everyone (yet), but that they could be. The findings suggest that it's worth further investiagation becauuse potentially something new has been discovered. With further evidence to support what was found textbooks may have to be rewritten.

It's not the MMR vaccine scare...

Reply 7

Grad_UK

Original post by Kiss

1. only been found in a minority of cases and 2. does not mean it can be applied to everyone who is in a similar vegatative state.

I'm sorry if I'm putting a downer on people's hopes, but I don't think they should be jumping at the first thing which has fallen through until there is more evidence.

Yep, I don't think we disagree. It is however most certainly worthy of further investigation even if the opportunity exists to improve quality of life in a only a small minority of these patients (which the early research suggests may be possible).

As usual I'm wary of the media coverage from which false promise too often arises following these types of stories.

Reply 8

DocHama

Read this story earlier today, seems incredible how far we've come scientifically, but I agree that they should ask the guy if he wants to die or not. Must be terrible stuck motionless, speechless, everythingless for 10 years.. Hpwever, a report I read somewhere (no source sorry) said that the vast majority of people in vegetative state or with locked in syndrome are actually happy and dont want to die!