Friday, June 17, 2005

I Was Wrong...

On Wednesday morning, I predicted that the autopsy report for Terri Schiavo would in some way purport to draw the conclusion that Terri was in a PVS.

I was wrong about that. But that's the kind of thing I'm happy to be wrong about.

I was pleasantly surprised to find that Dr. Thogmartin, the Pinellas County Medical Examiner, and Dr. Stephen Nelson, the consulting neuropathologist, were quite measured and reasonable in the conclusions they made concerning Terri's neurological state. They stated clearly in the report, and reiterated several times during Wednesday's press conference, that PVS is a clinical diagnosis and cannot be confirmed by autopsy. They confined themselves to stating that Terri had severe brain damage, and that such damage was "consistent with" a diagnosis of PVS.

A reporter questioned Dr. Nelson about whether Terri's autopsy results meant that Terri's family could not have interacted with her, as they claimed. Dr. Nelson, to his credit, said quite emphatically, "no, not at all". He again reiterated that pathological studies cannot confirm PVS. This conforms with what other neurologists have observed, that there is no correlation between the size of the brain, or the number of neurons present, and a person's cognitive function.

But I Was Right...

Unfortunately, the measured, reasonable conclusions of the autopsy report have not stopped ignorant journalists and pundits from making erroneous and outrageous claims about what the autopsy "proved". In my previous post, I quoted Boston neurologist Dr. Peter Morin, saying that he expected "gross overstatements regarding the implications of the neuropathology." Dr. Morin's pessimistic expectations have been realized: News reports such as this AP story describe the autopsy report as "vindicating" Michael Schiavo in his contention that Terri was a vegetable, when in fact it does no such thing. Joe Scarborough, on his MSNBC program Scarborough Country, asserted that the Medical Examiner said that Terri had "no brain activity". Tampa Tribune columnist Daniel Ruth, in a screed directed mainly at talk-show host Glenn Beck, claimed that the autopsy "confirmed" that Terri was in a PVS. Even more egregiously, he put words in Dr. Nelson's mouth, writing that the doctor stated that Terri had "no cognitive capability, " when he had neither said nor written any such thing.

It seems to me, barring the rage-induced excesses of Ruth and his ilk, that the pundits and reporters have made a fundamental logical error. They have interpreted the pathologists' statements that the condition of Terri's brain is "consistent with" PVS as somehow meaning "indicative of" or "supportive of" the PVS diagnosis. And that's not at all what the words mean. To say that something is "consistent" with something else is merely to say that they can co-exist - that one is not contradictory of the other. "Consistent with" is not synonymous with "indicative of" or "probative". To say that the condition of Terri's brain was "consistent with" PVS does not eliminate or exclude other explanations or conclusions.

And there is evidence to support other conclusions. Dr. Morin, elaborating on the lack of correlation between the amount of brain tissue and consciousness, said "No one knows how many neurons are necessary for consciousness." Indeed, patients with surprisingly little brain tissue are sometimes seen to have remarkably high function. Florida neurologist Dr. Mack Jones said "What is seen grossly doesn't always tell the story." He recalled the case of a patient who suffered from severe hydrocephalus: The patient had "a rim of cerebral cortex" only a few millimeters thick. "And yet", he said, "the young woman by all appearances functioned normally. If her brain were examined at autopsy without a clinical history, one would assume that this individual couldn't have had much useful function at all."

Now, clearly Terri was not going to regain anything like "normal" function. But the above case indicates how little we really know about what goes on in the brain, and how little we can conclude regarding the "awareness" of Terri, or any brain-injured patient. In short, the autopsy "proved" very little regarding Terri's level of consciousness or awareness. The pathologists made sober, reasonable judgments. But those reasonable and sober judgments were lost, apparently, on the opinion-arbiters of the MSM. The distortions and outright misrepresentations continue apace.

It may be just my cynicism again, but perhaps it was too much to expect otherwise.

Cross-posted at Blogs For Terri