In the September 25th issue of the online magazine Salon, neurologist Robert Burton expresses concerns about an article that appeared in the Archives of Neurology. The Archives article questioned the received wisdom about patients diagnosed to be in a so-called persistent vegetative state (PVS). To the amazement of researchers, the brain of a woman, the victim of a car accident and said to be in a PVS, responded in a manner indistinguishable from fully conscious volunteers.

But the title of Burton’s piece, “The Light is On, But is Anybody Home?” suggests where he is going.

Burton is the former chief of neurology at Mount Zion-UCSF Hospital and the author of “On Being Certain: Believing You Are Right Even When You’re Not.” He is writing a series for Salon on the human brain.

The patient at the center of the research was a then-23-year-old woman. She had been asked to imagine herself playing tennis or walking through her house while researchers conducted a functioning MRI or fMRI to determine how responsive she was to these suggestions.

The lead researcher, Adrian Owen at the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, told the Washington Post, “It was an absolutely stunning result,” he said, adding, “We had no idea whether she would understand our instructions. But this showed that she is aware.”

But Burton has little use for the Owen et al. study. The study’s “conclusions are not beyond a doubt,” he wrote. “There are plenty of questions about whether this young woman is conscious and capable of choice.”

Burton goes on: “Are we now to believe that an fMRI can tell us the level and nature of a patient’s consciousness even when the patient can’t respond? Putting aside for a moment the very considerable questions of fMRI methodology, and interpretation, are we ready to accept technology as the final word in assessing mental states?”

Ironically, Burton insists that this study gives false hope to parents and relatives of accident victims because it doesn’t change the prognosis or the chance for recovery.

Burton writes, “I cannot imagine a worse medical nightmare than being told that a clinically unconscious spouse or child has been shown on a fMRI to have an active imagination and substantial self-awareness, especially when the findings don’t alter the grim prognosis or substantiate the value of greater rehabilitative efforts.”

Laura Echevarria (www.lauraechevarria.com)

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