05 February, 2010

Brain Modulation in Disorders of Consciousness

Free full text is available for the paper in the Feb 4 NEJM, entitled:

These are the data I've been waiting for!
In brief: they report fMRI imaging of 54 patients in VS and MCS, using the mental imagery protocol that was described in Adrian Owen's Nature report (I think one of the patients in this paper is the same patient?)

It looks to me like they got "hits" on both the motor imagery and the spatial imagery task for four patients. In one patient, they got a hit on the motor task but not the spatial imagery task, which may be why they say "five patients" in the abstract.

All five of those patients had traumatic injury (not anoxic or stroke.) The four who got two hits were all in their 20s, and their insult happened 1, 6, 30, and 61 months prior to the scans. I think patient #23 in their table is Rom Houben.

They asked one of the two-hits patients (a 22 year old man in VS, 61 months out from TBI,) to do answer yes-no autobiographical questions, and got 5 out of 6 correct--the sixth was not an incorrect answer, but "no activity."

Okay, this is news to digest. All the reports until now have either lacked detail, or have only shown evidence of awareness in young patients less than 12 months after TBI (a group of patients who still have reasonable odds of emerging from VS.)

04 November, 2009

Clear morning!

Sent from my Verizon Wireless BlackBerry

29 October, 2009

A little past peak color.

Sent from my Verizon Wireless BlackBerry

09 October, 2009

Zoos



I generally don't like zoos, but in the case of the San Diego zoo, I'll make an exception.


07 October, 2009

Lousy arguments against health insurance reform

Lousy argument #1: The number of uninsured (e.g. 50 million) is exaggerated.

I'm not sure why this is thought to be helpful to opponents of reform. If the number is correct, then that's a LOT of people without insurance. If the real number is smaller by an order of magnitude (e.g. 5 million) then that's still a LOT of people without insurance. But here's why it's a crappy argument: the smaller the number is, the less excuse there is for refusing to insure those people.

Let's say--counterfactually--that the real number is 5 million. And let's say that 1 million of those are children (so that we're not picturing people who lack insurance because of poor choices they made.) What excuse is there for failing to provide basic health care to 1 million U.S. children?

Perhaps the excuse is:
Lousy argument #2: The uninsured can already get healthcare in emergency rooms.

I still hear this from people (including some doctors) who should know better. Three big problems with this argument.
  • First: if, as you claim, the uninsured are already getting adequate healthcare in emergency rooms, then it won't cost us any more to provide adequate healthcare in doctors' offices. In fact, it would cost less. (Who do you think pays for the ER visits?)
  • Second, do you really believe that children with cancer, with asthma, with juvenile diabetes, with genetic metabolic disorders are adequately treated in ERs? Really? Have you ever been in an ER? Do you have any idea what it takes to treat these problems?
  • Third, if this is your argument, please never let me hear you complain about waiting times in ERs. Don't come crying if your true medical emergency isn't treated in a timely fashion. Little Bobby is getting his chemotherapy in room 3 and little Suzie is getting a breathing treatment for her asthma in room 4. We just don't have room for you now; hold pressure on the bleeding and sit in the waiting area. If you lose consciousness, please let someone know and we'll do our best to move you up in the queue.
Lousy argument #3: The government doesn't do things well or efficiently, so we shouldn't allow the government to provide health insurance.

The first part of this argument is certainly true on some level, but the second part is a non sequitur unless there is a better alternative. If the argument is that the private markets do a better job of allocating health care resources, then why haven't the markets insured (for example) the uninsured children? The market has been operating since...always, so why is there still a problem? (If you're tempted to say "there's no problem" or "the problem is exaggerated," see Lousy Arguments #1 and #2 above.) Note, by the way, that this is a perfect argument for dismantling Medicare and Medicaid. If you believe we should do just that, then you lack historical perspective...if you were old before Medicare or disabled before Medicaid, you were just SOL.

I'd entertain this Lousy Argument if the people floating it proposed an alternative.

22 September, 2009

What?

What are all these people running from?
Sent from my Verizon Wireless BlackBerry

Almost qualifies...

...as a view of the East River!
Sent from my Verizon Wireless BlackBerry