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"At a minimum, the report demonstrates that clinical exams may not be sufficient to establish that all elements of consciousness have been extinguished in someone who gives no outward appearance of responsiveness."
     Chicago Tribune, September 8.

Having written thousands of news articles, analyses, and editorials myself, I don't have to be reminded that different news outlets can legitimately present the same information in vastly different ways. But I was still taken up short when I saw how, compared to many other stories, the Associated Press's account dramatically underplayed the significance of a study reported this week in the journal "Science."

The Los Angeles Times' headline was representative of most accounts: "Brain Images of Woman in Vegetative State Hint at Awareness." Measured, even overly cautious, it tells the reader that they are about to be told about something of potentially great significance. By contrast the AP's story was laced with qualifiers and three of the first five paragraphs tell the reader not to draw any conclusions.

The lead paragraph of the story written by the Chicago Tribune's Judith Graham captured both the nuts and bolts of what happened and the sense of shock. She wrote, "The scientists were stunned. The young woman whose brain they were examining appeared to hear and respond to their commands. Yet previous medical examinations indicated she was in a vegetative state, entirely unaware and unresponsive to her surroundings."

In a word, the 23-year-old British woman's brain activity almost exactly paralleled the responses researchers found in the brains of 12 volunteers. As the Washington Post's Rob Stein put it, she "showed clear signs of conscious awareness on brain imaging tests."

A little background makes the woman's responses all the more encouraging. About two weeks after suffering a head trauma in July 2005 which left her in a coma, she awoke and starting experiencing sleep and awake cycles.

As is so often the case, when "repeated tests" over just a few (five) months suggested "no signs of awareness or consciousness," the label "PVS" (persistent vegetative state) was affixed to her.

But brain researchers, led by Adrian Owen at the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, studied her brain for five months. While MRIs and other machines can show doctors structural brain injuries, to actually see the brain in operation requires more advanced imaging called fMRI. "The technique highlights areas of the brain that receive increased blood flow when in use," according to the Los Angeles Times.

She underwent a series of tests, but the most significant were experiments asking her to envision playing tennis and exploring the house. "Brain regions involved in language, movement and navigation, which would be active when someone was playing tennis, wandering around a building, or imagining doing so, lighted up in ways that were 'indistinguishable' from those in 12 healthy people," according to the Post.

In follow up testing, some six months later, she appeared to follow the movement of a mirror. "But that was the last hint of awareness, and her future remains unclear," the Post reported.

Again, all stories included cautionary notes, which is fair enough. The Associated Press, however, went way overboard. ("It's far too soon to raise hopes," "There's no way to know" this or that, and "Her brain injury may not be typical of patients in a vegetative state.")

But consider what others said! The study itself concluded, "Her decision to cooperate . . . by imagining particular tasks when asked to do so represents a clear act of intention, which confirmed beyond any doubt that she was consciously aware of herself and her surroundings."

"It was an absolutely stunning result," Owen told the Post. "We had no idea whether she would understand our instructions. But this showed that she is aware."

Owen went further in other statements. "These are startling results. They confirm that, despite the diagnosis of a vegetative state, this patient retained the ability to understand spoken commands and to respond to them through her brain activity, rather than through speech and movement."

In the Los Angeles Times article, we read, "The findings challenge the standard diagnosis of a vegetative state, implying that some patients may have what Dr. Lionel Naccache of the French National Institute of Health and Medical Research called 'a rich mental life' in an accompanying editorial."

Referring to the assessment techniques used, John Connolly, a University of Montreal neuroscientist, said, "If it was a relative of mine, I know I'd demand it."

There are two downsides, one already on display and one potential. There was the consistent attempt in virtually all accounts to distinguish Terri Schiavo's condition from the 23-year-old woman's, to write as if Terri's diagnosis of PVS was uncontested (it was a matter of intense debate), and as if she died when "life support" was removed (rather than because she was denied food and water.)

The other difficulty is the suggestion that eventually they will be able to make even finer distinctions--create a kind of gradated series of diagnoses for those who supposedly fall between those in a so-called "minimally conscious" condition and those said to be in a PVS.

Not only is such clarity, in all likelihood, impossible, there is a vague implication that some/many/most of these patients can ethically be starved to death. You would think that as more and more sophisticated tests reveal more and more capability among more and more patients essentially written off, doctors should/would err on the side of caution.

Moreover, in another sense, this almost begs the question. What would happen if such patients--including Terri Schiavo--were given vigorous, ongoing therapy? Often it doesn't happen at all, and, when it is, too often the therapy is prematurely ended.

Having said that, the report from "Science" is wonderfully encouraging. Let me conclude with this.

"One always hesitates to make a lot out of a single case, but what this study shows me is that there may be more going on in terms of patients' self-awareness than we can learn at the bedside," Dr. James Bernat, a professor of neurology at the Dartmouth Medical School, who was not involved in the study, told the New York Times. "Even though we might assume some patients are not aware, I think we should always talk to them, always explain what's going on, always make them comfortable, because maybe they are there, inside, aware of everything."

If you have any questions or comments, please send them to Dave Andrusko at dandrusko@nrlc.org.

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