A Few Good Men
I'm getting tired of hearing what neurologists have to say about Terri Schiavo's CT of the brain. Real Tired. The Florida Sun Sentinel had a gang of neurologists analyze one of Terri's CT's of the brain. Here's what they said:
About 70 percent to 90 percent of Schiavo's upper brain is gone, and there's also damage to her lower brain that controls instinctive functions such as breathing and swallowing, said three Florida neurologists who viewed 12 of her CT "computed tomography" X-ray scans Tuesday and Wednesday.
"This is as severe brain damage as I've ever seen," said Dr. Leon Prockop, a professor and former chairman of neurology at the University of South Florida College of Medicine in Tampa, upon viewing the scans.
Then there's the infamous Dr. Ronald Cranford, who has the double-whammy credentials of neurologist AND bioethicist (have you had enough of bioethicists for a while? Why is it they all have the same opinion and they all start out their spiels by saying "this is a tragic case for everyone involved...") who also defined Terri's CT of the brain as being as bad as he's seen.
So What Have You Seen?
I've watched a steady stream of neurologists, bioethicists, and neurologist/bioethicists from Columbia, Cornell, and NYU interviewed all week on Fox and CNN and MSNBC. They all said about the same thing, that Terri's CT scan was "the worst they'd ever seen"or "as bad as they've ever seen."
Here's the problem with these experts: THEY DON'T INTERPRET CT SCANS OF THE BRAIN. RADIOLOGISTS DO.
You see, a neurologist will look at the CT of the brain of one of his patients, but this is entirely different from interpreting CT's of the brain de novo, for a living, every day, without knowing the diagnosis and most times without a good history. In addition, whereas I heard Dr. Crandon say he's "seen" a thousand brain CT's... well I've interpreted over 10,000 brain CT's. There's a big difference.
When I look at a CT of the brain every case is a new mystery about a patient Idon't know. I must look at the images, come to a conclusion, dictate my findings and report a conclusion. This becomes a part of the official legal record for which I am liable. I bill Medicare for a CT interpretation and am paid for this service.
Neurologists do not do this. They don't go on the record, alone, in written legal documents stating their impressions about CT's of the brain. The neurologist doesn't get sued for making a mistake on an opinion of a CT of the brain THE RADIOLOGIST DOES.
A neurologist has no where near this type of practical experience. And their cases are skewed according to where they practice and what their specialty is. Now, some of my best friends and some of the smartest docs I eve4r met are neurologists, but that doesn't change my observation that most neurologists I've met, in my experience, show an incomplete grasp of the nuances involved in image interpretation.
I have seen several neurologists -- in the printed media and on television -- put up a Representative CT of the brain of a normal 25 year old female and contrast this with Terri Schiavo's CT. This is a totally spurious comparison. No one is disputing that Terri Schiavo does not have the CT of a 25 year old female.
What I'm saying is that Terri Schiavo's CT could be the brain of an eighty or ninety year old person who is not in a vegetative state. THOSE are the CT scans we should be showing next to Schiavo's, because in THAT case you would see similar atrophy and a brain much closer to Schiavo's.
Who Wants To Be A Millionaire?
To prove my point I am offering $100,000 on a $25,000 wager for ANY neurologist (and $125,000 for any neurologist/bioethicist) involved in Terri Schiavo's case--including all the neurologists reviewed on television and in the newspapers who can accurately single out PVS patients from functioning patients with better than 60% accuracy on CT scans.
I will provide 100 single cuts from 100 different patient's brain CT's. All the neurologist has to do is say which ones represent patients with PVS and which do not.
If the neurologist can be right 6 out of 10 times he wins the $100,000.
I Said What I Meant, And I Meant What I Said
My points are what I first said about the image from Terri Schiavo's CT scan:
1) It is NOT as bad as the neurologists and bioethicists play it up to be; and,
2) There are many elderly patients with various levels of mental functioning who have severe atrophy that is difficult to distinguish from Terri Schiavo's atrophy
I stand by what I said. And I'm putting my money where my mouth is.