On Fri, 06 Mar 2015 04:17:00 -0800, Paul C Bernhardt wrote:
It is easy to look back at medical and scientific thinking of a
previous generation and wave our fingers with air of superiority
and a "tsk-tsk".Maybe they were doing the best they could
with the tools and understanding of that era.
With all due respect, Paul, let me make the following points:
(1) Have you read the original article by Mauguire & Corkin?
did they say "tsk-tsk" or did they systematically examine that
data available at the time and demonstrate that another
physician may have made another diagnosis and perhaps
not conducted the brain surgery that so damaged HM?
I've only gotten a copy of the article this morning and have
yet to read it but the abstract does make strong assertions.
The key questions are do the facts support the assertions.
A response of "tsk, tsk" is sadly lacking in critical analysis
and substance.
(2) As someone who has had various health problems over
the course of my life, I can attest that (a) a second opinion
is always warranted and (b) one should look at the relevant
scientific and medical literature at the time that a diagnosis
and course of medical action is proposed -- I would argue
that this is particularly important in an area like neurology
where we still are developing knowledge about how the
brain functions and neurologists, like all other physicians and
researchers, may differ significantly in their interpretation
of a condition. Case in point: one reason why our knowledge
of Phineas Gage is so messed up, in part, is that the two
physicians who treated held different theoretical views of
how the brain worked: one was a localist (i.e., specific
areas did specific functions; this view was associated with
the phrenologist position which most academic physicians
thought was fraudulent) while the other was a globalist
(the predominant position -- this was held by the Harvard
physician who examined Gage). It should be pretty clear
that the interpretation of Gage's brain damage and its
long term effects would be very different for a localist and
a globalist. Macmillan in his "An Odd Kind of Fame"
works this out and shows how much of what has written
about Gage is often just speculation without an empirical
basis, usually in support for a phrenological interpretation.
Even today we do not really know what the long-term effects
were of his brain damage but we do know that much that
has been written about him has little basis in fact.
(3) Physicians are fallible human beings, whose beliefs guide
their interpretations, their diagnosis, and their course of actions.
Because they usually engage in abductive reasoning, different
physicians may come to different views of a disorder: some
might be more data based than others, some may simply
subscribe to popular medical views and discount other positions
uncritically (the case of ulcers solely being caused by stress
and not an infectious agent like H. Pylori illustrates how the
"common view" may be seriously wrong and produce wind
up doing more harm than good to people). Anyone who has
been misdiagnosed or has not received a definitive diagnosis
for a condition will understand that finding the right doctor to
get treatments that produce relief is often a long and difficult
process. The question regarding HM is how was he diagnosed,
how many physicians examined him, and to what extent did
they agree on a diagnosis?
(4) The issue is not one of "presentism", that is applying knowledge
and interpretation that is currently common to situations in the past
but, given the knowledge available at the time, why were certain
decision made, why were certain decisions not made or disregarded,
and could HM have been given a different procedure that would
not have produced his memory problems.
-Mike Palij
New York University
[email protected]
------------- Original Message ----------
On Mar 6, 2015, at 12:19 AM, Mike Palij wrote:
New research suggests that the brain damage caused HM to lose
his memory was a "medical mistake" driven by the surgeon's
incorrect beliefs about brain structure and function. One popular
media account of the research article is available here:
http://blogs.discovermagazine.com/neuroskeptic/2015/03/05/neurosciences-famous-amnesiac-hm-victim-of-medical-error/#.VPk0TY47xNt
I am having some difficulty accessing the original research article
so, here's the reference:
Mauguière, F., & Corkin, S. (2015). HM never again! An analysis
of HM's epilepsy and treatment. Revue Neurologique.
and here's the article on the publisher's website behind
a paywall:
http://www.sciencedirect.com/science/article/pii/S0035378715000260
Just might change the story about HM a little bit.
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