Headache, by Robert Magginetti (Tranquility Base)In the last post we learned about Alice in Wonderland syndrome, a rare phenomenon involving distortions of visual perception and body image, most often caused by migraines. Although a specialty practice in headache might seem dull [so to speak] at first glance to those interested in behavioral neurology, unusual and colorfully-named types of headaches can make things more interesting. In Case Studies of Uncommon Headaches (2006), Dr. Randolph Evans reviews a number of these unfortunate ailments, which include exploding head syndrome, neck-tongue syndrome, red ear syndrome, and burning mouth syndrome. So let's begin with a hot ear.Case 6. My ear is red, hot, and burningA 54-year-old white woman was seen who had a 10-year history of episodes of a burning sensation of the left ear. The episodes are preceded by nausea and a hot feeling for approximately 15 seconds and then the left ear becomes visibly red for an average of approximately 1 hour, with a range of approximately 30 minutes to 2 hours. Approximately once every 2 years, she had a flurry of episodes occurring over approximately a 1-month period during which she averaged approximately five episodes, with a range of 1 to 6. There also was an 18-year history of migraine without aura occurring approximately once a year. ... A cerebral arteriogram revealed a proximal left internal carotid artery occlusion of uncertain cause after extensive testing. MRI scan at age 45 was normal. Neurologic examination was normal. A carotid ultrasound study demonstrated complete occlusion of the left internal carotid artery and a normal right.The diagnosis? Red Ear Syndrome, first described by Lance (1994) in the aptly-titled article, The mystery of one red ear. Following a plea to colleagues to "lend me your ear," Lance (1996) subsequently reported on 12 cases. He concluded that RES:may be associated with irritation of the third cervical root [nerve in the neck], temporomandibular joint [jaw] dysfunction, or thalamic [pain] syndrome. It may also occur without obvious structural cause in response to touch or heat. The condition may be an example of the ABC (Angry Back-firing C-nociceptor) syndrome with the increase in ear temperature being caused by the antidromic ["backwards"] release of vasodilator peptides [calcitonin gene-related peptide and substance P].It can also occur in association with migraines, glossopharyngeal and trigeminal neuralgia, upper cervical spine pathology, and herpes zoster [shingles]. The GABA analogue and anti-seizure medication gabapentin can be helpful in preventing RES.By the way, the girl in the picture above [who is not Case 6] says her red ear doesn't hurt, and that she doesn't get headaches.Case 7. My mouth is burningA 49-year-old woman was referred by her primary care physician with a 1.5-year history of daily constant burning or numbness of the entirety of her tongue and the back of her throat. She also complains that the inside of her mouth is sensitive. She has had a dry mouth for the past year. ... Artificial saliva has not been helpful. She has tried a variety of pain pills without any help....Burning Mouth Syndrome1 most often afflicts middle-aged and older women. Causes include dry mouth (e.g., from medications or diabetes), nutritional deficiency, food allergies, fungal infection (candidiasis aka thrush), trigeminal small fiber neuropathy (nerve damage), and hormonal changes. Treatments range from estrogen-progesterone replacement therapy to nutritional supplements to switching prescription medications to addressing an underlying medical condition. I don't know if this syndrome can be considered a "headache" in the standard usage of the word, but then again I'm not a neurologist.Case 1. Noises in the nightA 43-year-old woman was seen with a 5-month history of a noise in her head. On an almost nightly basis, as she was falling asleep, she would hear a loud noise like "electrical current running" lasting a second. Sometimes her whole body would shake for a second afterwards. Very occasionally, she would have an associated flash of light. Frequently, a second episode of the loud noise occurred shortly after the first. She then could fall asleep without any problem.Exploding Head Syndrome (Pearce, 1988) is a bang-up way to be aroused from your nightly slumber. A small percentage (~10%) of sufferers see a flash of light, even fewer feel as if they've stopped breathing for a short time. It's more frightening than it is painful. Interestingly, Evans (2006) suggests that EHS might be caused by delay in the reduction of activity in the brainstem reticular formation as the patient transitions from wakefulness to sleep. In 1949, Moruzzi and Magoun were the first to recognize that stimulation of the brainstem reticular formation produces low-voltage fast activity in the EEG, characteristic of an alert and attentive behavioral state. So something might be neurologically amiss with the EHS patient's sleep-wake cycle, although Evans gave no direct evidence of this. And the explosion phenomenology is largely unexplained, as noted by Pearce (1988):The cause of the bomb-like noise remains a mystery: no known vascular or hydrodynamic changes in the brain, labyrinths, or cerebrospinal fluid would cause such a symptom, although a momentary (almost ictal) disinhibition of the cochlea or its central connections in the temporal lobes, or a sudden involuntary movement of the tympanum or tensor tympani, might be the explanation...Evans' other case studies recounted complaints of numb tongue (neck-tongue syndrome), painful scalp (nummular headache... Read more »
I rarely think about how invasive species affect genetics. It’s always in terms of ecosystems or species: invasive brown tree snakes gobbling up birds and lizards in Guam, or zebra mussels overwhelming and altering the environment of the Great Lakes. How one species outcompetes and replaces another, changing the natural system. This is partly [...]... Read more »
Fitzpatrick, B., Johnson, J., Kump, D., Smith, J., Voss, S., & Shaffer, H. (2010) Rapid spread of invasive genes into a threatened native species. Proceedings of the National Academy of Sciences, 107(8), 3606-3610. DOI: 10.1073/pnas.0911802107
Researchers have established to a more than reasonable degree that fat is important in longevity and aging. A compelling experiment in mice, for example, demonstrates that less visceral fat means a longer life. Then we have the link between fat and chronic inflammation, and the strong correlations between excess fat tissue and all of the common age-related conditions. Given all of this evidence, it shouldn't be surprising that at least some of those researchers interested in slowing down the aging process are thinking in terms of changing the fundamental processes of fat metabolism. One such paper caught my eye today, and I thought I'd share: Protein kinase A signaling as an anti-aging target: As one of its many functions, protein kinase A (PKA) plays a key role in the regulation of metabolism and triglyceride storage. The PKA pathway has become of great interest to the study of aging, since mutations that cause a reduction in PKA signaling have been shown to extend lifespan in yeast, and to both delay the incidence and severity of age-related disease, and to promote leanness and longevity, in mice. There is increasing interest in the potential for the inhibition or redistribution of adiposity to attenuate...... Read more »
Enns LC, & Ladiges W. (2010) Protein kinase A signaling as an anti-aging target. Ageing research reviews. PMID: 20188216
You’d think that recognising faces is one of those things that we all do well, or at least the vast majority of us do, yet in practice our ability to do this varies.
Recent twin studies present evidence that face recognition is heritable and is a distinct cognitive task in it’s own right.
At one end of [...]... Read more »
Wilmer, J., Germine, L., Chabris, C., Chatterjee, G., Williams, M., Loken, E., Nakayama, K., & Duchaine, B. (2010) Human face recognition ability is specific and highly heritable. Proceedings of the National Academy of Sciences. DOI: 10.1073/pnas.0913053107
The issue of land use change is a complex, with many factors being important historically, such as
population growth (more land required for more people)
technology (e.g., automobiles made suburban expansion feasible)
economics (cheaper land and rents in suburbs compared to cities)
policy (things like 30-yr mortgages, mortgage insurance, and FHA loans had a large impact on urban sprawl [...]... Read more »
McDonald, R., Forman, R., & Kareiva, P. (2010) Open Space Loss and Land Inequality in United States' Cities, 1990–2000. PLoS ONE, 5(3). DOI: 10.1371/journal.pone.0009509
A randomized controlled trial of using NT-proBNP to guide treatment shows that targeting a clinical score also reduced mortality as compared to usual care and the reduction was similar to the use of the NT-proBNP.... Read more »
Lainchbury JG, Troughton RW, Strangman KM, Frampton CM, Pilbrow A, Yandle TG, Hamid AK, Nicholls MG, & Richards AM. (2009) N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from the BATTLESCARRED (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial. Journal of the American College of Cardiology, 55(1), 53-60. PMID: 20117364
My post about fluorescent rabbits is gaining a momentum on the Flickr group 'Bunny Lovers Unite' and in the Rabbitmatch's blog. Most people ask itself: WHY making fluorescent bunnies? And others feel outraged.
Animal research is long debated, and my hope is that the development of new reporter probes would allow to reconsider current research protocols while increasing the scientific significance of the experiments done, this is the focus of my current research. Here, a take opportunity of this little exposure to the non-science world to say why WE CAN make better animal research.
From a modern mechanical and operational perspective, life relies on the interaction between a sworm of molecules and their hierarchical organization into structures in which we distinguish a functional unity (i.e., organelles, cells, tissues, organs and systems). It is current hope and belief that a whole, systematic decoding of such minute, living, interacting building blocks that are bio-molecules, will grant a better comprehension of life mechanisms. From more than one century, we learn how to identify and discriminate those molecules, by means of iterative, multidimensional separation techniques (i.e., 2D electrophoresis, tandem mass spectrometry). This provided us with the awareness of the vast compilation of molecules and their distribution among different single cells and, ultimately, into the whole biome.
Laboratory animals were the main source of specimens to put under our microscopes. However, from the slides, we progressively realized that the picture we were painting was actually a static still-life, without any motion. This is not surprising, given the fact that most of the research conducted so far have been based on post-mortem analyses. Worst, such frozen picture renders difficult to discriminate causes from consequences. Animal sacrifice raises scientific, ethical and economical concerns, moreover the paradox of studying life from dead samples, may reasonably induce to wonder about the artefactual side of the knowledge generated so far. Not only terminal euthanasia, but each animal distress poses the same doubts: are we acquiring a distressed knowledge?
Before the molecular age, giants like Darwin and Mendel revolutionized life sciences with a systematic observation of animal and vegetal living specimen in their natural environment (the galapagos) with minor to null human intervention other than observation. The point is: shall we systematically observe (and understand) molecular life into a living, awake, freely moving animal in its natural environment? Can we imagine a day in which our preferred pet, in the security of our home, would allow to make scientific discoveries because he/she possess a radio-gene able to communicate its physiological and molecular status to our wireless router which will promptly share this information to the scientific community online?
I'm dreaming about normal happy pets, that can be turned into research contributors just through a simple injection. This is science-fiction but we aren't very far from such a goal. Recent advances in molecular imaging led us to dream a clean future for animal research. Take the simplest molecule: H2O. Its diamagnetism led clinicians to monitor water in space and time by means of magnetic resonance imaging (the same can be done for fat). In 2003, we were able to monitor something more elegant than the space-temporal profile of a single molecule in a healthy living mouse: by means of optical bioluminescence imaging, my PhD mentor was able to observe in cycling female mice, not a molecule, but its molecular activity (specifically, the activity of the estrogen receptor, a hormone-regulated transcription factor).
This goal, was achieved by the conceptualization of so-called reporter mice: models engineered in order to allow the external non-invasive monitoring of any selected molecular mechanism in the full respect of animal’s dignity. This is, in other words, the ability to observe the molecular life into a living whole organism. A Darwinian legacy.
The most interesting feature of longitudinal imaging with living animal systems, however, is its excellent potential to Reduce the number of animals because animal sacrifice is NOT needed and each animal is its own control. We need now to improve this technology (toward the radio-gene) to Refine current methods by providing the opportunity to study molecular circuits systematically in 4 dimensions, furthermore new technology will abolish the pain for the animals (and voluntary humans). What we need now, are engineers providing multiplexing abilities and better resolutions (in space and in time). Molecular imaging should be considered a very valid Replacement alternative, and we need to shift mathematical engineers and bioinformaticians from still-life omics data set, to living data set. We need to hope and belief to alternative ways to conduct animal experimentation. Animals aren't humans. We need to develop safer, safest technologies to study gene networks in animals in order to validate the safety and to eventually apply this 'radio-genes' to humans, to ourselves. Nosce te ipsum (know thyself, said Socrates). This blog tales recent advances toward this vision, the vision of a clean, efficient, innocent biomedical research.
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Ciana, P., Raviscioni, M., Mussi, P., Vegeto, E., Que, I., Parker, M., Lowik, C., & Maggi, A. (2003). In vivo imaging of transcriptionally active estrogen receptors Nature Medicine, 9 (1), 82-86 DOI: 10.1038/nm809
Maggi A, & Rando G (2009). Reporter mice for the study of intracellular receptor activity. Methods in molecular biology (Clifton, N.J.), 590, 307-16 PMID: 19763513
Rando G, Biserni A, Ciana P, & Maggi A (2010). Profiling of drug action using reporter mice and molecular imaging. Methods in molecular biology (Clifton, N.J.), 602, 79-92 PMID: 20012393
... Read more »
Ciana, P., Raviscioni, M., Mussi, P., Vegeto, E., Que, I., Parker, M., Lowik, C., & Maggi, A. (2002) In vivo imaging of transcriptionally active estrogen receptors. Nature Medicine, 9(1), 82-86. DOI: 10.1038/nm809
Maggi A, & Rando G. (2009) Reporter mice for the study of intracellular receptor activity. Methods in molecular biology (Clifton, N.J.), 307-16. PMID: 19763513
Predicting the future is always difficult. Who could have known in the year 1775 that 100 years from then, ships and trains powered by coal would allow people to circle the earth in weeks rather than years? Who could have predicted that in another 100 years, the human voice—and moving images—would be able travel that [...]... Read more »
Puliafito, S., Puliafito, J., & Grand, M. (2008) Modeling population dynamics and economic growth as competing species: An application to CO2 global emissions. Ecological Economics, 65(3), 602-615. DOI: 10.1016/j.ecolecon.2007.08.010
Here is some more groovy stuff - Scientific American just alerted us to a new article in J Neuroscience. It is right up Charles Spence’s alley but I am stealing his thunder by passing it on now. Charles showed in humans that potato crisps taste better when you hear a crackling noise (I think he might have [...]... Read more »
Wesson DW, & Wilson DA. (2010) Smelling sounds: olfactory-auditory sensory convergence in the olfactory tubercle. The Journal of neuroscience : the official journal of the Society for Neuroscience, 30(8), 3013-21. PMID: 20181598
Have you ever been walking through the forest and thought to yourself, “Damn, its loud here…it’s really, really hard to hear anything anybody else is saying”? Well, maybe that’s what prompted Terry J. Ord and Judy A. Stamps, respectively from Harvard and UC Davis to investigate lizard exercise routines.
You ask: What do lizard calisthenics and [...]... Read more »
Ord TJ, & Stamps JA. (2008) Alert signals enhance animal communication in "noisy" environments. Proceedings of the National Academy of Sciences of the United States of America, 105(48), 18830-5. PMID: 19033197
Capitalists beware. No less a journal than Nature has just published a paper proving conclusively that the human brain is a Communist, and that it's plotting the overthrow of the bourgeois order and its replacement by the revolutionary Dictatorship of the Proletariat even as we speak.Kind of. The article, Neural evidence for inequality-averse social preferences, doesn't mention the C word, but it does claim to have found evidence that people's brains display more egalitarianism than people themselves admit to.Tricomi et al took 20 pairs of men. At the start of the study, both men got a $30 payment, but one member of each pair was then randomly chosen to get a $50 bonus. Thus, one guy was "rich", while the other was "poor". Both men then had fMRI scans, during which they were offered various sums of money and saw their partner being offered money too. They rated how "appealing" these money transfers were on a 10 point scale.What happened? Unsurprisingly both "rich" and "poor" said that they were pleased at the prospect of getting more cash for themselves, the poor somewhat more so, but people also had opinions about payments to the other guy:the low-pay group disliked falling farther behind the high-pay group (‘disadvantageous inequality aversion’), because they rated positive transfers to the high-pay participants negatively, even though these transfers had no effect on their own earnings. Conversely, the high-pay group seemed to value transfers [to the poor person] that closed the gap between their earnings and those of the low-pay group (‘advantageous inequality aversion’)What about the brain? When people received money for themselves, activity in the ventromedial prefrontal cortex (vmPFC) and the ventral striatum correlated with the size of their gain.However, when presented with a payment to the other person, these areas seemed to be rather egalitarian. Activity rose in rich people when their poor colleagues got money. In fact, it was greater in that case than when they got money themselves, which means the "rich" people's neural activity was more egalitarian than their subjective ratings were. Whereas in "poor" people, the vmPFC and the ventral striatum only responded to getting money, not to seeing the rich getting even richer.The authors conclude that thisindicates that basic reward structures in the brain may reflect even stronger equity considerations than is necessarily expressed or acted on at the behavioural level... Our results provide direct neurobiological evidence in support of the existence of inequality-averse social preferences in the human brain.Notice that this is essentially a claim about psychology, not neuroscience, even though the authors used neuroimaging in this study. They started out by assuming some neuroscience - in this case, that activity in the vmPFC and the ventral striatum indicates reward i.e. pleasure or liking - and then used this to investigate psychology, in this case, the idea that people value equality per se, as opposed to the alternative idea, that "dislike for unequal outcomes could also be explained by concerns for social image or reciprocity, which do not require a direct aversion towards inequality."This is known as reverse inference, i.e. inference from data about the brain to theories about the mind. It's very common in neuroimaging papers - we've all done it - but it is problematic. In this case, the problem is that the argument relies on the idea that activity in the vmPFC and ventral striatum is evidence for liking.But while there's certainly plenty of evidence that these areas are activated by reward, and the authors confirmed that activity here correlated with monetary gain, that doesn't mean that they only respond to reward. They could also respond to other things. For example, there's evidence that the vmPFC is also activated by looking at angry and sad faces.Or to put it another way: seeing someone you find attractive makes your pupils dilate. If you were to be confronted by a lion, your pupils would dilate. Fortunately, that doesn't mean you find lions attractive - because fear also causes pupil dilation.So while Tricomi et al argue that people, or brains, like equality, on the basis of these results, I remain to be fully convinced. As Russell Poldrack noted in 2006caution should be exercised in the use of reverse inference... In my opinion, reverse inference should be viewed as another tool (albeit an imperfect one) with which to advance our understanding of the mind and brain. In particular, reverse inferences can suggest novel hypotheses that can then be tested in subsequent experiments.Tricomi E, Rangel A, Camerer CF, & O'Doherty JP (2010). Neural evidence for inequality-averse social preferences. Nature, 463 (7284), 1089-91 PMID: 20182511... Read more »
Tricomi E, Rangel A, Camerer CF, & O'Doherty JP. (2010) Neural evidence for inequality-averse social preferences. Nature, 463(7284), 1089-91. PMID: 20182511
Anyone in the skeptical and atheist community who hasn't heard of the row that erupted over changes to richarddawkins.net forum probably still uses a 56K modem and a dialup connection.
This post summarises the fallout and explores the issue of online communities: are they real or illusory?... Read more »
Haythornwaite, C. (2008) Chapter 9: Social Networks and Community, Oxford handbook of internet psychology – Edited by Adam Joinson. British Journal of Educational Technology, 39(3), 561-562. DOI: 10.1111/j.1467-8535.2008.00855_4.x
Please welcome Laurel Mylonas-Orwig, author of today’s post and a new contributor to the blog!
Every two years, the best athletes in the world gather to compete in the modern Olympic Games. Against a backdrop of sand or snow, these seemingly superhuman competitors push their bodies to perform feats that would be impossible for the average [...]... Read more »
Svensson, E., Black, H., Dugger, D., Tripathy, S., Goldwasser, E., Hao, Z., Chu, L., & Leiden, J. (1997) Long-Term Erythropoietin Expression in Rodents and Non-Human Primates Following Intramuscular Injection of a Replication-Defective Adenoviral Vector. Human Gene Therapy, 8(15), 1797-1806. DOI: 10.1089/hum.1997.8.15-1797
Remember those perhaps gross but cool insect jewelry artists I mentioned before? Now, their incredible tube-making skill might be used in an entirely different field: medicine.Dr. Russell Stewart, an assistant professor at the University of Utah, has been studying natural adhesives for years. He was drawn to the caddisfly because it's one of the few creatures in this world to have accomplished a very difficult feat: it sticks things together underwater.Creating an adhesive that works when wet isn't easy - just think of what happens to your average band-aid in the shower. But the caddisfly has mastered underwater engineering, and Stewart wanted to know exactly how it sticks together its living quarters.Like many other organisms including spiders and silkworms, caddisfly larvae spin silk. It's their silken strands that stitch together their makeshift mobile homes. But scientists didn't understand how this worked while underwater - until now. A new study published online first in the journal Biomacromolecules reveals the caddisfly's architectural secrets. The caddisfly larvae uses its silk like tape, researchers explain. They took larvae and placed them in aquaria with glass beads. Once the bugs had created their homes, the researchers analyzed their homes with a wide variety of technical tools, including scanning electron microscopy. The SEM images on the right show the criss-crossed strands of silk that have woven together the beads into the larvae's tube. They learned that unlike the silk produced by terrestrial creatures, the caddisfly's silk works underwater because it's covered in phosphates (blue color in image F). Up to 95% of the serine residues in the silk protein are phosphorylated! We use phosphates in our own adhesives, including fillings and latex paints. In the caddisfly, these negatively-charged groups line up with positively charged proteins and cations like calcium, and the strong attraction between them holds the fiber together. What's so special about this adhesive is that it can be used on just about anything, as artist Hubert Duprat found out when he placed caddisfly larvae in aquaria with gold flakes and precious gems. Their silk can bind all kinds of things, and this unique trait may make it an ideal candidate for medical use.The hope is that since caddisfly silk works when wet, it could inspire a new kind of way to suture surgical wounds or even help repair small bone breaks. Characterizing the silk fibers is the first step towards copying the caddisfly's technology and creating a new line of medical glues or tapes that one day may replace sutures or stitches in sealing up wounds.Stewart, R., & Wang, C. (2010). Adaptation of Caddisfly Larval Silks to Aquatic Habitats by Phosphorylation of H-Fibroin Serines Biomacromolecules DOI: 10.1021/bm901426d
... Read more »
Stewart, R., & Wang, C. (2010) Adaptation of Caddisfly Larval Silks to Aquatic Habitats by Phosphorylation of H-Fibroin Serines. Biomacromolecules, 2147483647. DOI: 10.1021/bm901426d
The superficial summary is that depression is an evolutionary adaptation, and that is still helping us solve problems in modern society. Is this true? These are two very distinct claims and while each may have some merit, saying it like that may obscure as much as it enlightens. ... Read more »
Andrews, P., & Thomson, J. (2009) The bright side of being blue: Depression as an adaptation for analyzing complex problems. Psychological Review, 116(3), 620-654. DOI: 10.1037/a0016242
Fruit fly behavior mapped, resilience theory in an urban setting, changing the universe’s birthdate and genetic diversity in an all-female species. Here are extra news stories and studies on ecological science for the month of February.... Read more »
Siebeck, U., Parker, A., Sprenger, D., Mäthger, L., & Wallis, G. (2010) A Species of Reef Fish that Uses Ultraviolet Patterns for Covert Face Recognition. Current Biology. DOI: 10.1016/j.cub.2009.12.047
Lutes, A., Neaves, W., Baumann, D., Wiegraebe, W., & Baumann, P. (2010) Sister chromosome pairing maintains heterozygosity in parthenogenetic lizards. Nature. DOI: 10.1038/nature08818
Another week has gone by and some very interesting molbio blog posts have been aggregated to Researchblogging.org. Every week [see my opening post on the matter], I'll select some blog posts I consider particularly interesting in the field of molecular biology [see here to get a sense of the criteria that will be used], briefly describe them and list them here for you to check out.Note that I'm ... Read more »
Clements, A., Bursac, D., Gatsos, X., Perry, A., Civciristov, S., Celik, N., Likic, V., Poggio, S., Jacobs-Wagner, C., Strugnell, R.... (2009) The reducible complexity of a mitochondrial molecular machine. Proceedings of the National Academy of Sciences, 106(37), 15791-15795. DOI: 10.1073/pnas.0908264106
Schuster SC, Miller W, Ratan A, Tomsho LP, Giardine B, Kasson LR, Harris RS, Petersen DC, Zhao F, Qi J.... (2010) Complete Khoisan and Bantu genomes from southern Africa. Nature, 463(7283), 943-7. PMID: 20164927
Karten and Wade's (2010) research study finds that some men conflicted by their homosexual feelings and behaviours who engage in 'sexual orientation change efforts' (SOCE)later report a decrease in those feelings and behaviours. ... Read more »
Karten, E., & Wade, J. (2010) Sexual Orientation Change Efforts in Men: A Client Perspective. The Journal of Men's Studies, 18(1), 84-102. DOI: 10.3149/jms.1801.84
When discussing dinosaurs, the topic of what they ate often comes up, but what about the creatures that ate them? Obviously some dinosaurs ate other dinosaurs, but the famous prehistoric archosaurs were not immune to predation from other kinds of hunters, especially when the archosaurs were babies. In 2005, for example, paleontologists described a specimen [...]... Read more »
Jeffrey A. Wilson, Dhananjay M. Mohabey, Shanan E. Peters, Jason J. Head. (2010) Predation upon Hatchling Dinosaurs by a New Snake from the Late Cretaceous of India. PLoS Biology, 8(3). info:/10.1371/journal.pbio.1000322
If you have not heard of Kerrie Wooltorton, then you are either living in a box (like me) or an Indian medical student (again. like me, sigh!)...
So here is the deal.
Kerrie Wooltorton was a 26 year old woman who was suffering from an "untreatable" emotionally unstable personality disorder, infertility and depression. She drunk anti freeze and waved an advance directive in the face of the doctors when she was pushed into the ER. It said (1):
14/09/2007 To whom this may concern
If I come into hospital regarding an overdose or any attempt of my life, I would like for NO life saving treatment to be given. I would appreciate it if you could continue to give medicines to help relieve my discomfort, painkillers, oxygen etc. I would hope these wishes would be carried out without loads of questioning.
Please be assured that I am 100% aware of the consequences of this and the probable outcome of drinking antifreeze, eg death in 95-99% of cases and if I survive then kidney failure, I understand and accept them and will take 100% responsibility for this decision.
I am aware that you may think that because I called the ambulance I therefore want treatment, THIS IS NOT THE CASE! I do however want to be comfortable as nobody wants to die alone and scared and without going into details there are loads of reasons I do not want to die at home which I realise you will not understand and I apologise for this.
Please understand that I definitely don't want any form of ventilation, resuscitation or dialysis. These are my wishes please respect and carry them out.
Yours sincerelyKerrie Wooltorton
The Mental Health Act 2005, is a very complicated bit of law, under which this case was dealt with. In summary, the law stated that a person with mental capability to deny treatment must not be given any, and if give the treating doctor would be charged with assault. Now if you are Greg House (the TV show doc... remember him?) you can get away with it, but in the real world, things spin to a different tune.
Apparently, Ms. Wooltorton had been treated as many as 9 times the previous year for similar incidents of consuming anti freeze. However, this time, when she was rolled into the ER, she was conscious, and she shoved in an advance directive, putting the doctors in a fix (2).
Now, the whole thing has cleared up, Ms Wooltorton has died, the doctor has been patted on the back for his law savvy attitude, etc. etc. etc. But what still bothers me is that does this type of directive provide suicidal patients the "way out"? Or maybe patients considering euthanasia (here we go again. Off on my favorite ethics topic). I don't know about the UK scene, but in India, suicide attempts are punishable by law. Here it is (3):
Section 309. Attempt to commit suicide
Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for term which may extend to one year 1[ or with fine, or with both].
1. Subs. by Act 8 of 1882, sec.7, for "and shall also be liable to fine".
And granting an advance directive after suicidal attempts seems to my simple mind to clash with that law above.
So what is the way out? I believe in the sanctity of life. I believe that suicidal patients should not be let to die (maybe because I lost a dear friend that way). I believe that granting validity to such advance directives ti suicidal people are BS! The simple way out could be to consider the Advance Directive such as this null and void (oh come on, can't you see the woman is trying her best to kill herself off in that advance directive of hers?) when there is suspicion of suicidal attempt.
Either ways, I'd hate to be Kerrie Wooltorton's doctor...
Dyer, C. (2009). Coroner rules that treating 26 year old woman who wanted to die would have been unlawful BMJ, 339 (oct05 1) DOI: 10.1136/bmj.b4070
Picture Credits: The Daily Mail ... Read more »
Dyer, C. (2009) Coroner rules that treating 26 year old woman who wanted to die would have been unlawful. BMJ, 339(oct05 1). DOI: 10.1136/bmj.b4070
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