Sunday, February 10, 2008

A Hornet's Nest

How a scientist researching fetal pain and infant pain reacted to a paper from another researcher:

What about a fetus that draws back at the touch of a scalpel? Rosen says that, at least early on, this movement is a reflex, like a leg that jerks when tapped by a doctor’s rubber mallet. Likewise, the release of stress hormones doesn’t necessarily indicate the experience of pain; stress hormones are also elevated, for example, in the bodies of brain-dead patients during organ harvesting. In order for pain to be felt, he maintains, the pain signal must be able to travel from receptors located all over the body, to the spinal cord, up through the brain’s thalamus and finally into the cerebral cortex.

. . .

Sunny Anand reacted strongly, even angrily, to the article’s conclusions. Rosen and his colleagues have “stuck their hands into a hornet’s nest,” Anand said at the time. “This is going to inflame a lot of scientists who are very, very concerned and are far more knowledgeable in this area than the authors appear to be. This is not the last word — definitely not.”

What's kind of scary is this little bit:

Twenty-five years ago, when Kanwaljeet Anand was a medical resident in a neonatal intensive care unit, his tiny patients, many of them preterm infants, were often wheeled out of the ward and into an operating room. He soon learned what to expect on their return. The babies came back in terrible shape: their skin was gray, their breathing shallow, their pulses weak. Anand spent hours stabilizing their vital signs, increasing their oxygen supply and administering insulin to balance their blood sugar.

“What’s going on in there to make these babies so stressed?” Anand wondered. Breaking with hospital practice, he wrangled permission to follow his patients into the O.R. “That’s when I discovered that the babies were not getting anesthesia,” he recalled recently. Infants undergoing major surgery were receiving only a paralytic to keep them still. . . . Doctors were convinced that newborns’ nervous systems were too immature to sense pain, and that the dangers of anesthesia exceeded any potential benefits.

Newborns can't sense pain? I'm rather . . . surprised that this was, or is, a common medical belief. A good thing to keep in mind - Doctors are humans and are not all knowing or all seeing. Often their thoughts get caught up in the nature of their work, like the police chief or prosecutor who believes a suspect is guilty despite having no evidence:

Mr. Tankleff was convicted of the murders by a Suffolk County jury in 1990, largely on the basis of an incomplete confession, written out for him by detectives, which he repudiated almost immediately and never signed. The confession was elicited in a lengthy interrogation during which detectives tricked him, they later admitted: They told him that his father — who was in a coma for a month after being attacked but who never awakened before he died — had regained consciousness and identified him as his attacker.

James McCready, the Suffolk detective who led the interrogation, said during the trial that such tactics were not uncommon because all criminal suspects have one trait in common: “They all lie.”

All suspects lie. Not that even all criminals lie, but anyone suspected by anyone of violating a law must be lying. That may be a useful tool to analyze a case, but to really believe that it's true. . . not so smart.

Kind of like believing that newborns don't feel pain because, well, we don't use anesthesia, so obviously they're not feeling pain. Otherwise we'd use anesthesia, right?

Mmm. Wrong.

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