User:Neuroscientist/Notes

Notes to Self.

Terri Schiavo Talks: The SlimVirgin edits.
The posts that follow are duplicates of responses to important issues that arose during the editing of the Terri Schiavo article on July 11, 2005.

The SlimVirgin edits (on the Introduction)
The new contributor has asked a number of questions, edited a number of sections, and made a number of charges.

I would like to address some of them. I have made the assumption that SlimVirgin is a woman.

The Introduction
The edited paragraphs may be seen here:.

In justifying the changes, she wrote:
 * I added to the intro what the autopsy report said about PVS, about her brain size, and about her blindess, as these are the key points, and belong in the intro, in my view. I also added that one neurologist who examined her dissented and called her condition a "minimally conscious state," as that's needed for NPOV and accuracy.


 * [The autopsy report] speaks directly to the issues being debated, and it's the most up-to-date solid piece of information there is. It seems obtuse not to mention its key findings in the intro. Regardless of who has criticized the neurologist who diagnosed minimally conscious state, he did make that diagnosis, and you have no right to pretend it doesn't exist, no matter how strongly you disagree with it. A neurologist counts as a reputable source for WP in matters of neurology, particularly as he examined her. The way I introduced the information made it clear that his was the minority, dissenting view.

She has made similar points elsewhere. There are a number of problems with this.

Firstly — and without prejudice to the substance of her edits — she has a different belief about the purposes of an introduction than many of the regular editors here do. I understand the introduction to a work of non-fiction to be those opening sentences that offer a broad overview of the subject that is being dealt with. It is factual — but does not encumber the reader with factoids. It is informative - but is not stuffed with trivia. It is graceful and inviting — and it cannot be if it is struggling to be clear and concise. It tells the reader the various topics he may expect to read about — but it will not if it focuses on one or two topics alone.

If I were commissioned to write an article about the solar system, I will not litter its introduction entirely with references to Saturn and Jupiter. These are important subjects in their own right, and they are crucial to an essay on the solar system — no one disputes that. But if my introduction to the solar system spoke ponderously about the mass of Jupiter and the nature of Saturnian rings, it fails.

Exactly as SlimVirgin's version of the Schiavo introduction fails.

The regular editors have been trying to craft a good introduction for quite some time, and recently there has been much progress. Prior to recent versions, the introduction essentially told the whole story from beginning to end, and was therefore quite large. There was a recent move to make it clearer and more concise, yet fair and accurate. We essentially want to say, simply, that this is the story of a young lady who had a devastating brain injury, whose loved ones had disagreements over what to do after that, that these disagreements happened over issues of great significance to all of us (such as end-of-life care, guardianship of the incompetent, etc), that at its height the story involved the highest levels of the executive and judicial branches of government, and that finally, a decision was made, and the young lady died.

That she had multifocal cortical laminar necrosis was fine and all, and true, no doubt, but these are matters that properly belong in the body proper, not the introductory remarks of an article.

Or so we thought.

Neuropathology
Secondly, I find difficulty with the substance of some of SlimVirgin's claims. For example, she claims that "the key points" are the "size" [sic] of Schiavo's brain, and "[Schiavo's] blindness" [sic].

This is incorrect. These were interesting findings that were made post-mortem, certainly; lay individuals without any education in neurology, neuropathology or neuroscience jumped at them. However, they are far from "the key points." If we generously take SlimVirgin's meaning of this phrase to be "the most important findings of the autopsy," then she is badly mistaken about them. The critical findings of the autopsy were the pathological condition of her cerebral cortex, in particular the profound, total loss of large pyramidal neurons and accompanying multifocal laminar necrosis; the pattern of gradient antero-posterior loss of cortical neurons; the damage to the thalami bilaterally; and the total loss of Purkinje cells from her cerebellum. I would also regard the relative sparing of her lower brainstem as very important.

The mass of Schiavo's brain on the other hand is simply a crude indication of the extent of damage that her nervous system endured. It has little, if any, intrinsic discriminatory value as a clinico-pathologic feature. In fact, focus on this aside has actually been misleading: witness the uninformed but all too common riposte that many people who underwent epilepsy surgery as children have lighter brains. This is true, but of course it has absolutely nothing to do with the functional capability of an adult brain wrecked by an anoxic insult that destroyed very many specialized regions. But the confusion persists. SlimVirgin seems to have been misguided by a similar confusion.

In fact, the comments that SlimVirgin has made elsewhere conclusively indicate that she has an exceptionally poor understanding of elementary neuroanatomy, neurophysiology, and neuropathology. On the Talk page of Grace Note, she writes,
 * However, if you read my intro, I also added the brain size from the autopsy report. I did that in order to make it clear that any diagnosis of reversible minimal consciousness was unlikely to have been correct. In controversial articles like this, and particularly in the intros, the facts have to be allowed to speak for themselves in a subtle way.

And further,
 * Sure, when you know the person only has a half a brain, consciousness in any meaningful sense &mdash; what we would call a subjective experience or perception of I &mdash; becomes increasingly unlikely. But they didn't know she only had half a brain at the time. It was all guesswork, some of it educated and probably right, some of it less so.

Now, I’d like to put this very gently, but I do not know how else to accurately convey it except to say that this person has absolutely, totally, completely , no idea of what she’s talking about. This is an example of the worst in Wikipedia, when complete, arrant nonsense serves as the basis for editorial decisions.

Brain size, per se, has no direct correlation with consciousness. At all. As I’ve just mentioned, there are children walking around after hemispherectomies who’re perfectly conscious and self-aware, and whom you’d never think had so much as sore thumb wrong with them. Yet, a person can lose a tiny amount of brain in the right spot, and simply die.

If we imagine a hypothetical (and horridly bizarre) situation in which SlimVirgin demands a craniotomy and has me remove parts of her brain just to see what happens, I can cause her to become completely paralyzed on one side of the body by removing a portion of brain not much larger than a quarter; I can cause her to go blind by nicking 3cm³ worth of nerves; I can cause her to be incapable of balance and always walk like a drunk by snipping of some fibers at the back of her brain; I could render her comatose by destroying a small bit of brain just above her pons; and I could stop her heart from beating and her lungs breathing by removing just a couple of cm³ worth of her medulla oblongata. I could also remove much larger portions of her brain elsewhere, and she’d hardly feel a difference.

The brain is not like the liver, where every cell is exactly like every other cell. The brain is exquisitely complex — and the clinical manifestation of any damage that occurs depends on precisely where the damage occurred, how fast it occurred, what cells were involved, and sometimes how old the patient was when it happened.

So if SlimVirgin insists that specific details from the autopsy must be provided in the introduction, then she would have to include the following, which are far, far more "key" than a crude and passing indication of cerebral injury:

1. total loss of large pyramidal neurons throughout the cortex; 2. multifocal cortical laminar necrosis; 3. gradient antero-posterior loss of cortical neurons; 4. damage to the thalami bilaterally; 5. total loss of Purkinje cells from her cerebellum; and 6. relative sparing of her lower brainstem.

These are the set of findings that speak to Schiavo's neurological condition, and the diagnosis that was central to the entire Schiavo story. If an editor insists that the introduction must contain details of the autopsy — and these by necessity have to be the most crucial details — then I will insist that the above details are included, for if other, minor details are included in their place I can only conclude that bias and “POV editing” are at play.

Whoever has to fit that into a readable introduction has both my very best wishes and my heartfelt sympathies.

Does everyone now understand why some things are better said in the body of an article rather than in the introduction?

Cortical blindness
SlimVirgin is also wrong when she writes,"The pathologists found massive celebral[sic] atrophy with a brain weight[sic] of 615 grams, roughly half that[sic] of the expected weight, and cortical blindness, indicating she had been unable to see."

This is nonsense, of course. Dr. Nelson did not "find" cortical blindness. He found that Schiavo's visual cortex had been severely damaged, such that it was exceedingly unlikely that Schiavo was capable of sight. Cortical blindness is the clinical correlate of severe destruction of the visual cortex. One does not "find" cortical blindness in an autopsy. One either finds it in life through clinical examination, or deduces it in death upon finding a destroyed visual cortex.

To conclude this section :

1. There are a number of factual errors in SlimVirgin's writings on the neuropathology of the Schiavo case.

2. She makes a logical error of the form:
 * A. Details X and Y are true about a subject P.
 * B. Details X and Y are important about a subject P.
 * C. Therefore, details X and Y  must  be mentioned in an introduction to an article on subject P.

C unfortunately does not follow A and B, and she has yet to show us why it must — especially when
 * I. in truth, she is very wrong about the details themselves,
 * II. Subject P in our case (Schiavo) has important details n → ∞

~ Neuroscientist | T | C → 05:41, July 13, 2005 (UTC)

The SlimVirgin edits (on Hammesfahr)
The new contributor's version of the introduction includes a reference to Hammesfahr's contention that Schiavo was in the MCS prior to her death.

There seems to be a little confusion about Hammesfahr, so I'll just paint a quick picture (no references here, but they are widely available on the net and in the Talk archives).

1. Did Hammesfahr examine Schiavo?
 * Yes, he certainly did. He also videotaped his examination, and the video was available to Judge Greer to scrutinize.

2. Is Hammesfahr a "real" neurologist? (Does she imagine we imagine he's imaginary?)
 * He is a board-certified neurologist (yes, I know, unbelievable, but there you go). He is however not a member in good standing of the American Academy of Neurology, and is the only one of the eight neurologists who examined Schiavo who isn't.

3. Is this guy a quack?
 * Many in the neurological community have, for years — and well before his involvement in the Schiavo case — considered Hammesfahr to be, er, highly unorthodox. In private conversation the term charlatan is often bandied about (although some have no qualms even on national broadcasts). For years, he has been claiming to treat patients with a diverse variety of ailments with completely unscientific treatments, with no evidentiary basis in the literature. He has never formally published the results in peer-reviewed journals¹, although he has managed to successfully get published in the National Enquirer as well as a journal magazine called Lifelines on whose board of editors he sits (and whose address, I believe, is his). It must be a matter of some regret to him that these prestigious works have not garnered him the applause of the people he thinks of as his professional colleagues.
 * ¹ A search of the entire electronic bibliographic database of the US National Library of Medicine, which contains a record of virtually every biomedical paper ever written in any indexed peer-reviewed journal in the past 50 years, discloses not one single paper by Hammesfahr, on any subject. Not one single one.

4. Is he a Nobel laureate?
 * He has claimed, for many years, to be a "nominee" for the Noble Prize "in Medicine" (the title varies: sometimes it's "Nobel Peace Prize in Medicine," whatever that means - both titles are bogus). This is an enormous load of pure, unadulterated horseshit. Charlatanism in the truest sense. I have elaborated on this elsewhere; more details are easily found online.

5. Is he a practising neurologist?
 * Unfortunately, I believe he is, yes.

6. Is what he says trustworthy?
 * Now, this is less straightforward. Just because he's blatantly lied in the past, and appears to continue to deceive people, does not mean he always lies. All claims must be examined on judged on their merits. In re Schiavo, Judge Greer had complete access to this guy's examination, and he did an excellent job as a judge - he studied everything first hand to determine its veracity. From his judgement,


 * "Dr. Hammesfahr testified... he gave 105 commands... Mrs. Schindler gave an additional 6 commands... he asked her 61 questions and Mrs. Schindler, at his direction, asked her an additional 11 questions. [total 183]. The court saw few actions that could be considered responsive to either these commands or those questions. While Dr. Hammesfahr testified that she squeezed his finger on command, the video would not appear to support that and his reaction on the video likewise would not appear to support that testimony."


 * "...It is clear that this therapy (vasodilatation therapy) is not recognized in the medical community. ...What undermines his [Hammesfahr's] credibility is that he does not present to this court any evidence... he offered no names, no case studies, no videos, and no tests [sic] results to support his claim that he had success in all but one of them. If his therapy is as effective as he would lead this court to believe, it is inconceivable that he would not produce clinical results of these patients that he has treated. And surely the medical literature would be replete with this new, now patented, procedure. Yet, he has only published one article and that was in 1995 involving some 63 patients, 60% of whom were suffering from whiplash. (Note: I believe this to be a publication of the infamous Lifelines journal.)


 * "It is clear from the evidence that these therapies [hyperbaric oxygen and vasodilatation] are experimental insofar as the medical community is concerned with regard to patients like Terry [sic] Schiavo which is borne out by the total absence of supporting case studies or medical literature. ...The other doctors, by[sic] contrast, all testified there was no treatment available to improve her quality of life. They were also able to credibly testify that neither hyperbaric therapy nor vasodilatation therapy was an effective treatment for this sort of injury."

So there you go. The Judge decided he wasn't credible. Note that this is not the same as deciding that Hammesfahr had a valid point of view, but the others' view was more sound; this decision impeached the credibility of Hammersfahr's findings.

This issue is a lamentable part of the Schindler story. I will never understand how, with all that external funding and advice, they managed to pick him. (I have said before that I wished they'd chosen Cheshire or someone like him from the start; although I disagree with them, they deserved their day in court and this charlatan screwed up any hope they had).

Hammesfahr's credibility issues add a layer of difficulty for others (like us) who're trying to maintain a NPOV. If the disagreement was legitimate, then the solution is clear: include the legitimate "minority opinion," as SlimVirgin puts it, in the introduction. However,  no legitimate alternative diagnosis was made here : as Greer's example illustrates, Hammesfahr gave Schiavo something like 180+ commands, and she seemed to make some sort of response, that was not clearly non-reflexive, in a very small handful (IIRC from other sources, approx 5); with this and similar observations, Hammy said she was MCS.

Greer did not simply say that Hammesfhar had no evidentiary support for his methods in the literature. He threw out  the credibility  of Hammersfahr's  clinical observations , and since a diagnosis, PVS or MCS, rests on the integrity of those observations, Greer in effect has shown that no clinically sound, legitimate alternative diagnosis has ever been made.

Now, this is very different from finding that one clinician made observations that were legitimate and consistent with a suspicion of the MCS, but that since 7 other physicians didn't, and the MCS diagnosis requires reproducibility, then the opinion of the 7 is more likely to be true than the opinion of the one. That is not what happened in Schiavo: Greer found one physician's clinical observations to be not credible.

So I understand Fuel's and Duckecho's reticence to include reference to Hammesfahr in the introduction. They were not opposing divergent points of view in the introduction, and anyone who has been involved with this article for any length of time would know that they’ve supported versions of the introduction in the past that included many divergent PsOV. But they are opposed to this particular fellow, and as I’ve shown there are excellent, fair reasons to hold that view.

Having said that, I would now like to enter a defense — of SlimVirgin.

SlimVirgin on Hammesfahr: a defense
We must bear in mind the version of the introduction SlimVirgin happened upon. In part, it went like this:


 * (December 3, 1963–March 31, 2005), was a St. Petersburg, Florida woman whose medical circumstances and attendant legal battles led to landmark court decisions, historic legislative initiatives, and intense media attention.


 * On February 25, 1990, Schiavo (pronounced SHY-voh, International Phonetic Alphabet: ) suffered severe brain damage from cerebral hypoxia, after experiencing cardiac arrest from an undetermined cause. She briefly lapsed into a coma, then passed into an irreversible persistent vegetative state (PVS) as determined by more than a half dozen neurologists, and so remained the last 15 years of her life.

It is easy to see why some contend this violates the NPOV. The sentence in bold goes to quite a bit of effort to enter into details, but seems to present details that are "in favor" only of one side of the dispute.

I can understand SlimVirgin's attack on the introduction (in a way I cannot with some of her other editing efforts). She was trying to introduce what she perceives to be the NPOV - and it is a view that will likely be shared by many, many others.

Now, objection to SlimVirgin's editing of the introduction has thus far centered mainly on its undesirability from a literary and stylistic standpoint. I concur with this criticism, as my first post above will make clear. However, by that same standard, I suggest that the version she came upon was really not much better.

Seriously guys, don't you think this is clunky?
 * She briefly lapsed into a coma, then passed into an irreversible persistent vegetative state (PVS) as determined by more than a half dozen neurologists, and so remained the last 15 years of her life.

It does exactly what we say we've been trying to avoid. It has detail that is best dealt with in the body of the article. It has unnecessary numbers. How is numbering the neurologists different from numbering the brain mass? If you feel mention of Purkinje fibers is out of place in the introduction, why is mention of the number of neurologists relevant?

A proposed solution
I think there is a way out of this. Ann and I demonstrated it a few days ago, as a matter of fact.

 We can all find a way to agree on a version of an article, without agreeing on our reasons for it .

I am going to ask Fuel and Duck and Ghost and Proto and every one of the other regular editors to agree to work on creating a better introduction. A few days ago, there was a version of the sentence now under dispute that had been chiseled from the hard stone of many arguments, and had come to stand the test of time (for a Wiki). It avoided the "POV issue" by simply being simple, and not getting into numbers or unnecessary detail. I really like that sentence for my own reasons. Ann likes it for hers. Duck and Fuel and some others may prefer another version, but I think they can live with that one, and maybe even like it. A bit.

If I'm reading SlimVirgin's attack on the intro correctly, she moved because she perceived the introduction to violate the NPOV. Most of her assumptions were wrong. But not all of them. If we move around a fair objection by writing a sentence that cannot be seen as biased, I sincerely believe she will lay down her sword.

Please consider this:
 * Despite heroic resuscitative measures, she suffered severe brain damage from the ensuing cerebral hypoxia, briefly lapsed into a coma, and spent the remaining 15 years of her life in a condition diagnosed as an irreversible persistent vegetative state (PVS).

What say thee?

~ Neuroscientist | T | C → 05:41, July 13, 2005 (UTC)

The SlimVirgin edits: Actions & Intentions
I have addressed in the preceding posts the SlimVirgin edits to the introduction.

It is possible to go through each further edit in turn, methodically, and to show that they are in some instances excellent, and in others woefully ill-informed, or weak.

I do not have the time to do this.

I will address only some issues in this post, and mainly confine the following questions and remarks to certain events that I do not yet fully understand.

We have lost one exceptionally valuable, bold, hardworking editor in this absurd flare-up. I hope there aren't anymore blocks, including of the new contributor (can admins nevertheless get blocked?). There are however a few observations to be made about this incident.

Firstly, I would like to say that I think SlimVirgin was well within her rights to edit the page in the manner she did. Wiki policy is slanted toward encouraging bold editing, and the nature of the Wiki is such that edits are to be expected — they are inevitable.

However, I do not think the manner SlimVirgin went about this was wise, nor fruitful. The same page that promotes boldness also says:


 * But please note: be bold in updating pages does not mean that you should make large changes or deletions to long articles on complex, controversial subjects with long histories, such as Israeli-Palestinian conflict or Abortion. In many such cases, the text as you find it has come into being after long and arduous negotiations between Wikipedians of diverse backgrounds and points of view. An incautious edit to such an article can be akin to stirring up a hornet's nest, and other users who are involved in the page may react angrily. Even so, the editing of glaring grammatical errors is welcome.


 * If you encounter an article on a controversial subject that you would like to edit, it's a good idea to first read the article in its entirety, read the comments on the talk page, and view the Page history to get a sense of how the article came into being and what its current status is.


 * If you are an experienced Wikipedian, you will probably have a good sense of which edits will be accepted, and which should be discussed first.
 * (all emphases mine)

Now, some background first. User:SlimVirgin is not new to Wikipedia. If the boast on her user page is to be believed (and I see no reason it shouldn't be), she is in fact an extremely experienced Wikipedian, with some 12,000 edits to her name. A look at the subjects she's been involved with discloses wide experience with a slew of highly controversial articles.

She is also an administrator.

At the time SlimVirgin edited the Schiavo article, she was perfectly aware of its controversial nature.

She was perfectly aware that it was so controversial it was in an ongoing Mediation. In fact, just before she began her work on Schiavo, she was involved in adjudicating a dispute between two regular Schiavo editors over, of all things, a revert war.

She then came over, and did this.

Now, I completely and totally agree with SlimVirgin that that picture gives the misleading impression that more words were changed than was really the case, because of paragraph movements. However, I also think it's absurd to suggest this wasn't in fact a  major  edit. In an article like Terri Schiavo, where almost every single sentence and paragraph has been passionately argued over, waltzing in and rewriting the entire introduction is itself a major edit — especially since even a cursory look at the Talk page and archives would have disclosed it was actually undergoing active editing and discussion at the time.

It was not in any way wrong to go right ahead and edit, but would it not have been more sensible (and courteous) to simply join the discussion first? Rewriting the entire introduction that other editors have worked on is not a minor edit. No one should have to tell a 12,000-edit veteran this.

But even so, I know that this was not what provoked the revert war. When SlimVirgin had completed editing the introduction, Duckecho was online, and he posted a bemused remark on my Talk page. It was a parenthetical afterthought:
 * (by the way, take a look at the intro edit made just a few minutes ago. It'll make you want to cry.) Duckecho (Talk) 16:25, 11 July 2005 (UTC)

I seriously doubt he was going to revert it, especially since random Wikipedians have even in recent days made "drive-by" changes to the introduction that he found absolutely silly, but nevertheless didn't even touch.

But then SlimVirgin did something rather extraordinary. She "locked" the page with a "Major Edit" tag (irony) for 1 hour, 31 minutes, while she went through the page "copy editing."

This was incredible.

Many of the changes were minor, and involved removing embedded notes within the article. However, fantastically, even as she removed embedded notes — and she has since decried their use on the Talk page — she actually placed many embedded notes into the article herself. What gives?

Worse, her notes, criticisms, and suggestions — and some of them, I thought, were excellent — could more easily, more clearly, and more effectively been placed in Talk. Why did she go through her extraordinary “copy edit,” instead of simply setting up a nice post in Talk enumerating her concerns? We could all have had a jolly good go at them, accepted the excellent suggestions, talked about the rest, and referred the genuinely disputed to the mediation page. It would have been swell. What happened?

I do not know, and faced with the standing of this individual on Wikipedia, I’m unable to explain it.

One reason that occurred to me was simply principle. That is to say, she was determined to push the principle that Wiki is open to bold editing, no matter how controversial the article. Fair enough. However, when the very wise Proto suggested a very similar action to posting in Talk, she readily agreed. This is mystifying — was this really so inapparent a solution on July 11?

SlimVirgin claims the "copy edits" she made were all free of error (of both fact and grammar), with the implication that they should simply have been accepted. After one of the first reverts, she said "you are reintroducing all the errors." Leaving aside the hubris it must take to say that, the claim of course was simply untrue. I have already shown that her assumptions of fact in her version of the introduction are riddled with error; further, there are constructions of hers that are most aptly described with one of her favored phrases: "awkward English."

But the problems are not limited to the introduction. Many of the further edits are problematic (and, as I’ve also repeatedly said, others are very good — if she’d done this smartly, she’d have gotten support not only from me and many of the others, but probably also from Duck and Fuel).

I have already said I have no time at the moment to write out a response to each and every one of her edits. If fellow editors would like my thoughts, I may be able to get back to this later in the week, but this is unlikely. This episode has taken a lot out of my enthusiasm for Wikipedia.

My final impressions here are that this User demonstrated very, very,  very  poor judgment by doing what she did. She had a right to do it, but there are some things which are very dumb to do, even when one has the right to do them. A simple post on Talk, a simple gesture of courtesy to the regular editors, could have prevented this whole mess. Now there is ill-feeling between her and the two editors who reverted her, and at least one of them — an excellent, bold, intelligent, and hardworking editor — is blocked.

He was blocked for some of his actions which are indefensible, yes.

But great responsibility falls on the shoulders of the 12,000-edit administrator who doesn’t seem to have learned the corollary to the Wiki call to be bold: do not be reckless. ~ Neuroscientist | T | C → 05:52, July 13, 2005 (UTC)