Monday, July 31, 2006

Plan B may become available OTC after all

Almost a year after ruling that the morning-after pill could not be sold over the counter, the FDA is reconsidering. Early reports suggest that Plan B may become available to women 18 and older only (women younger than that would still need a prescription.)

News from NYT here.
Here's an FAQ from FDA for those who missed the earlier stories about this one.

Intelligent Design: Is it really all about our place in the world?

This article by Robert Lee Hotz of the LA Times pinpoints what he sees as the underlying agenda of the 'intelligent design' promoters: Darwinian evolution unseats humanity as master of a divine creation. With its emphasis on the mechanism of natural selection, it puts people on equal biological footing with barnacles and baboons.

TIME: the truth about stem cells

Hat tip to R. Alta Charo for bringing this story to our attention: Stem Cells -- The Hope and the Hype. The debate is so politically loaded that it's tough to tell who's being straight about the real areas of progress and how breakthroughs can be achieved. TIME magazine summarizes the issues.

Living Large, Part Deux

Gina Kolata asks how long can living large and healthy go on?: Longer life. Less disease. Less disability. The trends have continued for more than a century as humans have become bigger, stronger and healthier. But can they — will they — keep going? Or is there some countertrend, obesity or an overuse of medications, perhaps, that will turn the statistics around?

Nice Rats, Nasty Rats: Genes and Behavior?

Nicholas Wade of the NY Times explores the question of whether or not a single gene that affects the timing of neural crest cell development underlie the whole phenomenon of animal and human domestication? :

On an animal-breeding farm in Siberia are cages housing two colonies of rats. In one colony, the rats have been bred for tameness in the hope of mimicking the mysterious process by which Neolithic farmers first domesticated an animal still kept today. When a visitor enters the room where the tame rats are kept, they poke their snouts through the bars to be petted.

The other colony of rats has been bred from exactly the same stock, but for aggressiveness instead. These animals are ferocious. When a visitor appears, the rats hurl themselves screaming toward their bars.

“Imagine the most evil supervillain and the nicest, sweetest cartoon animal, and that’s what these two strains of rat are like,” said Tecumseh Fitch, an animal behavior expert at the University of St. Andrews in Scotland who several years ago visited the rats at the farm, about six miles from Akademgorodok, near the Siberian city of Novosibirsk. Frank Albert, a graduate student at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, is working with both the tame and the hyperaggressive Siberian strains in the hope of understanding the genetic basis of their behavioral differences.

The two strains of rat are part of a remarkable experiment started in the former Soviet Union in 1959 by Dmitri K. Belyaev and his brother, who were geneticists who believed in Mendelian theory.

But implications go far beyond issues in animal domestication: The genes, if Mr. Albert finds them, would be of great interest because they are presumably the same in all species of domesticated mammal, maybe even including humans. Richard Wrangham, a primatologist at Harvard, has proposed that people are a domesticated form of ape, the domestication having been self-administered as human societies penalized or ostracized individuals who were too aggressive.

Human self-domestication, if it occurred, would probably not have exactly the same genetic basis as tameness in animals. But Mr. Albert said that if he could pinpoint the genetic difference between the tame and ferocious rats, he would compare the chimp genome and the human genome to see if they showed a similar difference.

One possibility is that a handful of genes — perhaps even just one — underlie all the changes seen in domestication. A structure in the embryo of all vertebrates, known as the neural crest, is the source of cells that constitute much of the face, skull and pigment cells, and many parts of the peripheral nervous system and endocrine system. If the genes in the neural crest cells were delayed just a little in coming into action, a whole range of tissues could be affected, including the maturation of the adrenal glands that underlies the first fear response of young animals, Dr. Fitch has written.

Friday, July 28, 2006

But aren't you on the payroll, doctor?

Health researchers haven't been faring too well in the news lately. The most recent revelations about scientific misbehavior concern the failure of several prominent health researchers to disclose their financial interests in the treatments they praised in print. Info in the NYT here, here, and here.

Why should the general public care about conflict of interest in professional medical and scientific publishing? Because this one of the main sources (other than online databases) postgraduate physicians use to get information about what's the best way to treat patients. So if an author recommends a certain medication or treatment on the basis of his own financial gain--rather than on what's best for patients--your doctor may (unknowingly, trustingly) recommend that treatment for you or for a family member. (Btw, both of these studies are about treatment for depression--and one includes data on treating depression in children. High-stakes stuff.)

In related news, have you seen the new ads for Lipitor (a cholesterol-lowering medication) featuring Dr. Robert Jarvik? Yes, that's Dr. Jarvik, as in the artificial heart. You can hear ethicist Katie Watson's NPR piece about it here, and read about it here.

And don't get me started on Hwang Woo-Suk. I predict his next blame-deflecting move will be to claim alien abduction.

Thursday, July 27, 2006

It's My Body and I'll Decide if I Want To - You would too if it happened to you

Should a teen be forced to undergo chemo therapy? We need to be pay close attention to cases that pit "medical necessity against the explicit wishes of a competent (albeit in this case, a minor) patient." When I read Mr. Cherrix's quote "I can choose what is best for my body....If I don't have the right to do that, I don't have any rights at all" I could not help but consider the implications for reproductive choice including forced caesareans and abortion. Ethical considerations include not just what we "ought" to do but also "who decides”.

Here'e the full article: printable article, Originally published July 25 2006

In health freedom fight, Abraham Cherrix to refuse court-ordered chemotherapy sentence

(NewsTarget) Abraham Cherrix -- the Virginia teen who has been court-ordered to undergo chemotherapy for his Hodgkin's Disease after opting to treat his condition with an herbal diet -- says he will defy the court's order and refuse chemotherapy.
Cherrix says he refuses to subject himself to chemotherapy, which he tried after his initial diagnosis. The chemo made him feel sick, though his cancer briefly went into remission before returning earlier this year. If Cherrix were to submit to the court order, the radiation level for his chemo would be increased.

"I think it's my body. I can choose what's best for my body," says Cherrix. "If I don't have the right to do that, then I don't have any rights at all anyway." Cherrix has been seeing American doctors based in Mexico for five months for guidance with his herbal diet, with the blessing of his parents. Cherrix says, "I feel good. I believe that in my heart, the treatment will cure me."
The Cherrix family's attorneys have filed a motion to stay and are fighting for a new trial in the Circuit Court.

Last Friday, a judge for the Accomack County Juvenile and Domestic Relations Court ruled that Cherrix must resume chemotherapy, and also found his parents guilty of child neglect. If the Circuit Court upholds the lower court's decision, Cherrix's father says he is prepared to face possible jail time. "I'm not going to be an obstacle to my son. If a judge wants to throw me in jail, then he's going to have to do that."

Critics of conventional medicine say Cherrix's situation could bring about an end to health freedom and the ability of every U.S. citizen to choose their own method of healing. Cherrix says his ongoing legal battle to keep his right to naturally treat his cancer is distracting him from healing: "I should be concentrating on my recovery. This case is taking me away from that."

"With this stand against the tyranny of modern medicine, Cherrix has squarely positioned himself as a champion of health freedom," said Mike Adams, health freedom supporter and critic of conventional cancer treatments. "Cherrix's move is brilliant. By refusing to comply with the court order, the court must either back down and recognize his right to refuse chemotherapy, or it must stick a gun in his face, handcuff him and force deadly chemicals into his veins in a Guantanamo-style torture scene.

Either way, Cherrix wins. He either regains his freedom or single-handedly exposes the true tyranny and destructive intentions of conventional medicine. The public backlash against such images would be unprecedented." Adams also added, "My advice to Cherrix and his family is that they document everything. Record audio, take pictures and film whatever happens. Faced with the prospect of daylight, these cancer industry evildoers will be forced to back down. The Judge who ordered the chemotherapy, by the way, should be charged with attempted murder."

Monday, July 24, 2006

Searching for a 'middle ground' in the malpractice crisis

From the Sorry! Works Coalition:

Many states have adopted or are considering 'apology laws' that exempt expressions of regret, sympathy or compassion from being considered as admissions of liability in medical malpractice lawsuits. The intent is to encourage physicians and other healthcare providers to apologize to patients when a medical error, accident or unanticipated outcome occurs without the apology being taken as an admission of guilt. The consensus is that healthcare providers have become reluctant to explain to patients and their families what happened when procedures go wrong because they fear the information will be used against them in court. Many healthcare providers have struggled with their desire to explain and apologize to their patient, but have often been strongly advised against such open discussions by their defense attorneys.

And I love being here in Vermont ~ we're proposing legislation that Sorry! Works says is a true road map for every other state in the union.

This is your brain; this your brain on a computer

From Wired: DARPA (Defense Advanced Research Projects Agency) has been funding new brain-computer-interface technology could turn our brains into automatic image-identifying machines that operate faster than human consciousness.

Researchers at Columbia University are combining the processing power of the human brain with computer vision to develop a novel device that will allow people to search through images ten times faster than they can on their own.

The technology would allow hours of footage to be very quickly processed, so security officers could identify terrorists or other criminals caught on surveillance video much more efficiently.

The "cortically coupled computer vision system," known as C3 Vision, is the brainchild of professor Paul Sajda, director of the Laboratory for Intelligent Imaging and Neural Computing at Columbia University. He received a one-year, $758,000 grant from Darpa for the project in late 2005.

The system harnesses the brain's well-known ability to recognize an image much faster than the person can identify it.

"Our human visual system is the ultimate visual processor," says Sajda. "We are just trying to couple that with computer vision techniques to make searching through large volumes of imagery more efficient."

The brain emits a signal as soon as it sees something interesting, and that "aha" signal can be detected by an electroencephalogram, or EEG cap. While users sift through streaming images or video footage, the technology tags the images that elicit a signal, and ranks them in order of the strength of the neural signatures. Afterwards, the user can examine only the information that their brains identified as important, instead of wading through thousands of images.

Thursday, July 20, 2006

Legal, Medical, and Ethical Questions raised about the charges against healthcare providers during Katrina

Our Board Member R. Alta Charo is cited in a NY Times articles among the experts in medicine and ethics who have many questions about the accusations, to kmade on Tuesday by Louisiana’s attorney general, that a doctor and two nurses used lethal injections ill four critically ill patients in a flooded New Orleans hospital after Hurricane Katrina.

In interviews, several experts said that although they did not know the details of the case, they suspected that it had to be more complicated than the “plain and simple homicide” asserted by the attorney general, Charles C. Foti.

One possibility is that the patients were suffering and the only way to keep them comfortable was with high drug doses that may, incidentally, have hastened their deaths. It is not known, though, how much the patients were suffering.

Charo, a professor of law and bioethics at the University of Wisconsin, said: “The real dilemma here is in getting at the very precise facts of the case. I can say that, as a general matter, if you have a patient who is in distress and who needs pain relief and if the only level of painkillers that will relieve the pain also poses a high risk of death then it is permissible to give the pain relievers, provided the patient has consented to the risk of death.”

Even if the patient can no longer give consent, Professor Charo said, it is still ethical for doctors to treat the pain if they believe it is what the patient would want.

“If that was the case, then this is not simple homicide, and I can only hope the investigators were attentive to this,” she said.

Wednesday, July 19, 2006

Never Eat Anything Bigger Than Your Head and other guidelines to ethical eating

I love what Art Caplan has to say about shopping in the supermarket in this Washington Post article entitled, "Is there anything left to eat?": Caplan believes there's no need to have "a moral aneurysm" every time we go to the supermarket. Every person, he says, needs to establish a scale of ethical priorities. Is taste most important to you? Cost? The environment? Your health? Animal suffering? Pick one thing that matters most and let that drive your decisions.

For Caplan, No. 1 on his list is whether suffering was involved. "So I want happy chickens, no veal, no foie gras. After that comes environmental impact, and then labor. I have an ethical guide in my head that helps me through the store."

He also points out that, in a way, we should be grateful we are even considering all these ethical questions. "These are the dilemmas of abundance," he says. "If we were living in Darfur, the only answer to 'what to eat?' would be 'anything I can find.' "

Brainy Bots

At Stanford University computer scientists are developing a robot that can use a hammer and a screwdriver to assemble an Ikea bookcase (a project beyond the reach of many humans) as well as tidy up after a party, load a dishwasher or take out the trash.

Researchers at the École Polytechnique Fédérale de Lausanne in Lausanne, Switzerland, are building large-scale computer models to study how the brain works; they have used an I.B.M. parallel supercomputer to create the most detailed three-dimensional model to date of a column of 10,000 neurons in the neocortex -- it is known as the "Blue Brain" Project. (Anybody ever read The Footprints of God?)

Blue Brain researchers say they believe the simulation will provide fundamental insights that can be applied by scientists who are trying to simulate brain functions. Researcher Robert Hecht-Nielsen is seeking to build an electronic butler called Chancellor that would be able to listen, speak and provide in-home concierge services. He contends that with adequate resources, he could create such a machine within five years. (ooh, wouldn't you like one of those?)

Bush exercises his first veto on stem cell bill

The "veto bubble" has finally burst. Five-and-a-half years into his presidency, George W. Bush has ended his record stretch of bill-signings as he rejected legislation Wednesday that would expand federal funding of human embryonic stem-cell research.

Attempts in Congress to override the veto, which would require a two-thirds vote, were expected to fail.

According to the Christian Science Monitor, analysts agree that President Bush's veto was risky but unavoidable. Since the issue of stem-cell research arose early in his presidency, when Mr. Bush approved federal funding of preexisting stem-cell lines, he has remained adamant that no federal monies be used on newer cell colonies. The president believes the killing of human embryos, from which stem cells are harvested, is murder, says press secretary Tony Snow.

But an editorial from the Washington Post this morning poses an interesting argument:
"We understand that people can in good faith disagree on this question. But we don't understand the logic of Mr. Bush's position. If using discarded embryos to extract stem cells is murder, how can he permit it to proceed with private funding?" (or IVF research to continue for that matter?)

What’s wrong with being an old mother?

A 62 year old woman became Britain’s oldest mother, and one of the oldest in the world, on July 5 when she gave birth to a baby boy.Patti Farrant, a child psychiatrist, underwent fertility treatment abroad in order to fulfill her 60 year old husband’s dreams of becoming a father.Farrant used invitro fertilization techniques and a donated egg to get pregnant.The baby weighed 6 pounds and 10 and a half ounces.Doctor Severino Antinori was the doctor who supervised the procedures.In the early 1990’s doctor Antinori helped a 62 year old Italian women give birth using fertility treatments and a donated egg.Since then Italy has created Europe’s strictest laws about invitro fertilization techniques and other assisted reproduction procedures, and Farrant’s case was carried out in a former Soviet republic.Fertility clinics in Britain will not use assisted reproduction techniques for women past the normal child birthing years. Liz Buttle was Britain’s oldest mother until now.In 1997 she gave birth at the age of 60. The world’s oldest mother is Adriana Iliescu, a Romanian woman, who became a mother at the age of 66.
Read more:

Veto pending...

From R. Alta Charo just off the presses:

Rumor has it that the president's veto of the stem cell bill will take
place around 2 pm today.

To express either support or opposition to this action, you may call the
white house at comment line at 202-456-1111. other white house numbers are:



Living Large in Chicago ...

Catfish beignets, curly fries smothered in cheese, pierogies with sour cream, beer-battered artichoke hearts, and fried dough buried in berry sauce and whipped cream -- all part of the traditional Taste of Chicago and all contributing to Chicago's reputation for being one of the 'fattest' cities in the US. And if Edward M. Burke, Chicago City Councilman since 1969, has his way it will be illegal for restaurants to use oils that contain trans fats, which have been tied to a string of health problems, including clogged arteries and heart attacks.

But even Mayor Richard M. Daley, who often promotes bicycle riding and who not long ago appointed a city health commissioner who announced he was creating health “report cards” for the mayor and the aldermen, has balked at a trans-fat prohibition as one rule too many.

What do you think? I love Chicago, it's my favorite city, and I'll like to see it be more healthy -- but does this go overboard? Or is it in the same category as banning smoking in public places? It brings up a host of legal and ethical questions, what role does government play in regulating lifestyle? And if I consciously choose to smoke or eat trans fats, can I really expect society to pay for my care? I'd love to hear your thoughts on this matter...

Tuesday, July 18, 2006

Adult Stem Cell Bill Defeated

Another update via R. Alta Charo:

By KIMBERLY HEFLING, Associated Press Writer

WASHINGTON (AP) -- Sen. Rick Santorum, a conservative struggling to win reelection, suffered a political setback late Tuesday when the House rejected his bill to encourage adult stem cell research. The 273-154 vote fell 12 votes short of the two-thirds majority required under the rules. Opponents, mostly Democrats, said the bill would have given the Republican Santorum and other anti-abortion lawmakers political cover for opposing a related bill that instead would fund embryonic stem cell research. The bill had passed the Senate unanimously earlier in the day. Santorum likens embryonic stem cell research to abortion because a days-old embryo is destroyed in the process of extracting stem cells.

A spokesman for Santorum did not respond to requests for comment.

Stem Cell Research Act - Roll Call!

Thanks to R. Alta Charo for this link which colorfully depicts how the Senate voted on the Stem Cell Research Enhancement Act (HR 810.) You can click on your state to get details on how your Senator voted. To the 63 Senators who voted "yes" - thanks for putting partisan politics aside and doing the right thing.

Immoral Not to Support HR 810

At the Bioethics and Politics Conference in Albany, one of the neo-conservative speakers quipped in a Q/A session, “I wish liberals cared as much about the unborn as they do about the uninsured.” I was struck by the immense lack of compassion for those who are unable to receive the medical care they and their families so desperately need today. So I was delighted, in light of the political frenzy going on in Washington DC right now on the various stem cell bills, to find this statement from June Walker, National President of Hadassah:

In a statement today, June Walker, National President of Hadassah, appealed directly to Senator Bill Frist, Senate Majority Leader, who visited Hadassah Medical Center in May 2005, to do all he can to ensure Senate passage (of HR 810). “By passing this legislation, the Senate will definitively demonstrate that stem cell research is not an issue that divides Americans by political party or faith. This bill would affirm the sanctity of both human life and the spirit of free inquiry-two tenets of America’s spiritual and political life behind which the vast majority of Americans proudly stand. It is immoral for our families, neighbors and friends to suffer while Washington politics hold hostage treatments within our scientific grasp. A presidential veto would not reflect the American people’s political will.”

Now that's what I call being "pro-life". You can read the full statement at: Hadassah News.

Sunday, July 16, 2006

Bioethics: Struggle for the control of life (and death)

I just returned home from the Bioethics and Politics Conference in Albany. I say “just” because a flight delay in Albany caused me to miss my connection home to Seattle, forcing me to spend Friday night at the airport in Chicago. United finally got me back to Seattle (via a DC connection!) late Saturday night. The travel glitch made me miss an important personal event in Seattle and had my friends asking me once again, why are you so committed to these seemingly obscure “bioethical issues?”

I don’t usually share my personal woes on the WBP blog. But I’m doing so because it gives me the opportunity to point out that the most important achievement of Glenn McGee’s historic conference is that it clearly demonstrated that bioethics is neither a collection of sideshow issues (Schiavo, Baby Doe, or media issue du jour) nor merely a sub-specialty of philosophy.

As many of the speakers (Charo, Zoloth, Cohen, Moreno, Smith, Doerflinger, Cameron, Wolpe – wow, what a line-up) powerfully indicated, at the core of this politicized bioethics, is the ultimate power struggle for the control of life (and death) and our sense of ourselves as human beings. And this, my friends, is worthy of devoting ones life too. Congratulations to Glenn and the other scholars who participated for an excellent conference.

PS. WBP board member Linda MacDonald Glenn spent much of the conference interviewing all sides of this debate and will be posting a series of fascinating podcasts. Thanks to Linda for her commitment to bring the conference to a broader audience.

More podcasts from the ASBH conference

As a Women's Bioethics Project scholar and newly appointed faculty member of the Alden March Bioethics Institute, I was able to interview a number of speakers from the ASBH Conference on the Future of Bioethics and Politics in Albany, NY, including Glenn McGee, Art Caplan, Eric Cohen, Nigel Cameron, Jonathan Moreno, and Jay Hughes and capture the interviews for podcast, available here.

I was also able to capture two of the lectures from the conferences, those of R. Alta Charo and Edmund Pellegrino, although the sound quality on those is not as good as those of the interviews, at least until I can figure out how to sound edit them.

Look for pictures from the conference to be posted shortly ~ In the meanwhile, happy listening!

Thursday, July 13, 2006

Live from New York ! -- the ASBH Politics and Bioethics conference!

Listen to our podcasts (1 and 2) about the how the 'rumble' in Albany started off with a bang!

Fellow blogger Alison McCook had this to say about the conference:

The Bioethics & Politics conference hosted by the Albany Medical College got off to a bang today, not a whimper. As participants trickled in, networking and finding old friends, another, uninvited group calmly filed in, parked in front of the room, and started shouting at the tops of their lungs.

The protesters, around 30 or so, were from Not Dead Yet, a disability rights group that is against legalized euthanasia and other forms of "medical killing," as they call it. The meeting hall became quickly filled with cries of "nothing about us without us." Members quickly distributed fliers to participants that explained they were upset that conference organizers had gathered people from both sides of the political spectrum, but failed to include advocates of the disabled.

Huh? I’m all about pluralism, but the conference is about politics, and with only a day and a half at our disposal, it makes sense to focus the discussion. However, the director of the AMC’s Alden March Bioethics Institute, Glenn McGee, to his credit, took the microphone and said the organizers had decided to give Not Dead Yet a chance to speak. (Glenn even managed to open with a joke: "As you can see, everything is going according to plan.") Representative Stephen Drake spoke for 10 minutes about how politics is not important to people at the front lines of hot button issues ("We live in a world where partisan lines aren’t that important"), and received as much applause as any pre-planned speaker did the rest of the day. After his speech, he and his colleagues left, and it was all very civil.

The experience clued me in to the fact that bioethicists are, by the nature of their purview, adept at handling heated debates and, hopefully, finding a compromise many people can live with. If only other discussions had such a happy ending as this one.

Tuesday, July 11, 2006

Diagnosing Medical Malpractice -- Curing the Ailment, not just treating the symptoms

Senate Majority leader Bill Frist's answer to runaway health-care spending is to cap jury awards in medical malpractice suits -- for the fifth time in four years, he tried and failed to cap awards at $250,000 during his self-proclaimed "Health Care Week" in May.

But how's this for a novel approach?: Sens. Hillary Clinton and Barack Obama also want to save on health care, but rather than capping jury awards, they hope to cut the number of medical malpractice cases by reducing medical errors, as they explain in the New England Journal of Medicine.

Supporting this approach is a recent study out of the Harvard School of Public Health that showed that the legal system does a good job of weeding out claims without merit.

World's First 'test-tube' baby set to give birth; baby conceived the 'old-fashioned' way

On July 25, 1978, Louise Joy Brown, the world's first successful "test-tube" baby was born in Great Britain. Now the world's first test-tube baby is expecting a baby of her own. Brown, 27, is due to give birth in January. She has been married for two years to a security officer, Wesley Mullinder, and their baby was conceived the old-fashioned way."This is a dream come true for both of us," Brown told Britain's The Daily Mail newspaper. The couple live outside of Bristol where Brown is an administrative assistant for a shipping firm. They made headlines in 2004 when they married. The pregnancy is yet another in a long list of headlines surrounding Brown's life that began in such an unusual way.

Access to Abortion as a Human Rights Issue

Women's E-news reports that a Polish woman, Alicja Tysiac, applied for an abortion a few years ago, but her medical grounds were refused. She wound up carrying the pregnancy to term and losing her sight. Now her case awaits judgment by the European Court of Human Rights.

Friday, July 07, 2006

Rudeness ok for docs, says court

At first glance, you might think this was a story from the National Enquirer, but you'd be wrong. Apparently a New Hampshire physician told an obese patient that she was so fat "only black men would want her." The patient sued.

The judge agreed that the remark was uncalled for, but said that the physician had a right to speak bluntly, writing, "It is nonetheless important ... to ensure that physicians and patients are free to discuss matters relating to health without fear of government reprisal, even if such discussions may sometimes be harsh, rude or offensive to the listener."

Sure, sure--docs have free speech rights the same as the rest of us. But it seems neither professional nor kind. . . . which I think are characteristics we'd like to see in our physicians, no? One hopes that some professional organization will have something more to say to the doc in question.

Thursday, July 06, 2006

Johann Hari: Why I support liberal eugenics

Johann Hari of the Independent claims this has nothing to do with the evils of Nazi eugenics; it is entered into by parents and it is motivated by love.

Can anyone say "genetic idolatry"? Aren't we more than the sum of our genes? Or are we mere 'meatbots'?

Shades of "The Dead Zone" -- the rewired brain

Anyone who has watched the USA network's series The Dead Zone will be surprised (or maybe not) to hear that doctors contend that man's brain rewired itself after being in a minimally conscious state for 19 years. According to the Boston Globe, Terry Wallis awoke from a coma-like state 19 years after tumbling over a guardrail in a pickup truck and falling 25 feet into a dry riverbed. Now doctors armed with some of the latest brain-imaging technology think they may know part of the reason why.

Wallis showed few outward signs of consciousness, but his brain was methodically rebuilding the white-matter infrastructure necessary for him to interact with the outside world, researchers reported yesterday in the Journal of Clinical Investigation.

``I believe it's a very, very slow self-healing process of the brain," said Henning Voss, lead author of the study and a physicist at Weill Cornell Medical College's Citigroup Biomedical Imaging Center.

Wallis emerged from a minimally conscious state in 2003 at the age of 39 and uttered his first word since Ronald W. Reagan was in the White House: ``Mom." Since then, the onetime mechanic from Big Flat, Ark., has regained the ability to form sentences and recovered some use of his limbs, though he still can't walk or feed himself.

Using both PETscans (Positron Emission Tomography scans) and an advanced imaging technique called diffusion tensor imaging, the researchers examined Wallis's brain after he regained full consciousness, and found that cells in the relatively undamaged areas had formed new axons, the long nerve fibers that transmit messages between neurons.

``In essence, Terry's brain may have been seeking out new pathways to reestablish functional connections to areas involved in speech and motor control -- to compensate for those lost due to damage," said the study's senior author, Dr. Nicholas Schiff, a neurologist at the Weill Cornell Medical College in New York.