Nearly two years ago, a giant earthquake off the coast of Japan sent a 13-meter high tsunami crashing into the Fukushima Daiichi nuclear power plant, causing meltdowns in three of the six reactors and ultimately, triggering an explosion. Thousands were killed by the tsunami and earthquake.

No one has died from radiation and in fact no radiation health effects have yet been observed among the public or workers, according to a December, 2012 statement from a United Nations expert committee.

But even as the actual health effects from radiation — at least so far — are turning out to be much less dramatic than many people feared, a host of other, less-feared but very real, outcomes are causing lasting trouble. These include mental health problems such as alcoholism, depression, anxiety and, in the case of children whose parents and teachers are too afraid to let them play outdoors, a rise in obesity.

It is a striking illustration of what often happens in public health. What we think we should be most afraid of is often, in reality, less dangerous than we think, while other things that we are blasé about, carry higher risks. We fully believe, for instance, that we are being killed by toxic stuff in our air, water and food and ignore the huge health risks from sedentary lifestyles.

What we think we should be most afraid of is often, in reality, less dangerous than we think, while other things that we are blasé about, carry higher risks.

A fascinating article in last month in the journal Nature illustrates the point beautifully.

The Fukushima Health Management Survey, described in detail in the Nature article, found that the doses of radiation experienced by people evacuated from the nuclear zone were surprisingly low. For nearly all the evacuees, the exposure level was only about 25 millisieverts (mSv). That is considerably less than the 100-mSv level, at which risks from radiation, including cancer, are believed to increase. (A Sievert is a unit of ionizing radiation.)

And this is not the only research team to have found lower levels of radioactive pollution than feared. A World Health Organization project studied exposure to radiation in the six months after Fukushima.

The report concluded that “the estimated effective doses outside Japan from the Fukushima Daiichi NPP accident are below (and often far below) dose levels regarded as being very small by the international radiological protection community. Low effective doses are also estimated in much of Japan.”

Even right around Fukushima the report said, “the effective doses are estimated to be below 10 mSv, which can be considered within the order of magnitude of the natural radiation background, except in two locations.”

Indeed, that 10 mSv level is not dramatically more than the 6.5 mSv the average American gets every year from natural background radiation and medical procedures, according to another assessment of Fukushima after effects in the March, 7, 2012 Scientific American. That article, too, notes that heart disease and depression are likely to claim more lives post-Fukushima than radiation.

Indeed, the emotional fallout from Fukushima is serious. The big Japanese survey asked the more than 200,000 evacuees about their stress and anxiety and found that they showed about five times the normal rates of extreme stress, with children showing about double the normal levels.

Ronald Kessler, a professor of Health Care Policy at Harvard Medical School, said in an email that he was not surprised by this. “The possibility of radiation exposure creates long-term uncertainty that can complicate emotional recovery…the anxiety associated with this uncertainty, if not managed, could itself create long-term health problems even in the absence of subsequent physical health problems caused by radiation exposure.”

Obesity, too, is another serious consequence of radiophobia, or radiation fears, as the British newspaper, The Guardian, recently reported. Children in the Fukushima area are now the most obese in Japan, according to an education ministry report, because post-Fukushima radiation fears have meant restrictions on outdoor exercise.

All very sobering. Obviously, no one would advocate skimping on safety procedures around nuclear plants. In fact, the rapid evacuation of people out of the immediate Fukushima power plant area probably contributed substantially to the low radiation levels among the general public.

But if Fukushima is teaching us that our fears of radiation may be exaggerated, it also provides another lesson: That we should take seriously the more mundane, but potentially more lethal, aftereffects of disasters such as anxiety, depression, alcoholism and physical inactivity.

Late last Friday, an advisory panel to the US Food and Drug Administration voted – far from unanimously – to toughen restrictions on painkillers such as Vicodin, which contain the opioid hydrocodone. Typically, the FDA takes the advice of such advisory committees.

Bad, bad, bad move.

As always seems to happen in the tortuous world of pain and painkilling drugs, the loudest voices came from those concerned about prescription painkiller abuse, with the voices of legitimate pain patients relatively silenced. To wit: The committee voted 19 to 10 to tighten restrictions in the belief – mistaken, I believe – that such tightening would help combat abuse.

In reality, it might not help combat abuse much, if at all, and would certainly mean that legitimate pain patients will have a tougher time getting the opioids (formerly called narcotics) that they need to function.

For one thing, it should be clear by now that the much-touted war on drugs has failed. Indeed, recent evidence shows that the more the government tries to combat abuse, the more street addicts and abusers find ways around the restrictions. In a July, 2012 letter to the New England Journal of Medicine, for instance, researchers from Washington University reported that after OxyContin was made more tamper-resistant, abusers simply began turning to heroin instead.(1)

More to the point, if the FDA goes ahead and tightens restrictions, chronic pain patients – who number 100 million, according to the Institute of Medicine – will suffer. In testimony to the panel on Friday, Massachusetts pain patient Cindy Steinberg, Policy Chair for the Massachusetts Pain Initiative and New England Director for the American Chronic Pain Association, explained the toll chronic pain takes on sufferers and argued that hydrocodone medications, which she herself takes, should not, as proposed be moved from their current less restrictive status (so-called Schedule III drugs) into the more restrictive catgory (Schedule II).

Among other things, if the FDA accepts the advisory panel’s recommendation, it will no longer be possible for pain patients to get refills via called-in or faxed prescriptions from doctors. This means patients will have to go physically to the doctor every time they need a refill, a major obstacle for people in severe pain with mobility problems.

If you are a pain patient concerned about access to opioids, it is not too late to make your voice heard. Since June, 2012, the FDA has maintained a docket on which you can voice your opinion, but that docket will close on Friday, Feb. 1. The docket number is FDA-2012-N-0548. The link to submit electronic comments is http://www.regulations.gov/#!home;tab=search.

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(1) Cicero, T.J., Ellis, M.S., &Surratt, H.L. (2012). Effect of abuse-deterrent formulation of OxyContin [Letter to the editor]. New England Journal of Medicine, 367, 187-198.

 

It was almost child’s play.

Using a computer, an Internet connection and information available publicly online, researchers from the Whitehead Institute at MIT were able to figure out the identities of nearly 50 people who had submitted personal genetic information for a research study — information that purportedly had been “de-identified” so as to protect the subjects privacy.

Cracking the supposedly secret code turned out to be ridiculously simple, Yaniv Erlich, a Whitehead human genetics researcher, told the New York Times. “Oh, my God, we really did this. I had to digest it. We had so much information.” Erlich’s team quickly told the National Institutes of Health about the vulnerability of the information. The agency has taken steps to make re-identifying research subjects harder to do.

Great. But there’s a big issue of trust here. With this latest “Oops!” moment in the world of “Internet privacy,” that term itself seems well on its way to becoming an oxymoron. Particularly for health information.

No one is more concerned about this than Texas psychiatrist Dr. Deborah C. Peel, head of the Patient Privacy Rights Foundation. “We are actually in a very bad situation,” she told me by phone last week. “There is no way to protect your privacy today except to pay cash to a doctor who will keep your records on paper.”

For the record, Peel truly believes that there are many benefits to doctors, hospitals, insurers and researchers sharing information about patients and research subjects, for both the individual and the common good.

“The benefits of health technology systems are clear. We all know that. The problem is, we don’t know anything about the risks, about who has the data,” she said. In other words, it is unfair to ask people to balance the risks and benefits of electronic record sharing if they don’t know what the risks are. As it is now, she added, “everyone sells health data because it is so valuable. We live in a surveillance economy and the most valuable information is health information.”

At Harvard, a medical informatics specialist Latanya Sweeney runs the Data Privacy Lab and is working on a so-called DataMap. Personal health data can now be sent in an instant to growing numbers of people and organizations.

In fact, as an ABC investigation reported last fall, “millions of records can be bought online.”

To be fair, there are some decent souls inside the health care system trying to protect health privacy, among them Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center. And Halamka is reasonably upbeat about the possibility of protecting data security.

On January 17, he told me, new HIPAA regulations were released that are designed to enhance health privacy. (HIPAA stands for the Health Insurance Portability and Accountability Act, originally passed in 1996.)

With the new regulations in place, huge fines ($1.5 million a year) will accrue to any hospital — or other organization in the chain of groups receiving personal health data — that fails to adequately protect data security. Ideally, this could mean that nobody will be able to sell my personal health information to anybody else without incurring the huge fine. But the 563 pages of regulations are so complex, the effect may not do what Congress intended.

Will it work? Will these new protections be strong enough? I hope so. But frankly, I doubt it.

For one thing, we’ve seen too many hackers getting into big data bases. Nothing is that secure on the Internet. Besides, a $1.5 million fine for heatlh privacy offenders? That could be chump change, just the cost of doing business, for unscrupulous groups seeking to profit from your health data. And mine.

The woman in L.A. simply wanted a facelift. That’s all. But what she got was a nightmare – and a lesson for any of us who might be lured into the under-studied territory of cosmetic stem cell procedures.

Several years ago, the woman went to a California clinic that offered her a cosmetic procedure in which her own adult stem cells were harvested from her abdominal fat. (Adult stem cells are undifferentiated cells found amidst differentiated cells in tissues throughout the body; these cells can not only make many endless copies of themselves, they can also differentiate to yield some or all of the major cell types of the tissue from which they came.

At the clinic, doctors extracted from the woman’s fat stem cells that could turn into bone, cartilage or fat, according to a recent Scientific American article. Apparently, these cells were either mixed with a facial “filler” called calcium hydroxylapatite or injected into the same area as the filler. The filler can nudge stem cells to turn into bone.

Three months later, the woman couldn’t open her right eye without significant discomfort, and she heard a strange, clicking sound every time she opened and closed her eye.

Worried, she sought help from a different clinic, The Morrow Institute in Rancho Mirage, and a different doctor, cosmetic surgeon Dr. Allan Wu, chief scientific officer of the institute’s stem cell research lab.

In a telephone interview this week, Wu told me that, during a multi-hour procedure, the Morrow team extracted bits of bone from her eyelid and the area around her eye. The clicking sound, he said, probably came from these bone fragments hitting each other. Though the woman, whose name has not been released publicly, appears to be fine now, he said, other facelifts using isolated and concentrated stem cells alone may carry a risk of unintended bone growth and other potential long-term consequences.

The operation “took all of us a lot of work, a lot of sweating,” Wu told me. “Why? Because when you see bone and fat, or if you happen to see hair [in parts of the body where they shouldn’t be] you worry about a teratoma [a kind of tumor] that stem cells can form. We were all very worried – the question was, was this cancer surgery or cosmetic reconstruction?”

Luckily, it was the latter, Wu said, adding that his group supports the need for controlled studies and oversight by the U.S. Food and Drug Administration.

The FDA is trying to protect consumers against some untested cosmetic stem cell practices. Currently, the only FDA-approved stem cell-based products are blood-forming stem cells used for certain indications, such as bone marrow transplants in people with leukemia.

In the summer of 2010, the FDA requested an injunction in the U.S. District Court of the District of Columbia to stop a stem cell clinic called Regenerative Sciences from preparing its treatments. The company told me it has never performed any cosmetic procedures and only treats orthopedic conditions. The company was not involved in the case of the woman from L.A., according to Wu.

In July 2012, according to a report in the journal Nature, that court affirmed the right of the FDA to regulate therapies made from a patient’s own processed stem cells. The company argued that the cells it injects back are not significantly modified and that because of this, the procedures should be considered normal medical practice. The FDA argued that the cells are more than minimally manipulated.

Put differently, the court basically agreed with the FDA that the stem cells were manipulated enough that they should be considered drugs, and thus subject to pre-marketing approval. A blog post on Cell Therapy Blog saw things differently, believing that the court ruling was “just the beginning of what will be a long and interesting battle.”

Meanwhile, Regenerative Sciences is still in business. In Broomfield, CO, lead physician Christopher Centeno does a simplified stem cell orthopedic procedure at the Centeno-Schultz Clinic in which stem cells are harvested from bone marrow and re-injected into patients the same day; the company is also doing the more involved procedure with stem cell manipulation at its clinic in Grand Cayman.

More recently, the FDA has also been concerned about another stem cell company, Celltex in Houston. In a “warning letter” to the company in September, 2012, the FDA said that, following an inspection of the company’s plant in Sugarland, Texas, the agency found that the company’s processing of harvested adipose tissue did not meet the definition of “minimal manipulation” required and that the company’s promotion of its CellTex product causes the product to be considered a drug.

Not surprisingly, some consumer advocates are concerned. “The anti-aging market is where we see some of the strangest technologies and ingredients. Consumers are often surprised to learn how little oversight there is over cosmetic ingredients,” a spokesman for Environmental Working Group, a non-profit consumer watchdog group, told me.

The cosmetic stem cell industry is “huge,” though mostly outside the U.S., Stanford University cell biologist Christopher Scott, who also teaches ethics and law at the university’s Center for Biomedical Ethics, told me by phone this week. “Japan is a big practitioner, as are other Asian countries – China, India, and yes, also Europe. It’s a huge market.”

Scott noted that there are numerous legitimate studies underway exploring the potential of stem cells, but warned consumers against clinics that “overpromise” on their results and ones that, in pull-down menus on websites, offer stem cells for disparate conditions. “Cells are very different and the procedures are different. If a clinic offers a one size fits all fountain of youth, that’s a red flag.”

And don’t be fooled, he added, by clinics that tout testimonials from happy customers. “Testimonials are worthless as scientific evidence.”

Fixing the twin public health “epidemics” in this country — abuse of opioid painkillers by addicts and under-treatment of legitimate pain patients who often need those same drugs — will take time, a lot of creative thinking and a willingness to change dysfunctional government policies.

But there is one astonishingly simple step — a no-brainer, actually — that is immediately available and has been shown to reduce deaths from opioid overdoses. In fact, the city of Boston has already implemented this idea and is a model for the country. The utterly frustrating thing is that, so far, only 15 states and the District of Columbia have such programs — a far cry from what is needed.

The idea is what doctors call “harm reduction,” which means not necessarily trying to solve the root problem but to do things that make the problem less likely to be fatal.

The worst risk of opioid drugs (formerly called “narcotics”) is, obviously, fatal overdose. Opioids include heroin, oxycodone, methadone, fentanyl, codeine and morphine. Although reasonably safe when used properly, opioids do carry the risk of fatal overdose, whether used by a street addict or a pain patient.

The good news is that an antidote is available — injectable naloxone, which has been used in emergency rooms for years to reverse the potentially fatal breathing problems caused by an opioid overdose. It’s also available as a nasal spray called Narcan.

In both forms, naloxone rapidly knocks heroin and other opioids off opioid receptors. Naloxone brings about an instant, horrible withdrawal — but also saves the person’s life by restoring breathing. It has virtually no abuse potential and is considered very safe.

The chief flaw in the naloxone “rescue” idea is that, for the antidote to work, someone — conscious and functional — must be close by to administer the drug.

In Boston, deaths from overdoses among heroin abusers plunged after the city began distributing free Narcan kits to addicts in 2006, as the Boston Globe reported.

That success prompted the state Department of Public Health to run its own pilot program, which lists a number of places around the state where naloxone is available.

Nationwide, the Centers for Disease Control and Prevention reported in 2012 that community-based programs using naloxone have prevented the overdose deaths of 10,171 people since 1996. As of October 2010, there were at least 188 such programs operating in the U.S.

So encouraging are these results that the Food and Drug Administration is now considering ways to allow wider distribution of naloxone.

Few situations in medicine present such a clear take-home lesson: Naloxone could, and should, be made easily available to opioid abusers. It might also make sense for physicians who write opioid prescriptions for chronic pain patients to prescribe naloxone as well, with proper instructions for its use, so that patients could have an antidote on hand at home in case of overdose.

This might not prevent all opioid overdose deaths. But it would go a long way in the right direction.

A massive new study out today shows that around the world, people are living longer than they did 20 years ago, but there’s a catch: many of these extra years are spent in poor health — in some cases with conditions that might be preventable or treatable.

The collaborative project, published in a special issue of The Lancet and led by researchers at the University of Washington and a consortium including the Harvard School of Public Health and the Johns Hopkins Bloomberg School of Public Health, found that some of the old scourges of humankind — infectious disease and childhood illnesses — that were once the leading causes of death have decreased dramatically, even in many developing areas. Deaths among children under five used to be the biggest contributor to the world’s health burden; now it’s chronic diseases that cause severe pain, impair mobility or keep people from seeing, hearing and “thinking clearly,” as the university put it in a statement.

But as childhood deaths have decreased, there has been a troubling increase in deaths among young adults, those aged 15 to 49 – mainly because of violence and HIV/AIDS. And while malnutrition – including starvation – used to be the leading risk factor for death worldwide, now it’s the opposite that’s the big threat: poor diets and physical inactivity. In fact, dietary risk factors and physical inactivity now account for a whopping 10 percent of the world’s health burden, as excess weight and high blood sugar continue to soar.

As some health problems have lessened worldwide between the new study, called the Global Burden of Disease Study 2010 and its predecessor in 1990, others have soared, chief among them lower back pain and road accidents. The latest research, funded by the Bill and Melinda Gates Foundation, was a massive endeavor with 486 authors from 302 institutions and more than 30,000 survey participants in more than 100 countries. It resulted in seven scientific papers being published together.

In statistical terms, what’s happening is that although life expectancy from birth is still increasing all around the world, what might be called the “healthspan” is not keeping pace. In other words, we are living longer, but some of those “extra” years are years of pain, sickness, immobility, depression, anxiety and other forms of poor health.

Worldwide, life expectancy for men is now 67.5 and for women, 73.3, said Joshua Salomon, lead author of two of the seven studies and a professor of global health at the Harvard School of Public Health. Salomon spoke yesterday by telephone from England.

By contrast with life expectancy, his study found, “health expectancy” for men is only 58.3 years, and for women, 61.8. In other words, for the average man, who will live 67.5 years, the equivalent of 9.2 of the total years will be spent in poor health, counting both small and large losses of health, said Salomon. The average woman can expect the equivalent of 11.5 years of poor health.

“We can expect more years of good health, but also more years in poor health,” Salomon said. On average, the world as a whole loses more years of healthy life to various forms of chronic illness and disability today than 20 years ago. The best rates of health expectancy today, for both men and women, are in Japan, as they were 20 years ago as well.

Among the biggest chronic health issues are mental health problems and musculoskeletal problems, including pain and physical disability. Depression was not even viewed as a public health problem until the first global burden of disease study in 1990. The increasing burden of depression is troubling because mental health problems can often be helped with proper diagnosis and treatment.

Indeed, lower back pain, depression, iron-deficiency anemia and neck pain were the top four “sequelae,” or consequences of disease and injury, responsible for the greatest health loss in terms of the number of years lived with a disability.

From both an individual and a societal perspective, these worldwide shifts in health patterns raise major issues. Among the most important is that health care systems in many countries, including the US, are geared more toward acute than chronic care. We’ve gotten very good at handling life-threatening emergencies but much less good at helping people cope with the grinding burden of mental health problems, chronic pain and other forms of disability.

Salomon put it this way: “We have been more successful at finding ways to address things that are potentially fatal than things that cause chronic loss of health. One of our aims is that this study will raise awareness of this imbalance.”

Earlier this month, the American College of Obstetricians and Gynecologists, the country’s leading professional group for ob/gyn physicians, recommended that oral contraceptives — on the market for more than half a century now — finally be available over-the-counter.

It’s about time.

Even emergency contraception — better known as Plan B One Step — has been available over the counter since 2006 for women 18 and older, and subsequently, for women 17 and older.

Contraception, as everybody knows by now, was a hot button political issue this fall. (Haven’t we fought this fight already?) But perhaps, given the election results, the time is finally nigh to come to our collective senses and do as the ob/gyns recommend – make birth control pills available to women of any age, any time, at any pharmacy, no doctor visit or prescription needed.

Just because the ob/gyns have recommended over-the-counter availability of “the pill,” of course, does not mean that it will happen right away. A pharmaceutical company will have to take on the issue and go to the FDA for approval of an over-the-counter pill.

In the new recommendations, the ob/gyn physicians say that after reviewing numerous studies, they concluded that the benefits of making the pill more widely available vastly outweigh the risks. The benefits apply to women individually and to society as a whole.

Half of all U.S. pregnancies are still unintended and many of these lead to abortion. The best way to prevent abortion, obviously, is to prevent conception in the first place.

Admittedly, I do have a few concerns. One is that over-the-counter formulations could, depending on pharmaceutical pricing, be more expensive than the same drug bought with a prescription.

Dr. Kavila Nanda, a member of the committee that wrote the new recommendations, told me that “any plans to make oral contraceptives available over-the-counter need to address the cost issue because we are trying to remove barriers, not make it more expensive.” (Nobody knows yet what effect Obama’s Affordable Care Act will have on this question.)

Another concern — which is shared by the FDA — is that certain birth control pills (such as Yasmin and Yaz) that contain a hormone called drospirenone, similar to the natural body-made progesterone, may increase the risk of blood clots more than other oral contraceptives. The ob/gyn group, which has evaluated studies on the hormone, thinks the risk is “still very low,” Nanda said.

The solution, it seems to me, is to make oral contraceptives available to women of all ages, with lots of package inserts, posters and public education campaigns designed to help women decide if they are appropriate candidates for the pill. First and foremost, women should realize that, while oral contraceptives do protect against pregnancy, they do not protect at all against sexually transmitted diseases.

Women should also know that they should not take oral contraceptives without consulting a doctor if they are breastfeeding, if they are 35 or older and smoke, or if they have certain disorders like high blood pressure or diabetes. Women who have or have had breast cancer or who might currently be pregnant should also absolutely not take oral contraceptives.

So, let’s inform women and girls of these risks and hope that Big Pharma and the FDA will get on board. Soon. Before another generation of young women find themselves having to deal with unintended pregnancies.

One of the most vexing emotional and ethical issues in all of medicine is the decision by family members to “pull the plug,” that is, to take a severely ill, non-communicate relative off of the life-support systems keeping him or her alive.

What makes this decision so hard, of course, is, absent a really clear statement ahead of time from the patient about end-of-life wishes, family members basically have to guess. But there may be – not yet, but someday – a way to make this agonizing guesswork a bit easier, thanks to a stunning series of recent experiments by Adrian Owen, who holds the prestigious Canada Excellence Research Chair in cognitive neuroscience and neuroimaging at the University of Western Ontario.

The recent work by Owen, and others, using fMRI brain scanning technology shows that some patients diagnosed as being in a persistent vegetative state may actually have some degree of consciousness and be able to communicate, that is, by sheer thinking, be capable of answering comparatively simple questions such as “are you in pain?” (Obviously, that’s a much simpler question than “do you want to die?”)

The particular patient generating the latest excitement is 39-year old Scott Routley who, 12 years ago, had a car accident that left him with a severe brain injury. By standard tests, doctors thought he was in a persistent vegetative state, or PVS.

A quick primer here. There are various degrees of consciousness. In a coma, a patient looks asleep – the eyes are closed, the person doesn’t move and tests with an EEG (electroencephalograph) look much like the brain of someone under general anesthesia.
A persistent vegetative state is different. The patient’s eyes are open, he or she has regular sleeping and waking cycles and may actually look around, not really “at” anything, but with a so-called “roving gaze.” The person may even have REM, or dream, sleep stages. PVS is so confusing to onlookers – and doctors – that if a group of people watched a video of such a patient, half would say the patient was conscious and half would not. While a coma may last only briefly – as when someone gets whacked with a baseball bat – a vegetative state can last for years. If someone does recover from the vegetative state, at best he or she will be severely disabled.

In between PVS and severe disability is the so-called minimally conscious state (MCS). If you ask minimally conscious people to move a hand or look somewhere specific, they do so often enough that it’s clear they are responsive, while a PVS patient can never do that. (All these states, by the way, are different from “locked-in syndrome,” in which a person is fully conscious and cognitively intact but is unable to move except, in some cases, to blink their eyes to communicate.)

After his accident, Scott Routley couldn’t communicate and the usual tests showed no signs of awareness. Owen, who told me he has believed for 15 years that some PVS patients like Routley are “actually conscious but can’t show it.” Owen is now convinced that Routley is “definitely not” in a persistent vegetative state. (He has also documented Routley’s responsiveness with an EEG, a simpler technology than fMRI.)

Essentially, Owen trained Routley to answer questions through a kind of game. When he asked Routley to imagine himself playing tennis, a particular part of his brain, the premotor cortex, lit up on the fMRI brain scans “with a very big signal.” (The premotor cortex sends signals to the motor cortex, which actually signals muscles to move.) Routley learned that imagining to play tennis, thus lighting up this part of his brain, meant “yes.”

Owen then trained Routley to imagine himself walking through a familiar house from room to room. When Routley did this, a totally different part of his brain lit up, the parahippocampal gyrus, which helps people navigate through space. Routley learned that imagining this activity meant “no.” In a series of sessions, Routley was able to correctly answer questions like “Is the sky blue?” “Are bananas yellow?” convincing Owen that Routley could communicate “yes” and “no.” He then asked Routley if he was in pain, and Routley answered “no.” Routley was also able to show that he knew he was in a hospital, that he knew the year of his accident and knew what the current year was. “This guy is conscious, he just clinically appears vegetative,” Owen told me.

I think this is fabulous. And scary. It would be wonderful to know what an uncommunicative relative really wants. And terrible to depend too much on technology that, like the humans who invent it, might be wrong. And so far, none of this means that doctors should perform fMRIs on everyone with severe brain injuries, says Robert Truog, a professor of medical ethics, anesthesia and pediatrics at Harvard Medical School. But it could provide a way, Truog says, to ask some severely brain-damaged patients whether they value their life as it is “before we would make a decision to give comfort measures only.” I agree we should proceed, but with caution. More importantly, so does Owen. “I don’t think we should ask someone if he wants to live because we can’t do anything about it – there is no legal framework that supports euthanasia,” he said. But that legal framework may already be in the works.

But before he could say more, he had to get off the phone: The lawyers were calling.