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Welcome. The aim of this site is simple - to rail against the slow, but steady chipping away of traditonal American values by a host of groups & individuals bent on destroying them.

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Wednesday, March 30, 2005

Terri Schiavo - A Neurologist's Report

In September, 2002, a noted Neurologist spent a considerable amount of time examining Terri Schiavo. His conclusions leave enough doubt about the common wisdom of Terri's state that she should immediately have the feeding tube reinstated & a thorough investigation begin as to the condition of Terri & of possible physical injuries which may have caused her disability.
His report.

2 Comments:

Anonymous The Real Francis said...

"Hammesfahr Redux
My post about Dr. Hammesfahr below has provoked some questions via email. So, before I stop writing about him I thought I'd encapsulate more his story in a bullet-pointed post here. Some of this is in my previous post, but some is new.


Yes, Dr. Hammesfahr is an M.D., and he's a board certified neurologist.

No, he was not truly nominated for a Nobel Prize. At this writing, his claim of being Nobel Nominated is on his web page, meaning he is forwarding this misinformation himself.

He was disciplined by the Medical Board of Florida for charging for services he did not provide.

He has not published in legitimate peer-reviewed journals. Indeed, a 1999 St. Petersburg Times piece notes "His articles have been turned down by well-known medical journals," so it's not for lack of trying.

He is listed as one of the "Promoters of Questionable Methods" on Quackwatch.com, and an analysis of his treatments is posted there as well.

The only journal he's published in is one which is on a domain that's registered to his office (and for which the administrative contact phone number is his own office phone). He is on the editorial board, as is an employee of his and another Hammesfahr, likely a relative. The submission guidelines for this journal are laughable to anyone who has actually seen guidelines for a true medical or scientific journal.

The therapeutic regimen he has proposed has not been tested in any rigorous scientific manner; everything I've seen written about it is anecdotal.

He makes wild claims about his therapy being useful for a wide variety -- literally dozens -- of etiologically unrelated neurological and psychiatric disorders, without scientific validation.

He has not treated Teresa Schiavo: he examined her as one of five MDs which a Florida court asked to evaluate her. Two MDs were selected by Michael Schiavo, two (Hammesfahr, a neurologist, the other a radiologic/hyperbaric physician) by the Schindlers, and one neurologist was appointed by the court. All the neurologists except for Hammesfahr found her in a persistent vegetative state (the hyperbaric MD agreed with Hammesfahr that she wasn't). Here's what Theresa Schiavo's Guardian ad Litem (his report [PDF] is extremely worthwhile reading) wrote about the medical evidence of these five physicians (PDF File; pp. 16-17):

The scientific quality, value and relevance of the testimony varied. The two neurologists testifying for Michael Schiavo provided strong, academically based, and scientifically supported evidence that was reasonably deemed clear and convincing by the court. Of the two physicians testifying for the Schindlers, only one was a neurologist, the other was a radiologist/hyperbaric physician. The testimony of the Schindler’s physicians was substantially anecdotal, and was reasonably deemed to be not clear and convincing.

The fifth physician, chosen by the court because the two parties could not agree, presented scientifically grounded, academically based evidence that was reasonably deemed to be clear and convincing by the court.
Following exhaustive testimony and the viewing of video tapes, the trial court concluded that no substantial evidence had been presented to indicate any promising treatment that might improve Theresa’s cognition. The court sought to glean scientific, case, research-based foundations for the contentions of the Schindler’s physician experts, but received principally anecdotal information.


Evidence presented by Michael Schiavo’s two physicians and the fifth physician selected by the court was reasonably deemed clear and convincing in support of Theresa being in a persistent vegetative state with no hope for improvement.


On his webpage, Hammesfahr posts the following as an apparent selling point for his therapy:








In fact, this quote is taken from the disciplinary action (PDF of the record of that proceeding) that found Hammesfahr had not provided services for which a patient had paid. Another issue in the disciplinary action was whether Hammesfahr had actually engaged in false advertising by claiming his results were "peer-reviewed" and for saying he was the first to use this treatment to help patients. The paragraph from which Hammesfahr extracted the quote above is, in full:









The Judge essentially finds that, since Hammesfahr had run his so-called results by some friendly peers, he had actually had his results "peer-reviewed" in that narrow sense. And, since he was the first (and at the time, only) to use his therapies and some of his patients got better during the time he was treating them, the strict wording of his advertising was true.

It's hard to believe, but the guy is using that snippet, from a Judge in Florida which indicates that no other doctors are using his therapy, as a testament on his webpage. Amazing.

Also, the judge basically finds that his therapy is "alternative," which is protected under Florida law about alternative medicine. Thus we begin the slide to allowing doctors to use untested therapies.

Finally, to address a broader issue, many people seem to wonder why scientific evaluation should be necessary, if it seems that Dr. Hammesfahr is "helping people."


Since Dr. Hammesfahr resorts to anecdote, I'll illustrate the issues that arise with an anecdote. Let's say a patient was seen by Dr. Hammesfahr and given a treatment regimen to take home and have her physician implement. When this patient returned home, her doctor refused to administer the drugs Hammesfahr had indicated. She improved greatly anyway.

Would she likely have improved even more without paying for Hammesfahr's therapy? Would she have improved less, or the same amount? Would his therapies impede or improve her progress? These questions cannot be answered by a collection of anecdotes, no matter how high they mount. They must be assessed with rigorous, scientifically oriented, peer-reviewed studies.

Then, at least those who pay Dr. Hammesfahr money would know if they're throwing it away."

5:43 PM  
Anonymous More on Nut Doctor said...

Dr. Hammesfahr, Clown or Quack?
David Brock's Media Matters has written about some issues with William M. Hammesfahr, the MD who claims that Terry Schiavo's condition is "not that bad." He's also been disciplined by the Florida Board of Medicine. [It seems it's pretty hard to get disciplined in Florida, but that's pure hearsay. ] Hammesfahr was retained by Terry Schaivo's parents, the Schindlers, ito evaluate her in 2002. And here's a great post about his faux Nobel Prize "nomination."

Quackwatch.org keeps an eye out for questionable medical therapies. Lo and behold, they have a piece up, apparently from 2000, about Dr Hammesfahr's therapy. The analysis is not laudatory. It's also written by a Assistant Professor of Neurology at Yale University School of Medicine, no less.

It concludes: "The theoretical basis for Hammesfahr's vasodilation treatment for stroke clashes with current knowledge about stroke physiology. In fact, the prevailing current belief is that such treatments should worsen stroke outcome, not improve it. I believe that vasodilation treatment for stroke patients should be done only as part of an approved peer-reviewed protocol that includes informed consent about the treatment's experimental status and possible risks. Because of the potential risk, I doubt that an institutional review board would permit such a study unless animal studies can demonstrate that the treatment is safe and potentially useful."

Hammesfahr is listed on Quackwatch.org's Promoters of Questionable Methods page.

Also, look over Dr. Hammesfahr's own website. It's got a few things that remind one of quackery. One is that his treatment doesn't just work for one disorder, it works for many.


In 2000, this work resulted in approval for the first patent in history granted for the treatment of neurological diseases including coma, stroke, brain injury, cerebral palsy, hypoxic injuries and other neurovascular disorders with medications that restore blood flow to the brain. It was extended to treat successfully disabilities including ADD, ADHD, Dyslexia, Tourette's and Autism as well as behaviorally and emotionally disturbed children, seizures and severe migraines. [emphasis added]

It's a floor wax and a dessert topping for damaged brains!

Another hint of the questionable nature of his therapy is the section purportedly giving supporting evidence for success. His site has two pages of what he calls "reviewed results." One of these pages consists of five letters (written by three different individuals) touting his treatment. The first four letters have -- to say the least -- methodology that's difficult to divine.

Letters three (2 pages long, from 2001) and four (one page long, from 1999) on that page are written by a psychologist named Alexander T Gimon. These letters, despite their indecipherable methodology, claim to report results of Dr. Hammesfahr's treatment, tout his "successes" and claim he "discovered" that strokes could be treated with cardiac drugs. By coincidence, Alexander T Gimon appears as coauthor on a paper with Hammesfahr from 1996-7 at a purported peer-reviewed medical journal named L ifelines. (More about Lifelines below.)

The last letter on this page , relating a visit made to Hammesfahr's office, hardly even rises to the level of anecdotal. It's from a professor (a podiatrist and osteopath, not an M.D.) at Nova Southwestern University's Department of Family Medicine. Nova Southwestern doesn't offer a Doctor of Medicine degree. (Nova trains osteopaths, pharmacists, optometrists, allied health practitioners, dentists, and "biomedical scientists." The terminal degree at Nova's College of Medical Sciences is a Masters in Biomedical Science.)

Hammesfahr's "peer-reviewed" page consists of links to ten items he's submitted to a medical journal called Lifelines at Medforum.com. Lifelines doesn't appear to have a very rigorous review process, but I'd be interested in what others may know about the site. It also has a strange dating: for the Hammesfahr/Gimon paper I mentioned above, the copyright is 1996-7, but there is a note that it was revised in 2002. I'm not sure how a scientific journal can proceed when you can revise papers six years after they've been published with no indications of the changes.

Lifelines claims to be "one of the longest lived Peer Reviewed Medical Journals in existence." Huh? That comment is just bafflingly ludicrous, even as a flackish statement.

It appears that Lifelines is the only journal in which Dr. Hammesfahr has published. He has no writings indexed at the National Library of Medicine's PubMed, though others with his surname are listed there. However, he has been on Fox News.

-------

Update: A bit more on Lifelines, the dubious medical journal which is the only place Hammesfahr has published.

Dr. Hammesfahr is on the Editorial Board of Lifelines.

Another Hammesfahr, Dr. J.F. Hammesfahr, is also on the Editorial Board.

Alexander T. Gimon, the psychologist mentioned above who wrote the "evaluation" letters on Hammesfahr's web page and who coauthored a paper with Hammesfahr, is also on the Editorial Board.

Every member of the Editorial Board is from Florida (many from Tampa or St. Petersburg area), with the exception of J.F. Hammesfahr, who practices in the neighboring state of Georgia.

One member of the editorial board, Donald D. Adkins, an EEG Tech, lists on his C.V. that he is employed by William Hammesfahr.



And to go from the ridiculous to the abjectly hucksterish, the site that hosts Lifelines is medforum.com. Here's a screenshot of the registry information for this domain:


600 Druid Rd. E in Clearwater is also the office address listed in the c.v. of Dr. William Hammesfahr, M.D. The phone number and fax number listed for the adminstrative contact are those of Hammesfahr's office.

This looks like a vanity medical faux-journal that Dr. Hammesfahr is running out of his own office.

Finally, to get a whiff of the type of MD we're dealing with here, look at his Lifelines journal article titled To a new understanding of personnality,behavior and neurological disease [sic].

Yes, that title is howlingly grandiose, especially considering the mispelling. But look at the list of disorders he claims to treat with vasodilators. From the footnotes (we like how he calls it a "partial listing"):

What follows is a partial listing of diseases that have been successfully treated:
In the Psychiatric/Psychological arena:

Depression, Impulsive Rage Disturbances, Irritability, Emotional Lability, Psychosis, Autism, Attention Deficit Disorder and its variants, Memory Loss, Tourette's Syndrome, Transient Global Amnesia

In the Neurological/Physical arena:

Stroke, Grand Mal Epilepsy, Absence or Petit Mal Epilepsy, Psychomotor Epilepsy, Headache, Closed Head Injury, Post Concussion Syndrome, Vertigo, Ataxia, Tinnitis, Aphasia, Apraxias, Visual Loss, Visual Blurring, Blindness, Stuttering, Vasospasm after Sub-Arachnoid Hemmorhage, Vasospasm after Intracranial surgery not associated with trauma or Sub-Arachnoid Hemmorhage, disturbances of Word substitution and Word Finding, Dyslexia, Photophobia, Hyperaccusis, Tremor, Multiple Sclerosis, Multiple Sclerosis-Like Syndrome, Post Traumatic Stress Syndrome, Vertebrobasilar Insufficiency, Vertigo, Cerebral Palsey, Vertebrogenic Syndrome, Syncope, Multi-Infarct Dementia, "Alzheimer's" Syndrome, Whiplash Induced Headaches, Headaches in general, TMJ Headaches6 Steroid Induced Migraines, Steroid Induced Psychosis, Fibromyalgia, Prinz-Metal Angina, Neuro-cognitive changes associated with electrical and lightning injuries.


That's quite a list! And yet he can't get published in a medical journal that isn't connected with his own office.


When you see a list like that, coming from one MD and with no published research to back it up other than in his own so-called "journal," I offer a clue: don't believe it.


Here's a piece from the Saint Petersburg Times about Hammesfahr's controversial treatment. Note the abundance of anecdote and lack of scientific testing of his therapy.


The piece concludes:


Hammesfahr says he hasn't done the rigorous clinical studies because he's too busy treating patients and because he feels it would be unethical to withhold the treatment from some patients in order to study them.


But Novella said that is not a good enough reason.

"That is the absolute standard response of all snake oil salesmen - 'I'm too busy curing my patients to study my treatment,' " Novella said. "If his treatment does work, then it's still unethical because he's depriving all of the hundreds of thousands of patients that would benefit from it if we knew that it worked."


Nowadays, of course, rather than taking the time to test his therapies he's out grabbing facetime on cable news channels. It's possible that enhancing his name recognition could enhance his revenue, while actually scientifically testing his therapies could do who knows what.

5:46 PM  

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