The enormous debt that medical science owes to the sick and injured

by Marc Wilson / 25 February, 2019
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Behaviour regulator: the prefrontal cortex, in red. Image/Getty Images

Behind the scientific advances of many Nobel Prize-winners, there is an unsung group whose names we often don’t know.

We know the names of people who pushed the boundaries of physical sciences: Isaac Newton, Marie Curie, Albert Einstein … And the life sciences: Gregor Mendel, James Watson, Francis Crick, Alexander Fleming …

But there is an unsung group whose names we often don’t know, who don’t receive Nobel prizes – the people who inspired, informed and were guinea pigs for the advances some scientists are associated with. In medicine, think Henrietta Lacks, whose cells have played a major part in our understanding of cancer.

In neuroscience, there are some classic case studies, including Henry Molaison and Phineas Gage. Molaison, long referred to in scientific papers as “HM” until his death in 2008, was the subject of more than 50 years of study following surgery to remediate severe epilepsy. The surgery had the side effect of anterograde amnesia – the inability to create new memories.

Gage experienced serious injury to the front of his brain and reportedly (but perhaps incorrectly) went from being an affable and mild character to an angry and violent man. We can guess from this that the part of his brain that was damaged is associated with aggression in some way.

These people allow us, in their tribulations, to learn things that aren’t otherwise easily learnt. We can’t mimic the kind of brain lesions that Molaison experienced, or deliberately damage a bunch of prefrontal cortices just to see if people become more aggressive or quick to anger as in the case of Gage.

A contemporary example is the Vietnam Head Injury Study (VHIS), which has followed a tragically large group of American veterans of the Vietnam War who suffered traumatic brain injuries during their service.

It started as a database of more than 2000 veterans and by comparing them with each other (depending on the nature of their injuries) and healthy controls, researchers could test theories that weren’t otherwise easily testable.

Henry Molaison. Photo/Supplied

In 1996, Jordan Grafman and colleagues published an analysis of 279 VHIS veterans and 57 control participants that showed veterans who had experienced trauma to the prefrontal cortex of the brain did tend to report more verbal violence and aggression than controls or veterans who’d experienced trauma to different brain regions.

The take-home here is not that veterans are more violent, or that some veterans are violent, but rather that the prefrontal cortex helps regulate behaviour and predict the probable outcome of actions.

My own interaction with the VHIS and Grafman, professor of physical medicine and rehabilitation at Chicago’s Northwestern University Feinberg School of Medicine, is a little more left field. Along with University of Auckland religious studies professor Joseph Bulbulia, I pulled together a survey of religious and mystical experiences and beliefs that was then administered to the VHIS veterans. We found that veterans with damage to the frontal and temporal (just above your ears) brain regions reported more mystical experiences.

It’s vital to remember that these are people, and not just ”case studies”, but the VHIS and the database that grew from it have informed our understanding of head injuries and how to treat them.

An article in the New Yorker reported that information from the survey about the common locations of head wounds helped in the redesign of combat helmets.

So here’s to the unsung heroes whose misfortunes have made the lives of others better. And mind your heads.

This article was first published in the February 2, 2019 issue of the New Zealand Listener.

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