Fetal Brain Development: Myths and Disinformation

In her discussion on the NYT article I blogged earlier, Jill of Feministe says:

An interesting thing about growing up and living in the United States for your entire life, as I have, is that you really do believe all the things that Americans say about America. You believe that the United States is one of the most progressive countries in the world. You believe that we're at the forefront of technology, of women's rights, of human rights. You believe that people here have access to the best and most comprehensive medical care and information.

Then you find out that you were sorta wrong. And that's a fantastic disappointment.

I can already here the conservatives saying, "But look at how good you have it! You could be living in Iran!" Sure, and women in Iran could be living in Afghanistan. See how lucky they are?

The insularity of the USA makes it easy for their leaders to tell they're world leaders in every field when that is simply not so - they're the richest, sure - that doesn't mean they provide their citizens with the best. And particularly what US citizens don't get the best of is sex education at the most crucial time - pre-teen and teen years. And the anti-choice/contra-contraception activists want it to stay that way, and they deceive people in order to carry out their agenda.

This is a good jumping off point for me on a particular piece of anti-choice misinformation that's been bugging me for a while. As in the quote below about the 43-day-old-fetus from the NYT article on Contra Contraception:

A December 2004 report on federally financed abstinence-only programs conducted by the office of Representative Henry Waxman, Democrat of California, charged that the major programs presented misleading information about health (one curriculum quoted in the report stated that "condoms fail to prevent H.I.V. approximately 31 percent of the time"), state beliefs as facts (the report cited a curriculum that refers to a 43-day-old fetus as a "thinking person") and give outmoded stereotypes of the sexes.

Another post I recently read on a website called ProgressiveU.org, posted by a purported high-school student CrystalJ, gives here reasons for believing abortion is wrong (fine, don't have one), where she also argues that science supports her view (misspellings hers, italics emphasis mine):

There are also many medical arguments against abortion.

One argument is the definiton of life and death. Death is looked at there being no heartbeat, but when you really think about it, once a child is formed in the womb, you will here thier heartbeat by 18 days old. You may say no death is described as when there is no brain waves. Babies have functioning brains at 40 days old. The unborn child also feels pain as early as 8 weeks old. The fetus also has a genetic patterns different from the mother and a set a fingerprints all to its self.

Now, having done a fair amount of university biology, I knew that this fetal-brain claim was entirely bogus, and I thought I could maybe add a nice little debunking of this factoid to my pseudoscience series. But Google showed my my plan was unnecessary, because Margaret Sykes (previously of about.com) has already written the article, and although it pains my hubris, she's done a much better job than I could have.

The assertion is made over and over again that "fetal brain activity" has been observed or "fetal brain waves" have been measured at 40, 43, or 45 days, or at 6 weeks after fertilization. You can find the claim in "pro-life" and sometimes even nonmedical pro-choice literature. Sometimes a reference is cited, but most often not. This false information has passed into the general understanding about fetal development and is simply stated as fact. It is however a factoid instead, which is the name for a statement repeated often enough that people accept it as truth, though it's not.

Sykes digs through the generations of pamphlets citing other pamphlets to find the original science on which the factoid is based, and comes up with a cite from a 1964 AMA convention speech transcript (not a research paper at all) published in the JAMA arguing for brain function rather than heart function to determine cessation of life, and a 1982 letter (not a peer-reviewed paper) published in the NEJM. As Sykes says, "no original research is being described here, which makes it dishonest and misleading to quote it as the source of a claim".

The quotes used by 'pro-lifers', when laid out in formal cite form, certainly do look impressive to anyone not in the habit or reading the original paper to evaluate a scientist's conclusions:

At only 40 days after fertilization electrical waves as measured by the EEG can be recorded from the baby's brain, indicating brain functioning^{47, 48.}

^{47. Hamlin, H. (1964), "Life or Death by EEG," Journal of the American Medical Association, October 12, 113.}

Brain function, as measured on the Electroencephalogram, "appears to be reliably present in the fetus at about eight weeks gestation," or six weeks after conception.

J. Goldenring, "Development of the Fetal Brain," New England Jour. of Med., Aug. 26, 1982, p. 564

Sykes dissects the misuse of these citations (both should strictly mention the status as convention proceedings/letters rather than research papers), showing that both of these opinion pieces incorrectly summarise science that is now either discredited or obsolete (and always refers to "electrical activity" rather than "brain waves"), then goes on to detail what medical science actually does show about the development of a functioning human brain:

When people, including physicians, talk about "brain waves" and "brain activity" they are referring to organized activity in the cortex. While no embryo or fetus has ever been found to have "brain waves," extensive EEG studies have been done on premature babies. A very good summary of their findings can be found in Pain and its effects in the human neonate and fetus," a review article (often cited by "pro-lifers" writing about fetal pain, but not about brain development) by K.J.S. Anand, a leading researcher on pain in newborns, and P.R. Hickey, published in NEJM:

"Functional maturity of the cerebral cortex is suggested by fetal and neonatal electroencephalographic patterns...First, intermittent electroencephalograpic bursts in both cerebral hemispheres are first seen at 20 weeks gestation; they become sustained at 22 weeks and bilaterally synchronous at 26 to 27 weeks."

The irony of citing Hamlin and Goldenring as anti-abortion apologetics is that both of them mentioned fetal brain activity casually and tangentially in any case - both opinion pieces were arguing for the wider acceptance of the EEG as the final arbiter of the death of the individual, as without a functioning brain the body is just a collection of tissue. Indeed, Sykes notes that this is the crux of the point the anti-abortionists are arguing in their promulgation of this factoid:

all authorities accept that the end of an individual's life is measured by the ending of his brain function (as measured by brain waves on the EEG), would it not be logical for them to at least agree that individual's life began with the onset of that same human brain function as measured by brain waves recorded on that same instrument? (in Willke's Abortion: Questions and Answers)

The trouble is that there is no scientific basis for the "functioning brain at 40 days" claim, no matter how often the factoid is repeated.

As a secondary matter, I note the mythologising process at work in the way the factoid has developed. The original overclaims by Hamlin and Goldenring drop the scientific exactitude of "electrical brain activity " for the more vernacular "brain function" and "electrical waves", and this allows some who read it and lack the proper knowledge of the widely varying types of electrical activity recorded by EEGs to make an unjustified leap, and thus the myth of early fetal "brainwaves" is born.

CrystalJ, the highschool student referenced above, cited Kerby Anderson's Arguments Against Abortion as the source of her claims. Anderson wrote:

Physicians now use a more rigorous criterion for death: brain wave activity. A flat EEG (electroencephalograph) is one of the most important criteria used to determine death. If the cessation of brain wave activity can define death, could the onset of brain wave activity define life? Individual brain waves are detected in the fetus in about 40-43 days. Using brain wave activity to define life would outlaw at least a majority of abortions.

Anderson provides no references for his fetal brain waves claim. Notice then how CrystalJ leaps from "individual brain waves" to "functioning brain" in her summary of the medical arguments.

ADDENDUM: Anderson's argument also totally misunderstands what a "flat EEG" is. A brain-dead person with a functioning heart/lungs/brainstem will still show electrical activity in the brain, but they won't show the particular "brainwaves" that are characteristic of the higher cortical functions of cognition. So the whole EEG isn't "flat", just the part of the EEG profile that shows a thinking person is using that brain tissue.

These people believe the factoid that has been passed down and grown ever more dramatic as it goes. They really do. They don't mean to tell falsehoods (at least most of them don't know any better), but that's what they're doing. If only they understood that a large number of pro-choicers also base their abortion beliefs on neurological maturity of the fetus, they just use actual facts to do it instead of factoids.

When the shapers of public policy and health education fall for such factoids as well, then you get the situation which so disappointed Jill when she first came up against the true facts: the richest country in the world does not provide "the best and most comprehensive medical care and information" to its citizens. Given the attitudes displayed by various politicians in Canberra regarding the RU486 debate, we need to be vigilant that our citizens are provided with the best standards of care and information as well.

UPDATE 19th May 2006: my sitemeter shows that this post has become the #1 entry page for people coming to the blog from a search engine, using variations on 'fetal brain waves', 'fetal brain development' and 'fetal brain 40 days'. Commentor "worldpeace and aspeedboat" over at Moment to Moment was moved to pedantry (a favorite hobby of mine own) over spelling fetal vs. foetal and fetus vs. foetus, so I'm going to add those more Commonwealth spellings here purely to widen the hits on search engines, as obviously people are looking for the information. Besides, I agree the 'oe' spelling looks more elegant.