I read with interest your coverage of Ron Houben (report, 25 November), the Belgian student wrongly diagnosed as being in a persistent vegetative state (PVS) for 23 years before being correctly identified as a sufferer of "locked-in syndrome".
The tragic tale is by no means unique. As a consultant on the assessment of "locked-in" patients for the Royal Hospital for Neuro-disability (RHN), an independent medical charity with specialist teams highly trained in caring for such sufferers, I have worked with many patients misdiagnosed as being in a permanent vegetative state, one for as long as eight years, who have subsequently been found to be fully conscious and aware of their surroundings.
In 1996, the RHN made a study, featured in the British Medical Journal, to see how many patients, on average, were being misdiagnosed with PVS. Astonishingly, we discovered that 43 per cent of patients assessed had been wrongly diagnosed as being in a PVS, with serious implications for their care, including the removal of life-support.
A second study in 2003 found little had changed. This is because most of the techniques used to assess consciousness in vegetative state patients are outdated and inaccurate. Writing off a patient after such minimal investigation is like diagnosing a broken leg without taking an X-ray.
The RHN has consistently stressed the need for such patients to be comprehensively assessed using state-of-the-art brain-scanning technology and sophisticated detection methods such as the Sensory Modality Assessment and Rehabilitation Technique, or Smart. This works by training specialist assessors to search rigorously for any signs of consciousness by testing each patient's responses to stimulating all five senses as well as their wakefulness and motor skills. Crucially, these tests are conducted over, say, a couple of weeks, providing a clearer picture of the patient's awareness and ability to communicate.
Unfortunately, our patients make up only a small minority of those being treated for severe brain injuries across the UK. Worryingly, many of them may even be forced to endure listening to their carers and clinicians discuss their care, unable to participate themselves. Such tragedies will continue until regular and rigorous assessments of coma patients become the rule and not the exception.
Royal Hospital for Neurodisability, London SW15
Supreme Court backs the banks
Your leading article about the Supreme Court ruling on bank charges (26 November) reinforces the sloppy thinking that is at the heart of the problem. You use the word "borrowing" to describe overdrawing an account without permission.
A similar term is used by tearaways who, having wrapped a stolen car around a lamp-post, tell the arresting officer, "I was only borrowing it, guv." You say customers were "required to pay overdraft charges that bore no relation to the scale of their borrowing". Substitute "theft" or "taking without permission" for "borrowing", then try to justify your stance.
The Supreme Court ruling on bank charges showed a lack of understanding of the broader issues and the need to build public confidence.
The banking industry should not be able, essentially, to fine customers. It is equally unreasonable that many of these fines are applied after the bank allows spending that breaches an overdraft. In the 21st century, there is the technology to avoid that.
Would it be impolite to ask how reasonable were the charges for the £62bn overdraft run up by RBS and HBOS?
Floods herald worse to come
The catastrophic events in Cumbria may have led people to think more seriously about climate change.
We are already observing severe climate-related problems, drought and wild fires, severe storms and flooding, and this with only the tiny rise in temperature so far. This should be giving us insight into the serious problems that are inevitable because a further rise of two degrees cannot be avoided.
It is also cause for concern that the reason for recurrent upgrading of the rate of warming may be due to positive feedback having already commenced. Reports suggest that methane is being released from permafrost areas, and the carbon dioxide uptake by seas and rainforests is diminishing. Heat reflection must be diminishing due to loss of polar ice-fields.
Is it time for us all to press the countries involved in the climate-change conference to give due emphasis to this issue, which dwarfs the banking crisis in its likely consequences?
Dr E F Doherty
It is not true that the storm of 19 November gave the highest recorded daily rainfall in Britain (report, 20 November). It is likely that the highest fall in 24 hours was on 11 June 1682 when about 580mm was recorded at Oxford.
The next highest fall was 355mm in an oil-drum by the Hardy Monument, near Dorchester on 18 July 1955 during the Martinstown storm, which was accompanied by catches in standard raingauges of 343mm at Goldcombe Farm and 305mm at Winterbourne Steepleton.
Therefore your reported fall of 314mm has been exceeded in Britain at least three times before. This finding excludes the Cheviot Hills storm of July 1893, when about 320mm was caught in a bucket whose exact depth cannot be determined due to a lack of knowledge of the bucket's dimensions.
Dr Colin Clark
Charldon Hill Research station, Bruton, Somerset
Europe's nations will outlast the EU
Dominic Lawson's light-hearted comments on the theme that "Wogs begin at Calais" (24 November) are but another way of not mentioning the issue everyone wants to avoid.
A bedrock principle of the EU, which differentiates it from a free-trade area, is the free movement of peoples. Not being able to control who can reside in the UK is a fundamental abridgement of sovereignty. When the Spanish government recently granted an amnesty to hundreds of thousands of its illegal immigrants, every one of them acquired the right to reside in the UK.
The irony is that the British, wishing the EU to remain a mere "free-trade area", led the wideners to victory over Old Europe's deepeners. Our three mainstream political parties, in accordance with Washington's globalisation agenda, favour an ever-expanding EU to encompass not just Turkey and Ukraine but Georgia as well, with all that this implies for immigration into western Europe.
Ideologically-driven globalisation and national sovereignty make poor bedfellows. Just as nationalism was the undoing of the Soviet Union, so it will prove for our globalists, whose first loyalty is to Brussels and Washington.
Winterborne Houghton, Dorset
Perhaps understandably, the preponderant reaction to the outcome of the EU presidency election is that of relief that the post will not be held by Tony Blair (letters, 23 November). As a manifestation of our rejection of subservience to the USA, it is a positive reaction.
More importantly, let's hope David Cameron and Co will see the light and reject antediluvian views of reactionary Czechs. To compete on equal terms with China, India, USA, Japan, or Russia, we must secure political and economic synergies of the union of European nations. As Winston Churchill observed in 1948: "It is said with truth that this involves some sacrifice, or merger of national sovereignty. But it is also possible to regard it as the gradual assumption by all nations concerned of that larger sovereignty which can alone protect their diverse and distinctive customs and characters and their national traditions."
It is true that in 1948 Churchill would regard British Empire as a viable entity in itself. But the "wind of change" observed by Macmillan in 1960, makes it obvious where Britain's future lies.
Spurious argument from Conservatives
Again a Conservative spokes-person, in this case Caroline Spelman (You ask the questions, 23 November), uses spurious arguments to justify the first-past-the-post electoral system. She ignores the well-researched Jenkins report and trots out the old canard that PR would destroy the link between the constituents and their MPs. Not so. Jenkins suggests the AV-plus system, in which constituency MPs are elected by AV and there is a top-up to ensure some proportionality.
As far as having fewer MPs (without changing the electoral system) is concerned, it is clear that David Cameron and Eric Pickles believe the Conservative Party is disadvantaged by the present constituency boundaries. That is the real reason Mr Pickles wants fewer MPs: let us not pretend that it is simply to try to save money.
Mr Pickles wants the changes to happen very quickly, without a referendum or proper consultation. Such a change would embed the Conservative party as the "party of England"; their minimal Westminster representation from Scotland and Wales would not matter then.
Isn't it ironic that Conservative representation in Edinburgh depends significantly on the PR system used in Scotland? In my area of Sheffield, the Conservatives poll about 14 per cent in the city in local elections and yet have no city councillors.
Professor R J Moffett
Demand to know Menezes payout
In reaching agreement with the family of the murdered Brazilian (report, 23 November), the Metropolitan Police considers that in view of their "physical and mental distress... caused by these events... it is in the best interests of the family that no further statement... will be made". So we are to be left to speculate how much public money is being spent in seeking to buy the silence of a grieving family who have, throughout this terrible affair, been treated in appalling fashion by the Met and by our political leaders.
The Met may wish to believe it is in the interests of the family that there is silence about how much blood-money it is spending. I have my doubts. But it is my money the Met is spending and I demand to know how much.
I hope it is not the measly £100,000 suggested. It would need to be many multiples of that if it were even to begin to reflect the acute embarrassment which I, and many others, feel about this event, and the shame it brought upon us as a nation.
As a soft-bodied pedestrian I value the sanctuary of the pavement (letters, 25 November). I feel my space violated if a cyclist mounts the pavement and rides along it, usually at speed, and without warning of his or her presence. The absence of a bell, or even a shout, comes from the guilt of knowing they should not be there. Pavement cyclists should be relentlessly pursued and prosecuted.
On the right track
Victoria Summerley (Comment, 19 November) is correct, for other reasons. Toilets in railway carriages deposit sewage on the track and have been shown to spread disease, but are cheap to service. Toilets in aircraft are technically complex and expensive for the airline, therefore excellent toilet facilities exist at airports. Free, high-quality toilets on stations would minimise a public health hazard as well as providing comfort for passengers.
Cllr Colin Barrow's letter (10 November) talks of the number and cost to council taxpayers of the estimated 24,000 "hidden" immigrants in our midst. I live in the City of Westminster, no doubt alongside a good proportion of them. I also note, as a Band E council taxpayer and resident, the poor quality of council services and general neglect of this particular locality by Cllr Barrow's consistently unobtainable staff. I wonder if these two observations are by any chance related?
Liz McParlin should not have been surprised by the national newspaper reporter querying whether she had spelt her own name correctly (letters, 25 November). When I worked in Fleet Street, a colleague took a call, didn't put his hand over the phone and said to me, suspiciously, "Some bloke for you. Claims he's your brother". My brother was not amused.
Eastbourne, East Sussex
The correspondence following Judi Martin's letter (11 November) has been entertaining. My surname has had some interesting twists over the years. The most recent was last week when I answered the phone to a woman asking, "Am I speaking to Mrs Bollock?" I replied, "No", and hung up.
Bourne End, Buckinghamshire