Układ równowagi - Nowe odkrycia w dziedzinie otoneurologiii
Prof. Nakiela J.: Vertigo. The vestibulo-cerebellar system according to the latest investigations and interpretation of the author
Jerzy Nakiela M.D., Ph.D.
Tomaszów Maz. 1992.02.10

Appeal to the Central Commission for Scientific Degrees and Titles

 

I kindly inform that at the beginning of January 1992 I received a letter from the Central Commission for Scientific Degrees and Titles in which I was informed that the above mentioned Committee refused to confirm the resolution of the Medical Faculty Council of the Military Medical Academy in Lodz of 20 November 1990. The above decision is caused by the results of the ballotage, I suppose, based on the opinion which I also received together with the covering letter. After reading this opinion I guessed without any difficulty that its author was Prof. Grzegorz Janczewski, M.D., Ph. D., the Head of the Otolaryngological Clinic of the Medical Academy in Warsaw. In my opinion it is not a scientific opinion but a cunningly constructed letter containing blatant distortions and falsehood in order to explicitly convince the members of the commission that all my scientific achievements should be rejected. And apparently the Professor succeeded in that in 100%. The style of his review and his statements has been well-known to me for many years and on this circumstance I possess extensive documentation on that. Because the decision of the Committee is a great surprise to me and also it is highly inexplicable, I decided to gain closer information at the office of the Committee. I was seen by the Director of the Committee Office, Mr Henryk Halemba, MSc., Engr. At first I showed him the reviews of my earlier papers issued by Prof. G. Janczewski. Then he revealed that the opinion which I received had also been written by Prof. G. Janczewski, who presented this opinion personally to the members of the Central Commission. After my question why the commission based their the opinion on one Superreviewer's review, He replied that there had already been another earlier opinion. I was surprised and puzzled because I knew nothing about that and I was not informed about this fact in the letter which was sent to me. I asked for enabling me to see this opinion. It turned out that the opinion is positive. The author of the opinion is Prof. Bolesław Semczuk M.D., Ph.D., the Head of the Otolaryngological Clinic in Lublin. I asked then whether that opinion would be sent with the documents to WAM. The reply was it would. My next question was why the Committee, having three good opinions of the reviewers of my thesis, a good voting result of the Medical Faculty Council and a good opinion by the Superreviewer, did not adopt the resolution of Medical Faculty Council of WAM from 20 November 1990. Mr Halemba informed me that he did not know exactly and that he had no knowledge on that because is not a medical doctor. I was not shown the voting protocol, I was only informed that 6 persons voted for the adoption of the resolution, 5 were against and 12 abstained from voting. I was not shown any justification of this decision, either. I acknowledged that those activities did not have anything to do with science. With reference to the remark included in the opinion by Prof. Semczuk regarding the location of lesions found during neurosurgeries (the tumor of the hemisphere or the midline of the cerebellum) I wish to explain that I examined only those ill persons who were after operations of tumors of the cerebellar hemispheres. From the neurosurgical perspective it was referred to by Prof. A. Radek, saying in his review: - quotation:" The group of ill persons consists of mainly ill persons with removed hemisphere tumors of the cerebellum among which in 42 cases, as shown by the histopathologic research, they were astrocytomas, in 5 cases - hemangioblastoma (angioblastomas), in 4 cases - cysts of the cerebellum, so they were tumors destroying directly the cerebellar hemispheres. The remaining 7 tumors - 5 neurilemmomas and 2 meningiomas, damaged the cerebellar hemispheres through indirect compression."  Before I take a stance on the opinion written by Prof. G. Janczewski, I will take the liberty of saying several sentences about earlier my encounters and experiences with Prof. G. Janczewski. I met Prof. Janczewski for the first time at the otolaryngological congress in Lodz in 1983. After presenting my paper entitled: "The value of the rotation test according to Arslan in persons with peripheral injuries of the vestibular organ", I expressed an opinion included in one of the conclusions to this paper that the use of the rotation test according to Arslan for assessment of the efficiency of the equilibrium as the only test often leads to gross diagnostic and certification errors. I included this conclusion, among other things, because both the foreign and the Polish literature (including also the literature from the Otolaryngological Clinic of Medical Academy in Warsaw) often overestimated kinetic tests both in the otoneurologic diagnostics and in certification. Ii ts known that in the conditions of produced habituation, on the side of the really damaged labyrinth we can obtain a greater nystagmus reaction in the rotation test. It is not by chance, as I suppose, that these observations are are mentioned by the neurosurgeon Prof. A. Radek in the review of my thesis, expressing his opinion on the diagnostics of tumors of the cerebellopontine angle: quotation: "On the other hand, it is known that the tumor detected in the otologic period, whose most permanent symptoms are unilateral deafness or also considerable hearing impairment, cancellation or impairment of the reactions of the labyrinth to thermal and rotary stimulation, can be removed completely with the use of the microsurgical technology with impunity for the patient. It must be stressed that otologic symptoms are often misleading and their atypism is frequently found, e.g. the lack of hearing disturbances, the correct excitability of the vestibule, the impairment on the side opposite to the tumor or the bilateral impairment". This expression - the impairment on the  side opposite to the tumor - is connected with habituation. I explain these phenomena for the first time from their basics in my habilitation lecture. I remember that after my delivering the above paper a fierce discussion with Prof. Janczewski took place. At the same time at the congress I presented the film entitled "Research into the equilibrium system". For the first time I presented my dynamic test in a film. After the film I received stormy applause from the participants of the congress, however, in the lobby I noticed that Prof. Janczewski was very dissatisfied. Once again an exchange of views with Prof. Janczewski occurred during the Congress of Military Laryngologists in the Military Aerospace Medical Institute (WIML) in Warsaw in 1984. I presented then my paper entitled "The value of pendular stimulations performed on the swivel chair in persons with peripheral injuries of the vestibular organ". While discussing the paper I expressed the following thought - quotation: "The pendulum chair test itself is not enough for the complex assessment of the vestibular organ. Such assessment can be performed when comparing the results of the pendulum chair test with the results of the Hallpike thermal test and with vestibulo-cerebellospinal tests". My trouble started when I began to publish papers under the aegis of my Electronystagmografic Laboratory in Tomaszów Mazowiecki, signed with my name. Here is the lot of some of my papers whose reviewer was Prof. G. Janczewski. The paper entitled: "The usefulness of the Fitzgerald-Hallpike bi-thermal caloric test for the assessment of vestibular reactions in persons after removal of tumors of the cerebellar hemispheres", was sent to the journal "Medical Problems". In his review Prof. Janczewski used such wording as: "the paper should be rejected, the paper does not include any original scientific results, the paper is not unambitious, do not lower standards, etc. I was depressed and almost gave up my scientific research. The paper really presents a large scientific value. In the foreign and Polish literature there were no such studies, based on such rich material. After translating it into Russian, without any corrections, I sent the paper to the editorial office of the journal "Wiestnik Otorinołaringołogii". The editorial office accepted the paper without any provisions and I enclosed a copy of this publication in the list of 10 papers which were sent to the Central Commission. Certainly Prof. Janczewski watched this paper with interest. And here are the titles of the remaining papers which I sent to the editorial office of "Polish Otolaryngology", and whose reviewer was also Prof. Janczewski.

1.  The comparative assessment of reactions obtained with the Fitzgerald-Hallpike bi-thermal caloric test and with the Torok monothermal test in healthy people.

2. The horizontal optokinetic nystagmus in injuries of the cerebellar hemispheres.

3. The value of the Torok caloric test in the diagnostics of injuries of the cerebellar hemispheres.

4. The analysis of reactions obtained in the pendulum chair test in ill persons with injuries of the cerebellar hemispheres.

None of my papers was assessed positively by Prof. Janczewski. There was nothing else for me to do but undertake a matter-of-fact discussion over the remarks in the reviews. Finally all the papers were accepted for printing. The last paper, after a negative review written by Prof. G. Janczewski, was sent to another reviewer, where it earned a good opinion. I must mention that in one of the presented papers I introduced into the Polish literature the Torok monothermal differential test, which is widely used in the USA and in western countries. In Poland I had not encountered any case study with the use of this test. I presented its technique and the rule of interpretation of its results. My reward for that were such words included at the end of the opinion - quotation: "To sum up, the paper in presented form is not suitable for publication. A reader who is less oriented in otoneurology can only become confused, while those who  deal with clinical otoneurology on an everyday basis can be only discouraged by this paper from the caloric test according to Torok". I am not going to comment these words. Numerous remarks in the reviews were groundless, which I showed in letters sent to the Chief Editor of "Polish Otolaryngology". I must admit that it is difficult for me to take a stance on such a concocted opinion by Prof. Janczewski. The opinion begins with accusations against the reviewers of my paper. Please notice how the last sentence in this fragment of the opinion was formulated - quotation: In their assessments of the  habilitation thesis the reviewers were quite tentative in pointing out rather essential  shortcomings of the thesis, and especially its assumptions, the methodology and the interpretations of the results yet they reached a conclusion that the high degree of difficulty of resolution put forward by the author, who, practically speaking, did not have skills and tools for resolving it, justifies their conclusion to honor the candidate's efforts and  trouble by conferring a degree of habilitated doctor of medical science on him".

These are sheer lies. I cannot imagine a review in which the reviewer reproaches the assumptions of the paper, the methodology of the performance, the interpretation of the results and finally puts forward a motion for allowing the candidate to further stages of the habilitation procedure. What does it mean - "did not have skills and tools to resolve it"? What "skills and tools" are meant here is not specified by the Professor? It is an interesting statement. I can reply in short that I performed all the tests which were vital for solving the scientific problem of the highest weight. So, I also performed those tests which in Poland were not performed. I do not expect mercy from reviewers. I only require honesty. I think that every reviewer writes his/her opinion based on his/her knowledge and conscience, I think that other factors should not occur. Knowledge, which, as we know, does not mean the greatest knowledge, without resorting to malice. The Professor may have meant the electronically controlled chair for kinetic tests, computers, etc. I have worked also based on such equipment, but these tests, as I published earlier, have a limited diagnostic value. In my habilitation thesis I used kinetic stimulation with the pendular course. In scientific articles from famous labyrinthologic laboratories, case studies based on kinetic tests are seldom encountered at present. The basic vestibular tests are caloric tests. I am delighted that at least one stage of my scientific way was evaluated positively by the Professor, i.e. the course of my habilitation colloquium. Yet I am enormously worried by the fact that Prof. G. Janczewski does not mention anything about my habilitation lecture. And I remember well (I have the video recording of it) that this was a separate part after which the Faculty Board voted in a secret ballot. Therefore, the Medical Faculty Council of WAM conferred the degree of habilitated doctor in medical science on me based on my scientific achievements, my habilitation colloquium and my habilitation lecture. 

Also, there is no mention of my habilitation lecture in the opinion written by Prof. B. Semczuk. I do not know what I should think about it. Was the lecture removed deliberately from the documents sent to the Central Commission? In the presented lecture entitled "The vestibulo-cerebellar system according to the latest research and interpretations of the author" I reveal new findings concerning the foundations of the physiology of the labyrinth and the cerebellar hemispheres. I introduce the rules of formation of the vestibulo-cerebello-ophthalmic reaction and vestibulo-cerebellospinal reaction after using kinetic and caloric stimuli. I also explain the rules of co-operation of the  horizontal canals with the cerebellar hemispheres. Further I explain such phenomena as habituation, compensation, adaptation - i.e., those mechanisms which, as it were, are permanently mounted into the functioning of the equilibrium system. By the time these foundations of otoneurology had not been known. Without this ABC it was possible to correctly read and interpret the complex equilibrium system. Please forgive me if it should sound immodest, but in my opinion this is one of the greatest scientific discoveries in the field of otoneurology, the branch of science which has already lasted for almost 150 years.                              

 

Ironically enough, in such circumstances the Central Commission refuses to confirm the resolution of the Medical Faculty Council of WAM.

So far nobody has denied the reliability of this discovery though I presented these issues to a group of professionals (the lecture at the session of the Lodz Otolaryngological Company and at the Congress of Military Laryngologists in Duszniki Zdrój). I work out individual otoneurological problems comprehensively and send them gradually for publication. I prove that certain theories and established laws are false today (e.g. LeDoux's theory binding in explaining the rules of stimulating the horizontal canals in kinetic and caloric tests; Ewald's second law). And here is a response for Prof. G. Janczewski concerning those pathetic skills and tools. Nobody has made such a discovery in famous and computerized laboratories in the richest countries in the world, but in the modest Electronystagmografic  Laboratory in Tomaszów Mazowiecki, Poland, where the state and different government departments have not spent a zloty on this research. And how should we understand the words written by the Professor that my thesis did not contribute to the scientific development of the pathology of the equilibrium organ? These attempts of writing opinions in the false light seem ridiculous. My habilitation thesis, as the Professor wants to see it, as a matter of fact does not concern only the assessment of spontaneous vestibulo-cerebellospinal reflexes in persons with injuries of the cerebellar hemispheres. Irrespective of this assessment there were also assessments of oculomotor reflexes and vestibulo-cerebello-ophthalmic reflexes, using a whole range of tests for it. The Professor was able to cunningly deceive the members of the Central Commission, who do not have knowledge on those difficult problems. Yet, as can be seen, a lie has a short life. Next, the Professor writes a lot about the statokinesiometric test. It does not have anything to do with the assessment of my thesis. I have been well-aware of these problems for many years now. But if the Professor thinks that drawing a stabilogram by means of a computer has a greater value than well performed and read reflexes in the Unterberger test and in my own dynamic test, he is seriously mistaken. I have already made a thorough study of the vestibulo-cerebellar system and nonetheless I do not see greater advantages in using the posturograph for the otoneurologic diagnostics. The last fragments of the opinion are also completely false if the Professor claims that - quotation:"The habilitation thesis by Dr. Jerzy Nakiela is in fact a recapitulation both of his doctoral thesis as and most of his publications, which were devoted to issues of otoneurology (...)". In this situation I can suppose that the Professor had not read my doctoral habilitation thesis. In conclusion I only want to underline that these 24 paper (or contribution papers as proposed by Prof. G. Janczewski) in otoneurology which I published, was exactly as many as it was necessary to write in order to recognize thoroughly and penetratingy oculomotor reflexes, vestibulo-cerebello-ophthalmic reflexes and vestibulo-cerebellospinal reflexes in ill persons with peripheral injuries of the vestibular organ and in ill persons with injuries of the cerebellar hemispheres. This knowledge was simply not available neither in scientific articles nor in textbooks of otoneurology or physiology. And this knowledge which I had gathered finally allowed me to make this scientific discovery. Here is the final reply for Prof. G. Janczewski: the direction of my research was correct, so the assumptions of the thesis, the methodology of performance and the interpretation of the results were also correct. I have always thought that was the labyrinth was the key to recognizing the role of the cerebellum in the equilibrium system. I have solved the problems which I set myself many years ago. It has taken me 18 years. What is this in comparison with 150 years of the development of this discipline and thousands of doctorates and habilitations which were written and an innumerable quantity of conferences, congresses and symposia devoted to these issues? And still I want to strongly stress that if, at the beginning, there had not been my dynamic test and recognition of vestibulo-cerebellospinal reflexes in this test, there would not have been those discoveries. I do not know which way would have been used to discover the foundations of the physiology of the labyrinth and the cerebellum and how many years this would have taken. Prof. Janczewski tried to put into the mouths of the reviewers of my thesis words which they never said. They say something completely different, for example the words sais by Prof. A. Radek in conclusion to his opinion - quotation: "I would like to emphasize that both the entirety of Dr. Nakiela's scientific achievements, his consistent aspiration to solving the problem and his habilitation thesis, resulting from it, show Dr. Nakiela as a mature clinician and an explorer who, in my judgement, provides an original and precious contribution to clinical otoneurology as well as neurophysiology." 

In order for science to develop correctly, apart from suitable authors, there must be suitable reviewers. It is necessary to allow people to deveop themselves in every conditions (not only clinical ones) and nobody is allowed to kill the freedom of thinking. We know what kind of scientific achievements there are in countries with totalitarian systems and what in democratic free countries. Every scientist has his/her own ideas and it is necessary to enable him or her him to fulfill them. I will do everything so that the truth will win, I do not agree to putting the splendid scientists, following their conscience, I mean my Reviewers and my Superreviewer and the Professors of Medical Faculty Council of my Alma Mater, to suffering as a result of false judgements and assessments. Therefore, I kindly ask to investigate the legitimacy of the refusal to confirm by the Central Commission for Scientific Degrees and Titles the resolution of the Medical Faculty Councils of the Military Medical Academy (WAM) in Lodz of 20 November 1990 on conferring the scientific degree of habilitated doctor of medical science on me. What seemed impossible to me became possible. What happened in the Central Commission does not have anything in common with the assessment of scientific papers. It looks that voting depends on the light in which the superreviewer presents his/her opinion about the scientific achievements and findings of a candidate. And here one can determine secretly that bad is good, or good is bad. Answers to certain questions which I was asked during the habilitation colloquium included ideas resulting from my latest findings, never having been expressed anywhere before. Assessing positively the course of the habilitation colloquium I think that Prof. G. Janczewski agrees with those statements. From the history of scientific discoveries we know that creators of new scientific achievements were furiously attacked by the so-called acknowledged scientific authorities. It might be normal. Therefore, in order to solve this situation in which I found myself, I would suggest the Chairman of the Central Commission holding a public discussion with the participation of Prof. G. Janczewski and me. For me it is a vital matter to which I devoted so much effort and time. I kindly ask you for explanation why the Central Commission, having at their command three good reviews, a very good vote of the Medical Faculty Council of the Military Medical Academy (WAM), new scientific achievements in this field presented in the habilitation lecture and a good opinion by the Superreviewer Prof. B. Semczuk did not confirm the resolution of the Medical Faculty Council of WAM. My further question is what conditions must be fulfilled so that the Central Commission will confirm the scientific degree which I was conferred. I would be grateful if you could consider my request to my advantage.

 

Yours faithfully

Jerzy Nakiela (signature)

 

NOTE:

I have not received any reply to the presented appeal to the Central Commission.

What else would one expect in the Third Republic of Poland from this highly democratic institution (Central Commission) which originates from the Stalinist times?

If I had not paid a visit to the Central Commission in person I would have never found out that within the statutory time-limit the Central Commission had received the positive opinion by the Superreviewer Prof. Bolesław Semczuk, M.D., Ph.D., the Head of the Otolaryngological Clinic in Lublin. This opinion was hidden deep in a drawer. Prof. Janczewski did not take a risk of public discussion which I asked the Chairman of the Central Commission.

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