-----Original Message-----
From: Robert A. Fink, M. D. [mailto:[log in to unmask]]
Sent: Monday, June 25, 2007 10:07 AM
To: [log in to unmask]
Subject: Obituary for Dr. Iacono

Bernie,

The following Obituary appeared in our local paper today.  You might wish
to forward this to the Parkinson List:

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Dr. Robert Iacono -- promoted radical form of Parkinson's surgery

Thomas H. Maugh II, Los Angeles Times

Monday, June 25, 2007

Dr. Robert Iacono, the troubled neurosurgeon who was one of the first
practitioners of a radical form of surgery for Parkinson's disease but whose

impetuous reputation derailed his career, died June 16 in a plane crash. He
was 55.

Dr. Iacono was flying alone from Los Angeles to Mississippi in a twin-engine

Beechcraft 58 Baron to visit family when the plane crashed into the western
face of the Sandia Mountains in New Mexico.

Rescue efforts began after satellites picked up a signal from the plane's
emergency transmitter. The body was recovered last Monday.

Dr. Iacono made a national reputation for himself during the 1990s while he
was at Loma Linda University Medical Center, near San Bernardino,
performing a controversial surgical procedure called a pallidotomy on
patients with Parkinson's, which is characterized by tremor and rigidity in
the
limbs and a loss of muscle control.

Pallidotomies involve destruction of a small part of the globus pallidus, a
region of the brain involved in the control of movement. Destroying part of
the pallidus restores balance in that part of the brain, and Dr. Iacono was
one
of its early promoters.

In the surgery, a probe is inserted into the brain while the patient is
awake so
that speech and other functions can be monitored. When the probe is
positioned correctly, a radio frequency current is passed through it,
producing
heat that destroys nearby tissue.

The effects are almost immediately apparent and include a dramatic reduction

in tremors and rigidity and a decreased need for levodopa, the drug most
commonly used to treat the disorder.

Dr. Iacono performed hundreds of the operations during the 1990s. In a 1995
report in the journal Neurosurgery on his initial 126 patients, he claimed
an
85 percent success rate in improving the patients' mobility and a surgical
complication rate of only 6.3 percent.

Critics, however, were brutal. Dr. Roy A.E. Bakay of Emory University said
at the time that "Dr. Iacono and his colleagues have undoubtedly
overestimated their surgical success and underestimated their surgical
complication rate."

In a Wall Street Journal article, Dr. Robert Feldman, a neurologist at
Boston
University, said that he "wouldn't refer patients to Iacono. I don't think
he is
thinking critically. He's thinking surgically."

The American Parkinson Disease Association, the largest patient group in the

country, also refused to refer patients to him on the advice of its medical
board, although the group did not explicitly say why.

Many of his patients praised him effusively for the benefits they received
from the surgery. But Dr. Iacono and Loma Linda also had to defend several
malpractice suits resulting from operations gone awry.

By the end of the decade, most neurosurgeons had switched to an alternative
procedure called deep-brain stimulation, in which the destruction of tissue
is
not necessary. Electrodes are permanently implanted in the brain, and
passing
a small current through them produces the same benefits as pallidotomies,
but
without the risk.

Meanwhile, his career began to deteriorate.

In 1992, he was accused of using sexually inappropriate language and
touching a female staff member.

In 1994, he was accused of using drugs not approved by the Food and Drug
Administration.

On at least two separate occasions, he was accused of verbal or physical
abuse of staff, and in 1999, the hospital suspended him for 20 days and
ordered him to complete anger management therapy.

After two subsequent charges of abuse, the hospital's executive committee
began making plans to terminate his privileges. He voluntarily resigned
before his privileges were revoked.

Two months later, he applied for privileges at Desert Regional Medical
Center in Palm Springs, but he marked "no" on a box asking if he had ever
been in trouble at any other hospital.

As a result, he faced a formal accusation of wrongdoing by the California
Medical Board and surrendered his license to practice medicine, effective
Sept. 19, 2005.

His license also was suspended in Arizona and North Carolina as a result of
the California action.

Before his license was suspended, he had established a private practice in
Loma Linda (San Bernardino County), where he treated brain tumors and
continued to perform pallidotomies, ultimately performing more than 2,000 of

the procedures, which he argued were beneficial for patients. At the time of

his death, he had written a book called "Reversing Parkinson's Stress and
Aging," which is expected to be published soon.

Robert Paul Iacono was born April 7, 1952, and raised in Los Angeles
County on the Palos Verdes Peninsula, where he graduated high school. He
received his undergraduate and medical degrees from the University of
Southern California and performed his residency in neurosurgery at the Duke
University Medical Center.

He was chief of neurosurgery at the Veterans Affairs Hospital in Tucson,
Ariz., from 1984 to 1990, then joined Loma Linda.

http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/06/25/BAG3EQL3H91.DTL

This article appeared on page B - 5 of the San Francisco Chronicle


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Hope is going well with you.

Best,

Bob

**********************************************
Robert A. Fink, M. D., F.A.C.S., P. C.
2500 Milvia Street  Suite 222
Berkeley, California  94704-2636
Telephone:  510-849-2555   FAX:  510-849-2557
WWW:  http://www.rafink.com/

mailto:[log in to unmask]

"Ex Tristitia Virtus"

*********************************************

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