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Hi Charles: I do invite you to read the article in the New England Journal. It claims to compare the effects of early treatment with ropinorole against early treatment with levodopa. The study design is flawed fatally, in my opinion. I do not know how the NEJM reviewers let it pass. The "standard" way of treating Parkinson's has been to begin with levodopa and then, as levodopa has decreasing efficacy and/or increasing side effects, to add an agonist. The NEJM article compares: 1) Ropinorole first, supplemented with levodopa 2) Levodopa first, supplemented with more levodopa. Of course, the second group ended up with a higher dose of levodopa and more dyskinesias. Why the investigators omitted the "standard" group from the comparison is unexplainable. This would have been a group in which one would use levodopa first, and then supplement with agonist. The interpretation that the occurrence of fewer dyskinesias in group 1 has to do with a beneficial effect of early ropinorole or a toxic effect of early levodopa is not proven scientifically unless you also have group 3: 3) Levodopa first, supplemented with agonist. So long as that group is missing, the same data can be explained by observing that the average dose of levodopa in group 2 was greater than in group 1 - i.e. a dose dependent effect of levodopa - NOT a protective effect of early ropinorole. Indeed the study was paid and supported by Smith-Kline. In the same issue of the New England Journal there is a powerful editorial by Marcia Angell (editor of the NEJM) and a special article on Health Policy that addresses the issue of drug company influence on research, publications, and academic efforts, that will be very sobering. Not even the NEJM is protected from those influences. Jorge ----- Original Message ----- From: "Charles T. Meyer, M.D." <[log in to unmask]> To: "Jorge A Romero, MD" <[log in to unmask]>; <[log in to unmask]> Sent: Saturday, June 03, 2000 2:36 PM Subject: Re: Re: questions for Charles Murray > Jorge and Charles and Jim, > > I have not read the primary article but if the NEJM holds here to their > usual high standards of review it is more than market research that is > operative here. While I would not put it beyond the ethics of a drug > company to slant data I highly doubt that they put one over on the NEJM > editorial staff. but it is possible. I would like to review the article if > someone has it in an easily transmissible form. The citation is as follows: > > A five-year study of the incidence of dyskinesia in patients with early > Parkinson's disease who were treated with ropinirole or levodopa > O Rascol, DJ Brooks, AD Korczyn, PP De Deyn, CE Clarke, AE Lang, for the > 056 Study Group > NEJM 2000;342:1484-91 > > Early use of ropinirole alone or in combination with levodopa reduces the > incidence of dyskinesia in patients with Parkinson's disease, according to > this double-blind study. The data in this study were originally presented > at the XIIIth International Congress on Parkinson's Disease, July 24-28, > 1999, Vancouver, Canada, as reported by E-MOVE in > http://www.wemove.org/ema/em_pd_01.html. > > > ----- Original Message ----- > From: "Jorge A Romero, MD" <[log in to unmask]> > To: <[log in to unmask]> > Sent: Sunday, June 04, 2000 8:20 AM > Subject: Re: questions for Charles Murray > > > > To Charles Murray and Benjamin Winter: > > > > To the statement that "Research suggested starting with Sinemet was unwise > > if an > > agonist would work," I would only comment that > > > > it is important to ask what kind of research. > > > > If you are talking about MARKET research, then it is certainly unwise to > > start with levodopa if you own stock in any one of the companies that make > > the agonists. > > > > Remember that the data used to promote the agonists is being pitted > against > > 30 years of good experience with levodopa. There is not a single drug > used > > to treat Parkinson's that has the safety and efficacy record that levodopa > > has when used correctly. > > > > Jorge Romero, MD > > > > > > ----- Original Message ----- > > From: "Benjamin Winter" <[log in to unmask]> > > To: <[log in to unmask]> > > Sent: Friday, June 02, 2000 10:26 PM > > Subject: questions for Charles Murray > > > > > > > Charles, > > > > > > You wrote: > > > "Research suggested starting with Sinemet was unwise if an > > > agonist would work ... and studies seem to be showing that > > > this is a wise way to start treatment in mild cases." > > > > > > I would appreciate some leads to the research, some > > > references to the studies, that you are referring to. > > > > > > Thanks in advance. > > > > > > Ben Winter 66/66/64 > > > Not on any meds yet - the great weather in Victoria BC is > > > enough to keep me going (for now). > > > > >