 |
 |
Dr. Romero: Thanks for your input. I had some of the same questions as Raj and your email helped to clarify some points for me. As I see the landscape based on my research, it is very difficult to hear a truly objective point of view. For some I guess, it is publish or perish. And there is that motive to please the pursestrings and research has to be funded by someone. So we are left to separate the wheat from the chaff. But, as you point out, this was a consensus statement of 28 neurologists. This doesnt mean that all 28 agreed 100% but it does bias it towards the wheat for me. The second article seems a little less weighty in my view. The authors quickly summarize in tables why piribedil is the best agonist. Have you read it? Can you throw any light on this paper? Again thanks, Bob ----- Original Message ----- From: "Jorge Romero MD" <[log in to unmask]> To: <[log in to unmask]> Sent: Tuesday, September 24, 2002 5:58 PM Subject: Re: Medscape articles/Levodopa Controversy > Dear Raj: > > You raise many important points in your communication. I think you will > find that perspectives different from the ones you have tacitly accepted as > truth regarding many of your points are presented in the article in > Medscape. I recommend that you read it before discounting it by looking at > only one side of the polemic. > > Novartis does market COMTAN (entacapone), the use of which depends on the > use of levodopa/carbidopa at the same time, since COMTAN by itself is not > effective in Parkinson's Disease. COMTAN extends the duration of each > levodopa/carbidopa dose. > > Orion Pharma has plans to market a combination tablet - levodopa/carbidopa > combined in one tablet with entacapone - see press release at > http://www.alertnet.org/thenews/newsdesk/L23516614 > > Entacapone was developed by Orion, and is marketed in the US by Novartis as > COMTAN. > > <<<QUOTE>>>Orion Pharma has a marketing agreement for the combination tablet > with Novartis, which will pay a milestone payment of $3 million to Orion > Pharma based on the EU filing of the new drug application, Orion said. > <<<END QUOTE>>>> > > In order to successfully market both COMTAN and the new combination tablet > later in 2003/2004, both of these companies benefit by promoting the safety > and efficacy of levodopa/carbidopa, in much the same way that the agonist > manufacturers have benefitted from raising doubts about the putative > toxicity of levodopa, and making unsubstantiated claims of "neuroprotection" > by the agonists. Both sides are interested in marketing and promotion of > their products, motivated by profits and market share. But what else is > new? > > The task of the careful clinician and scientist is to separate the wheat > from the chaff. > > The authors of the Medscape article are C. Warren Olanow, MD, and Yves Agid, > MD, who are both well known and recognized researchers in Parkinson's > Disease at an international level. (There is a list of the panel members at > the end of the article) The report represents the consensus of: > > <<<QUOTE>>>This meeting involved a panel of 28 neurologists and > neuroscientists, including world-renowned experts in the pathophysiology and > clinical treatment of PD. Evidence from tissue culture studies, rodent and > primate models of PD, and clinical studies were discussed to reach a > consensus on how these findings should influence the use of levodopa in the > clinical management of PD.<<<<END QUOTE>>>> > > Remember also that the articles promoting the use of the agonists before > levodopa are in large part, or in whole, also subsidized by the drug > manufacturers and marketers. > > Which camp is right? The levodopa promoters or the agonist promoters? > > In my opinion, the Medscape article seems reasonably well-balanced - it very > cautiously states: > > <<<QUOTE>>>The decision of when and how to prescribe levodopa should be > based only on considerations of efficacy, the potential of the drug to > induce side effects, and the individual patient's response to therapy. > <<<END QUOTE>>> > > > I believe that the article is well-written, and presents a very nice > overview of PD and its treatment with levodopa. It does not address the use > of agonists at all. The issues are not black or white, but there are many > shades of gray in between. > > I would recommend reading it before condemning it. > > Jorge Romero, MD > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: mailto:[log in to unmask] > In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn