Greetings, I received a long, thoughtful, informative letter from a neurologist in the U.S. trying to set the record straight concerning pallidotomy, neurologists, science, medicine and the prudent use of the written word. I do hope he posts it to the list for the benefit of all. The following, omitting his identity, is my reply which I hope will further clarify my position for those interested in our pallidotomy dramma as it unfolds: David & Aviva Devor, 8 Mevo Hamaavak, French Hill, Jerusalem 97877, Israel tel: 972-2-814941 fax: 972-2-823276 email: [log in to unmask] January 24, 1995 Dear Dr. Thank you for last night's fax dated Jan. 17. While I agree with much of what you say, I'm rather puzzled by why you would address all this to me. I am a layman and my openly stated purpose was to get the best help possible for my wife that is consistent with our idea of reasonable risk. As you rightly point out there are many issues I did not address. I passed along my informal, March 5 observations to the Parkinson's list so that others might glean some benefit from the impressions I gathered. I am pleased that you estimate the potential impact of my report as "widespread" but the modest feedback I've seen indicates to me that people have received my report with the prudence and common sense that one should apply to any information, scientific or not. And, as you yourself say in a different context, "let the buyer beware." Controlled experiments are essential to science. There can be no argument here. But when seeking help for a loved one, one has to take other considerations into account, including experience and intuition. Based on over one hundred conversations with those who have had at least one pallidotomy at the hands of Dr. Iacono, and based on other anecdotal information I have collected, my intuition tells me the following: 1. Given my wife's relatively young age and good general health, I guestimate the risk factor for even slight damage at the hands of Dr. Iacono at under 5%. 2. Someone who has done about 400 pallidotomies with such good results must have some edge as to skill, technique or knowledge (perhaps as yet undeclared), over the others. 3. Someone who dares to do simultaneous bilateral pallidotomies while no one else in the field does suggests to me that there is genuine confidence at work here based on experience that I am in no position to evaluate except for the results which appear to be excellent. I have further reason to have confidence in this man that I have yet to meet. My wife has been treated by the top neurologists in this country who, in my view and in the view of my wife, have treated her rather like a cypher and have failed to go beyond the conventional in her treatment. In fact, they have left almost all short-term drug modulation up to her (which makes sense since she's closest to the situation). But not until we came into contact with Dr. Iacono's office last September did my wife get significant relief from her severe off's and dyskenesia. It may not be their job, nevertheless one of the doctors on Dr. Iacono's team, on his own initiative, suggested tips and medication that have effectively eliminated almost all of Aviva's off's and most of her dyskenesia. When we told our local neurologists about this in the hope that they might pass these tips along to their patients, the neurologists didn't want to hear about it. So much for compassion. Concerning referral for pallidotomy you wrote, "contrary to your article, it is not an issue of personality of the physician or scientist." Well, I have discovered that the experience of patients contradicts this, as does mine. Personality, ego and self-interest play a much larger part in medical judgment than any of us care to believe. Most abuses in science and medcine are simply beyond our ability to scrutinize. When you consider that Aviva has received more neurological help free of charge over the telephone from Loma Linda than in ten years of expensive treatment locally, it makes you think. Again, I am considering only the results which in this case are observable and incontestable. Official credentials aside, it seems obvious to me that Dr. Iacono is the leader in the field today. I will frankly be much surprised if the results of the Atlanta and Toronto teams come even close to those of Dr. Iacono's. That there will be reams of data describing what was done will be small consolation to patients who might have got better results at less cost and with fewer hours on the operating table at Loma Linda. Since you went to the trouble of writing me and succeeded in eliciting this response, I think I shall post my response to the Parkinson's list without mentioning your name. If you would like me to include your name and address, please let me know right away. You are of course free to post your letter to the list as well. I do not have a scanner, otherwise I'd have offered to do it for you. Sincerely, David S. Devor