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February 24, 1995 Listmembers: With the flurry of responses to the Wall Street Journal article on pallidotomy, I think that some are losing sight of what my original "objection" was concerning this issue. I do *not* object to the research, development, and performance of pallidotomy or any other new procedure for the treatment of Parkinson's Disease or any other serious and disabling condition. People like Dr. Kelly in New York are carrying out vital research and their work should be supported. The methods for carrying out clinical research (on human beings) are well-established and have been used for many years. Many of the great advances in medicine have come from this kind of work. Such work is done mainly in University centers or other large institutions where not only are there groups of qualified clinical investigators, but there are groups and committees which oversee the use of human patients in such research. The research, when some conclusions are reached, is then submitted to "refereed" journals, where other similarly-trained and educated scientists review the procedures and results, and only if such work has been performed within accepted standards, will the articles be published. Dr. Laitinen's work on pallidotomy has been published in the medical literature, as has the work of others (and I am including the work of the group at Loma Linda, although I am not totally familiar with "The American Surgeon", the journal that was cited as the one where Dr. Iacono's work was recently published and which I have read as well. I am not sure that "The American Surgeon" is a fully-refereed scientific journal such as the "Journal of Neurosurgery" which is one of the major scientific publications in our field). What I have objected to in this issue has been the *methods* used by some individuals in "promoting" pallidotomy in general, and the procedure as done at a specific institution in particular. It is, to me, "testimonializing" to call pallidotomy a "cure" for Parkinson's Disease, this when the current literature suggests that this is *not the case*. A "palliative" operation (makes the patient better for a while) it may be; but the long-term effect of the surgery, even as done today, is far from certain. I believe that people have a right to spend their own money for a procedure that may help them (provided that they understand and accept the risks); but I just cannot accept the fact that some people are "advertising" a procedure which is still going through a period of scientific investigation, and touting it as a "cure". Finally, it is my opinion that the most *serious* issue involved in this situation is the issue of David Devor's "impromptu" poll (the word was originally used by one of the "advertisers"). I believe that it is improper for anyone to have given Mr. Devor a "list" of patients who have had the pallidotomy procedure and allow Mr. Devor, a layperson, to call them to ask for their opinions, this unless those patients had expressly agreed to have their names placed on a list available to the general public. I do not fault Mr. Devor for "taking his poll"; he is acting out of love and concern for his wife; I would have probably done the same. It is the act of providing this "list" that I feel has violated a basic canon in medicine, that of confidentiality and privacy; and this, to me, is the most upsetting thing which I have observed in this issue. Let us hope that Aviva Devor (David's wife) will have a good operation in Loma Linda; my hopes and prayers are certainly with her; but let us remain cautious and not be too quick to give up the basic "rules" of clinical research and patient privacy, rules which have allowed medicine to develop to the place where it currently is. Best wishes, Bob -- ******************************************************** Robert A. Fink, M. D., F.A.C.S. Phone: 510-849-2555 Neurological Surgery FAX: 510-849-2557 2500 Milvia Street Suite 222 Berkeley, California 94704-2636 USA E-Mail: [log in to unmask] CompuServe: 72303,3442 America Online: BobFink "Ex Tristitia Virtus" ********************************************************