I to want to thank Dr. Kelly for his responce to the N. y. times article
the fallowing is a reprint of that responce again thanks.
*--* 03-17-95 - 04:44:07 *--*
7
Message 7:
From <@UBVM.CC.BUFFALO.EDU:[log in to unmask]> Thu Mar 16 18:19:00 1
995
Date: Thu, 16 Mar 1995 21:06:00 EST
Reply-To: "Parkinson's Disease - Information Exchange Network"
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Sender: "Parkinson's Disease - Information Exchange Network"
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From: "P.J. Kelly" <[log in to unmask]>
Subject: Re: New York Times Article 3/16/95
Comments: To: [log in to unmask]
To: Multiple recipients of list PARKINSN <[log in to unmask]
LO.EDU>
To Listmembers:
Friends:
Ordinarily I would not get into a debate over inaccuracies published in a
newspaper. After all, it happens all of the time. However, the coverage of
Pallidotomy in the recent New York Times article (3/16/95) was so distorted
and unfair that it is unconscionable that I feel that I should comment even
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though it may seem self-serving since I do Pallidotomies within a carefully
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controlled research effort at New York University Medical Center. Please be
assured that I could stop doing pallidotomies tomarrow (they comprise less
than 10 percent of my practice) and would have plenty of work-brain tumors,
thalamotomies and other general neurosurgical procedures. I have no real
vested interest in the procedure except that I feel that it's a good operation
in selected patients with Parkinson's disease.
However, this reporter has done a major disservice to the community of people
suffering from Parkinson's disease in a vicious attempt to slander a member of
the medical community who has done much more good than harm. In the process she
has destroyed hope for many who wish for a better life but are now scared out
of their wits of having a surgery which could help them. She has created
needless anxiety in those who plan on having the operation.
First, some of the points raised in the article are true but incomplete. All
surgery (including pallidotomy) has risks. In addition a good result cannot be
expected in each and every individual. This is true for any surgical procedure
one can name. Dr. Iaconno has done over 500 pallidotomies and as in any
surgical series a certain percentage of patients may be worse off
(complications). It seems as if the New York Times has found a few of
them-that's not surprising in a large series such as his. Had they wanted to do
a marginally adequate job of reporting they would have found many more
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individuals who had benefitted from the procedure than had been hurt by it.
There is no doubt about the fact that every patient who undergoes any medical
procedure; surgery, getting intravenous contrast for a diagnostic test or even
filling a prescription for medication assumes a risk. Obviously, the doctor and
the patient hope for the desired benefit; but there is no way to predict if a
patient will have an adverse effect (if there were, we wouldn't do it). All of
us are human (even if some of us have an MD after our name) and none of would
consciously do harm to another human being. Nonetheless, as a neurosurgeon, I
freely admit that some of the people that I've operated upon are worse off
after my procedures. If I had only known prior to surgery that this person or
that would suffer a complication in my hands, I wouldn't have touched them.
But every surgery has a benefit to risk ratio; with thalamotomy in Parkinson's
disease there is a 90% chance that we'll stop tremor-a 4.8 percent chance that
the patient will have some side effect or complication. With Pallidotomy-a very
similar procedure- the benefit is harder to measure (tremor is either there or
it isn't; pronouncement of improvement in rigidity and bradykinesia relies on
the subjective impressions of the patient and examiner). Nevertheless, with
pallidotomy the benefit appears to be about 80% and the risk of complications
with a carefully done proceure about 5%. For example if Dr Iaconno performed
500 pallidotomies, there would be about 25 people who are worse off by some
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complication or other, but 400 people who derived benefit and now think he's a
great guy - even though the New York Times in a feeble effort to sell
newspapers finds it in their interest not to agree.
What about the effects of the procedure not lasting? Some patients have had
only short term benefit to pallidotomy. What the NYT article didn't say is that
many of Laitinen's patients were found to have derived long term benefit.
Please understand this. Parkinson's disease is a progressive disease whose
course is unaltered by treatment. The best a physician can do is to create
plateaus in the patient's disability by palliating the symptoms causing that
disability. All initially effective therapy (L-DOPA, Sinamet, thalamotomy,
pallidotomy) results in "temporary" improvement. But temporary can be months or
many years until the disease catches up again. As I'm sure all of you
know-Parkinson's disease progresses faster in some people than in others.
Now with the above as background, I hope that the members of the list will
indulge me as I take this silly "reporter" and her article apart: (My comments
will be in CAPS, those following the >represent the original text of the
article)
