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Monday, March 20, 1995 Dear Peter: I downloaded your message of yesterday, this containing the Nova Scotia Newsletter on Parkinson's Disease. I have forwarded it to my father-in-law, a retired physician (age 90) who is living in Hawaii and who has advanced PD (he is becoming refractory to the medications, but has opted to decline surgery). As you probably know, I am one of those "conservative types" who has been urging a note of caution regarding pallidotomy. My caution is based on the fact that I, in the sixties, was active in the era of stereotactic surgery for PD and other movements disorders, and saw how inadequate those operations were at that time. I think that there is good support for the "revival" of the research into ablative surgery (and that's what pallidotomy is, a destruction of "normal" cells and pathways in order to treat an "abnormal" condition); and I am interested in and respect the work being done at Emory University and by investigators such as Dr. Patrick Kelly at NYU. I am somewhat puzzled at your trying to relate those of us who are urging caution to financial considerations. I do not do this operation (I stopped in the late sixties); if I wanted to increase my income, it would not be too difficult to get my hospital to purchase some equipment for me and start doing pallidotomies (it is not a difficult operation as neurosurgery goes). At $30-40K a case, I could make a fine income just doing these cases; and, in many cases, these would be essentially cash payments, since many insurance companies consider the procedure "experimental" and patients would have to pay "out of pocket". I am content, however, to leave the pallidotomizing to those investigators who have the facilities and experience, and wait the time necessary to fully evaluate the possible benefits. I have had extensive correspondence with Dr. Kelly, and the most salient point of his messages to me is: "The true test of pallidotomy is whether we will still be doing them five years from now". I agree with his view, and what I object to in the current debate is the portrayal of this procedure as a "cure". Please do not denigrate the "scientific method". It has served us well over the years and there are good reasons to maintain a conservative approach. I do not know how old you are, Peter, but I remember, back in the fifties and early sixties, when we had the Thalidomide controversy. Thalidomide was a drug, developed in Britain and Europe, which was touted as a "cure" for the "morning sickness" of pregnancy, and was prescribed to many pregnant women (often in the first trimester when the nausea is often at its worst) on the other side of the Atlantic. The company which manufactured Thalidomide tried to have it approved in the United States, but the then-director of the Food and Drug Administration, a woman named Frances Kelsey, M. D., would not allow importation of the drug without careful evaluation by the "scientific method", this due to her concerns (which later proved correct) that the chemical structure of the drug was related to other substances which had been found to cause fetal defects. Many Americans, while on trips to Britain and Europe, brought back supplies of Thalidomide and took the drug; and when the fetal malformations developed (birth of babies without arms or legs), we had an amazing series of debates over abortion for these people (the well-publicized case of Sherri Finkbine of Arizona, who was denied an abortion here and finally got her abortion in Sweden). Thalidomide was finally withdrawn from the market even in Europe; but the courageous actions of Dr. Kelsey prevented an even larger tragedy in the United States. I do not object to a "review" of any "rules"; but before one changes a "time-tested" rule based on sound scientific principles, one must be very careful to "not throw the baby out with the bath-water". If you think that this note is appropriate for same, please feel free to publish my comments in your Newsletter, and, if you do, please send me a copy. 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" ********************************************************