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With the budgetary constraints hospitals (teaching and otherwise) are encountering, perhaps some medical teams are being forced to market their procedure to a wider audience. Pallidotomy is rapidly becoming a "hot commodity" and hospitals are always searching for ways to fill their beds with more "paying" customers. If I was starting-up, learning a new technique, I think that Dr. Water's patients who have had excellent care and diagnosis would make me look better and make my selection process easier. As a patient, I would feel better to receive the blessing and referral from my doctor who has confidence in the work done by the neurosurgical team that he/she knows, firsthand. Informed Consent is of no solace to those who receive no benefit or are hurt by the procedure. Ethics in healthcare were turned upside down when insurance companies started second guessing our doctor's professional opinion, just to save profits. I can symphatize with Dr. Water's feelings upon hearing that her patients were being contacted by some out of area team. Some of the Loma Linda patients in my state haven't been followed-up in over a year. That includes sucesses as well as failures. The idea of doing the procedure on anyone and everyone and then in a few years when you have done a significant number, looking them up to do a study is unthinkable. I am afraid that this is becoming the rule rather than the exception. Really, ethics is something each group needs to work out. Proselytizing could be a hot topic in the Ethics seminar at the AAN convention next month. John Cottingham [log in to unmask]