Here is Bob Martone's excellent article from the PAN web pages
which, because I wanted to e-mail it to it someone, I converted from
web page to straight ASCII text and then re-margined:
MAJOR RETURN ON INVESTMENT
IN RESEARCH IN PARKINSON'S DISEASE AND RELATED NEUROSCIENCE
PARKINSON'S DISEASE: A chronic, progressive neurodegenerative
disorder killing brain cells that produce dopamine (a neurochemical
controlling motor function). When 80% of the dopamine-generating
cells have died, slowness of movement, stiffness and tremor appear.
The drug L-dopa eliminates some symptoms for a limited period but
does not slow cell degeneration process. Approximately one million
Americans are currently afflicted. The average age of symptom onset
is 57; 30% diagnosed under age 50. Approximately three million more
have at-risk, pre-symptomatic dopamine cell loss.
CURRENT COST BURDEN: According to Dr. Ole Isacson of Harvard,
Parkinson's is estimated to cost America an estimated $25 billion
per year. The costs are spread among afflicted families, health and
disability benefit providers, SSI, SSDI, Medicare and Medicaid.
L-dopa and related drugs run $1,000-$6,000/year per patient. Ongoing
care required includes neurologist visits, various physical therapies
and often treatment for depression. Typical early-stage annual
medical cost per patient: $2,000-$7,000; advanced cases higher.
Treatment and hospitalization for Parkinson's-caused falls can run
$40,000 or more. (According to Dr. William Koller of the University
of Kansas, an estimated 38% fall, 13% more than once a week.)
According to Dr. Roger Kurlan of the University of Rochester, 31% of
those employed will lose employment within a year. Disability income
subsidies can run $30,000 or more. As the disease progresses,
substantial disability (inability to maintain balance, walk, speak,
move) requires assisted living and nursing home care. That can exceed
$100,000 per patient.
CURRENT SCIENTIFIC POTENTIAL: Several preventive and restorative
strategies such as neural growth factors, gene therapy techniques
and surgical therapies show promise in animal studies or human
clinical trials. Important links to the cause (including genetic
susceptibility and role of toxic agents) are becoming established.
Leading scientists describe Parkinson's as the neurological disorder
most likely to produce a break-through therapy and/or cure within
this decade.
STAGNANT CURRENT NIH INVESTMENT IN PARKINSON'S RESEARCH: $26
million per year; no increase since 1989. 10%-14% of NIH-approved
projects are funded at 1995 funding levels.
RETURN EXPECTED FROM INVESTMENT IN PARKINSON'S RESEARCH:
According to Dr. Isacson of Harvard, an additional $20-40 million
per year spent to fund 100 of the most effective preclinical and
basic research programs (@ $200,000-$400,000 each) will produce new
treatments within 2-3 years, an effective therapy or cure within 5
years. According to Dr. Kurlan of the University of Rochester, even
a 10% slowing of progression will save $327 million per year.
PARKINSON'S DISEASE
WHAT IT IS
------WHAT IT COSTS
------------- WHAT ACTION IS NEEDED
THE DISEASE
In Parkinson's disease or Parkinsonism (PD), cells that produce the
neurochemical dopamine inexplicably degenerate, causing tremor,
muscle stiffness and loss of motor function. Although medication
masks some symptoms for a limited period, generally four to eight
years in most victims, they begin causing dose-limiting side-effects.
Eventually the medications lose their effectiveness, leaving the
victim unable to move, swallow or speak.
PD is the biological opposite of Alzheimer's: While Alzheimer's
destroys the mind, leaving the body intact and functioning,
Parkinson's destroys the body's ability to function, taking away the
physical abilities necessary to daily life and leaving the mind
prisoner inside it.
Although the cause is still uncertain, environmental toxins are a
prime suspect. In the June 1993 Neurology, for example, researchers
concluded that the "relative contribution of environmental agents" to
young-onset Parkinson's "appears to be fairly large," and that their
findings "add to the increasing weight of evidence that relates PD
risk to exposure to pesticide-related products, mainly . . .
insecticides or herbicides."
THE COST
The NIH estimates that between 500,000 and 1,500,000 Americans are
afflicted with Parkinson's, with 50,000 more diagnosed each year.
Approximately 40% are under the age of 60, effectively removing them
from the productive work force. Unlike many other deadly ailments,
Parkinson's victims remain alive but incapacitated for many years,
sometimes decades, requiring a similar number of family members to
be diverted from the work force by their role as caregivers.
As a result, PD is estimated to cost the U.S. $25 billion a year in
direct health-related expenses, indirect disability related costs and
lost productivity.
THE POTENTIAL FOR A BREAKTHROUGH
Great advances in neurological research in the last few years have
created the potential for major treatment breakthroughs, very
possibly a cure -- in this decade. Such potential caused the Congress
to declare the 90's the "Decade of the Brain." Among those scientific
developments are: Neural Growth Factors: These "trophic" factors hold
the potential for rejuvenating dormant neurons that have ceased to
function in the Parkinson's-afflicted. Scientists are anxious to
proceed to clinical research, since it appears these growth factors,
once developed, may reverse symptoms and restore victims' ability to
function.
Fetal Tissue Implants: Scientists have produced remarkable results
in animals and in the few humans able to participate in clinical
trials during the six-year ban on federal support. While it is too
early to predict its full potential, further clinical trials are now
underway, and scientists expect to improve on these encouraging
results.
Genetically Engineered Cells: The creation of neural cells through
genetic engineering is expected to add an additional means, beyond
the use of fetal tissue, to replace dead brain cells. Scientists are
working to develop this capability.
THE NEED FOR A FAIR, ADEQUATE RESEARCH BUDGET
History of Low Investment: Parkinson's has been very low on the
funding priority list for years. Parkinson's research support from
NIH in 1994 totaled $26,066,000 broken down as follows: NINDS: 56%;
NIA: 22%; NIMH: 18%; NIEHS: 2%; Other: 2%.
While federal funding of Parkinson's research in 1994 amounts to
approximately $26 per patient, in comparison, research funding for
most disabling or deadly diseases has been substantially greater. The
following chart details NIH research funding per patient in 1994,
for selected diseases.
DISEASE/DISORDER # AFFLICTED 1994 FUNDING PER PATIENT
Parkinson's 1,000,000 $26,056,000 $26
Alzheimers 4,000,000 $217,283,000 $54
Heart 7,000,000 $652,358,000 $93
M.S. 450,000 $55,462,000 $158
Cancer 8,000,000 $2,356,578,000 $295
AIDS/HIV 1,390,000 $1,486,221,000 $1069
This disparity exists because the Parkinson's community has been
largely invisible: too crippled and too overwhelmed by their
symptoms to function publicly, they disappear from society -- and
Washington. In addition, bureaucratic roadblocks like the six-year
ban for fetal tissue transplant research stalled significant research
contributions.
This unfortunate and inadequate level of funding must be rectified
now, beginning with the 1996 federal budget.
Investing in Parkinson's and other neurological research will not
only save millions of Americans from immense suffering; it is also an
economic tool that will help fight the deficit, pay for health care
reform, and strengthen the U.S. economy -- in this decade.
-----------------------------------------------------------------
ROUTES TO A PARKINSON'S CURE . . .
The symptoms of Parkinson's disease result from the degeneration of
nerve cells in the mid-brain, and the corresponding loss of the
neurotransmitting chemical dopamine produced by those cells. Conven-
tional treatments revolve around pharmaceutical substitutes for
dopamine (such as L-dopa) and drugs that temporarily enhance the
cell's dopamine production. Such measures lose their effectiveness as
more cells are lost; so a true Parkinson's cure requires finding ways
of replacing damaged cells with healthy, viable ones...or nurturing
those damaged cells back to life.
GENETIC RESEARCH: Proponents in the research community maintain that
identification and mapping of a Parkinson's gene is a very direct
route to a cure...and that the gene could be identified within
months. Such an advance would not only provide a means for
identifying people at risk, but would potentially reveal the function
of the gene -- how it triggers or effects a change in the nerve cells
at risk.
NEURAL TISSUE TRANSPLANTS: Researchers implant fetal neural tissues
into the degenerate area of the brain, with the object that the new
tissue will thrive and renew the production of dopamine. Dramatic
results have been achieved in clinical studies, and a prototype
therapy may be close at hand...however, increased funding is
necessary to broaden the test population, increase cell survivability
and determine precise implantation techniques.
NEUROTROPHIC PROTEINS: Researchers are identifying a growing number
of proteins that function to nurture nerve cells...and even appear to
restore life to "dead" cells. Although "nerve growth factor" and
similar proteins are relevant to many neurological diseases, at
least one protein has been directly linked to the survivability of
dopamine cells. Advances toward a neurotrophic cure will require
novel ways of delivering a therapy inside the brain's largely
impermeable blood-brain barrier.
NEURO-PROTECTIVE AGENTS: On a different analytical plane, the damage
done to nerve cells that result in Parkinson's and some other
neurologic diseases is viewed as the work of "free radicals" --
molecular, metabolic by-products that can destroy healthy cells.
Researchers are closing in on a naturally occurring enzymes that
appear to deactivate free radicals in a healthy brain, and are
testing antioxidant drugs that could mop up molecules before they do
damage.
GENETIC ENGINEERING: Scientists are modifying the genetic code of
individual cells to obtain ways of supporting and extending these
therapeutic technologies...for example, altering a patient's skin
cell to become a dopamine-producing cell, one that could be implanted
in the brain without rejection. Other researchers have fabricated an
"adenovirus," a viral agent capable of invading a nerve cell and
reprogramming the genetic code to produce dopamine.
ENVIRONMENTAL LINKS: While some researchers are closing in on a
Parkinson's gene, others are focusing on the increasing evidence
that environmental toxins play some role...perhaps as a trigger in
conjunction with a genetic susceptibility.
FETAL TISSUE TRANSPLANTATION: THE SCIENCE, THE ETHICS, THE POLITICS
BRIEF HISTORY OF THE SCIENCE AND POLITICS. For decades, researchers
worldwide have been experimenting with the use of transplanted fetal
neural tissue as a therapy for Parkinson's and other disorders
including diabetes and various immune function disorders. In the
mid-80's, success with laboratory and animal studies in curbing
Parkinson's symptoms by substituting the fetal cells for degenerated
dopamine cells led scientists to begin human clinical trials. When
scientists at the federal National Institutes of Health sought to
assist such work with intramural and extramural support, however,
they were blocked by the imposition of a ban on federal support for
such research by Presidents Reagan and Bush.
In 1991 and 1992 the Congress passed legislation lifting the ban and
adding a series of ethical guidelines to govern any federally-funded
transplantation research using fetal tissue. The provision, known as
the Research Freedom Act, was passed by the House (274-144, 7/25/91)
and the Senate (87-10, 4/2/92). Despite support from strong
opponents of abortion, including Senators Mark Hatfield, Robert Dole,
John Danforth, and Strom Thurmond, the Act was vetoed by President
Bush and a veto override failed in the House by 13 votes. The Act was
again passed and signed by President Clinton in 1993.
FETAL TISSUE TRANSPLANTATION IS NOT MENTIONED IN THE UDALL BILL. The
Morris K. Udall Parkinson's Research, Education and Assistance Act,
the first legislation to address the longstanding need for an
expanded Parkinson's research program, authorizes $100 million in
federal support. The bill contains no restrictions on what research
should or should not be included. The intent is to advance research
breakthroughs as fast as the current scientific opportunity permits.
Nationwide experts in Parkinson's research and participants at a 1995
NIH-sponsored Parkinson's research planning conference have
identified a comprehensive research agenda full of breakthrough
potential that caused the Dana Alliance for Brain Research 1996
Report to name Parkinson's as "one of the brightest spots in brain
research." Neural cell transplantation is only one component of this
agenda.
DESPITE THE OBSTACLE OF THE EIGHT-YEAR FEDERAL BAN, NEURAL CELL
TRANSPLANTATION SHOWS GREAT PROMISE. Although the eight-year ban on
federal support undoubtedly slowed the progress of such work, cell
transplantation is showing great promise as an effective therapy for
Parkinson's, Huntington's and other disorders. Results from human
clinical trials in the U.S. and elsewhere show continued symptomatic
improvement as researchers refine their understanding of the
process. Two Parkinson's patients (one in the U.S.) are reported off
medication and symptom-free.
THE ETHICAL GUIDELINES PRACTICED BY RESEARCHERS AND CODIFIED IN THE
RESEARCH FREEDOM ACT PREVENT THE PROMOTION OF ABORTION. The
provisions of the Research Freedom Act codified in federal law
contain ethical restrictions intended to ensure that neither the
decision whether to have an abortion nor the abortion procedure would
be affected in any way by the subsequent use of the tissue for
transplantation. They include the following protections:
A woman may not be approached for consent to donate the aborted
tissue until after she has made the decision to have an abortion.
The donor may not be paid for donation of the tissue.
The donor may not designate who will be the recipient of the
tissue, nor be informed of the recipient's identity.
Violation of the restrictions is a federal felony punishable by 10
years in federal prison. There is no reported instance of any
infringement of these guidelines, nor of any evidence that any
woman has been encouraged to have an abortion as a result of
transplantation research.
TISSUE FROM SPONTANEOUS ABORTIONS OR ECTOPIC PREGNANCIES IS NO
ALTERNATIVE. Prior to President Bush's veto of the Research Freedom
Act, the President issued an executive order awarding $2 million to
establish a "fetal tissue bank." The bank was to collect tissue from
the remains of ectopic (tubal) pregnancies and spontaneous abortions
(miscarriages) as an alternative source of transplanted neural cells.
In January 1995 a definitive study of 1500 embryos from ectopic
pregnancies and spontaneous abortions published in the Journal of
the American Medical Association found that only seven -- less than
one percent -- were healthy enough for use in transplantation. This
was consistent with studies of the use of such tissue indicating high
rates of infectious agents, bacterial contamination and chromosomal
abnormalities that render the tissue unfit for human use. See e.g.,
48 Archives of Neurology, September 1991.
THE SUCCESS OF FETAL CELL RESEARCH WILL NOT DEVELOP A DEMAND FOR MORE
ABORTIONS. Much of the concern over fetal cell transplant research
stems from the fear that its success will simply create a larger
ethical dilemma: if it develops an effective therapy dependent on
fetal tissue from elective abortions, it will create a permanent
demand for abortions. As the research progresses, it becomes
increasingly clear that is not in the future. To the contrary, the
fruits of the research are producing spinoff breakthroughs in
development of alternative cell sources that will eliminate the need
for any aborted tissue. Among them are xenografts (use of cells from
pigs or other non-human sources), development of lines of implantable
cells from a small quantity, and genetically engineered cells.
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