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Hello Stephan, Thanks for your swift reply, I read it yesterday, but hesitated to reply because, as I said in my response of 24/7, I really do not think my opinion is important. Nor do I want to be drawn into a "for" or "against" argument. It would give me no satisfaction at all to argue the Parkinsons Disease Research Group (PDRG) report as being the true story. I would like to learn that there is indeed a flaw in this research and my hopes are that this will be the case. My response to your memo was simply because I believe that, in the interests of those trying to make difficult decisions, it should be pointed out that they should at least be aware of the adverse report of the PDRG printed in the BMJ of Dec 1995. They could then read it and/or discuss it with their Neuro and make up their own minds. Stephan, I believe you are right in taking comfort from the previous studies which do not show the problems of the 1995 report. This is fair enough. Equally, Gray Miller is right if he does not want to take a chance and settles for a different drug. Your reply to me made a number of points which, if taken at face value, would indeed cast great doubt on the PDRG research. In the interests of getting the full picture on this, could you perhaps just clarify or comment on the following: >Many >responses to the results pointed out flaws in the >methodology, Who made these responses? Were they medically qualified, or researchers? Are they on record and do you have an example? > not the least of which was accuracy of clinical >diagnosis protocols. The criticism that I read was that detailed causes of death were not recorded in each case. Well, I agree this was a failing because detailing accurately the cause of death could have more accurately pinpointed a specific medical problem. However, the clinical diagnosis of death is not so hard and if you take two randomized groups, each on different medication, and one group has a 60% higher mortality rate at the end of 5-6 years, then suspicion has to fall on the medication, would you not agree? These results were independent of sex or age by the way. Also, you will have no doubt read that the PDRG report criticized the Birkmeyer et al studies in turn as having "several major deficiencies, including a retrospective, non randomised design". >The data was reanalyzed and the >conclusion was that the study could not support the finding >of increased mortality in the use of selegiline and Levodopa >medication. Who reanalyzed the data? I contacted the Parkinsons Society today and they confirmed that they have not yet finished reanalyzing their data. So, who concluded that the study could not support the finding of increased mortality? >Subsequent studies have published findings that >there has been no increase in mortality in patients using >selegiline and Levodopa. I must admit I have not seen any studies on the subject since the DEC 95 report. Can you let me have any details as to which body conducted and published them? I would be very interested. Stephan, I am not taking sides one way or the other, I simply say we have two conflicting reports and we should not yet dismiss EITHER of them as wrong. If the UK research proves to be unreliable, then we all breath a sigh of relief. If it turns out to hold water, then further studies will probably be done to determine the truth. Anyway, let us get this in perspective, all our drugs carry some increased risk with which we have to live. People are not exactly dropping dead in the streets from Eldepryl poisoning. The research simply gives us information which we can use to make informed judgements. If we have any further personal views on the subject perhaps we should continue them off list? On a friendly note, of course! Ernie. 54/3.8 Hi Ernie: You wrote: >>> Ernie Peters <[log in to unmask]> 07/24/97 08:01am >>> >>Unfortunately, there has also been a more recent study >>(reported in the British Medical Journal) that states >>entirely the opposite when the drug was combined with >>Levodopa. Some people have said the study was flawed. >>I hope so, but the figures were such that one should at >>least consider them when making decisions. I do not offer >>my opinion on this, but simply point out how difficult it is >>to get at the truth. >>Ernie Peters <[log in to unmask]><<< I am familiar with the December 1995 article in the British Medical Journal describing the selegiline study. Many responses to the results pointed out flaws in the methodology, not the least of which was accuracy of clinical diagnosis protocols. The data was reanalyzed and the conclusion was that the study could not support the finding of increased mortality in the use of selegiline and Levodopa medication. Subsequent studies have published findings that there has been no increase in mortality in patients using selegiline and Levodopa. To me these are more reassuring and I think accurate. Stephan 53/7 Ernie Peters <[log in to unmask]>