(+++) THE SOLUTION, YET AGAIN

Ending Parkinson’s Disease: A Prescription for Action. By Ray Dorsey, M.D., Todd Sherer, Ph.D., Michael S. Okun, M.D., and Bastiaan R. Bloem, M.D., Ph.D. Public Affairs. $17.99.

     Here is how we end the [scourge/tragedy/awfulness/societal shame] of [name your preferred disease]: 1) Change one or more things that are major and significant in everyday life – things that it would be extremely difficult to change; 2) Rely on government to become an even bigger part of everyday decision-making in the health field than it already is, and expect government officials to be knowledgeable, empathetic and even-handed; 3) Get members of the public to spend copious amounts of time and effort persuading the government to make the necessary efforts to eradicate/alter/reshape whatever needs to be eradicated/altered/reshaped; 4) Spend copious amounts of taxpayer money, either by redirecting it from elsewhere or by getting more from taxpayers through increased taxes, fees, or some other revenue-raising method.

     The underlying assumption here is that existing priorities, whatever they may be, are wrong, and so they must be abandoned/adjusted/altered to accommodate the need to end the [scourge/tragedy/awfulness/societal shame] of [name your preferred disease] instead of being used to end the [scourge/tragedy/awfulness/societal shame] of [something else].

     Here is how this formula is employed in Ending Parkinson’s Disease by its four authors, three of them academic neurologists at universities and one a neuroscientist who is CEO of a Parkinson’s foundation: 1) Ban a wide variety of pesticides and chemicals, speedily clean up disposal sites, and institute a number of efforts to protect people who may be exposed while all this is going on – all initiatives to be accomplished by spending a lot more money. 2) Switch all people’s food intake to the Mediterranean diet, and switch consumption to higher-cost organic foods, and significantly increase everyday exercise – most initiatives accomplished by spending more money, although for activity, “it does not matter what you do – tap dance, fly on a trapeze, weed your garden at top speed, do yoga on a mountain, or simply go out and take a brisk walk,” so long as you “avoid activities with a high risk of head trauma” and provide extensive additional protective equipment for such risky activities by spending more money. 3) Spend more money at the National Institutes of Health to study Parkinson’s. 4) Make pharmaceutical companies spend more money on medications for Parkinson’s. 5) Give more money to organizations advocating change on behalf of Parkinson’s patients. 6) Spend more money training Parkinson’s specialists and educating clinicians. 7) Spend more money expanding the availability and type of care for Parkinson’s patients. 8) Spend more money to “make dopamine-replacement therapy more widely available.” 9) Spend more money to reach out to people who have symptoms that may indicate the very earliest stages of Parkinson’s or may indicate something else entirely – symptoms such as loss of smell. 10) Spend more money ensuring “reasonable pricing of Parkinson’s drugs,” with “reasonable” determined by governments and advocates because “the price may have to be less than the cost to manufacture drugs.”

     It is important to understand that there is nothing wrong with the recommendations in Ending Parkinson’s Disease and that the authors appear quite sincere in their proposals and advocacy. It is equally important to understand that virtually identical proposals and advocacy could come, have come and continue to come from equally caring and concerned individuals who are equally devoted to the cause of eradicating other diseases. Being primarily academic in orientation, the authors of Ending Parkinson’s Disease cannot be expected to be particularly familiar with or concerned about market forces, government function (and dysfunction), or the extreme “micro” difficulty of implementing a fine-sounding “macro” idea such as widespread alteration of people’s approach to food. And since Parkinson’s disease is these authors’ cause, they are understandably uninterested in trying to balance their ideas, concerns and financial desires against those involved in other causes – such a balancing act is presumably to be left to a beneficent and knowledgeable government, even though much of this book notes ways in which the government has failed to address Parkinson’s-related issues to date.

     Parkinson’s is a horrible disease (one of many), and its neurological effects, with which the authors are familiar, can be devastating (as can the effects of other serious conditions). It is a disease whose incidence is increasing, although the specific reasons for this are not necessarily (or at least not entirely) the ones on which the authors focus, such as the use of pesticides and other chemicals. Like other significant diseases, Parkinson’s does deserve more attention, more funding, a greater governmental focus – in other words, it does deserve to be taken far more seriously, commensurate with its seriousness as a medical condition. To that end, the authors call their book “A Prescription for Action,” and certainly it is that. The problem is that this prescription is offered as if Parkinson’s is the only major, debilitating, increasingly common, highly serious disease to which the prescription should be applied. There is no context here – only advocacy. Given the provenance of the authors, that is understandable; but it vitiates the power of their message, since their clarion call for societal change and significantly increased spending on their particular cause is identical to the clarion calls of other, equally concerned and committed advocates whose focus is on their particular causes.