title: Time to change the blind men and the elephant approach to Parkinson disease?
abstract: Parkinson disease (PD) is a progressive neurodegenerative disease that is associated with substantial morbidity and early mortality. Disease-related costs exceed $10 billion, not including medications, out-of-pocket expenses, or societal costs. Symptomatic treatment with levodopa, which has been available for over 30 years, and advanced therapies such as deep brain stimulation improve outcomes. Yet most new medications for PD provide a therapeutic benefit that is relatively modest compared to the benefits from levodopa. Despite dozens of neuroprotective clinical trials, there are no medications proven to slow the progression of the disease. Given these limitations, we provide evidence of the potential public health impact of a research agenda that emphasizes identification of risk factors to reduce disease burden through exposure mitigation. In addition, we emphasize health care policy that focuses on increasing health care expenditures for neurologic evaluation and management services to increase access to specialists to improve disease outcomes and reduce costs through better disease management.
authors.affiliation: From the Department of Neurology (B.A.R.), Washington University School of Medicine, St. Louis, MO; the School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa; and the Department of Neurology (A.W.W.) and the Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania School of Medicine, Philadelphia. racetteb@neuro.wustl.edu.
authors.forename: Brad A
authors.initials: BA
authors.lastname: Racette
authors.affiliation: From the Department of Neurology (B.A.R.), Washington University School of Medicine, St. Louis, MO; the School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa; and the Department of Neurology (A.W.W.) and the Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania School of Medicine, Philadelphia.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Willis
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis* / Q000628:therapy*; D011634:Public Health / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods; D012307:Risk Factors