From: gts (gts_2000@yahoo.com)
Date: Sun Feb 09 2003 - 14:02:56 MST
Rafal wrote:
> gts wrote:
>> I will however for the
>> moment concede that the evidence for neuroprotection in PD is not
>> unequivocal, and in fact I sincerely do agree that it isn't, just so
>> that we can get past this point. Okay? Nevermind PD for now.
>
> ###... I am glad you agree on this.
Good. Me too.
However I don't agree with your assertion that *all* experts agree that
selegiline is not neuroprotective in PD. On the contrary I know that
some do not accept your view despite the results of the one DATATOP
study that you and your associates are relying on so heavily to support
your opposite stance.
Old ideas die hard, and often for good reason. In this case the reason
is that there is still much evidence to suggest that the DATATOP results
may have been a statistical aberration in this one respect.
The situation is similar right now in female hormone replacement therapy
(HRT). Recently a large well-controlled study, one that could be
considered as reliable as DATATOP, was halted due to initial evidence
that the risks/benefits ratio of HRT is unacceptable. The study was
halted even while other evidence and a lot of very good scientific
theory suggests the opposite should be true. Gerontologists are now
divided over the subject. In fact in Britain I believe they practically
scoffed at the fact that we Americans halted the trial before it was
over; the Brits have therefore initiated a similar trial of their own.
Good for them, I say!
My point here is that DATATOP should not be considered the "last word on
the subject" of selegiline in PD, as you have suggested it should be.
There are simply too many good theoretical and empirical reasons to
think selegiline is neuroprotective in or out of PD, even despite the
statistics of DATATOP. Statistics are, after all, statistics. There is
always room for error.
The preponderance of the evidence outside of DATATOP very clearly
supports my view that selegiline is neuroprotective, *in general*, and
in fact even the DATATOP evidence only barely suggests that it isn't
even in PD!
The DATATOP data very strongly supports my view that selegiline delays
the onset of PD symptoms, and there is only a philosophical difference
between the delay of a disease's symptoms and a delay of the onset of
the disease itself.
The conflicting evidence in PD suggests however that there may be
something peculiar about Parkinson's Disease that would mitigate
selegiline's neuroprotective effects in PD. It is to *this* and only
*this* that you and I are in agreement. (But hey, agreement is still a
good thing! :)
Because this discussion list is not a support list for Parkinson's
Disease patients, I suggest we stop focusing only on PD and start
focusing on the likely risks/benefits of selegiline in healthy and aging
people.
-gts
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