February 19, 1999 12:00 PM 

Parkinson's Disease What it is, What it costs, What action is needed

Parkinson's 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 effecfiveness, 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 for daily life and leaving the mind prisoner inside it.

Although the cause is still uncertain, environmental toxins are a prime suspect. In the 3une 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 National Institutes of Health 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 prematurely from the productive work force. Unlike many other deadly ailments, Parkinson's victims rernain alive but incapacitated for many years, sometimes decades, requifing a similar number of family members to be diverted from the work force by their role as caregivers.

As a result, PD is estirnated to cost the U.S. $25 billion a year in health related expenses, indirect disability-related costs and lost productivity.

The Potential for a Breakthrough

The symptoms of Parkinson's result ftom the degeneration of nerve cells in the mid-brain, and of the corresponding loss of the neurotransmitting chemical dopamine produced by those cells. Conventional treatments revolve around pharmaceutical substitutes for dopamine (such as L-dopa) and drugs that temporarily enhance the cells' doparnine production. Such measures inevitably 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 damaged cells back to life.

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 as the "Decade of the Brain."

Among those scientific developments are:

·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 cell8. Animal studies are exploring novel ways of delivering a therapy inside the brain's largely impermeable blood-brain barrien

·Neural Tissue Transplants - Researchers implant fetal neural tissues into the degenerated 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 some clinical studies, and a recent report confirmed the link between the implantation of the new tissue and symptomatic improvement. While a prototype therapy may be close at hand, further research is necessary to increase cell survivability and determine precise implantation techniques.

·Neuro-protective agents - The damage done to nerve cells that result in Parkinson's and some other nenrologic diseases is viewed as the work of "free radicals" - molecular, metabolic by-products that can destroy healthy cells. Researchers are closing in on 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.

·Gcnetic 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 rejec-tion. Other researchers have fabricated an "adenovirus," a viral agent capable of invading a nerve cell and reprogramming the genetic code to produce dopamine.

·Finding the cause - genetic and environmental links - Some researchers are closing in on identification and mapping of a Parkinson's gene. Such an advance would provide a means for identifying people at risk and potentially reveal the function of the gene - how it changes the nerve cells at risk. Other researchers are focusing on the increasing evidence that environmental toxins play some role...perhaps as a trigger in conjunction with a genetic susceptibility.

·Pallidotomy - Pallidotomy is a surgical procedure that creates a thermal lesion in the globus pallidus, the movement control area of the brain. Some people who have received this treatment experience significant symptomatic relief, but the procedure remains experimental: the basis for improvement is. not yet well understood, and some patients have lost function or suffered other debilitating side effects. Further research is needed to fully determine the success rate and long-term effects.

Federal Funding of Parkinson's Disease

I. Federal Funding of Biomedical Research

The federal National Institutes of Health (MR) spends $12 billion per year on biomedical research. This is funded by Congress in a two-step process.

* First, they "authorize" federal programs, such as the expanded research program provided in the Udall bill.

* Second, in a different cycle occurring at a different time of year, they "appropriate" the funds needed to make each of those "authorized" programs run. Working with a proposed budget presented to the Congress by the President and his departments, the Congress each year revises it and finally comes up with a set of appropriations that the President and Congress agree upon. Although in the "authorization" process the Congress describes the amount of funding it intends will be spent to run a given program, it will only be funded if those funds are also appropriated.

This two-step process involves separate committees. For example, the House Commerce Committee and the Senate Labor Committee are charged with developing federal research programs run by the Department of Health and Human Services' (HHS') National Institutes of Health (NIH). They are the "authorizing" committees for HHS and the NIH. The Senate and House Appropriations Committees are the ones that control the actual appropriations decisions.

II. NIH Parkinson's Research and Appropriations

Federal Parkinson's research, through the NIH, has not received the attention that it deserves from the federal governmenL As other materials describe in greater detail, Parkinson's research receives far less, on a per patient basis, than most other disorders - three times, ten and even twenty times less than some diseases. Parkinson's scientists nationwide describe the NIH Parkinson's program as providing only a very small part of the funding needed to support current, vital research.

To change this situation with new and expanded programs and research grants, such as those provided in the Morris K. Udall Research and Education Act, will require more than simply enacting the Udall bill. The funds must also be found, either within the existing federal budget or from additional sources, to finance these programs.

III. Action Needed to Increase Parkinson's Research Appropriations

[ Home ] [ Up ] [ Funding Guide ] [ Latest Research ]

Send mail to bobmartone@kingwoodcable.com with questions or comments about this web site.
Last modified: February 19, 1999