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NEWS & VIEWS

NEW PARKINSON DISEASE PROGRAM FOCUSES ON ENVIRONMENTAL FACTORS

A new multicenter research program dedicated to discovering the environmental factors that influence the development and progression of Parkinson disease (PD) was announced in late August. The program will be funded by the National Institute of Environmental Health Sciences (NIEHS) and has been awarded five grants totaling $20 million over the next five years.

The collaborative effort involves three research centers led by top scientists in the field of Parkinson research. By sharing knowledge and resources, the participating researchers hope to rapidly discover the environmental influences on Parkinson development, which are indicated by several recent research studies.

“Working together, we can accelerate the pace of research with a dream team of multidisciplinary experts,” said J. William Langston, MD, founder and Chief Executive Officer of the Parkinson's Institute, one of the three centers involved in the collaboration. The other two are Emory University's Collaborative Center for PD Environmental Research, and the University of California-Los Angeles's Center for Gene-Environment Studies in Parkinson's Disease.

In a press conference, Dr. Langston and others stressed the importance of including Parkinson patient advocacy groups in their research efforts, both for a perspective on how the research is progressing and for suggestions on where research should go.

Early research will focus on suspected causative agents of Parkinson disease, such as herbicides and heavy metals, as well as possible protective agents, such as caffeine and, more controversially, cigarette smoking. Pesticides are a prime research target for identifying a causative agent because they inhibit energy production in cells – both insect and human. Another research priority is developing animal and cellular models to study gene-environment interactions and to test the various causative and protective agents. According to Dr. Langston, “This could be the final chapter of our search for the cause of Parkinson disease.”

TWO PARKINSON ORGANIZATIONS MERGE

In other Parkinson disease news, two top advocacy and research organizations, the National Parkinson Foundation and the Parkinson's Disease Foundation, are merging to form a new organization, The Parkinson Foundation, Inc. Lewis P. Rowland, MD, the Parkinson's Disease Foundation's president, will co-chair the new organization alongside Nathan Slewett, the National Parkinson Foundation's chairman.

In a press release, officials from the two organizations expressed hope that this merger will lead to more open and cooperative exchanges of information among “leading medical institutions.” They are also looking forward to forming working relationships and alliances with other prominent Parkinson research institutions, such as the Parkinson's Action Network and the Michael J. Fox Foundation for Parkinson's Research.

Commenting by phone, Robin Elliott, Executive Director of the Parkinson's Disease Foundation, called the merger a “wonderful and much needed move,” adding that the real challenge will be to “combine the complementary cultures of the two organizations.”

Among other goals, Mr. Elliott said the new organization will work on “increasing the amount of money spent on research of the highest caliber,” targeting research dollars more efficiently, and “doing all that we can to improve the ability of people with Parkinson disease and their families to live comfortably” with the best medical advice and treatment options available.

To assist the busy neurologist, Mr. Elliott continued, The Parkinson Foundation, Inc. will provide public education and educational materials to supplement the doctor's work. He cited the need for educational materials at the point of diagnosis, to provide information to the patient after the doctors or nurse practitioners have done what they can in their limited time with the patient.

Still another goal, Mr. Elliott said, is encouraging people with Parkinson disease or symptoms to see a movement disorder specialist. According to an informal survey that the Parkinson's Disease Foundation conducted among its correspondents, only 35 percent of responders had seen a movement disorder specialist.

The Parkinson Foundation, Inc. will have over $20 million in annual contributions to finance a range of activities, including research and training grants; clinical education programs; various advocacy activities, including a liaison with the National Institutes of Health to formulate research initiatives; and efforts to improve the quality of life for Parkinson patients and their families.

The merger is expected to be completed in early 2003.

NEUROSCIENTIST TO DIRECT NIMH

Thomas R. Insel, MD, was appointed Director of the National Institute of Mental Health (NIMH) in early September, and will assume his position in mid November, according to a NIMH press release.

Dr. Insel, currently a Professor in the Department of Psychiatry and Director of the Center for Behavioral Neuroscience at Emory University School of Medicine in Atlanta, GA, has spent his career studying the neurobiology of behavior, both at the NIMH and at Emory University. His research projects include treating obsessive-compulsive disorder with serotonin reuptake inhibitors and identifying the important role of two neuropeptides, oxytocin and vasopressin, in the maternal and aggressive behaviors of animals.

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Dr. Thomas R. Insel

Dr. Insel's plans for the $1.3 billion NIMH research budget include using neurobiological approaches to help people with mental disorders. “We have important new insights into the molecular and cellular basis of brain function. Now our challenge is to translate these discoveries from basic science into new insights and new treatments for mental disorders,” Dr. Insel said in a news release.

He also stressed the importance of working with consumer groups, professional organizations, and other federal agencies to provide “high-quality mental health treatment services” to the people who need them and whose needs often go unmet.

MEDICARE CODING MISTAKES DUE TO CONFUSING CODES, STUDY FINDS

A September study shows that there can be great variation in the CPT-4 codes assigned to identical medical charts by experienced coders – even within a single agency. Coding mistakes on Medicare bills can lead to delayed payments, denied claims, audits, and even to fines and criminal penalties, when a higher-paying code is used than the service provided warrants. However, the researchers found a high degree of disagreement in what the code for a chart should be among professional coders, calling into question the reliability of the coding scale as a measure for reimbursement.

The study, published in September's Annals of Emergency Medicine (2002;40(3):275–9), had groups of randomly selected medical charts coded for billing by several agencies and experts within their own agency, to measure the level of correlation among coders. Four outside coding agencies were given two identical sets of about 200 records each to code, and five coders in the researchers' agency were given identical sets of 100 records to code.

The researchers found only poor to fair agreement among coders on which codes were assigned. The correlation for coders from different agencies was considered poor, with only 15 percent of the charts receiving the same code from all four agencies, and six percent of the charts receiving a different code from each agency. The correlation for coders from the researchers' agency was slightly better, but still only fair. The researchers also found that the distribution of the codes was significantly different among coders.

Commenting on the policy implications of this study in an accompanying editorial, Brent R. Asplin, MD, of the Department of Emergency Medicine at Regions Hospital in St. Paul, MN, wrote: “If the current modus operandi of imposing large fines on health care institutions and threatening providers with removal from the Medicare program for improper coding is to continue, then the [Office of the Inspector General] must demonstrate that the coding system it is enforcing is reliable enough to support its investigative approach.”

CANADIAN MAN DIES OF VCJD

In August, a man from Saskatchewan became the first North American to die of variant Creutzfeldt-Jakob disease (vCJD). Officials from Health Canada, the federal department that monitors and protects the health of Canadian citizens, believe that the victim contracted vCJD while visiting the UK, not from Canadian meat products. The diagnosis of vCJD was confirmed by both Canadian and UK experts through autopsy.

vCJD is a fatal brain disorder with a lengthy incubation period that is most likely transmitted by consuming animal products infected with bovine spongiform encephalopathy (BSE), or mad cow disease. A probable case of vCJD was identified in April in a British woman living in Florida.

Health Canada officials learned that the Saskatchewan man had been in the UK during a BSE outbreak and had consumed processed meat products there. Furthermore, he had eaten very little beef and no venison upon returning to Canada in the 1990s. This, officials say, points to an infection that occurred in Europe.

Health Canada also learned that the man had undergone a medical procedure in Canada, and have advised the hospital that performed the procedure to dispose of all medical devices used during the procedure. They have also advised patients who were exposed to these medical devices not to donate blood, tissue, or organs. Canadian officials are calling these measures precautionary, however, and the risk of contracting vCJD from medical devices is considered very low.