Dear Vicc -

Along with Roz I have to plead the holiday excuse of responding in any detail to you post, specifically, your very thoughtful treatment of the Oaklander and Albrecht studies. I will respond later to them in more detail.

But a couple of preliminary points first. I consider the biggest thieves in this business to be the makers of implantable stimulators and/or pumps and the doctors who reflexively implant them. I saw one of them a few years ago, to say that I got an "entrepreneurial" vibe from him and his accept no medical insurance private single-purpose hospital in Beverly Hills would be an understatement. (And while I have wondered from time to time about the "relationship" between said docs and the implantable medical device manufacturers, I have nothing other than a general sense with which to support my speculations.) On the other hand, and for what it's worth, I know from personal experience that Dr. Schwartzman is a man in his seventies who will if necessary schedule a hospitalization such that he has to come in for a discharge interview on the weekends. I worked as a business bankruptcy lawyer for 20 years, largely cleaning up after massive frauds, and while I too know that these guys can be charming, I doubt very much that they regularly come into the hospital to see their patients on the weekend. (You would be surprized how many people I've known who've spent time in the joint.) Dr. Schwartzman treated me at my bedside, for goodness sakes. I too can read human nature, especially when it's up close and personal.

As noted above, I've seen guys who fit the entrepreneurial profile and in my experience, Dr. Schwartzman doesn't. He and his hospital regularly accept medical insurance payments at reduced rates, "entrepreneurial" doctors don't. Secondly, when I was registering for the trip to Germany I was given detailed instructions as to how payment to the hospital there was made. To suggest without any evidence that Dr. Schwartzman was/is receiving kickbacks from these hospitalizations is, in my opinion, not only outrageous but actionable.

Vicc, with all sincerity, I believe that your hostility towards Dr. Schwartzman is misplaced. We all agree that neurological based treatments such as sympathetic nerve blocks make a great deal of difference if given early in the course of the disease. Studies I have posted on the old board also showed gray matter atrophy in pain and specifically CRPS-1 patients, an atrophy that NMDA receptor antagonists such as Namenda may block: which is why I'm on it. I know that none of this proves a "unitary" CNS/SNS based mechanism, but it's not inconsistent with it either. Nor do I believer that Dr. Schwartzman is irrevocably linked to that model, where some of his recent work is specifically focussed upon the immunological components of this disease.

Finally, I want to be really clear on one point: I don't reject that there is a vascular component to CRPS-1. If you are aware of peer-reviewed published research that isn't making it to the RSDSA page, you should take it up with their executive director, Jim Broatch. His email address is as follows: jwbroatch@aol.com On the other hand, if your point is that no effective work can be done so long as one man or group of men lives, then I don't know what to say.

May this holiday season bring you peace and an alleviation of suffering.

Mike

p.s. One follow up comment regarding the Subanesthetic Ketamine Infusion Therapy article. You note that:

Only two of the subjects who reported having RSD longer than 24 months were followed up for more than 24 months. This represents another deceptive practice; screening subjects out from follow-up protocols. The thinking behind this is that if we don't ask them we won't have to report what we believe will be a greater number of unsuccessful outcomes.

I think you may have missed the point of the study: at some point they had to cut off their research and publish. Thus, the fact that some patients were "followed" for more than 24 months where others were not, seem to me to be more likely than not just a function of when the respective patients were treated during the course of the study.