Hi lindylanka

I have never read of any theory regarding receptors – only of too much or too little dopamine – so I can’t comment on that.

In my opinion, there are several problems with the idea that it can’t hurt to inform people – what it boils down to is that it is not that simple.

First of all, for a decision to be truly informed, one has to have accurate information. Secondly, the question of whether or not to take a DA does not exist in a vacuum, i.e., it is not a matter of taking a DA or taking nothing – it is a matter or taking a DA or taking something else. Therefore the risks of the options must be compared.

In the case of deciding between a DA and levodopa (and for the purposes of this example, I am just going to compare the alleged risk of gambling to the unequivocal risk of dyskinesias), assuming the 2003 gambling study data was valid, it found a risk that was 0.2% higher among those taking Mirapex than those in the general population, which I believe represents a 15% higher risk (1.5% for Mirapex, 1.3% for general population) – in data collected over a 12 month period.

Compare that to the risk of dyskinesias, on Mirapex vs on levodopa according to a 2004 study by the Parkinson’s Study Group. After four years, the risk of dyskinesias was 25% with Mirapex and 54% with levodopa. Thus the risk of dyskinesias was found to be 116% higher with levodopa, and that doesn’t even take into account that 2/3 of the people taking Mirapex were also taking levodopa (talk about clever trial design.)

They do not provide numbers for the risk of dyskinesias at the one year mark but the graph indicates that the risk is double with levodopa at that point, i.e., 100% higher.

Now, that comparison assumes the 2003 gambling study actually provided sufficient evidence to support its widely publicized claim. Even if it really did find an association, Mirapex’s risk is being distorted by publicity – which effects people’s ability to make a truly informed decision.

But consider the possibility that that study did not actually find an association. What if that study was demonstrably a crock, but no one who was actually going to be impacted by what it claims read it? And what if the second and third studies were also crocks, demonstrably so, but no one read them, and so the headlines went unchallenged?

If that were the case then clearly anyone who opted for levodopa over a DA would be courting a 116% higher risk of dyskinesias within four years than they would have been otherwise (assuming all other side effects are equal for the sake of this point) – and they would be doing it for nothing – they could have bought themselves several more motor complication-free years in the limited time we all have left, but they didn’t, because they had bad information.

And then there is the whole other possibility that neurologists might not even offer people DAs or might discourage them from taking them – because neurologists don’t always read the studies either.

I hope that makes sense – DAs offer the very real possibility of delaying the onset of the very real deficits of levodopa for years – in my case, six years and counting – if people decide to take levodopa instead based on bad information, they could be being cheated out of some very, very precious time.

And the scenario I describe in which the studies are demonstrably crocks but no one reads them - it is the reality here. Expose (as in expos-ay) coming to my blog, soon – the FDA study is already exposed there, if anyone is interested.

Oh and just for the heck of it, I downloaded the data from the Adverse Event Reporting System database for the third quarter of 2006 and tallied the drugs that were cited as primary suspects in cases in which pathological gambling occurred, and in cases in which OCD occurred.

Out of 20 reports involving OCD (most reports include a host of complaints) eight cited Paxil as the primary suspect, which is interesting considering that Paxil is used to *treat* OCD. Two cited Accutane, and the rest were one-offs: Clozaril, Citalopram, Depo-Provera, Effexor, Escitalopram, Lexapro, Lyrica, Mirapex, Tegretol, Zoloft.

Out of four reports involving pathological gambling, no drug was cited twice – Sifrol, Mirapex, Stalevo, Requip.

It is far from an exhaustive scientific analysis, but it doesn’t surprise me that Mirapex shows up as a minor player in the OCD realm, nor does it stand out in the pathological gambling realm. Now Paxil, on the other hand, could be a whole ‘nother ballgame.