Philosophy


Causation

One might consider Parkinson’s disease (PD) to result from a complex interaction between genetic predisposition, certain ubiquitous exposures, and occurrence or lack of specific modifying factors.



Inertia of consensus opinion

Time is at a premium to people with PD and their families. Difficulty unravelling the chain of events may have grown out of all proportion because of boundaries imposed by medical specialities. Moreover, those set in judgement over funding often represent the prevailing view. “Consensus is always conditioned by the antecedent knowledge and its interpretation…….it should be associated with permanent criticism, which hopefully will induce corrective changes.” (Vladimir Vonka, Phil. Trans. R. Soc. Lond. B 2000,355,1831-41).

Lumping or splitting

Identifying the causes of chronic diseases is a prerequisite of prevention, amelioration of the underlying processes, and cure. Embracing the complexity of the problem is crucial. However, the prevailing strategy does not. Clinicians strive to split off uniform subgroups, presumably with a view to revealing that necessary and sufficient cause.

Jigsaw pieces to clear picture

We have a coherent, hierarchical and biological-plausible hypothesis. Suppression of unexpected and heretical findings would have negated scientific method. We accept that interpretation of details may be wrong, due to real gaps in knowledge or lack of awareness of alternative explanations. However, when a large number of observational and interventional findings fit together, the likelihood of the overall thrust being off-course must be small.

Clear picture to practice

We have a prima facie case for the role of infection. One switch in the circuitry has been defined. The strategy is clear: a series of protocols have been planned carefully with appropriate experts. Proper circumspection tempers the process. Efficiency demands that clues are pursued in parallel, and is facilitated by building on different focuses of collaboration.

Ongoing surveillance and production of guidelines for routine practice run in parallel with the 5 year programme, to interpret clinically useful information rapidly as the scientific picture unfolds. Adequate funding of the whole is needed to avoid piecemeal, superficial and inappropriate ‘translation’.