Prof. Andrew Lees is a Professor of Neurology at the National Hospital for Neurology and Neurosurgery and an advisor to the UK Medical Research council. From 1985 to 2010 he was the most cited investigator in Parkinson’s Disease research.

This is my second interview with Prof. Lees. Click here to read the first one.

Your recent paper titled “Prognosis and Neuropathologic Correlation of Clinical Subtypes of Parkinson Disease” was the first to show that clinical subtypes of PD can predict disease course and survival. Do you have any thoughts on how we can use this to inform therapeutic strategies?

The single best prognostic factor in Parkinson’s disease is the persons age and the second is the magnitude of response to therapeutic doses of L-DOPA.

From your twitter account – “There is no more a contradiction between medical science and the art of healing as there is to forensic medicine and catching crooks. Leave your office get your hands dirty.” Do you fear that this era of medicine, where emphasis has shifted largely towards genomics and big data, may thus be a step in the wrong direction?

Yes because it has led to a belittlement of clinical research and a lack of precision in assessing clinical parameters in Parkinson’s disease. You cannot reduce the clinical picture to a series of scales and tick boxes administered by a generation of doctors who have not been taught clinical skills at medical school.

Terms like ‘patient-centered care’ have, for the most part, become empty buzzwords. What needs to be done to truly ensure the various stakeholders are more directly accountable to the needs of patients?

The first thing that is needed is that the questions people with Parkinson’s want answering become centre stage with respect to research funding.

The assumption that understanding molecular mechanisms causing cell death will lead to cures is not justified on the basis of the last 50 years research.

If you had the ability to remove just one of the obstacles that slows down the development, or the delivery, of improved therapeutics which would it be and why?

I would remove risk averse roadblocks which are laid down by lawyers and governments and become businesses like Research and Development Departments in Universities.

Any updates you can share on trials into Banisteriopsis caapi (ayahuasca)?

It has been slow to get the pilot trial started but we hope this will occur this year in Rio de Janeiro.

Where would you place your bets as to where a biomarker of PD will come from?

I’m optimistic about MRI of the substantia nigra.

Often in medical science a compelling enough body of evidence emerges around an idea to sway entire fields. Any advice you would give to those trying to discern truth from dogma?

I think there are two very over hyped areas at present in PD research, synuclein and non motor features of Parkinson’s disease.

On the other hand I do think looking for risk factors for Parkinson’s disease is worth pursuing along with a search for specific triggers that may unmask the illness. Aging research is vital and still underfunded.

In biology there is a gaping hole between how much we know and how much there is to know. This creates a level of uncertainty in everything we do. Yet, we have to make decisions, sometimes with lives at stake. How do you cope with having to make these decisions with such imperfect knowledge?

I tend to be influenced more by epidemiological clues, serendipitous quantum leaps (eg. MPTP story) and patient’s observations.

If you could redesign how neurology is practiced from scratch, would you? Is there a particular guiding principle or two you would want to instill?

Back to basics- more bedside teaching, more grand rounds with a view to improving observation skills and clinical judgement.

Where do you derive optimism for the future of neurology from?

Young neurologists who can see that the system is broken and that academic medicine is in crisis.

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