DUOPA Is An Excellent Alternative Treatment But With Some Caveats

I read the recent article by Burack et al. with great interest, but I see some problems with it.1 Per acknowledgements in the article, “Crystal Murcia, PhD, Kelly M. Cameron, PhD, CMPP, and Lamara Shrode, PhD, CMPP, of JB Ashtin provided medical writing and editorial support to the authors in the development of this manuscript.” They were paid for this work by AbbVie. I am amazed the editorial team accepted this manuscript knowing that the drug company clearly has vested interest in it. It looks more like a nicely designed advertisement, but disguised as a peer‐reviewed article in a reputed journal. Plus, many of the authors have received payment from AbbVie in some form or other per financial disclosures provided.

It is also interesting to note that the authors failed to mention some very practical problems faced by the U.S. patients. (1) There is no procedural code (CPT code) specific to titration of the medicine, which can consume a significant amount of office time. In my practice, a patient would be in the office for several hours on the first day, a few hours the following day, and, sometimes, 1 or 2 hours the third day depending on the individual patient's requirement. A physician's time (billed as a regular office visit) is not reimbursed accordingly. This does not even count the nurse's time spent in between the physician's assessment of the patient. (2) Another big hurdle, particularly for the Medicare patients, is that if they need to go to a care facility even for a brief period of time following any illness, facilities are very reluctant to accept them because of the cost of the medicine, and they are not reimbursed for the medicine by the insurance. I have had a patient who cannot be placed in a nursing home despite severe dementia because of this very issue. The authors do not mention a solution for this difficult situation, which is not likely isolated to my practice.

Otherwise, I do agree that this can be excellent option for some patients with advanced Parkinson's disease with motor fluctuation. Most of my patients, who have had it, are happy that they chose this.

Disclosures

Ethical Compliance Statement: I confirm that the approval of the Peoria Institutional Review Board was not required for this work. I confirm that I have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.

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