Who is Abraham Lieberman

If you have Parkinson Disease, you may ask who I am, and why have the authority to write about the disease. I've studied PD for 30 years, and I'm currently the national medical director of The Parkinson Foundation, the largest charitable organization devoted to finding a cure for PD. The Parkinson Foundation (TPF) was formed in 2003 from the National Parkinson Foundation (NPF) headquartered in Miami and the Parkinson Disease Foundation (PDF) headquartered in New York. I am the Harold S. Diamond Professor of Neurology at the University of Miami.

My medical training is as follows: I'm a 1963 graduate of the New York University School of Medicine; Board Certified in neurology and psychiatry; and a Fellow of the American Academy of Neurology, the American Neurological Association, and the Movement Disorder Society. I trained in neurology at Bellevue Hospital, one of the largest and busiest hospitals in America, between 1964-1967. During the Vietnam War, I was a neurologist at the United States Air Force Hospital in Tachikawa, Japan, 1967-1969. From 1970 to 1989, I was, successively, an instructor, then an assistant professor, then an associate professor, and then a full professor of neurology at NYU. I was principal or co-principal investigator of more than 200 grants and studies of such diverse topics as Alzheimer disease, brain tumors, coma, epilepsy, migraine headaches, nerve and muscle disease, Parkinson disease, and stroke. Most of the studies involved inventing ways of evaluating these diseases. The studies were complemented by a large and varied neurology practice, seeing people from every corner of the globe who came to NYU to consult specialists in AIDS, cancer, cardiac surgery, endocrinology, GI disease, infectious disease, liver disease, neurosurgery, orthopedics, stroke, and psychiatry.

Beginning in 1970, but accelerating after 1980, my practice centered on Parkinson disease. This intensified during the nine years I spent as Chief of Movement Disorders at the Barrow Neurological Institute in Phoenix, Arizona, 1989-1998. Here I helped start the Muhammad Ali Parkinson Research Center.

My interest in Parkinson disease was stimulated by a revolutionary breakthrough, the introduction of levodopa, also known as L-dopa, by Dr. George Cotzias in 1967. The interest was sharpened by the presence at NYU of gifted scientists in biochemistry, neurochemistry, neuropharmacology, neurophysiology, and neu-ropsychology. I'm especially indebted to Dr. Menek Goldstein, a renowned neurochemist, and Dr. Albert Goodgold, a renowned clinician, who introduced me to the great thinkers in Parkinson disease and made me critical of myself.

With colleagues at NYU and the Barrow, I've authored or co-authored more than 200 articles published in major medical and neurology books and journals, including the New England Journal ofMedicine, The Lancet, the Journal of the American Medical Association, Annals of Internal Medicine, Annals of Neurology, Archives of Neurology, Neurology, Journal of Neurology, Neurosurgery, Psychiatry, and the Journal of Pharmacology and Therapeutics.

In 1998 Mr. Nathan Slewett, Co-Chair of TPF, invited me to Miami. With Mr. Slewett's encouragement and support, I started a major Parkinson disease website: www.Parkinson.org. The site receives more than 100,000 "hits" a day and more than 100 questions a day from 25,000 people with PD from every corner of the world: from Algeria to Australia, from Alberta to Argentina.

On a personal note, I've been married 37 years to Ina Lieber-man, a pediatric anesthesiologist. We have 4 children, two daughters-in-law, one son-in-law, and 3 grandchildren. At age 6, I had polio, spending 18 months in hospitals, clinics, and rehabilitation centers. So I know the anxiety, the uncertainty, the insecurity, the fear, and the panic centered around having disease—both as a neurologist and a patient. This dual perspective—patient's and doc tor's—is central to the book you hold in your hands. 100 Questions & Answers About Parkinson Disease is my second collaboration with Jones and Bartlett Publishers. Previously, I wrote Shaking Up Parkinson Disease: Fighting Like a Tiger, Thinking Like a Fox (2002). All royalties from both books will be given to TPF to support research toward finding a cure for PD. It is my hope that such a cure will come in our lifetime and make further books on Parkinson disease unnecessary.

Abraham Lieberman, MD

October 2002

Dedication

The book is dedicated to Lynn Diamond and her mother, Selma Diamond. For 27 years, Lynn Diamond has been my patient, and she and Selma have both been my friends.

I met Lynn in 1975 when I was an unknown assistant professor of neurology at New York University (NYU). Lynn, recently diagnosed with PD, wanted another opinion. She called NYU, and they referred her to me. I, rightly or wrongly, was the designated local "guru." I don't remember my first meeting with Lynn—she reminded me that she "was the young lady who spoke softly, walked backward, and asked many questions."

Lynn was not self-important, nor flamboyant, nor intrusive, but, I realize in retrospect, she was observant. I had received a grant worth a great deal of money today, much more in 1975. The grant allowed me to hire a nurse, whose job was to ask why people did not take their drugs as directed. Was it because they did not understand instructions? Was it because they could not understand any instructions? Was it because of conflict at home? Was it because they couldn't afford to pay for the drugs?

Ruth, the nurse, spent 8 hours a day on the phone. We didn't learn anything we didn't already suspect, but Ruth gave comfort and support to many, many, people. When the grant ended, Ruth left. I could not afford a nurse whose sole job was to talk to people, no matter how comforting. During a visit, Lynn asked me what had happened to Ruth, and I told her. She said, "But so many people benefited. So many people were consoled. How much was she paid?" I told her.

Lynn, who had never availed herself of Ruth's services, was silent. Then she sat down and, in her small script, wrote out a check for Ruth's salary. Lynn had never struck me as wealthy; she had no "airs," she made no demands. How could she write such a check? Certainly I could not. And, for the next 12 years while I was at NYU, Lynn paid for a nurse—a nurse she never used, a nurse who was an angel to hundreds and hundreds of people with PD.

In 1982 I began to prescribe selegiline (Deprenyl). It hadn't been approved in the United States, and I had to navigate an extraordinary bureaucratic maze to obtain it, legally, from Hungary—at the time, a Communist country, part of Ronald Reagan's "Evil Empire." But I had to buy it. I bought it for 30 cents a pill (it's considerably higher now) and sold it at cost. One afternoon, I received a delivery while Lynn was in my office. She asked me about selegiline and how I got the drug. I told her. She nodded and asked, "Who pays for the drug?"

"And then you sell it?" she asked.

"Yes, but at cost," I replied.

"Suppose someone can't afford it?" she asked. I shrugged.

"How much is it?" she asked. I told her.

Lynn sat down, wrote a check, and said, "I don't want you to charge anyone for the drug." This, from someone who had no need for the drug.

When I moved to Arizona, Lynn and Selma Diamond gave the Barrow Neurological Institute a substantial grant to start a laboratory in molecular genetics. PD was not in their family, but they understood the value of genetic research and were prepared to fund it. When I moved to Miami, their generosity continued: They gave to the National Parkinson Foundation, to the University of Miami, to research, to education, and to all people with PD.

Lynn has had PD for almost 45% of her life. She has never been bitter, she has never complained, and she has felt the suffering of others. Twenty-seven years later, she is still, "The young lady who speaks softly, walks backward, and asks many questions."

I wish Lynn didn't have PD. But she does. I wish no one had PD. But they do. I can't prevent PD. Or cure it. I try, but I can't. Lynn and Selma can't prevent PD. Or cure it. But they try. I wish more people tried as hard and as unselfishly.

PART ONE

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