The delayed-start study in Parkinson disease: Can't satisfy everyone: Rasagiline, Parkinson neuroprotection, and delayed-start trials: Still no satisfaction?

# {#article-title-2} To The Editor: The recent exchange between Drs. Ahlskog and Uitti1 and Drs. Olanow and Rascol2 regarding the ADAGIO study demonstrates a curious paradox in our professional debates. Research trials intended to affect patient care must meet high standards in supporting data and rationale. However, it seems that counterclaims made in commentaries are exempt and just the possibility of the counterclaim is considered sufficient. Drs. Olanow and Rascol pointed out the many speculative and unsubstantiated counterclaims. The concern is the paradox, which is the result of failure to distinguish and therefore conflate the nature of scientific/academic and clinical debates. Scientific/academic and clinical debates are not synonymous,3 despite the attractiveness to the contrary. Given the fundamental epistemic limits of science,4,5 the standards for encouraging criticism in scientific debate are necessarily less and mere possibility justifies consideration. In patient care, however, higher standards are necessary on both sides of the issue. Applying the more freewheeling scientific criticism to clinical questions risks radical skepticism and therapeutic nihilism, which is not what patients need. From a scientific perspective, the commentary by Drs. Ahlskog and Uitti is welcome, but as to the clinical import, perhaps it is not so useful. # {#article-title-3} To The Editor: Drs. Ahlskog and Uitti1 and I6 raised concerns …