Dr. Iacono killed in plane crash

[rayilynlee <rayilynlee@xxxxxxx>]

If you live(d) in CA's "inland empire" you may have heard of Dr. I as I did,
Ray

Dr. Robert Iacono -- promoted radical form of Parkinson's surgery
Thomas H. Maugh II, Los Angeles Times
Monday, June 25, 2007

Dr. Robert Iacono, the troubled neurosurgeon who was one of the first
practitioners of a radical form of surgery for Parkinson's disease but whose
impetuous reputation derailed his career, died June 16 in a plane crash. He
was 55.
Dr. Iacono was flying alone from Los Angeles to Mississippi in a twin-engine
Beechcraft 58 Baron to visit family when the plane crashed into the western
face of the Sandia Mountains in New Mexico.
Rescue efforts began after satellites picked up a signal from the plane's
emergency transmitter. The body was recovered last Monday.
Dr. Iacono made a national reputation for himself during the 1990s while he
was at Loma Linda University Medical Center, near San Bernardino, performing
a controversial surgical procedure called a pallidotomy on patients with
Parkinson's, which is characterized by tremor and rigidity in the limbs and
a loss of muscle control.
Pallidotomies involve destruction of a small part of the globus pallidus, a
region of the brain involved in the control of movement. Destroying part of
the pallidus restores balance in that part of the brain, and Dr. Iacono was
one of its early promoters.
In the surgery, a probe is inserted into the brain while the patient is
awake so that speech and other functions can be monitored. When the probe is
positioned correctly, a radio frequency current is passed through it,
producing heat that destroys nearby tissue.
The effects are almost immediately apparent and include a dramatic reduction
in tremors and rigidity and a decreased need for levodopa, the drug most
commonly used to treat the disorder.
Dr. Iacono performed hundreds of the operations during the 1990s. In a 1995
report in the journal Neurosurgery on his initial 126 patients, he claimed
an 85 percent success rate in improving the patients' mobility and a
surgical complication rate of only 6.3 percent.
Critics, however, were brutal. Dr. Roy A.E. Bakay of Emory University said
at the time that "Dr. Iacono and his colleagues have undoubtedly
overestimated their surgical success and underestimated their surgical
complication rate."
In a Wall Street Journal article, Dr. Robert Feldman, a neurologist at
Boston University, said that he "wouldn't refer patients to Iacono. I don't
think he is thinking critically. He's thinking surgically."
The American Parkinson Disease Association, the largest patient group in the
country, also refused to refer patients to him on the advice of its medical
board, although the group did not explicitly say why.
Many of his patients praised him effusively for the benefits they received
from the surgery. But Dr. Iacono and Loma Linda also had to defend several
malpractice suits resulting from operations gone awry.
By the end of the decade, most neurosurgeons had switched to an alternative
procedure called deep-brain stimulation, in which the destruction of tissue
is not necessary. Electrodes are permanently implanted in the brain, and
passing a small current through them produces the same benefits as
pallidotomies, but without the risk.
Meanwhile, his career began to deteriorate.
In 1992, he was accused of using sexually inappropriate language and
touching a female staff member.
In 1994, he was accused of using drugs not approved by the Food and Drug
Administration.
On at least two separate occasions, he was accused of verbal or physical
abuse of staff, and in 1999, the hospital suspended him for 20 days and
ordered him to complete anger management therapy.
After two subsequent charges of abuse, the hospital's executive committee
began making plans to terminate his privileges. He voluntarily resigned
before his privileges were revoked.
Two months later, he applied for privileges at Desert Regional Medical
Center in Palm Springs, but he marked "no" on a box asking if he had ever
been in trouble at any other hospital.
As a result, he faced a formal accusation of wrongdoing by the California
Medical Board and surrendered his license to practice medicine, effective
Sept. 19, 2005.
His license also was suspended in Arizona and North Carolina as a result of
the California action.
Before his license was suspended, he had established a private practice in
Loma Linda (San Bernardino County), where he treated brain tumors and
continued to perform pallidotomies, ultimately performing more than 2,000 of
the procedures, which he argued were beneficial for patients. At the time of
his death, he had written a book called "Reversing Parkinson's Stress and
Aging," which is expected to be published soon.
Robert Paul Iacono was born April 7, 1952, and raised in Los Angeles County
on the Palos Verdes Peninsula, where he graduated high school. He received
his undergraduate and medical degrees from the University of Southern
California and performed his residency in neurosurgery at the Duke
University Medical Center.
He was chief of neurosurgery at the Veterans Affairs Hospital in Tucson,
Ariz., from 1984 to 1990, then joined Loma Linda.
This article appeared on page B - 5 of the San Francisco Chronicle

Rayilyn Brown
Board Member AZNPF
Arizona Chapter National Parkinson's Foundation
rbrown@xxxxxxxxx

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