Article Biomarkers of Parkinson’s disease: 20 years later
Here is the latest example of our 20 years of cognitive dissonance. That the "heterogeneity of PD" remains "a major problem" but that better techniques (such as "utilization of complex analysis strategies and automated standardized assessment methods") will circumvent it. If even LRRK2-PD, as indirectly suggested by the authors, represents a collection of different diseases, can we rely on the brute force of newer and sophisticated analytic methods to bring us out of the conundrum that our unabated allegiance to PD as a unitary disease construct brings? Our field remains stuck in the quest to validate the century-old clinico-pathologic, convergent model of disease nosology, unlike most other fields of medicine, ahead by three decades of embracing systems biology divergence. No analytic technique will overcome the basic flaw in our ongoing biomarker-discovery efforts: that we, clinicians, get to set the gold standard against which to validate biology. It should be the other way around: biology validating disease subtypes. Unless we start walking the talk of PD as a syndrome of many biologically distinct diseases --we will continue banging our heads against the same wall. It is time to move beyond the search for biomarkers of convergence. Whatever is found to be common to all forms of PD is unlikely to be pathogenic in any.
Thank you for taking the charge against this matter. I share your concerns and opine them to any willing listeners.