The government has so much bureaucracy, it’s hard to initiate change. Good onboarding makes a big difference.

Some of the same concepts as health fraud, quackery, snake oil, device promotion and medical misinformation that has been promoted from probably time began.

Hello! Spontaneous CSF leak?

Could I suggest there may be selection bias? I don’t have the full manuscript to review but it’s “advanced PD” and likely a selection bias for levodopa responsive PD. If the tremor doesn’t respond are they really PD and culled out from being “advanced PD”.

This is one of the most difficult things to get treated. I used to be able to get my colleagues to do empiric blood patches within days of onset of orthostatic headache, now they want exact localization of the leak which delays early intervention.