Open Letter to Dr. Zorba Paster -- Dangerous Assumptions and RLS

Dear Dr. Zorba Paster,

While I appreciate your patient-centered approach to medical queries on your radio show, as a neurologist I was very concerned to hear how you answered a question regarding nonspecific nighttime leg symptoms. On September 12, 2010, a caller asked about her uncomfortable leg sensations. Without a complete history or physical examination, you informed her that she has restless legs syndrome (RLS) and should ask her doctor to place her on Requip(R) (Ropinirole). Not only is this favoring one medication over others. You did not encourage the patient to look for the source of her symptoms, for example if this is truly RLS, iron deficiency should be looked for.

Most concerning, it is unclear that this patient even has RLS. There are many other causes of nonspecific nighttime symptoms, such as spasticity, peripheral neuropathy, skin disorders etc.

I am concerned because this patient may have then gone primary care physicians and told her that she has RLS and needed to be on Requip(R). This unexpecting physician, may have taken the diagnosis as an established one and not investigated it fully, nor treated it appropriately. This patient may have then had the rare side effect of suicide, all because she was on an unneeded medication.

Once again, I implore you to stick to your excellent expertise and comingling of CAM (complementary and alternative medications) and approaches because whenever you make an assumption and recommendation outside your specialty area, it raises doubt over all your other answers.

Please remember, Primum Non Nocere (First Do No Harm).

Thank you,

Daniel Kantor, MD BSE
Medical Director
Neurologique

President-Elect
Florida Society of Neurology