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PRESIDENT’S
MESSAGE

A lifelong fascination

with neurology

By Sheldon Gross, MD, 2018 BCMS President

Dear Colleagues,

This month’s issue of San Antonio Medicine is dedicated to the health standpoint. We know that staying active physically and men-
field of neurology. As a child neurologist, I am delighted that neu- tally can help delay and slow down the progression of dementia.
rology is receiving this attention. I have always considered myself fortunate to have a career in
I remember when the first CAT scan images were being re- neurology. From my perspective, there is nothing more fascinating
viewed during my residency. Back then, it seemed like nothing than brain function and the interface between mind and body.
short of magic to be able to image the brain in this fashion. Look- Neurology together with psychiatry remain two of the most cap-
ing back on some of those images from the 1970’s, I wonder how tivating specialties in medicine.
any types of diagnosis could be made. By today’s standards, those Along with the progress being made, new challenges and ethical
images would have been interpreted as artifact and would simply dilemmas require address. Child neurology now has the dubious
have been repeated. It has been fascinating to watch the evolution honor of having two of the most expensive treatments for neuro-
of neuroimaging and our ability to diagnose conditions so much logical disease. We can effectively treat spinal muscular atrophy as
more quickly. With CAT scans, MRI scans, PET scans, and a vast well as Duchenne muscular dystrophy from a genetic standpoint.
array of other technologies available, it seems that there are no The cost of these treatments is in the hundreds of thousands of
boundaries with regards to our ability to diagnose and treat neu- dollars. I have no doubt that with time we will see more and more
rological patients. neurological disease as well as other chronic conditions becoming
Neurology takes on a special significance when looking at the amenable to genetic manipulation and treatment. How do we fi-
demographics of our nation. As the average age in this country nance these extremely expensive treatments? We are rapidly ap-
gets higher and higher, we are seeing that a huge percentage of proaching an era in medical ethics when we have to decide how
Medicare expenditures are going towards patients with chronic our resources will be directed. We are quickly reaching, or perhaps
neurological conditions. If one simply considers three condi- have already reached, a stage where we can no longer afford to do
tions including dementia, stroke, and Parkinson’s disease, this the things that are possible. We will have to address these and many
accounts for billions of dollars and a huge amount of resources other issues as a nation.
to care for these individuals and to help families deal with this I could spend the next 20 pages documenting progress in the
type of chronic burden. areas of migraine, epilepsy, perinatal asphyxia, and hypoxic en-
In response, the NIH has allocated a very large amount of re- cephalopathy. Suffice it to say that neurology is one of the most
sources for research regarding these areas. We are looking at these dynamic and rapidly changing specialties in the country. I may be
chronic neurodegenerative conditions not only from a treatment biased. In fact, I am most certainly biased. I hope you will find this
standpoint but also from a prevention standpoint. However, we issue of interest. Enjoy the rest of the summer.
should not lose sight of the fact that along with new and dazzling
progress in research, we already know that there are specific risk Sincerely,
factors for stroke. We know that chronic untreated hypertension, SHELDON GROSS, MD
diabetes, and obesity all increase the likelihood of stroke. These President, Bexar County Medical Society
are public health issues that need to be approached from a public

8 San Antonio Medicine • August 2018