Sunday, April 19, 2009

Parkinson's Adult stem cell Breakthrough and more




More about Parkinson’s and stem cells….Keeping you posted as I learn too… The photo showing where damge occurs is from web MD (2002)

Would you be surprised that the technology to implant neural tissue in humans to alleviate Parkinson’s Disease was available as early as 2001 and in case studies has produced more successful remission than any drug on the market and with fewer side effects?

Michel F. Levesque, M.D., F.R.C.S.(C), F.A.C.S.Cedars-Sinai Medical Center in Los Angeles, Associate Clinical Professor of Neurosurgery at the UCLA School of Medicine, and member of the UCLA Brain Research Institute applied for Phase 11 FDA approval in several years ago. This was granted but sponsor complications and new rules by the FDA have put this phase on hold until Levesque and company can jump through the new hoops and negotiate more sponsors. This is tragic for Parkinson’s patients who could die or degenerate significantly before help is available.

It seems that the FDA would apply the same standard to our own cells that they do to foreign drugs. Pharmaceuticals take a ten year, 750,000 million dollar investment on average to bring to market and to start to make a profit. I do wonder about the stability of stem cell companies that have not counted the cost or prepared a strategy and stored up ammunition for battle. What did they think was going to happen? Nevertheless it makes one long for the days when scientists bit the bullet and practiced on themselves and family members. The results produced their own script. It seems today the trend is to scorn the establishment while begging to get into ‘the inner circle’. This cannot in all fairness be blamed on the FDA but rather on the inconsistencies of human nature and the need to belong. It is tragic that ethics and human decency for ‘the little people’ are tossed aside in the parade of blind ambition that ignores the simple concept that if you take away from the foundation (those that have supported your growth) the structure will destroy you…but I digress, on with the story….

It does seem strange that it is a woman’s ‘right’ to terminate a child but it is not an individual’s right to choose their own stem cells. The right to terminate brings death and is endorsed but the right to life through the harvesting of our own stem cells is denied by an outside source.

It is not like the FDA is even particularly good at culling out the problem children in the industry or adding to medical knowledge. A simple Google search on major drugs and problems in approved FDA pharmaceuticals is an eye opener in politics and commerce rather than the mainstream of patient safety for which they purport to represent.

Levesque and his colleagues did a successful case study with a man suffering from Parkinson’s in 2001 and yet in 2009 Parkinson’s patients are still dying needlessly. The FDA is still a bureaucracy which people are distracted into attacking while Scientists followed by the masses line up on the adult stem cell or embryonic bandwagon instead of putting partisan economics and politics aside to join together as scientists to promote healing and answers for those without hope.Here is a little about the study below:
“MATURE NEURONS DERIVED FROM THE PATIENT’S OWN BRAIN CAN BE TRANSPLANTED BACK SAFELY AND IMPROVE SYMPTOMSWe recently presented the clinical outcome of our autologous method at the International Congress of Parkinson’s disease and Movement Disorders in Rome. In accordance with our institutional review board, we transplanted a patient with advanced Parkinson’s disease with differentiated neurons derived from an initial needle biopsy. At three years post-operatively, the overall Unified Parkinson’s Disease Rating Scale (UPDRS) improved by 81% while “on” medication and 83% while “off” medication. We demonstrated here the long-term clinical remission of Parkinson’s disease symptoms in a single patient.Because of their biocompatibility, safety and potential integration into the host striatum, autologous adult neural stem cells and stem cell-derived neurons represent an effective alternative to current cell therapy aimed at the restoration of dopamine neuronal loss in Parkinson’s disease. Under the guidance and supervision of the Food and Drug Administration (FDA) office of Cellular, Tissues and Gene Therapies and the Center for Biologics Evaluation and Treatment (CBER) we are about to begin Phase II trials using this promising cell therapy.
CONCLUSION
Degenerative and traumatic disorders of the brain represent an enormous burden to the patient, their family and health care providers. The current debate between the embryonic stem cell proponents and those who are opposed to their use distracts from other avenues with promising outcome, such as adult stem cell therapy. It also overlooks other important issues of resource allocation between basic and clinical research, health insurance, and patient care. Scientific knowledge has rapidly progressed in the last five years (written in 2004) and stem cell research and therapy remains a very promising field for treatment of neurological disorders. In a recent biotechnology industry meeting, a presentation had the approximate title: “Businesses are from Mars, Academics are from Venus”. What was forgotten there is that patients are from planet Earth and this is what should guide our efforts “ (Levesque, 2004)For the complete story read here and for an update on where things are today check out this link

Love S et al., Glial cell line-derived neurotrophic factor induces neuronal sprouting in human brain, Nature
Medicine 11, 703-704, July 2005
Slevin JT et al., Improvement of bilateral motor functions in patients with Parkinson disease through the unilateral intraputaminal infusion of glial cell line-derived neurotrophic factor, Journal of
Neurosurgery 102, 216-222, February 2005
Gill SS et al.; “Direct brain infusion of glial cell line-derived neurotrophic factor in Parkinson disease”;
Nature Medicine 9, 589-595; May 2003 (published online 31 March 2003)

Saturday, April 18, 2009

Dyslexia FMRI implicates Cerebellum


Dyslexic individuals seem to struggle with pattern learning. Reading is like pattern learning on steroids. Recent research compares a group of adult dyslexics with a control group of normal readers in the learning of a simple sequencing task. Participants pressed one of four buttons that corresponded to a visual stimuli that appeared in a predictable pattern during an fMRI scan. Previous studies had found that dyslexics are worse at learning this simple sequence and the researchers were interested in the differences in brain activity between the two groups.

The study found that there was a notable difference in brain activity between dyslexics and non-dyslexics. Significantly the cerebellum was more active in the dyslexics than it was in the non-dyslexics.


Research suggests that the cerebellum plays a key role in learning by comparing what the brain expects to happen with what actually happens. As the subjects learn the sequence, the difference between expected and actual results diminishes and the work load on the cerebellum reduces. In the non-dyslexic brains, the cerebellum is more efficient at this process so sequence learning and the corresponding drop off in cerebellum activity occurs sooner.


It is of interest that expert learners such as chess champions and experts at logic games can play with a lot less cognitive loading, thus freeing up other processing resources for memory, attention and learning. Even for experts this takes hours of practise. Perhaps a focus on effective categorization and efficient filtering rather than endless attention and working memory games could produce skills that would transfer to new areas of learning.


Tuesday, April 7, 2009

Gain Ground by Building Brain Potential


By Amy Price PhD

Of the 1.4 million who sustain a TBI each year in the United States: 50,000
die; 235,000 are hospitalized; and 1.1 million are treated and released from an
emergency department. The number of people with TBI who are not seen in an
emergency department or who receive no care is unknown.

Major causes of TBI are: Falls (28%); Motor vehicle-traffic crashes
(20%); Struck by/against events (19%); and Assaults (11%). TBI costs the USA
approximately 60 billion dollars per year in care and lost productivity (Statistics supplied by BIAA)

Helmets are often proposed as a cure all. The problem is according to the statistical breakdown above over 50% of related injuries would occur from non helmet activities. Better immediate care and follow up would lessen the severity of impairment for a large proportion of survivors

TBI can cause a wide range of functional changes affecting thinking, language, learning, emotions, behavior, and/or sensation. It can also cause epilepsy and increase the risk for conditions such as Alzheimer's disease, Parkinson's disease, and other brain disorders that become more prevalent with age.

Survivors report the areas they most need help are: Improving memory and problem solving; Managing stress and emotional upsets; Controlling one's temper; and improving social and employment skills.
A mind is a terrible thing to lose...if you have sustained a head injury all is
not lost help is available .
The links above in blue contain help and information.


We are often asked how do I find a good treating professional? Ask your local brain injury association. Word of mouth is good. Check with healthcare facilities, neighbors and friends. Find a professional who will work with you or your family member to get results rather than just tell you to learn to adjust to the problem.

Many individuals have run out of health care options. They ask what can be done at home. The Wall Street Journal has an excellent article about how people can be pro-active in retraining their brains. There is continuing research going on in this area. If you have a strategy or treatment that you have found helpful please let us know.

Here is a place where you can try brain games for free. This site is monitored by scientists from Stanford university who are collecting brain function data for a mega study.

Jig saw puzzles can help with spatial function. You can try these free from a simple six piece
puzzle to a 247 piece challenger
. Crossword puzzles can help with language and reasoning

The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing. - Albert Einstein

Saturday, December 27, 2008

Stem Cells For Parkinson's

By Amy Price PhD

Brain picture
Can Parkinson's patients benefit for stem cell therapy? The answer is likely that in the future this will be possible. Right now stem cells for orthopedic applications are a working reality and cardiac
applications are showing great success.

It was interesting to see a company with customer testimonials claiming success for Parkinson's . What happens is they are injecting stem cells intravenously and claiming these cell are migrating to the brain to "fix" Parkinson's. There are big problems with this...some cells migrate but the number of cells that would actually make it to the brain are fewer than finding a friend in a 50,000 seat foot ball stadium, the rest of the cells go the the lungs and then are reabsorbed by the body and filtered out through the liver and excreted by body wastes. Patients are paying thousands of dollars and travel expenses for cells they will end up flushing.

Think about it this way. If cultured cells could just fix things intravenously why would leukemia
patients even need bone marrow transplants?
With Parkinson's the underlying cell structure in the brain has been compromised and unless that is restructured new cells will be taken over like ants on a chocolate cake. For stem cells to work treatment needs to be targeted and care needs to be given as to how to best treat the underlying problem.

So why are some Parkinson's "patients" saying it could be working for them?
First of all Parkinson's is a dopamine deficiency issue. Anytime we do something
that brings pleasure or excitement, dopamine is circulated. For a short period of time patient's actually feel better. This principle is biological not psychosomatic. Plus the cells have some anti inflammatory properties so this benefit is felt as a temporary relief from pain.

Just after Thanksgiving a family member ran over our cat in full view of three small children. Having done some veterinary work and some first aid I could see the cat was not long for this world. She was bleeding from her mouth and her lungs were filling with blood and yet I held her in my arms and my son and I drove to the vet in hopes that someone bigger and smarter could do something...they couldn't. I guess I would do the same for a person I cared about and so would a lot of people. This makes us vulnerable in spite of knowledge so even when a celebrity claims to be healed it may not be the whole story. About the Parkinson's stem cells.... no fMRI or electrical studies of before and after treatments are shown and a search on PubMed turned up nothing.

This is in stark contrast to stemcell company scientists who publish research results and actual case studies to show where and how treatment is progressing. One question to ask when you are considering a new medical treatment is do the people I am dealing with offer any other options in case of candidates that are not suitable for the procedure?

What can you do right now until stem cells catch up with the ability to treat
brain disorders? There are meds, deep brain stimulation and brain training
options that can all help. The love and care we surround people with also makes
maximum use of the dopamine available and can enhance the quality of life for a
loved one with Parkinson's.....keep posted as soon as we see safe viable
treatment it will be posted here!



Monday, December 8, 2008

Fibromyalgia Pain and Cognition


By Amy Price PhD
Photo courtesy of (Earthopod, 2009 )depicting pain areas in fibromyalgia.
Fibromyalgia (FMS) comes from three words, the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Another way of saying this is muscle knots tied by painful ropes. This condition is not amenable to the medical model so clinicians fell back on the old standby “It’s all in your head” implying the problem is generated by emotional instability rather than specific biological origins.


Fibromyalgia was tagged a syndrome (Fibromyalgia, com, 2008). Patients got mad. They refused to be stonewalled by ignorance or marginalized. Instead they formed strong lobby groups and started campaigning for funding and action (Fibromyalgia network, 2008). This resulted in research getting funded, better treatment options and social change. (CRISP lists 695 NIH funded projects since 2000)


Researchers are finding that FMS could be a disorder of the central processing system resulting in neuroendocrinal and neurotransmitter dysregulation (Bennett, 2008). The FMS patient experiences pain amplification because their pain sensors are slow to recognize pain but the pain they feel spreads across a wider area, lasts longer and is more severe than in a person without FMS ( Staud et al, 2008). Increasingly scientific studies demonstrate physiological abnormalities in the FMS patient including increased levels of substance P in the spinal cord (Helle et al ,1998), low levels of blood flow to the thalamus region of the brain (Kwiatek et, 2000), HPA axis hypo function (McBeth et al, 2007) low levels of serotonin and tryptophan plus abnormalities in cytokine function (Crofford, 1998). Abnormalities like these spell pain. This leads to losses in sleep quality, cognition and coordination, and to increased drug use susceptibility.


New research strengthened by the advent of physical evidence such as SPECT, PET, FMRI and QEEG is confirming fibromyalgia is a biological problem that may cause psychological distress rather than a psychosomatic hysteria pioneered by women as appears to be insinuated by Mcdermid et al, (2008)

New hope may come for some FMS sufferers in the discovery of the brain’s ability to regenerate dendrites a process known as neuroplasticity (Toates, 2006). It is possible that targeted brain and body training may alleviate the severity of chronic pain and cognitive dysfunction associated with FMS (Leurding et al, 2008)


Leurding et al (2008) demonstrates that in fibromyalgia both white and grey brain matter is compromised. Brain imaging studies in FMS patients point to alterations in regional cerebral blood flow (Mountz et al., 1995), in cerebral processing of sensory and nociceptive stimuli (Gracely et al., 2002; Cook et al., 2004) also in dopamine response to pain (Wood et al., 2007). Leurding (ibid) used these imaging studies as a foundation for neuropsychological tests to show that the changed state of brain matter leads to “brain fog” rather than psycho-social maladaption, drug induced confusion, or loss of sleep as primary factors.


Patients offered cognitive rehabilitation tools may improve mental function when these tools are offered before significant white and grey matter dysfunction appears. Neuroplasticity can still be of benefit after damage occurs but progress is slower (Saczynski, 2004)
Brain areas responsible for proprioception damaged in fibromyalgia may be modified by body awareness training according to a pilot study carried out by (Kendall et al, 2000). Targeted body awareness physiotherapy programs led to patient improvement in pain levels and functional capacity even when patients were retested eighteen months after treatment (Kendall et al 2000).
Kendall et al (2000) were dismissive of positive effects realized by stress reduction, hypnosis or neurofeedback training but other researchers such as Meuler et al, 2001 found these treatments were beneficial. FMS is not one size fits all (Bennett, 2006).


A trial of cognitive rehabilitation synergised with neurofeedback and cognitive rehabilitation is underway to determine how combining passive and active therapy can multiply positive effects. Participants will be tested at timely increments and their ongoing level of progress studied.


Another option is to decrease pain to restore function. This is where regenerative medicine can help with therapies like adult stem cell treatment and prolotherapy. Another option is a treatment called IMS where overly sensitized nerve points are reset using a medical system similar to acupuncture.



Bennett, R. (2006) Understanding Chronic Pain and Fibromyalgia: A Review of Recent Discoveries Oregon Health Sciences University, National Fibromyalgia Association. A non-profit 501 (C)(3) organization 2121 S. Towne Centre, Suite 300, Anaheim, CA 92806 714.921.0150 Copyright ©1997-2008 National Fibromyalgia Association (NFA) http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_science (accessed 12/01/2008

Buckelew S, Conway R, Parker J, Deuser W, Read J,
Witty T,. Hewett J, Minor M, Johnson J, Van Male L, McIntosh M, Nigh M, and Kay D, Biofeedback/Relaxation Training and Exercise Interventions for Fibromyalgia:A Prospective Trial Department of Physical Medicine and Rehabilitation, Missouri Arthritis Rehabilitation Research and Training Center, School of Medicine, University of Missouri-Columbia. Submitted for publication June 16, 1997; accepted in revised form October 13, 1997.
1998 by the American College of Rheumatology.

Cook DB, Lange G, Ciccone DS, Liu WC, Steffener J, Natelson BH.Functional imaging of pain in patients with primary fibromyalgia.J Rheumatol 2004; 31: 364–78.

CRISP http://crisp.cit.nih.gov/crisp/crisp_lib.query (accessed dec 04, 2008)

CROFFORD LJ. Neuroendocrine abnormalities in fibromyalgia and related disorders.American Journal of the Medical Sciences 1998;315(6):359-66. Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0680, USA

Fibromyalgia.com http://www.fibromyalgia.com/ (accessed Dec 01,2008)

Fibromyalgia Network, P.O. Box 31750, Tucson, AZ 85751 (800) 853-2929. http://www.fmnetnews.com/about-philosophy.php (accessed Dec 04,2008)

Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 2002; 46: 1333–43.

Helle H,, Førre R , Kåss E, Terenius L (Jan 1988). "Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis". Pain 32 (1): 21–6. doi:10.1016/0304-3959(88)90019-X

Kendall S, Sog¨ ren, B Gerdle B, and Gustav K, Henriksson, Department of Rehabilitation Medicine,
Faculty of Health Sciences, Linko¨ping, and Pain and Rehabilitation Centre, University Hospital Linko¨ping, Sweden; and Kerstin
Brolin-Magnusson, Fysioteket, Billdal, Sweden.Submitted for publication January 20, 2000; accepted in revised form June 17, 2000.
© 2000 by the American College of Rheumatology.

KWIATEK R, BARNDEN L, TEDMAN R, JARRETT R, CHEW J, ROWE C, and PILE K REGIONAL CEREBRAL BLOOD FLOW IN FIBROMYALGIA,Single-Photon–Emission Computed Tomography Evidence of Reduction in the Pontine Tegmentum and Thalami ARTHRITIS & RHEUMATISM, Vol. 43, No. 12, December 2000, pp 2823–2833© 2000, American College of Rheumatology

McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R, Dickens C, King Y, Macfarlane GJ. (2007). "Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: findings of a population-based prospective cohort study.". Arthritis Rheum. 2007 Jan;56(1):360-71.. 56 (1): 360-71

MCDERMID A. J. (1) ; ROLLMAN G. B. (1) ; MCCAIN G. A. (2) ; Author(s) Affiliation(s) (2008) Generalized hypervigilance in fibromyalgia : evidence of perceptual amplificationAuthor(s) (1) Department of Psychology, University of Western Ontario, London, Ontario N6A 5C2, CANADA(2) Division of Rheumatology, University Hospital, London, Ontario, N6A 5A5, CANADA, Publisher, Elsevier, Amsterdam, PAYS-BAS (1975) (Revue) Published 2008 http://cat.inist.fr/?aModele=afficheN&cpsidt=3210987 (accessed 12/01/2008)

Mountz JM, Bradley LA, Modell JG, Alexander RW, Triana-Alexander M,Aaron LA, et al. Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. Arthritis Rheum 1995; 38: 926–38.

Mueller H, Donaldson C, Nelson N, Layman M, Treatment of Fibromyalgia Incorporating EEG-Driven Stimulation: A Clinical Outcomes Study JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 57(7), 933–952 (2001) © 2001 John Wiley & Sons, Inc.

Saczynski, J., Margrett, J., Willis, S. “Older Adults' Strategic Behavior: Effects of Individual versus Collaborative Cognitive Training.” Educational Gerontology. 2004 Aug; 30(7): 587-610.
Staud R, Craggs J, Perlstein W, Robinson M, Price D, Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls a Department of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Department of Oral and Maxillofacial Surgery, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States Received 22 May 2007; received in revised form 13 December 2007; accepted 2 February 2008
Available online 25 March 2008

Toates, F. (2006) Biological Psychology, Pearson Education, Harlow. UK

Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner EA, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci 2007; 25: 3576–82.

Monday, November 24, 2008

Your Brain On Trauma

By Amy Price PhD

Brains have axons. These are tiny fibers that are like an electronic circuit board. Axons make brain communication possible. If these are stretched past ten percent of their length they can not function and the connection is broken. To put this in perspective you can stretch your hair sixty percent beyond its length before it breaks. Broken connections mean lost function. Hair can be broken simply by running a brush through it. We seldom question the news when we are told the ninety pound teenager shook the baby to death. Yet when an adult brain is shaken by the impact of a 2500 pound car people think this could not happen. The injured are often asked if they were unconscious. The sad truth is that most brain injured people will not know if they were unconscious and will just say no.

The brain...you can build it a team can help!

Dr. Gail Denton author of the best selling book Brainlash states the Brain Injured person needs a team to restore their potential. Dr Denton wrote the first addition of this book after she sustained a brain injury. She is a successful artist, author and therapy consultant. She is presently working on research to determine the optimal brain diet and has contracted with her publisher to produce a new book featuring food for the brain and great recipes. Brain Injury does not have to be a death sentence! For helpful strategies for yourself or others take a look at this book!

Every brain injury is unique. Recovery usually does not mean returning to who and how you were before, but rather finding a new relationship to your abilities and your world. Lisa sustained a brain injury in 1993. She used her recovery to create a remarkable tool for individuals and families that struggle with brain injury. The kit was developed with Sandra J. Knutson, CRC, CDMS, CCM, Lisa’s former brain injury caseworker, and a thirty-year veteran in the brain injury recovery community. The Brain Injury Recovery Kit™ (BIRK) was created by Lisa Keller.

Try the complimentary 39 Point Learning Assessment to see if you can be set free from brain fog and live in the land of clarity! Try some free brain games to help with brain fog. CDC has published a helpful guide about what to do if you or a loved one has experienced a head injury with or without loss of consciousness. It is free http://www.cdc.gov/ncipc/tbi/tbibook.pdf

'Peace is not the absence of war....it is a deposition for benevolence, confidence and justice' (Francis Bacon)

Monday, October 6, 2008

Open Access..Key to Knowledge?



In January 2007 Five leading European research institutions launched a petition that called on the European Commission to establish Open Access which would require all government-funded research to be made available to the public shortly after publication. Despite scant media attention, word spread like wildfire through scientific and research communities and more than 20,000 signatures, including multiple Nobel Prize Laureates and 750 organizations. In response, the European Commission committed more than $100m (£51m) towards facilitating greater open access Read Full Article

From a social change perspective this is good. As reading increases and rights to access are enforced, society is enriched and autonomy is increased.

At present institutions access funds for research, Academics and Scientists submit materials for 'peer reviewed' publication. The journals sell this content back to subscribers and institutions at hefty prices. There is also serious concern for bias. Journals are known to present their view free of charge but yet charge upwards of thirty dollars for each access to rebuttals effectively subverting the scientific process. Many journals now sell ads which further subverts the objective process.

The journal argues peer reviewing is costly and they can not afford to create open access. It seems to me that paying for something that has already been paid for by the various universities and grants is like graft. Furthermore some journals are triple dipping. They get the research for free, have advertisers, and sell subscriptions.

In answer to the journals position that they are paying big money for peer reviewers...I asked around. It seems most peer reviewers do this as a part of a job or in some cases because of political demands. They are expected to lend their time and name to make publishers fat and if they don't do it they are excluded politically.

The old argument that research is complex and the scientifically uneducated majority will read to their own harm is as old as the religious dogmas refusing access of the Bible to common people. This kind of exclusionary power led to the crusades where people were unjustly executed in the name of God to further political agendas.

Let's not forget the search engines in all of this. They have no obligation to disclose search sources so are also potentially huge political players in the area of research and access.
It is important for society at large to see the original research. This way they can go to medical appointments fully prepared. I have personally accessed treatment not available to others because I laid out research to support my position. With access individuals can monitor the sources for funding and learn how statistics can be adjusted or ignored because of a journals bias....They are also less likely to fall prey to inaccurate media reports and agree to treatments that are not in their best interests. Knowledge is power and journals want to keep it ...well my view is Open Access can open dialogue and lead to expanded knowledge we are all working let them pay their fair share and hold up their end of the piano!