"I think the surgeons may not be aware of the long term consequences of denervation"

Email response from Dr. Ahmet Hoke of  John Hopkins School of Medicine,  School of Neurology - Specifically I asked him his opinion on three things:

1. What was his opinion of ETS in terms of risks vs benefits
2. His opinion on why Thoracic surgeons would advertise a surgical reversal approach when, as he sees it, it would  have a very low probability of success
3. His opinion on the Davinci Robot Reversal article regarding surgical reattachment of the sympathetic nerves

1. It all depends on the risk benefit analysis, for some patients yes it may make sense as not everyone develops as severe side effects.
2. I think the surgeons may not be aware of the long term consequences of denervation.

The paper you refer to is not a good model of what happens to the patients because they cut the nerve and immediately repaired it. In such immediate repairs, the ganglia does not loose it's neurons and can regenerate. A better model would be to cut the nerves, wait 6 months and then do the repair; I suspect the recovery would be a lot less.
Ahmet Hoke M.D., Ph.D. FRCPC
Professor of Neurology and Neuroscience
Director, Neuromuscular Division
Johns Hopkins School of Medicine
Department of Neurology
855 N. Wolfe St., Neurology 248
Baltimore, MD, 21205
USA

It is of concern that most mental health initiatives are associated with an increase in suicide rates

Aust N Z J Psychiatry. 2004 Nov-Dec;38(11-12):933-9.
http://www.ncbi.nlm.nih.gov/pubmed/15555028

"Pharma Collaboration", unreported in the Australian media, linked the Mental Health Council of Australia directly to global pharmaceutical giants

IN OCTOBER 2004, the nation's most influential mental illness advocacy group signed a deal that financially tied it to some of the world's biggest pharmaceutical companies.
The so-called "Pharma Collaboration", unreported in the Australian media, linked the Mental Health Council of Australia directly to global pharmaceutical giants Pfizer, Eli Lilly, Glaxo SmithKline, Bristol Myers Squibb, Lundbeck, Wyeth and Astra Zeneca.
It has been a good deal for the non-profit council, which promotes itself as Australia's peak mental health group, providing 8 per cent of its total income. It also seems to have benefited the drug companies, which have a strong financial interest in selling medication to treat mental illness, especially the "new epidemic" of depression.

http://www.theage.com.au/news/national/mental-health-takes-industry-pills/2006/08/07/1154802820416.html

Mental health funding lacks transparency

9% of the population of Australia is taking psychiatric drugs, 5% are on antidepressants. In USA 6% are on antipsychotics making them the most commonly prescribed drugs but information on our percentages is not available in Australia. About 1% of the population suffers from schizophrenia, http://www.schizophrenia.com/szfacts.htm 0.5% to1% from bipolar http://en.wikipedia.org/wiki/Bipolar_disorder (found by the WHO's epidemiological studies over scores of years and across cultures) and biological depression is rare and treatable. 40% of these tiny percentages of persons who do suffer from genuine schizophrenia or bipolar also have genetic mutations: they are hard to treat and require close monitoring with special care. The small number of persons being treated for mental illness diagnosed and confirmed before medication, comprise a tiny minority of those I see. It is the population with side effects that manifest as the huge increase in demand (and costs) since the first of the new generation drugs, Prozac, was introduced in 1990. An adverse response to the first drug or illicit substance should suggest that the patient might have a diminishing metabolism genetic polymorphism. This information can be gained, in retrospect, by taking a good history and a buccal swab. This problem is the outcome of the education of psychiatrists by the pharmaceutical industry, which fund key opinion leaders, guideline writers, beyondblue, Lifeblood, Sphere all organisations that provide psychiatric education that serves their commercial interests and are all funded by the Pharma Collaboration. This is in conflict with the altruism, the need to put patients first, that one associates with the practice of medicine and is in the realms of the unthinkable. http://www.theage.com.au/news/national/mental-health-takes-industry-pills/2006/08/07/1154802820416.html http://www.mhca.org.au/index.php/our-work/mhcapharma-collaboration Drug-company-funded Key Opinion Leaders write tomes on “intractable schizophrenia.” The relationship of drug side effects and genes shows that most persons so diagnosed are suffering from side effects, and only a few from side effects superimposed on pre-existing mental illness. www.trsconsensus.com.au Mental illness should first be diagnosed before treatment that has similar side effects is introduced. This also accounts for deteriorating outcomes in serious (read medicated) mental illness. The evidence from epidemiologists is that the death rate and suicide rate (and violence) have increased hugely for treated serious mental illness and are 20 times as high now as they were before we started medicating willy-nilly with no regard for genetics. I quote again from Akathisia Homicides http://www.dovepress.com/articles.php?article_id=7993. "Deteriorating outcomes in mental illness, deaths, violence, and suicide rates have been documented by epidemiologists and have increased up to 20-fold since 1924. http://bjp.rcpsych.org/content/188/3/223.long http://www.ncbi.nlm.nih.gov/pubmed/21172095 http://www.ncbi.nlm.nih.gov/pubmed?term=Do%20nations’%20mental%20health%20policies%2C%20programs%20and%20legislation%20influence%20their%20suicide%20rates http://www.arafmi.org/resource/tracking-tragedy-report-homicide-serious-injury-and-suicide-2008 http://www.epi.msu.edu/janthony/EpidemiologyReviewsPathopsychology/McGrath2008.pdf Some people taking psychiatric drugs develop akathisia and some people who develop akathisia kill themselves or others. Yet the drugs can be effective in persons suffering serious depression, provided their doses are adjusted according to their ability to metabolise them normally and there is informed monitoring.

http://www.mjainsight.com.au/view?post=mental-health-funding-lacks-transparency&post_id=7889&cat=issue-3-30-january-2012