TG,

Right on! Placebo research design is spurious to say the least. It is the easy way to prove the so-called efficacy of a treatment. By testing a drug against a sugar pill, they are really setting the bar high, aren't they? What wouldn't have an effect measured against that; not to mention that it is ethically suspect. The true test is an active control design. This involves measuring a potential new drug against existing treatments. Imagine TEVA and Azilect taking on Selegiline, for example. It doesn't happen because the risk is too big that there isn't a whole lot going on with the new MAO-inhibitor. Better to come up with an iffy delayed start trial design and measure against de novo patients with all in the earliest stages of disease process. That way they improve their chance of a much more positive spin. The real test is to look at patients who took either selegeline vs. rasagaline for a five year period, who comes out ahead of the game then? Truth is pharmas select a design model based on what yields the best result for their bottom line, and the FDA does what again?

Do you know the work of Marcia Angell? She is a former editor of NE Journal of Medicine and a critic of the FDA and the whole clinical research "system" especially the role of pharma.

Sham surgery is beyond reprehensible. Talk to Paula about that one. It is banned in Europe, yet embraced here as the "gold-standard"- pish!

Here is a great article on the ethics of sham surgery. Placebos that harm It just so happens to focus on Parkinson's shams....