I wonder if anyone else, as I do, sees a fundamental flaw in the way many of these trials are designed. With a condition such as PD, where is is widely acknowledged that there is huge variation in presentation, progression, response to medication, and a whole host of other things, including the experience of side-effects that even to the patient maybe virtually indistinguishable from the symptoms of the disease, trial design might NEED the modifications that Laura talks about. Further to that, it does not surprise me that this trial showed better results at a lower dose. I remember reading once that many patients with PD are exquisitely sensitive to medications, something that is born out by the many patients who split medications, and vary timing and combination patterns. I simply do not see how they quantify anything through the ratings of the UPDRS scale, it is simply too subjective. This is not a condition that can be treated by the 'one aspirin, two aspirin' approach to medicine, why is there an assumption that trials should be any different..........

Another case for including patient input in trial design.............

Lindy