Originally Posted by johnt

The referenced research uses "functional magnetic resonance imaging to reveal areas where Parkinson's disease and related conditions cause progressive decline in brain activity".

The ability to "see" what is happening in the brain is enormously useful in understanding the pathogenesis of the disease. But, I am skeptical about its usefulness as a biomarker: it has high cost; it is hospital based, forcing the patient to go to travel; observations are likely to be infrequent; and most importantly the measure that comes from this imaging, perhaps size of the affected area, is a proxy for the real impact of the disease, which is reflected in the symptoms.

In my opinion, a better way forward is to measure the symptoms of the disease. This can be done objectively, with high frequency (perhaps every second) and as the patient goes about his life. One way to do this is to use accelerometers to measure movements of the body.

On the issue of the placebo effect. I understand that in Parkinson's the placebo effect is more than just the perception that a therapy improves the condition. Rather, it is a stronger effect: as measured externally and objectively, it does improve the condition, and not just the perception of it. Some would argue that a placebo is effective for a shorter period than a "true" therapy. In my opinion, a placebo is as much a true therapy as a drug. It needs to be engineered, measured and judged against more conventional therapies. Fortunately, it is not the case that we can only have an organic effect or a placebo effect, the best therapies will have both.

John