what advantage is there to measuring the placebo group 6 months on - PD is degenerative (with fluctuations)
many patients get the Hawking effect, that is, they reduce their inflammatory dietary impact and eat regularly, do their exercises, get the right amount of sleep, take their prescription punctually, consistantly chat positively with family and friends, resultant a patient exhibits very positive scores (relatively) and they tend to keep this effort up, it's a circular psychologic effect - this amplifies a positive spin on their answers by them - this effect works for both groups so there is no edge in this "boost" period, until the trial is over, however, some placebo patients may go onto to keep up the effort and even tho PD degenerative that effect can last many months as the degeneration is slowed down, the pre-trial rate has changed course but the trend remains longterm, conversely some patients will tend to become less than attentive to their PD needs when they find out they were a recipient of the implant - it's a fair to ask how scores are conducted because of this effect
there is no marker for absolute dopamine production and there is no absolute marker for how much is being produced at any time or any rate,
for example if a PD patient has low pineal gland activity, a hormonal imbalance causing lack of sleep can mask/increase PD symptoms
dopamine as a regulator, on days when it's low there is neural donwregulation and vice versa when more is produced so these affect pathway communication but those pathways are also affected by the patients activities especially in what passes thru the gut, many things we think are innocuous act as switches regardless of the volume (grams/litres)
there should a be a considerable shift in the curve 18 months out, at least a flattening of the curve for implant patients, versus placebo which should, in toto, continue to widen from the trial (zero) level
from this deck chair anyways
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