Placebo Surgery in Trials of Therapy for Parkinson's Disease

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Abstract
The Sounding Board articles by Freeman et al.1 and Macklin2 (Sept. 23 issue) provided an excellent discussion of sham surgery for patients with Parkinson's disease. However, Freeman et al. seem overenthusiastic about downplaying the risks of sham surgery. Their statement that these procedures are easier to perform, standardize, and reproduce than traditional surgical procedures does not do justice to the neurosurgical skills involved in performing stereotactic brain surgery. It is probable that the wide range of outcomes regarding the effectiveness of and morbidity associated with pallidotomy is related to the varying skills of the operating neurosurgeon.