Parkinson's sufferers often have impassive faces, speak in soft monotones and walk with small, shuffling steps, hunched forward. The disease inflicts both the inability to move and uncontrollable movement, from slight tremors to wild flopping that can dislocate joints. Skeptics about pallidotomy often cite the false hopes raised in 1987 by a Mexico City surgeon named Ignacio Madrazo. He reported helping patients by transplanting into their brains cells from adult adrenal glands, which were thought to spew chemicals offsetting a neuronal deficiency. Patients rushed to get the transplants, but U.S. researchers in 1989 quashed the fad by reporting that careful evaluations of such patients showed minimal, short-lived benefits and a high rate of complications.
Surgery can cause a placebo effect.
With Parkinson's, the risk of overestimating an operation's benefits is heightened by the subjective nature of many of the disease's symptoms, says Chicago neurologist Harold Klawans. While acknowledging that pallidotomies can help some people, the doubters say desperate patients may rush to get the operation from surgeons who don't have much experience doing it, with potentially disastrous results. Indeed, Dr. Laitinen reported that six of his first 38 pallidotomy patients had permanent blind spots in their visual fields after the surgery. The problem no longer occurs, he says, because he has figured out how to avoid damaging neurons that carry visual signals. The skeptics also note that before L-dopa, neurosurgeons often tried, with only limited success, to help by destroying parts of the pallidum.