February 27, 2015

A Bedtime Snack that Promotes Regularity

Yesterday's post about toilet bidets focused on the end of the digestive process. Today, let's go back to the beginning.

Arthritic hip pain impacts my quality of life less than a few days of constipation. Fortunately, the frequent bouts of unpleasant irregularity that plagued much of my life practically disappeared when I started taking the over-the-counter, serotonin-boosting supplement 5-HTP after my Parkinson's diagnosis in 2009. Since constipation is a common non-motor symptom of PD, the relief from 5-HTP was a special blessing.

Late last year, I tried going without that supplement for a month. Within a few days, constipation came roaring back. My geriatrician recommended Senokot -- the non-prescription laxative containing senna -- and the stool softener Colace. Neither did much good.

The only thing that helped was returning to 5-HTP. But it needs help to keep me regular.

I've used Metamucil crackers at bedtime, but they require lots of fluid to wash them down... intake that means additional bathroom visits during the night. Recently, I've found the most effective, natural bedtime concoction to keep things moving.

Just before hitting the sack, I mix several tablespoons of applesauce with a tablespoon of powdered Metamucil and a tablespoon of chia seeds (picture above). This combo works better than anything else I've ever tried.

February 26, 2015

Toilet Bidets: Safe, Effective, and Great for the Elderly

The bidet is a fixture in bathrooms the world over, but it has never really caught on in the U.S. Instead of washing with water after relieving ourselves, Americans would rather deforest millions of acres in order to produce toilet paper.

We think bidets are too European, too Parisian. We suspect they have something to do with s-e-x.

But more and more people – myself included -- are beginning to tout the bidet as a safer, more effective way for seniors to clean themselves.

Bidets: Not Created Equal
We’re not talking about traditional free-standing bidets. They take up lots of bathroom space, and older users could have trouble mounting them.

What I’ve found very helpful are toilet bidets. These provide an underseat wand that moves into position and sprays water over the perineal area.

I don’t remember how I first learned about toilet bidets. But when I found a cheap one that could be easily installed on my toilet without major plumbing expense, I decided to give it a try.

The Blue Bidet -- now a feature on all the toilets in my house – retails for just $37.12. Kohler, the largest U.S. manufacturer of bidets, has one model that costs over $1,000… and another (with a remote control!) goes for about $2,000, plus installation fees.

When I installed mine several years ago, I became an instant fan. As I age -- and as my Parkinson's infirmities increase – I am more and more disgruntled when I have to use a standard toilet.

February 25, 2015

Author Oliver Sacks Reacts to News about His Metastasized Cancer

Last Thursday, I read a brief op-ed piece in The New York Times by Oliver Sacks, neurologist and author of many books, including Awakenings and The Man Who Mistook His Wife for a Hat.

Sacks provides the title “My Own Life” for his commentary, while his editor adds the subtitle, “Oliver Sacks on Learning He Has Terminal Cancer.”

I've already reread this several times.There’s nothing more to say about this piece, which I include below, in full.

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A month ago, I felt that I was in good health, even robust health. At 81, I still swim a mile a day. But my luck has run out — a few weeks ago I learned that I have multiple metastases in the liver. Nine years ago it was discovered that I had a rare tumor of the eye, an ocular melanoma. Although the radiation and lasering to remove the tumor ultimately left me blind in that eye, only in very rare cases do such tumors metastasize. I am among the unlucky 2 percent.

I feel grateful that I have been granted nine years of good health and productivity since the original diagnosis, but now I am face to face with dying. The cancer occupies a third of my liver, and though its advance may be slowed, this particular sort of cancer cannot be halted.

February 24, 2015

FDA OKs Faster, Simpler Access to Unproven Drugs for Terminally Inn Patients

Earlier this month, Dr. Peter Lurie – the Food and Drug Administration’s associate commissioner for public health safety and analysis – announced a much simpler and faster process for doctors to get unapproved, experimental drugs for their patients who have serious or life-threatening diseases and no other alternative.

While a 60-day interval for comments must pass before the revolutionary process officially becomes effective, Lurie made it clear the FDA will allow doctors to submit requests according with the new policy now.

In the past, doctors needed about 100 hours to assemble applications for experimental drugs for a qualifying patients. They were required to supply 26 different kinds of information and seven separate attachments.

Now, the process will take less than one hour, requiring doctors to give only eight pieces of information, with only one attachment. They must provide the reason they want to use the experimental drug, along with the patient’s clinical history. 

In sharp contrast to a gridlocked Congress mired in partisan politics, the FDA slices away layers of red tape for sick and dying patients who have no other options. It seems a triumph of good sense, offering hope for terminally-ill people.

Conditions Still Apply
The process, while much simpler, still carries certain requirements:
  • There must be no other product that can diagnose, monitor, or treat the patient’s condition,
  • The patient may not be already involved in some clinical study testing the requested drug,
  • Doctors must show that the risk of using the unapproved drug doesn’t exceed the risk posed by the disease it is designed to treat,
  • Doctors must guarantee that the drug’s manufacturer is willing to provide it.

Even when all conditions are met, the FDA can’t force a manufacturer to supply the requested drug. It simply provides guidance on how to do it.

February 23, 2015

Oil-Burning Furnace Safety

My friend JoAnne sent me an email last week that seemed an important heads-ups for anyone whose heat comes from an oil-burning furnace. I suspect this alert applies for many readers during this continuing cold weather.

Thanks, JoAnne, for the important warning.

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Hi John,

Just thought I’d share with you a close call I had this past week.

I lost my sense of smell many years ago. When I owned my own home I made sure the gas furnace had regular maintenance checks and installed smoke and carbon monoxide detectors on each floor. As my PD progressed I could no longer afford my home and ended up renting an older home with an oil furnace.

In the last month I’ve woken up to find the house was quite cold and that the furnace had quit some time through the night. I’d press the red restart button and it would run again. Last week I had some misgivings at having to do this for the 5th time. I hated the idea of bugging the landlord, but I asked to have a repair person check it out.

February 20, 2015

Lonely? Got Cabin Fever? Try a Long Lunch at Whole Foods

Loneliness is not a problem for me these days. But I was getting cabin fever after being cooped up in the house for much of the past week thanks to the cold and snow. I hesitate to mention our three meager inches of snow -- which shut down the federal government, local governments, schools, etc. -- when I consider what my family in Upstate New York and friends in Cape Cod and elsewhere are going through.

On Wednesday, a terrific three-hour midday outing revived my spirits. I needed to go downtown to my doctor's for some blood work. Fortunately, the office is just across the street from one of the busiest Whole Foods stores in DC.

The bloodletting took only half an hour. Afterward, I walked to Whole Foods for lunch and some grocery shopping. I filled a cardboard container with healthy selections from the many buffet choices, grabbed a bottle of water, and headed for the checkout.

I found a great table -- all to myself -- in the back of the dining area. I spent the next two hours engaging in my favorite sport -- people watching. I'd also brought along some health-related reading material, so I enjoyed two hours of good food, fun people watching, and productive work.

Reflections on Past Spells of Loneliness
Though not these days, loneliness has been an issue for me in the past. My childhood was fairly lonely, and attending college as a day student wasn't the typical fun- and friend-filled experience.

But BNA, the publishing company where I worked for 40 years, provided me a wealth of friends... and not all of them disappeared when I retired. Finally coming to terms with my sexuality and alcoholism also gave me many good friends from AA and the gay world.

My travel addiction created two "homes away from home" for me -- first in London, later in Nepal. Now, I have treasured friends from both places.

But my preference for independent travel also resulted in spells of loneliness. My wife died in 1978, and my children left home the same year. For the next five years, my annual vacation involved buying a 15-day Eurail pass and bouncing around Europe on my own. I tried to stay within Frommer's "Europe on $25 a day" budget, so I often ended up staying in some depressing accommodations.

February 19, 2015

Physician-Assisted Suicide: Yea? Nay?

Is legal physician-assisted suicide inevitable in all 50 states? In the argument for assisted suicide, which outweighs the other -- pros or cons? Does it make sense for a government to support suicide prevention and legal assisted suicide at the same time?

These are questions raised in an article published on February 13, 2015 by True Dignity Vermont (TDV), a grassroots, independent, citizen-led initiative in opposition to assisted suicide in Vermont. The headline: “A Deep and Tragic Irony: In Vermont, Lawmakers Praise Suicide Prevention While Legally Enabling Suicide.”

The topic of assisted suicide – the right of terminally ill people to choose the time and manner of their own deaths – has been more and more in the news. Full disclosure here: I am not neutral on the subject. I have frequently written about assisted suicide, and have said I’d definitely consider the option under certain circumstances. I feel that way today, and it is highly unlikely I’ll change my position.

Nonetheless, the story raises a few interesting issue for debate.

Are All Suicides Created Equal?
According to the TDV article, pain – or the fear of pain – is rarely cited by terminally ill patients who want to die. Instead, the author writes that in Oregon – apparently the only state for which data is now available -- the top three reasons terminally ill patients want to die… the reasons they give their doctors when asking for assistance with suicide -- are:
  • loss of autonomy,
  • loss of ability to engage in enjoyable activities,
  • loss of dignity

At the same time, as the article points out, suicide.org (“Suicide Prevention, Awareness, and Support”) begins its catalogue of suicide causes this way: “Over 90% of people who die by suicide have a mental illness at the time of their death. And the most common mental illness is depression.”

Under its lengthy list of the causes of depression are:
  •  “Feeling that things will never ‘get better,’”
  • “Feeling hopeless,”
  •  “Inability to deal with a perceived ‘humiliating situation.’”

The TDV article asks: Are the two lists really all that different? Is it reasonable – even conscionable -- to use these reasons to support assisted suicide for the first group, and the same reasons to support suicide prevention for the second?

February 18, 2015

Coconut Oil Updates: Dementia and Blood Pressure

I've posted often about the coconut-oil-for-Alzheimer's bandwagon. I've often discussed my concerns about the product's efficacy as a treatment for dementia; just enter "coconut oil" in the search box at the upper right for earlier posts.

Dr. Mary Newport led the charge for the "coconut oil miracle." She fell silent about two years ago but re-emerged last fall with a blog post suggesting she was scaling back her claim.

I continue to read anecdotal reports -- some from people I've met online and respect -- that describe cognitive benefits from coconut oil. But anecdotal reports are not science. My own "anecdotal" experience with 5-HTP turned out to be very unique to me. I'm afraid my early raves about the supplement may have caused disappointing false hope for others.

The Alzheimer's Society of the UK recently released the video below. I knew a clinical trial was underway, examining coconut oil's possible effectiveness in treating dementia. We expect to see the results of that trial in September, finally bringing science to bear on the issue.

February 17, 2015

Bill Maher on Ageism in America

When was the last time you heard a talk show host tell his audience “Ageism is the last acceptable prejudice in America”? 

Those were Bill Maher’s words on HBO’s “Real Time” as he launched into a six-minute diatribe about our national obsession with youth (and arse) and lack of regard for the value that age can bring.

Maher made these comments last November. I just saw the clip and wanted to share it without further comment.

Caregiving, Parkinson's, Aging: A Reader Responds

Occasionally, blog posts prompt reactions from readers... a big reward for me. What follows is a friend's email in response to my post last week about caregiving. She gave me her consent to share it, but -- as you might expect -- I've tweaked a few names and details.

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John, Enjoyed your blog as usual. I agree that there is a fine line between loving caring and doting. I find that the more services we render to Jackson, the more dependent he becomes. He has lost confidence in doing simple tasks that he has the ability to perform.

This relates to your article on exercise. I find that the best time to encourage Jackson to do anything is after our exercise classes. One that we like is "Zumba." You exercise to music and go through movements that require some thinking. You have probably done this. An example is moving your hands to form the letters YMCA. This sounds simple, but it is challenging to do it in keeping with the music.

Jackson doesn't like discomfort, let alone pain. While PD underlies his total health problems, he has fairly serious knee and hip injuries that severely compound his problem. Specialists have indicated that surgical intervention would be in order for each problem, but osteoporosis and PD weigh against surgery. Oh. The joys of aging.

We came up to our place in the mountains. Fortunately one of our daughters and her husband are here and have taken on all of the meal preparation and cleaning up. The writer is finding it more and more difficult to do routine tasks. I used to enjoy cooking, and did most of it for several years. That talent has left me. I don't find pleasure out of a lot of things I did for pleasure, like gardening.

So, PD has an influence on activities and physical ability, but so does aging. Without caregivers, life would be very difficult for both of us. Fortunately we live in a great place where all services are rendered, including dining in a nice dining room with others. Our exercise is done with others and we participate in activities with others every day. Being with and doing things with others is good for both of us.

Jackson doesn't like to perform any tasks, but he enjoys going to various activities in our community. Here in the mountains, he enjoys our house, but has to get out at least twice a day and experience something. His favorite activity is to ride with me on our golf cart and explore the golf course and environs. We look out on a golf course with wonderful views beyond. We never tire of the beauty. This perks him up more than anything. When we return to the lake, we enjoy scenic drives almost daily.

February 13, 2015

A Caution for Caregivers: Treat Me Like an Invalid and I'll Become an Invalid

So far, I haven't needed much help handling normal everyday tasks. But as I approach my 86th birthday -- and the sixth anniversary of my Parkinson's diagnosis -- I can see the handwriting on the wall. I'll probably need increasing help from family members, friends, and -- eventually -- paid caregivers.

As a result, I think a lot about the relationship between patient and caregiver. I spoke recently with a friend who has been both a volunteer and professional caregiver. She told me the biggest problem she sees is the tendency of family members to treat their elderly loved ones as invalids. The result, she said, is that patients become invalids. My friend often encounters tensions with family members when she comes in and gets granddad up from his wheelchair and out for a walk.

February 12, 2015

Diagnosing Parkinson's from a Simple Puff of Breath?

What if doctors could detect and diagnose a patient’s Parkinson’s disease – early on – with just a simple breath test?

It may sound a bit like science fiction, but the technology has shown promise, and more testing is underway.

In 2015, there is no useful diagnostic tool for PD. Doctors might detect the disease based on their patients’ symptoms -- like tremor, stiffness and difficulty with movements and speech. Test results might lead to diagnoses. 

But these techniques often don’t’ ID the disease early enough, and they aren’t foolproof. In fact, studies have shown that up to 20% of people diagnosed with Parkinson's show no evidence of the disease in post-mortem examinations.

The Curse of Late PD Diagnoses
Millions of others – like me – don’t get a proper, formal PD diagnosis until long after the disease has begun to do its destructive work on the brain’s dopamine-producing neurons.

In my own case, one arm wasn’t swinging normally – evidence that some Parkinson’s-related stiffness was already setting in. I also lost my sense of smell – a common early-warning sign -- long before any of my doctors spoke the word “Parkinson’s” to me.

There’s no question: the current absence of a reliable, useful PD diagnostic tool puts people with Parkinson’s (PWPs) at a real disadvantage. Some estimates suggest that up to 80% of PWP’s dopamine levels have been lost before diagnosis. In those advanced cases, therapy becomes mostly a matter of damage control.

Take a Deep Breath
Scientists believe that the degradation of nerve cells in the brains of PWPs leaves a kind of chemical footprint in the body… a biomarker which an appropriate test might be able to indentify. Find that biomarker early enough, and useful, symptom-thwarting treatment could begin right away.

February 11, 2015

Ebb and Flow of Bigotry toward Jews, Gays and Transgenders

Two weeks ago, I posted about the positive direction of public attitudes toward gays since the early 1950s. That's when Alan Turing -- the World War II hero who broke the German Enigma code -- was arrested just for acknowledging a gay relationship. He was sentenced to chemical castration, a horrible process that led to his suicide. Then last week, I posted about the growing awareness of transgendered people between the early 1980s -- when my friend Ron was changing from female to male -- and now, as the very public Bruce Jenner is reportedly changing from male to female.

I came away from writing those posts feeling upbeat about the progress we've seen combating discrimination and prejudice. But other readings this weekend reminded me of the ingrained nature of bigotry.

Anti--Semitism: 1945-2015
The Sunday New York Times carried a disturbing story about the aftermath of the liberation of the Nazi concentration camps by Allied forces. I’d always been proud of the role U.S. Army played in freeing the death camps, but I didn't have all the facts.

The Times story described the disturbing reality of what “liberation” actually meant for hundreds of thousands of Holocaust survivors, mainly Jews. With the American forces overwhelmed by the sheer number of refugees, the survivors lived for months in decrepit camps in Germany and Austria -- many of them in the same camps where they had been imprisoned. Even after conditions improved, thousands remained in limbo for as long as five years, because the United States and most other nations refused to let them immigrate.

President Truman sent former immigration official Earl Harrison to inspect the camps. In his report to Truman in the summer of 1945, Harrison wrote:
As matters now stand, we appear to be treating the Jews as the Nazis treated them except that we do not exterminate them. They are in concentration camps in huge numbers under our military care instead of S.S. troops.

February 10, 2015

How Exercise -- Like Boxing! -- Benefits People with Parkisnson's

Last week, a story on National Public Radio (NPR) reiterated the importance of exercise for people with Parkinson’s (PWPs).

For the one million Americans with PD, the piece suggests, any kind of exercise is beneficial: boxing, drumming, dancing, tai chi, singing, golfing… in particular, any social activity that stimulates the heart and lungs, lights up the brain, and gets the dopamine flowing.

Dr. Daniel Tarsy -- director of the Parkinson's disease program at Beth Israel Deaconess Medical Center in Boston – sees firsthand the benefits that PWPs reap from exercise programs: "I'm a believer. Patients look a lot different walking out an hour later than they did walking in.”

Tarsy says people in these programs finish their workouts feeling freed from "this straitjacket that's called Parkinson's disease. They say, 'I can do this!' And in many of those people it carries over into their everyday life."

His exercise endorsement for PWPs is anything but new.

Power of Tai Chi
Researchers at the University of Oregon concluded in their 2012 study that PWPs who did tai chi twice a week for half a year showed improved balance and movement control, plus a reduced risk of falling, than another group that did stretching and weight training. PWPs who lifted weights had better balance and fewer falls than PWPs who only stretched.

There’s more evidence for tai chi, too. Harvard Medical School’s Peter Wayne used tai chi to study how Parkinsonian brains change after six months of exercise. Wayne thinks of tai chi as “mindful movement,” suspecting it may help patients use undamaged parts of their brains to compensate for the areas that normally control automatic movements like walking.

Wayne said: “Because the movements of tai chi are geared to be upright and moving, they translate a little better into going downstairs and walking the aisles in a supermarket and being able to lift and put things down carefully."

February 6, 2015

Bruce Jenner and My Friend Ron: Gender Identity and Sexual Orientation

Yesterday’s Washington Post brought the news about Bruce Jenner's transitioning from male to female. I’m just back from the Safeway where I saw People magazine featuring Jenner’s picture on the cover with this headline, ”He is finally happy.” ABC's Diane Sawyer has apparently signed him up for an interview in May. Jenner -- who hasn't commented about these developments -- is said to be planning a reality TV series documenting his transition.

For people like me -- apparently living in a cave and unaware of Jenner's current claim to fame -- here's a brief refresher.

I vaguely remember that Jenner won the decathlon at the 1976 Montreal Olympics. Afterward his world-record-breaking victory, he lived much of his life for the cameras. Fading into obscurity in the late 1980s, Jenner turned it all around by marrying Kris Kardashian in 1991.

The newlyweds launched a lucrative line of exercise equipment. But the big move back to center stage came in 2007. The Kardashian/Jenner clan became a multi-million dollar empire when Kris sold TV host/producer Ryan Seacrest on a reality TV series based on the lives of the publicity-savvy Kardashians.

Much of this was news to me. While the Kardashian name was familiar, I never really knew why they were famous. 

So, here's the 35-year-old flashback triggered by these latest headlines.

Introduction to Transgender Issues: My Pal Ron
After reading this latest news, I thought about my friendship 35 years ago with a transgendered person... a friendship that came at a time of many changes in my own life.

February 5, 2015

Will Dietary Supplements Soon Require Official (Perhaps FDA) Approval?

On February 2, the New York State attorney general’s office advised four of the country’s largest retailers -- Walmart, Target, Walgreens, and GNC -- to stop selling certain dietary supplements.

AG Eric Schneiderman said: “Mislabeling, contamination and false advertising are illegal. They also pose unacceptable risks to New York families — especially those with allergies to hidden ingredients.”

Using DNA bar coding that produces a kind of genetic fingerprint, the AG’s office determined that a whopping 80% of all tested samples of several top-selling products contained no trace of the key, advertised ingredient. Other products contained substances -- not shown on the label – that could prove harmful, even fatal.

CEOs of the four retail giant received notices to immediately cease and desist selling the products in question. In addition, they were given one week – a deadline of February 9 -- to provide details of the procedures they have in place to vouchsafe the ingredients in the supplements they sell.

Advocates of improved oversight – any oversight, really – of the gigantic $13-billion-a-year industry (in America only, not worldwide) hailed the action. It was the first time the unregulated industry faced real legal action. The only “regulation” in place now is a Food and Drug Administration (FDA) “requirement” that supplement manufacturers verify that their products are safe and accurately labeled.

The key words above – regulation and requirement -- are in quotes, because the whole process operates on nothing more than a vague and unenforced honor code.

While Congress has tried -- and failed -- to impose some oversight of the gigantic industry, the new action from New York gives those words some teeth.

Examples of Those "Fraudulent" Supplements

February 4, 2015

My Depression, Parkinson's, and 5-HTP

I believe this "last year of my life" period will end up looking as crazy as your "selling Eskridge Terrace" period. 

That quote comes from a recent email from my pal David. He and I have exchanged emails almost every day for 20 years, so he's very familiar with my eccentricities.

He's referring to these two incidents:
  1. After I got my Parkinson’s diagnosis in the fall of 2009, I decided I needed to sell my house and move into a senior residence. Family and friends told me the notion was crazy, and it was. But I came damn close to doing it. I love the house, the garden, the Palisades neighborhood. And I love sharing the place with my treasured housemates. No retirement home could have provided the quality of life I've enjoyed by virtue of aging in place at my Eskridge Terrace home. 
  2. During the second half of 2014, I was overwhelmed by the roller coaster ride my blood pressure had created. The systolic (upper) number would spike over 200, and later the same day drop below 60. Those spikes raised the stroke threat; the dips – which made me dizzy and unsteady -- raised the risk of falling. I was monitoring my blood pressure constantly, because the twin irregularities required two completely different responses. The chaos reduced my social activities and brought my plans for future travels to a halt. I even decided that 2015 would likely be the last year of my life. Overreacting is normal for me. I've heard my nearest and dearest occasionally mutter "Drama Queen!” But this “last year of my life" business was a classic. Gloria Swanson, move over! 
The Connecting Link
David's linking these two events got me thinking: I had a mother who suffered from clinical depression most of her adult life, and a sister who committed suicide. As a consequence, I've always worked hard to convince myself I do not suffer from depression. I do not suffer from depression. I DO NOT SUFFER FROM DEPRESSION!

Several months after my PD diagnosis, my neurologist at the time recognized my denial and recommended an antidepressant. I was willing to concede I might need a little mood booster, but certainly nothing labeled “antidepressant.” God forbid.

Several years earlier, as I struggled through a bad spell caused by overusing Tylenol PM and Ambien, somebody recommended the serotonin and mood booster 5-HTP. It had helped then, and I suggested I give it another try. My neurologist said OK.

February 3, 2015

Placebo Effect's New Wrinkle: The More You Pay for Drugs, the Greater the Perceived Benefit

There’s a new twist on the well-established placebo effect. The perception you have of a drug’s cost may affect the benefit you receive from taking it.

The study which reached that conclusion appeared in the January 28 online edition of Neurology, the medical journal of the American Academy of Neurology. 

Study author Alberto Espay, MD -- an associate professor at the University of Cincinnati (UC) Department of Neurology and Rehabilitation Medicine, and director of the James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders at the UC Neuroscience Institute -- explained the study’s purpose this way:
Patients’ expectations play an important role in the effectiveness of their treatments, and the placebo effect has been well documented, especially in people with Parkinson’s disease. We wanted to see if the people’s perceptions of the cost of the drug they received would affect the placebo response.

How the Study Worked
Researchers told 12 people with Parkinson’s that they would receive two injections to treat their disease, and that the two shots were different formulations of the same drug. The second injection would come after the effects of the first had worn off.

The 12 believed that the two shots would have identical efficacies, and that only their pricetags differed significantly because of manufacturing costs. Study leaders told them that one injection cost $100 per dose, while the other one cost $1,500 per dose. Before both injections, subjects were told which type they were getting.

Of course, the “cheap” and the “pricey” injections were identical saline solutions.

To make sure the order of injections – $100 and $1,500 -- didn’t affect the subjects’ perception of effectiveness, some of them got the cheaper one first. Other received the pricier injection first.

Before and after both placebo injections, researchers tested the subjects to measure their motor skills affected by Parkinson’s, and conducted MRIs to assess brain activity.