Controversies in Neurology (CONy) launched about 15 years ago as an annual get together for neurologists to discuss topics where there is no single answer. And there are obviously many questions without a single answer in neurology just as in medicine as a whole. Over the years, CONy has become a fixture in the calendar of many of my colleagues. I co-chaired the MS section in March; here’s the programme:Multiple-Sclerosis-1
Now, what I didn’t know until that meeting was over, is that there is an Indian spoke of CONy. CONy India met last weekend in Goa, and I was generously invited to debate the motion that people with MS “should be offered off-label immunotherapy when licensed disease modifying treatment is not available”.
I really wasn’t sure how colleagues would vote on this, but a whopping >80% were in favour even prior to exchanging any arguments, which I thought was great. However, knowing the rules of debate – it’s all about the swing vote – I felt some mild trepidation messing this one up. Even more so given my opponent was a highly decorated neurologist, Lieutenant-General and Honorary Surgeon to the President of India, Dr CS Narayanan. Here are my slides:CONy_India_20220423_4_Blog
Reassuringly, and following some very well delivered points from the floor highlighting the extensive use of rituximab (and some azathioprine) to treat pwMS in India, about 90% voted in favour of the motion.
If you’re interested in access to healthcare, particularly immunotherapies, for pwMS in LMICs, I suggest you visit the MSIF’s website and scroll to the MSIF Off-Label Treatments (MOLT) panel’s guidelines covering azathioprine and rituximab. Public consultation on these has just closed, but it’s encouraging colleagues are putting pwMS first, doing what is biologically (and IMO ethically) the right thing to do when there are no equivalent or licensed options.MSIF_4_Blog_20220427
I guess some of you may be wondering did he travel all the way to Goa to win a debate, and the answer is no, despite respective invitation, the attraction of balmy 33°C, no doubt wonderful food and F2F conversations with colleagues. I rather set myself up at home facing the garden (13°C), saving the planet my share of 2.25 tonnes CO2 emissions and absolving myself – on this occasion – from hypocrisy.
Disclaimer: The opinions expressed on this Blog are those of the author and nobody else.