Firstly, this is not about money (I say this without a tell as my accountant taps away at their calculator nonchalantly). Really, this concept of cost-effectiveness is only obtrusive if you dislike politicking in any form or kind, or you’re British. The easiest way to understand cost-effectiveness models in healthcare in my view is to understand the principles of bartering. In bartering...
Pathways to Cures
Barts-MS rose-tinted-odometer ★★★★★ I am en route to a ‘Pathways to Cures’ meeting in Washington DC hosted by the National MS Society. The aim of the meeting is to refine the ‘Stop, Restore, and End Pathways’ for MS and to develop an international consensus on what an MS cure looks like. I am honoured to be invited to participate in this meeting and would like to thank the NMSS for inviting me. ...
How healthy is your lifestyle?
Barts-MS rose-tinted-odometer ★★★★★ It is a no-brainer. A healthy lifestyle is one of the most effective preventive health interventions available. The study below shows that you can increase your chances, by a factor of over 20, of a life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 by making ensuring you maintain 4 or 5 low-risk lifestyle factors; i.e. not...
As the New Year dawns, a look back @ Barts neurofilament service
Back in 2015 there was a great need to prognosticate in MS, predict high risk subjects from low risk, and select appropriate treatments based on disease activity in MS. We envisaged back then that the neurofilament test (a neuronal protein that is released during damage) would be a robust marker for risk-stratification in MS, and introduced into our clinical practice at Barts, instead of it being...
What is advanced MS?
Barts-MS rose-tinted-odometer – zero stars Someone recently asked what is advanced MS? I suspect they have been getting frustrated with our use of this adjective without a clearer understanding of what it really means. To find out if you have advanced MS you need to put yourself through a battery of stress tests to find-out much reserve you have left to deal with MS and life in the future...
Is siponimod the first cul-de-sac DMT?
Barts-MS rose-tinted-odometer ★ A big worry for neurologists and pwMS is the sequencing of DMTs. What DMTs can be used before and after each other and does the sequencing of DMTs change the risk profile of the individual DMTs concerned? These have been dealt with many times on this blog and I am in the final stages of completing phase 1 of my app that will address the specific issues around each...
Slip-sliding away – do I have secondary progressive MS?
Barts-MS rose-tinted-odometer – zero stars We have been running a campaign that #MS_is_1_not_2_or_3_diseases for sometime. This is based on the biology of MS and not what we see clinically. The pathology that underpins so-called progressive MS is the loss of axons, loss of neurons and loss of synapses, which are the chemical connections between neurons. All three of these processes begin...
To smoke or not to smoke that is the question
Barts-MS rose-tinted-odometer ★ ★ ★ ★ ★ Yawn! I am getting tired of the saying the same-old things on this blog. Is it time to retire and do something new? We have done some modelling work and predict that ~20% of new or incident cases of MS could be prevented if we stop the population from smoking. The question is how do we achieve this? Taxation has worked to some extent in that we...
Do no harm
Primum non-nocere is a Latin phrase that means “first, do no harm”. On the tube this morning I recognised one of our medical students reading Henry Marsh’ book “Do no harm”. He is a semi-retired neurosurgeon, turned author, who uses his past patients to discuss ethical dilemmas and to criticise the NHS. His book does showcase the life of a surgeon, warts and all. It is clear that to be a...
Air pollution and MS
We know that smoking, passive smoking and solvent exposure increase your risk of getting MS. The hypothesis, supported by animal work, suggests these risk factors alter antigens or proteins in the lung that then trigger autoimmunity. In other words, the altered proteins are interpreted as being foreign by the immune system. Particulate air pollution is another respiratory toxin that has...