As I write this I am on the way back from an ‘atypical’ summer holiday with my family. We spent a week in the ‘Oude Land’, South Africa, celebrating my mother in law’s 80th Birthday and then a week in the subtropics for some warm sunshine. The internet access was dismal, which was a good thing that allowed me to switch-off, sleep, eat, exercise, think, relax and recharge my batteries. The...
I was in the Netherlands at a science meeting (Yep ProfG let’s me out occasionally) and a pharma (marketing) person gave a presentation. They were there for the people with MS and it wasn’t all about the money. Now the Dutch are not known for their tact and tend to say it how it is, from their prospective, and “mushroom food” was uttered. I think Jeffery J in the audience...
‘Primum non nocere’ – Do no harm; the Hippocratic injunction. It could be argued that perhaps were are too ready to dose our expectant patients with the next golden ticket in MS. Mayhap, withdrawal of the long list of medications that they are already on, can prove to be just as efficacious? Yet, I am not a great supporter of masterful inactivity on the part of the physician...
I had an interesting discussion with some like-minded colleagues recently about active and inactive MS. We seemed to agree on what active MS is, be it in the relapsing or progressive phases of MS. However, we couldn’t really agree on what inactive MS is. Take this following case scenario; many said he was inactive, but others felt he had active MS and should have his treatment switched. Would you...
Autoimmune encephalomyelitis in NOD mice is not initially a progressive multiple sclerosis model. Baker D, Nutma E, O’Shea, Cooke A, Orian JM, Amor S, Baker D .Ann Clin Trans Neurol 2019 Objective Despite progress in treating relapsing multiple sclerosis (MS), effective inhibition of nonrelapsing progressive MS is an urgent, unmet, clinical need. Animal models of MS, such as experimental...
At our second MS Services Variance meeting, ‘Raising the Bar’, in Birmingham last week my colleague Helen Ford and I co-chaired the workstream on the social determinants of health (SDoH). What are the SDoH? The SDoH are life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education and health care, whose distribution across populations...
Most research is about investigating the known unknowns. In other words, investigators have a certain hypothesis, but also a range of plausable possibilities as outcomes. However, in some instances the outcome is unexpected – the unknown unknown. Rare side effects are an example of this, and not always evident in the initial randomized-placebo (dummy treatment) controlled clinical trials...
I am speaking at the Multiple Sclerosis International Federation (MSIF) Access to Treatment and Healthcare meeting next week in London. My talk is on “Off-label opportunities, barriers and risks in availability and affordability”. My journey to this point goes back 5-years and started when I was on sabbatical and was visiting countries all over the world and seeing how MS was managed. I soon...
Let’s talk about death, that is unassisted suicide. The meta-analysis below, not surprisingly, shows that if you have MS your chances of suicide are about twice the background rate. The risk is particularly high at diagnosis compared to symptom onset. I suspect this latter is an artificial finding; if you commit suicide before you are diagnosed with MS the code ‘multiple sclerosis’ is...
How do we colour in each block of this cube? Making a decision about which DMT to prescribe, or preferably to help your patients make a decision, many of my colleagues mix up their priorities. For example, some mix-up baseline prognostic profiling and disease activity, and then some of them throw disease-stage or disability progression into the mix. I think this occurs because these factors are...