TagGROLDI

Damp Squib

The Editors’ of The Lancet Neurology weigh-in with a commentary on the decision of the WHO committee not to recommend glatiramer acetate, fingolimod and ocrelizumab for the WHO EML (Essential Medicine List).  The Editors’ reiterate the usual recommendations to address the challenge of treating MS in resource-poor countries.  They acknowledge that adequate funding is needed for national health...

Azathioprine revisited

Has azathioprine been given a fair chance as a treatment for MS?  I have noticed over the years that most neurologists, including myself, don’t always use azathioprine correctly. In general, we under-dose azathioprine. Why?  As an example, one of my patients with myasthenia gravis, an autoimmune disease of the nerve-muscle junction, came in this week with a relapse. He weighs 107kg and was on...

GROLDI hits a wall

To help with our #OffLabel campaign to help HCPs treat pwMS in resource-poor environments I asked Gisela Kobelt, a health economist, who I have worked with for many years for help. What she said to me made me realise that the hurdles we face are much higher than I expected.  These are her relevant comments: “The economic case for any treatment in resource-poor countries is difficult, simply...

Compounding Pharmacies

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going...

Buyers Club

Have you seen the film Dallas Buyers Club? It is one of the movies that haunt me and keeps coming back to me in my thoughts and dreams. I now know why. Dallas Buyers Club is a 2013 American biographical drama about a patient diagnosed with AIDS in the mid-1980s when there were no licensed treatments for HIV. It was in an era when HIV infection was highly stigmatizing. Out of desperation, the main...

Off-label methotrexate

Prior to interferon-beta being licensed, I used to manage several patients under Prof. W. Ian McDonald who were insistent on being on treated with some form of DMT. The rationale was better to be on something rather than nothing. At the time there was some evidence that methotrexate was effective in MS and as it was relatively safe, so Prof. McDonald acquiesced. In retrospect, I have no idea if...

Politician G

If I was a politician I would change the way drug regulation works to stimulate repurposing of off-label and unlicensed drugs. The wider MS community thinks off-label prescribing is accepting second-best. This is not the case.  The fact that a drug has a license or a label for a certain indication is because a pharmaceutical company has submitted an application to one of the regulatory...

Catastrophe

Have you heard the term catastrophic health expenditure or CHE before? You should have as many MSers and their families are exposed to catastrophic health expenditure.  CHE occurs when the spending on health exceeds a pre-defined percentage of a person’s or household’s capacity to pay. CHE has a massive impact on MSers’ lives and usually discourages them from using healthcare services and often...

Translate

Categories

Recent Posts

Recent Comments

Archives