Medicine doesn’t lend itself to sound bytes. It’s confusing enough to live in the non-medical world of 20 second TV News pronouncements:
Russia and Georgia shoot and kill each other - South Ossetians cry foul!
Yao Ming commits foul on U.S. Olympian in the act of shooting!
These stories and an Iraq War update straight ahead after Action Weather!!! But first, the latest on Lindsay Lohan’s alleged lesbianism!!
Also disconcerting is the disjointed world of medical research. I made reference to this in the past column. Medical information is released at an explosive rate. Definitive and practical medical wisdom on the other hand is not keeping pace with the sheer volume of journal publications.
We not only have a problem whereby someone will publish isolated but tantalizing research on Epstein Barr Virus (EBV) as a potential trigger of MS or on Vitamin D supplementation as a seductive weapon against MS. We get a distilled report somewhere in the lay press on these topics.
The mass communication effect? Heightened interest but some ambivalence concerning clinical value from both professionals and patients.
Medical headline splashing came through recently with news of the Bernie Mac passing. The public learned the comedian died quite young of pneumonia at 50 and that he had Sarcoidosis in remission since 2005.
Sarcoidosis, usually involving the lungs and affecting blacks more than whites, can also strike the nervous system. Neurosarcoidosis often comes up in the differential diagnosis of Multiple Sclerosis. Like MS, it has autoimmune features and may be related to Vitamin D deficiency and a virus. Another sister disease in this autoimmune category is Systemic Lupus Erythematosus (SLE) which also can strike the nervous system; it too has been associated with a Vitamin D lack and a viral etiology.
Like MS, these autoimmune disorders are often treated with corticosteroids and have no known cure. Immune related problems can occur in all of these diseases, which can then increase the chance for infection such as pneumonia.
It is possible that although Mr. Mac was in remission from his Sarcoidosis in terms of no active disease in his lungs, he still may have had hidden immune problems that could have served as a backdrop for his pneumonia.
The take home point relates to MS. The absence of disease progression or relapses does not mean one’s MS is cured. Like Sarcoidosis, there is no known cure for MS.
Autoimmune disease definition may undergo an overhaul in the coming years if we learn more about what causes these diseases so we can go about curing them. Why Sarcoidosis dominates as a lung disease, MS confines itself to the CNS and SLE so often damages the kidneys all need more explanations. In the meantime, both clinicians and the public grapple with this kind of partial information: “Vitamin D lack may feed into Lupus, MS and Sarcoidosis- Breaking News at 11”.
Here’s the kind of research I appreciate. I hope others advance our knowledge of the 2008 hypothesis by Hayes and Acheson from the University of Wisconsin: Lack of sunlight exposure (dropping Vitamin D levels) plus viral infection (such as by EBV) might combine to cause an immune deficit (through Interleukin 10) in MS patients that in turn leads to an autoimmune attack against nervous system proteins.
Published On: September 16, 2008