“Throwing the kitchen sink” at any clinical problem an MS patient might have is sometimes "generally justified" based upon our high tech world of testing gadgetry and sophisticated immunomodulators combined with the devastating threat of the disease.
I actually can trace my career in medicine back to the day when there were neither sophisticated immunomodulators nor high tech testing gadgetry.
It was the time of the cave man, the late 1970's. There were no credit swaps or derivatives. People and not bankrupt banks actually owned homes. You see back then, when confronting a problem involving MS, all we had was a steroid and a dream. There were no interferons and copolymer (Copaxone's forerunner) was unproven. Neurologists earning modest livings would go to the MS patient's bedside and labor through time consuming examinations, unsupervised by HMO clerks limiting such profligate activity.
Many would pine for a definitive test for MS. But even CT scanning was in its infancy. The closest thing to an MRI (truly a milestone in MS evaluation) was its NMR (Nuclear Magnetic Resonance) predecessor- an organic chemistry test confined to lab experiments and not involving brain imaging.
MS patients actually got diagnosed on clinical grounds, perhaps with some help from cerebrospinal fluid oligoclonal bands and evoked response testing. ACTH and steroids helped some acute attacks. (Like now). Therapy for chronic progressive disease was as it is now- less than satisfactory.
Over these thirty years, scientific advances in imaging and therapy have outpaced our abilities to consistently utilize them to dramatically impact upon the lives of MS patients. (Key word is dramatically). Expensive MS research as Science Project Winner? First Prize. Expensive MS research to greatly reverse or cure MS? No prize. Yes we have cut into the number of relapses of MS patients with relapsing and remitting disease. Yes, we now have heavy hitters that can help a few patients with progressive disease. And yes, we are exploding research initiatives at an unprecedented rate.
I bring this up not to disparage the great advances we have made in the science of MS and even in helping particularly those with its common relapsing and remitting variant. I raise these points to highlight cost vs. outcome. If MS were the yardstick for measuring whether advances in diagnosis and treatment in the last 30 years can be supported economically, it would highlight an economically crippled "health care" system.
Wait a minute; we happen to have an economically crippled "health care" system.
Now we have a nearly crippled general economic system.
The fear of socialized medicine is a canard that links a single payer "health care" system with the kind of regulation that would limit the free flow of research dollars needed to develop "breakthroughs" in diagnosis and treatment for a disease like MS.
You see back in the cheapo late 1970's MS patients were falling face down in the streets because no one examined or treated them- NOT.
You see back in the late 1970's there was limited MS research and imaging and no MS patients were getting fantastically improved or cured- LIKE NOW WHEN NO MS PATIENTS ARE GETTING FANTASTICALLY IMPROVED OR CURED DESPITE AN EXPLOSION OF MS IMAGING AND RESEARCH.
We need to focus on what went wrong with the economy the way we need to focus on what ails the research and clinical "health care" world. MS is an index case.
“Throwing kitchen sinks” and money at problems rarely works anyway. Now we have a shortfall in research and clinical health care cash to throw at anything.
Maybe it's time to regroup. I think Wall Street is leading the way with that ideation.
Published On: September 26, 2008