Thursday, April 15, 2010

Barn Door's Open

In the late 50s a Greek doctor began treating patients who had peptic ulcers with antibiotics. But it wasn't until the early 80s that an Australian pair of researchers began their studies of Helicobacter pylori, a bacteria that appeared to cause ulcers. It took 15 years, but by 1997, the Centers for Disease Control in Atlanta (and other academic and medical institutions) were spreading the word about the link between the bacteria and ulcers. The use of antibiotics soon became a standard treatment for ulcers.

So, here we have an idea in the 1950s, unproven to work, or, at the very least, do no harm. For a number of reasons, the Greek doctor did not or was unable to conduct accepted scientific studies. So the idea languished for 25 years until the Australians began their research. And without the research that backed up the idea, the medical community would not get on board.

Now, in the 21st century we have a new idea about multiple sclerosis, CCSVI. And the uproar this idea has caused is unnecessary if folks would stop to think about it for a minute. It is an idea, unproven to work, or, at the very least, do no harm. Yes, it's a very interesting idea. It may have merit. It may add to our collective knowledge of multiple sclerosis, but without scientifically based research, it is not a treatment.

One misconception about diagnosing CCSVI is that it's a simple thing to do. It's not. It requires an ultrasound technician trained specifically to detect 5 factors in determining whether or not someone has the condition. The process takes an hour and a half and at least 2 of those 5 factors must be present for diagnosis. It's not like getting an ultrasound of your baby when you're pregnant.

The early numbers from a survey of 500 people in the US, half of whom have MS, half that don't, show that at most, 63% of the MS folks have CCSVI, and 25% of the non-MS folks have it. We cannot say that CCSVI causes MS unless 100% of MS patients have CCSVI, that CCSVI preceded the onset of MS symptoms, and a host of other conditions are met, not to mention, that those without MS who have CCSVI do develop MS.

Some more interesting stuff is coming out of the American Academy of Neurology meetings going on in Toronto this week. Nearly 50% of those treated in Dr. Zamboni's initial group of 65 patients have had to have the "liberation procedure" repeated. Many of those initial patients were on disease modifying drugs prior to the procedure. The initial trial was not blinded, there was no control group, and the sample size was small.

I have objected to people jumping the gun on this possible treatment for all of those reasons (and more, if truth be told). And even Dr. Zamboni is urging caution to MS patients, telling them to wait until the treatment is thoroughly tested. Kinda late now, Doctor, with people spending thousands of dollars traveling to countries where they can be scanned and have the procedure done.


Check out Science Based Medicine. Steve Gorski has an excellent article on the Greek doctor I mention above. And it's a cool site.

1 comment:

Nuraffinah said...
This comment has been removed by a blog administrator.