As we look toward the future in MS therapies the key will be risk versus benefit. The market for MS treatments appears to be very high despite the fact that there are eight FDA approved treatments. As newer, different treatments come into being it is going to be even more important for the physician and the person with MS to weigh the risk/benefit ratio to decide whether the “newness” and unexplored (outside of studies) treatment is worth passing on the older/potentially safer models. The risk for untoward destructive viral infections is already real and there may be other problems coming. Having said that, the future looks extremely bright as interest increases and treatment possibilities abound. What was once a very unpredictable disease has become more predictable. Experts agree that early treatment (some may define early differently) is important. The potential to change the course of MS appears realized for many. The treatments on the horizon have different mechanisms of action giving even more practical choices for patients failing older treatments.
There are still going to be some who desire “alternative” medical treatments. If they do not combine their desires with studied actual management solutions (complimentary) they are taking a big risk that likely will end up with a very unsatisfied ending. The placebo effect brings about many initial enthusiastic responses that after several years end up with disgust. Experience has taught that the person who embraces this as opposed to trying to understand the scientific approach to research will react with anger when confronted with an explanation of the worthlessness of the treatment in question. The messenger then becomes the target of the anger and nothing is gained. However, letting these false treatments run their course leave a wake of disability that could be avoided so the message must continue to be discussed. It behooves all of us to become educated about what is available and not jump on a horse, either research/evidence based or alternative, without asking: “Does this treatment really make sense?”, “is this treatment worth the risk versus benefit?”, “what is the cost/benefit ratio?”.
These are exciting times for MS management. Every year brings us something new and different. Sometimes there are failures as well. We can all learn from all of it.
Randall T. Schapiro, M.D., FAAN
President, The Schapiro Multiple Sclerosis Advisory Group
Clinical Professor of Neurology (Ret.)
University of Minnesota