Clinic Speak: Who should decide?

Which wheelchair would you like? You have a choice on the design. #ClinicSpeak #MSBlog #MSResearch

"Mouse Doctor and I were at a meeting a few weeks ago when a prominent London MSologist stated that 'he was not prepared to prescribe alemtuzumab as it was too risky'. This is quite a remarkable statement in 2014 when we  have been trying so hard to push the concordance (patient-partner) over the compliance (paternalistic) model. After the encounter Mouse Doctor wondered if this particular MSologist allowed his patients a choice when it came to choosing a wheelchair, or did his attitude change as his patients became more disabled. I countered that to be fair to him he was prioritising their safety."


"The vignette above is very common and I had many similar experiences with MSologists from many countries. I try and quote them results from surveys done on this blog (see below) and none of them buy into MSer-choice. This attitude is quite pervasive despite the EMA giving alemtuzumab a liberal first-line license for active MS defined clinically or on MRI. Why did the EMA give alemtuzumab such a liberal license? Simnply, because they considered the risk:benefit ratio to be favourable and that if you waited too long to use alemtuzumab you will have missed the window of opportunity to give MSers  the maximum benefit of the drug. What I am having difficulty getting across to my colleagues is that it should all be about MSer-choice and preventing end-organ damage. Why wouldn't you adopt a preventative strategy? We simply can't repair, or replace, a failing nervous system. I do agree that alemtuzumab is a risky drug and if we can sort out the risks, or if another drug emerges with similar efficacy but lower risks, the outlook for MSers will be so much better."

"I plan to focus my talk at our 5th Research Day this weekend on this topic."




CoI: multiple

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