Why do we insist on using an “escalation model” in treating MS? By escalation model, I’m referring to the common practice of starting a person with MS on a low efficacy drug (that is generally considered quite safe) and only “escalating” or “upgrading” to a more effective drug if “things don’t work out”. Well, what do you think “things don’t work out means?” It MEANS BRAIN DAMAGE that can not be given back. This makes no sense to me.
I think part of the reason that we use an escalation model is because of the “SINS OF OUR FATHERS.” The men and women that were of the generation who trained me recall when there were NO therapies to treat this disease. When the 1st drug came out it was a revolution!! To go from NOTHING to SOMETHING (even if it’s interferon beta- low efficacy and pretty darn safe) is a big deal. Over the subsequent 10-15 years more similar low efficacy drugs came to market and those men and women back very comfortable using these low efficacy drugs.
As newer, more effective (yes, they work better guys) but more complex drugs came to market, it’s my opinion that many of these men and women, who are not towards the later half of their careers, were reluctant to embrace these high efficacy drugs. It’s easier for them to use what they always have used, and maybe “escalate” if things don’t work out…
These same men and women are of the generation who trained me. They taught me their sins and I carried them forward. Until I realized what I was taught didn’t make sense and resulted in my patient’s accruing brain damage. MY FELLOWS and TRAINEES do not suffer from the sins of my fathers. They will suffer from my sins, and hopefully carry forward an era of rational application of the most effective therapy a given person with MS is comfortable with, started as early as possible!
I risk upsetting many people with this video. My intention is NOT to throw stones but rather to spark discussion and debate. Yes I’m very aware that many MS Neurologists HAVE embraced the use of high efficacy drugs. Yes I know I can’t generalize to every person at the same time. No I’m not picking on older doctors. I’m trying to share my personal philosophy and why I disagree with what’s been done in the past.
Agree with me? Disagree? Sound off below and please share your comments and questions. I want to know what you think about the “sins of our fathers” and escalation therapy in treating MS!