Thursday, July 29, 2010

Head, Meet Wall

Well, Brad Wall, that is:
Saskatchewan Premier Brad Wall bolstered his support for a controversial multiple sclerosis treatment on Monday, predicting clinical trials could launch in the province as early as next year.

“I do believe there will be a solid proposal before the end of the year,” he said, urging other provinces to collaborate. “I think there’s a chance we’ll see potential trials in the new year.”

On Tuesday, Mr. Wall broke ranks with his provincial counterparts, vowing his government would finance liberation therapy, an experimental method of opening veins in the neck and spinal cord to combat the symptoms of the nerve-wasting disease.
While I do find it unseemly that politicians like Premier Wall have seen fit to intervene/interfere in research programs, the "head smashing" element comes more from the way the so-called liberation treatment has been treated in the media.

First, the very term "liberation treatment" itself sounds more like the work of a scam artist or at least a PR hack. Second, many articles or stories on the controversy seem to construct a narrative of desperate, hopeful MS patients set against skeptical neurologists (possibly in collusion with "Big Pharma") and governments. Certainly, most internet commentators seem to follow that pattern, arguing that the treatment (a sort of venous angioplasty) is common place (it isn't), perfectly safe (nope), and warranted even in the absence of symptoms or evidence of any connection to a disease process (definitely not). There is more than a little bit of lay person ignorance on display - conflation of arteries and veins, ignorance of anatomy and hemodynamics, and a lack of understanding of physiology. The general attitude that, since the procedure provides hope, and anecdotal reports have been favourable, we needn't bother with properly conducted clinical trials or research and simply began booking expensive imaging studies and scarce time in the cath lab for patients who may neither need nor benefit from the treatment. I think Colby Cosh at Maclean's has said it better, though:
How could anyone be so pessimistic? Well, even leaving aside the history of MS quackery and hype, there is no shortage of circumstantial reasons. The “liberation therapy” tag is an obvious mark of heavy con-artist and/or halfwit involvement in the publicity effort. Why not go all the way and just call the Zamboni technique “super amazing unicorn magic”? In newspaper accounts (and even in our own exemplary coverage), recipients of the therapy often report renewed energy without necessarily enjoying total relief from symptoms; this may not be a sign of the placebo effect at work, but it is certainly consistent with it. And it is hard to understand how the instantaneous improvements so often described by the “liberated” can possibly be consistent with Zamboni’s actual theory of MS etiology—i.e., that poor drainage of blood from the brain encourages, over a long term, the formation of cerebral iron deposits that then lead to immunological issues and demyelination of the nerves.
He's completely right on the last point, of course - even if the "liberation" treatment worked, the effects would not and could not be seen immediately, let alone within seconds or minutes of angioplasty (as seemed to occur with a woman interviewed on the National last night, who reported instant resolution of numbness in one finger). Hope is a great thing, and the placebo effect is non-trivial in these cases - to say nothing of the impact of individual psychology. However, as one of my colleagues has said in the past, "Hope is not a plan." Brad Wall should stick to politics, but should surely resist political pressure to interfere in things he shouldn't.

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