Wednesday, September 8, 2010

Last Post on the "Liberation" Treatment

Well, hopefully. I'm listening to this, an interview with an MS patient who underwent (I assume) balloon venoplasty in Bulgaria. He notes "gradual improvement", but his own descriptions of his symptoms do not sound entirely dramatic. Or notable at all really. The patient correctly notes that current studies underway aim to determine whether, in the first place, MS patients have "blocked" veins and whether there is an association between such "blockages" and MS. Since the so-called liberation treatment in principle treats such blockages, it seems, a priori, that determining the presence of such blockages and their association with MS is, ya know, paramount. You don't treat a "blockage" that has no clinical consequence and you don't treat someone for a blockage that they don't have. A patient with chest pain doesn't go straight to the cath lab.

I've also noticed something curious about most of the anecdotal reports of symptomatic improvement following (or even during!) the procedure; patients seem to report increased ease of movement, which improves with increased activity to some degree. I even came across a blog a while ago detailing a patient's course while following a physiotherapy regime post-procedure. On one hand, it seems clear that the "liberation" treatment conveys a significant positive placebo effect, to the point that patients report instant improvement on the OR table - which itself is as clear a sign as any that the procedure has no intrinsic therapeutic effect (repair of MS-damaged white matter on such an instant basis isn't just implausible, it's impossible). Conversely, it seems that patients see some improvement with increased activity and/or direct participation in physio, which is not altogether unexpected. If there are to be any trials of the "liberation" treatment, I think it would be prudent to control for such factors or even to include physio as a treatment itself. I'd bet money that patients attending and participating in regular physiotherapy do better on several functional outcomes than those who don't (controlling for MS progression variables), and that any effect attributable to physio would exceed any observed effect of invasive venoplasty (if there is any). Of course, in light of the questionable association between CCSVI and MS (i.e. pending verification from groups NOT associated with Paolo Zamboni), such trials of the "liberation" treatment are premature.

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