Sunday, 26 May 2013

ABN Debate: Brenner vs. Giovannoni on treating active MS

"In keeping with my current policy of uploading all of my presentations; the following are my slides that I used in my debate with Dr Brenner at the ABN is Glasgow. I managed to scrape home with a few swing voters; probably my staff who felt sorry for me."

"I built up my arguments against the motion by using a fictitious, but quite real, case study. In essence this lady had active MS in that her MRI was very active with an increase in lesion load, gadolinium enhancing lesions and progressive brain atrophy. But as she did not have overt clinical relapses I was not able to escalate her treatment to either fingolimod of natalizumab under the current NICE guidance. I also used surveys I had done  to show that the majority of my colleagues in the UK don't use MRI to monitor MS disease activity and  neither do they use guidelines that incorporate MRI into decision-making algorithms regarding switching or escalating DMTs. Therefore on the balance of probabilities the Judge did not find me negligent. The debate did however focus attention on NICE guidelines; the current guidelines leave many MSers in no man's land or in the middle of the so called DMT doughnut - with active disease on a platform therapy but not be able to access more effective second-line or escalation therapies as they don't fulfill NICE guidelines."

"The solution is obvious we need to lobby the NHS, preferably via the ABN, to change the DMT prescribing guidelines  to allow MSers access to more effective therapies early on, i.e. before MS does too much damage. Early aggressive treatment is not for everyone; however, in my opinion MSers should at least have the option of choosing these treatments up front."

"I also threw in a curved ball by getting Dr B in the case to prescribe  more active DMTs using a private prescription under the NHS; please note this was a fictitious scenario, but quite possible in the 'new NHS'. The socialists in the audience were horrified at Dr B's disregard for the sanctity of the NHS; i.e. free at point of access and equitable."

"There are no winners and losers in these debates; the topic was chosen to highlight the thin line we have to tread in trying to keep the NHS affordable for all and our commitments and responsibilities to the individuals who we look after. In my opinion there is no compromise; we need to look after the individual and the politicians and public health doctors can look after the drug budgets and the population. May be this is wrong?"



Dr Brenner 0 - Professor Giovannoni 1
(Prof G may have cheated by presenting a fictitious case scenario; unfortunately the rules of engagement had not been defined so this is a moot point)

19 comments:

  1. Why did you consider in your invented case a switch from GA to IM IFN beta ? studies : GA = betaferon > Avonex
    Thank you

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    1. I had to allow for the MSer in the scenario to have failed both classes of 1st-line or platform therapies. No other reason. As you may or may not be aware of in the UK you have to fail interferon beta therapy clinically to access fingolimod under the current NICE guidance.

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    2. You are right. Cochrane says that if you want to quickly fulfill natalizumab criteria, prescribe Avonex ! http://summaries.cochrane.org/CD008933/comparative-efficacy-and-risk-benefit-balance-of-modulator-and-suppressant-drugs-of-the-immune-system-in-people-with-multiple-sclerosis-ms

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  2. Dr Brenner is a gentleman but I honestly think that we must never allow for MSers that can afford to pay for treatments bypass those of us at the mercy of NHS funding. We are one nation, in it together. Seriously, this narrow-minded and selfish approach will kill off the NHS. The NHS is the closest thing we have to a shared religion in the UK, please don't berate it anymore.

    Buy allowing RRMSers to purchase drugs we will witness crap like CCSVI and other charlatan medicines creep into Britain because we usurped our commitment free health care for all, not just those with money.

    I like Dr Brenner and was a patient of his but he is wrong.

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    1. You ought to proofread before submitting a comment anon 4:02pm. All I care about is how MS affects me, not everybody else. I have worked hard for the money I made and created my own opportunities in life. I have MS and have a chance of using the next two years to acquire Alemtuzumab in order to stop my MS progressing and becoming disabled. Your views and those of the NHS are holding me back. I want to be cured and can be but the window to accomplish that is a short one. Those of us that can pay for it will show the UK how great Alemtuzumab is and then the NHS will eventually agree to fund it for everyone.

      This demented British communist devotion to access for everyone is ruining lives.

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    2. You need to realise this was a fictitious case to highlight the problem of the current NICE Guidance. Dr Brenner did not see the case personally. I used to private prescription to highlight that we are really not treating MSers the way the should be treated.

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    3. "This demented British communist devotion to access for everyone is ruining lives."

      Strange how some see a commitment to fair access to treatment for all based on clinical need as communist. It's usually the preserve of our more swivel-eyed cousins across the pond.

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    4. I, too, think that if we can afford good DMTs then let us pay. This is people's lives we're talking about. Anon 4:15pm has a valid argument.

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    5. I have MS. I do not have a job. Perhaps I'm even unemployable. All my money and medicines are provided for by the state. I am very much dependent on society for petty much everything. It breaks my heart to read that I would be little more than a second class citizen when it comes to effective DMTs because I'm not wealthy enough to afford them. Where is the justice in that?

      The direction is headed in scares me. Its citizens are becoming heartless.

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    6. Perhaps access to the NHS should be means tested. Those with enough money to fund their own care should be required to do so, freeing up resources for those less financially fortunate.
      (Posted to be perverse - I can't see such an idea working)

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  3. I hope that MSers get a fair deal. It's not good that new DMTs are being denied in the here and now because of costs.

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  4. We need to get these DMTs on the NHS and fast... period!

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  5. Don't forget, these DMT don't cure MS.
    Some people simply want to pay for being a guinea pig.

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  6. As an American, I find the British vilification of U.S. medical insurance both bemusing and enlightening. You guys obviously love the N.H.S. and will defend it even when it may put some of your citizens in compromised situations. It truly is like a sanctimonious institution to you people. I know you Brits don't believe in God, at least not openly, but you seriously venerate your right to free health care. I admire that.

    The thing is that sometimes I get the feeling that the N.H.S. is a tad all too powerful, and to criticize it is at one's peril. I believe in the Church, but I will rebuke aspects of it only because I want it to be better. I get the feeling your N.H.S. can be better as long as there is some dissent.

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    1. Well said American P.o.V; I agree the NHS is simply a safety net and we need something else on top of it.

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    2. Brittania Ruled the Waves!Sunday, May 26, 2013 7:06:00 pm

      I think one of the big problems right now on planet Earth is that of Americans thinking they can run the world better than its inhabitants. I think Britain needs to extricate itself from American influences and try and be British again. America is America, Britain is Britain. Let's be ourselves and run our NHS the way it was supposed to run. There is no Special Relationship twixt our nations because America is always in it for itself.

      The NHS is the greatest thing on Earth. It is bigger than God and more important. Long may it live.

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    3. Britain: 1/ America: 0

      Viva, NHS.

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    4. From my American P.o.V., and representing for the blue team, everything I know about the NHS comes from this blog and repeated viewings of Ask the Midwife. I envy you all that you don't live in fear of losing everything when you come down with a major illness. But I understand NHS has its limits. Otherwise, I wouldn't dream of telling you what "you people" should do. When we have all the answers over here, we'll be sure to let you know.

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  7. Aspire, the charity, says that every eight hours, someone's life is changed forever by a spinal cord injury.

    There are about 40,000 people affected by spinal cord injury in the UK - and 1,200 people are paralysed each year.

    I wonder if MS is a part of that statistic? It seems bizarre that our spinal cords can suffer such trauma without any outside factors affecting it. There really is no cause and effect to MS and that's what makes it such an unfair and brutal disease. I can handle disability, it's the illness that does us in.

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