ClinicSpeak: should we stop prescribing DMTs?

Should therapeutic nihilism rule the day? #ClinicSpeak #MSBlog #MSResearch

"A few commentators (trolls and non-trolls) have suggested our Blog is a proxy for Big-Pharma as we are far too pro, prescribing, high-cost DMTs. I don't agree with this criticism because; (1) when the need arises we take an anti-Big-Pharma position, (2) we actively support and promote off-label prescribing, (3) we try to manage expectations and don't pull our punches, (4) we don't always agree with each other (there is no party line) and (5) we declare our conflicts of interests. Our posts are what they are, opinions based on personal interpretations of the data. If we lack credibility please ignore us; a blog is just a medium for communicating our position. Similarly the guest posts are the opinions of the guests and not ours."

"It is important to stress that this blog is run using freely available software provided kindly by Google. We have deliberately kept it advertising free, despite numerous opportunities to run paid-for-posts and other adverts. As a group of bloggers we devote significant amounts of time to keep the content current and hopefully useful to the community. Please note we commit a significant amount of our free time to this blog. As we are running the blog to update people with an interest in MS we would find it very difficult not discussing DMTs and treatment strategies."

"For those of you who 'believe' DMTs don't work and make little difference to the course of MS need to propose a testable hypothesis. This blog is based on science and not religion. The difference between the two processes is quite distinct. A belief system cannot be challenged, but a hypothesis can be tested and then rejected, or accepted, based on a set of experiments. The latter is how scientific knowledge accumulates over time."

"The following hypothesis addresses the position proposed by some readers that relapses don't count and that DMTs don't alter the progressive phase of the disease."

Null hypothesis: The proportion of people with relapse-onset MS, on DMTs, entering the secondary progressive phase of the disease has remained unchanged over time.

"Do we have enough evidence to reject the null hypothesis? If we don't then we should accept the null hypothesis and stop prescribing DMTs."

CoI: multiple

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