Monday, 18 June 2018

Happy Anniversary Prof G

It is 25 years to the day that I arrived in London to start my PhD on body fluid biomarkers in MS. 


What has changed in the last 25 years?


I am still into MS body fluid biomarkers and I am fortunate to have been one of the innovators, and early adopters, of using neurofilament light chain levels in MS clinical practice. NFL is making a big difference and will almost certainly change the way we practice. I predict peripheral blood NFL levels will become the MSologist’s equivalent to CRP in rheumatology.

In the last 25 years, I have witnessed a transformation in MS care from one in which we had no DMTs to one in which we have so many options. Even HSCT is back on the table. When I did due diligence on setting up an HSCT treatment programme at the Royal Free back in 1999 I decided it was too risky; back then the mortality rate was close to 5%. Now the mortality is below 1% and closer to 0.3%-0.5% in low-risk subjects. Many of my colleagues now put HSCT on the table as a treatment option, with many UK centres beginning to use it in everyday practice. I anticipate us getting the necessary funding to run our head-2-head study of HSCT vs. Alemtuzumab so that we will be able to present the risk and benefits of these two treatment options to pwMS.

Other important innovations have been the adoption of the early effective treatment paradigm, treat-2-target of NEDA, rapid escalation and flipping the pyramid. I have also seen the ushering in of the immune reconstitution therapies and have started to participate in the debate of what an MS cure may look like. We are now looking beyond NEDA to the ambitious target of treating MS to maximise lifelong brain health. 

I have seen the concept of combination therapy strategies begin to gain traction with several trials underway to target neuroprotection, remyelination and neuro-restoration. The holistic management of MS movement is now the norm, which not only focuses on MS-specific disease mechanisms but also addresses comorbidities and lifestyle factors.

We are looking beyond the relapsing phase of MS and have a licensed treatment for primary progressive MS and potentially another for secondary progressive MS. We are starting a new PPMS trial that aims to protect hand and arm function in pwMS who are already using wheelchairs. A lot of us are pushing for MS to go back to being one and not two or three diseases.

But what has revolutionised the field of MS the most in the last 25 years has been the democratization of knowledge and the emergence of social media as a forum to empower people with MS. No longer do neurologists control knowledge. People with MS are now true partners. The inevitable downside of social media has been the spread of anti-science movements. At least the latter has nudged neurologists and other healthcare professionals to join the debate and to start using social media to communicate with their patients.


My big disappointment is the fact that we haven’t started MS prevention trials. This is despite us have good evidence that EBV is likely to be the cause of the disease. However, this is a challenge I look forward to tackling in the next 25 years. What I am very proud of is our patient and public engagement programmes to raise awareness about the issue of MS prevention.

I feel privileged to be part of such a golden era in the history of both London and the field of MS and to have worked with such dedicated people at the Institute of Neurology and now at Barts and The London.

From a personal perspective, I am obviously older and I think a little wiser. I have two grown-up daughters and I am still happily married to my wife of 32 years. I am still running, albeit shorter distances and less often, and I have taken up gardening. I am also trying to walk-the-talk and to live a brain healthy lifestyle; in particular, eating real food. I admit I feel better for it and would recommend it to everyone.


I now identify myself primarily as a Londoner with a waning South African identity, which saddens me a bit. I often cry for my beloved country and miss my mother and siblings and many other things about my homeland. Maybe one day I will become a swallow and return more regularly. As for British politics, I feel European and doubt I will lose this identity any day soon. I have too many continental friends and colleagues who shape my worldview.

Here’s to wishing myself happy anniversary and to the next 25 years as a Londoner!


27 comments:

  1. Happy Anniversary and best wishes for whatever the next 25 years may hold! I'd imagine there are a lot of people interested in what you may achieve!

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  2. Happy Anniversary and thank you for all that you have done for us MSers these last 25 years. I am really glad you and your brain exist :)

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  3. Congratulations on your quarter century in London. A great summary of where MS research / advances have moved in the past 25 years. The summary also shows how slow the advances have been - many coming (such as licensing of Alemtuzumab) in the last 5 years of so. Lets hope we see some big advances in the next 5 years (not the next 25 years). I'm a Londoner born and bred (of some 48 years) and have seen changes to my city (from a different perspective from you) - terror attacks, fatal stabbings almost every other day, and foreign visitors asking me where they can meet "English people". But we must be doing something right as those that come to London rarely want to leave. I wouldn't get to hung up about visiting your country of birth. I visited last year and was told that the country was on the verge of collapse - murder capital of the world, corruption everywhere, and white farmers being killed or pushed out. Staying in a gated development with relatives where the glass was bullet proof was an eye opener. So remain in London Prof G, but don't continue with MS for another 25 years. You've made an impressive mark for which we are all thankful, but all of us get stale and innovation is needed in medical research as it is in most industries and fields. Perhaps a key change you haven't mentioned is how the top neuros have become pseudo-celebrities - blogs, tweeting, international tours, sharing their political views. I imagine when you first came to London most neuros wore a bow tie and a tuning fork was their only tool when confronted by a suspected case of MS. I wonder if there is a half way house between these old school neuros and the celeb types.

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  4. happy anniversary from an ex guinea pig team g changed my life

    "First they ignore you, then they laugh at you, then they fight you, then you win."

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  5. Thank you, thank you for your amazing work. Best wishes for the next phase of your life.

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  6. Thank you.

    "Today is the first day of the rest of my life."

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  7. Please tell us more about real food? Is this a fad?

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    1. https://realmealrevolution.com/

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    2. Re: "Please tell us more about real food? Is this a fad?"

      Real food is simply an extension of the slow-food movement. You simply need to prepare and cook your own food, i.e. avoid processed foods.

      I have also taken the real food movement a bit further in that I am growing some of our own food (vegetables) and I have applied evolutionary biology to the way I eat. I have started preparing posts on evolutionary medicine on Medium to cover this topic: https://medium.com/@gavin_24211/evolutionary-medicine-why-low-fat-diets-are-bad-for-you-95922f2f1999.

      I am a big proponent of seasonal eating and trying to eat the way our ancestors did prior the industrialisation of food production, i.e. seasonally, fermented foods and not being satiated 24/7. Intermittent fasting with intermittent ketosis is good for you and your brain.

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  8. Can't be a partnership or a debate when a dichotomy is created by using terms like an "anti-science movement" and "neurologists are forced". This is not democratiozation just another form of control. Until we know the cause of MS it is it might be a good idea to; listen to your patients and believe them, be curious, keep an open mind, and, above all, be humble. Researchers using social media and the media to communicate science is not, and will never be a good idea. You are wrong about that Gavin.

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    1. "Researchers using social media and the media to communicate science is not, and will never be a good idea."

      Do we move back in to the ivory tower then? It's in need of refurbishment.

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    2. More neurologists need to be forced to change their behaviour; many are dinosaurs.

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    3. Prof G maybe you should have used the term 'fake news' instead of anti-science movements. I understand what you mean.

      Flo, I am not sure if you have read the small print. Prof G knows what the cause of MS is. What he needs is support from people like you to get the necessary trials off the ground to prove it.

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    4. Trials are done, (then repeated). "Proof" of anything may or may not comes afterward.

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    5. "Prof G knows what the cause of MS is. What he needs is support ... to get the necessary trials off the ground to prove it". Seriously?

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  9. Happy Anniversary and best wishes to you for the next phase of your career. Given the ins and outs of ms remain unknown it does seem appropriate that someone take up the preventative challenge to minimise future numbers.

    I have ms and feel quite alarmed by the way my young adult children choose to live. They were raised on healthy home cooked meals, sweets were a once a week treat, fizzy drinks saved for special occasions and my husband and I do not smoke. They both ate and enjoyed a wide variety of vegetables from the start. With their independence though has come all kinds of junk food and copious amount of sugar, one of them smokes and the other doesn't like moving or going outside. The attitude is that I am old and don't understand how people live now. Apparently I am old fashioned. It breaks my heart.

    What I would like to show them is someone such as yourself speaking to camera telling it how it is in a way that the average teenager can absorb without too many charts and statistics. It is frustrating watching them do this to themselves, they need to hear it from someone other than mum.

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  10. Thank you very much.
    Despite the shortfalls and the inadequacies of the systems in place and the provision of treatment and care of PwMS, I have nothing but meaningful appreciation and gratitude.
    As someone who was diagnosed two & half years ago I've been on a massive learning curve and the vast majority of my knowledge and understanding have come from this Blog.
    ProfG and the team - if only there were many more who were as focussed and dedicated and amenable to sharing and dialogue as you are!
    No way would I be as well as I am now without you and this site, and that's before I learn, at the end of the month, whether or not Alemtuzumab has been successful.
    Genuinely there aren't enough ways to say : Thanks!
    Happy Anniversary and long may your contributions continue to benefit so many of us.

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  11. Thank you for the kind words Fi. Hope Alemtuzumab has been a complete success for you.

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  12. all the best g. look forward to drruth and prof ndg delivering MS prevention in the next 25 years. power to women and BAME

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  13. Thank you Prof G. I have learnt an enormous amount from you and this blog. I haven't had a relapse or any activity since diagnosis and this, I am sure, is because of the treatment regime I pressed my neurologist to put me on based on the science coming from this blog. Thanks should also go to Mouse Doctor 1 for his efforts also. He his a gem! Thank you thank you so much for caring.

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    1. Thank you. MD1 is on a well deserved holiday and I will pass on your message when he gets back.

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    2. P.S. I actually met MD1 back in 1993 when he was still working at the Royal College of Surgeons. We have known each other for 25 years and have been partners for 18 years. When I returned from the Royal Free to Queen Square back in 2000 one of my conditions of employment was for MD1 to be employed at UCL to support basic MS research.

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  14. A splendid way to fill 25 years of a life. And such a joy to work with, mostly!

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  15. privilege to know you. inspired by the work you continue to do

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