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)