ClinicSpeak: MS comorbidities

A focus on MS comorbidities; at least it is something we can target in progressive MS. #ClinicSpeak #MSBlog #MSResearch

"I  have just arrived in Toronto to attend, and speak at, the NMSS-ECTRIMS Comorbidities meeting. The programme below may be of interest to you. What is a comorbidity?  The following is a reasonable working definition:


'In medicine, comorbidity is the presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases. The additional disorder may also be a behavioral or mental disorder.' Source Wikipedia

Please note the definition defines it as the presence or additional disorders or diseases. Implicit in this definition is that it affects health; i.e. comorbidities makes you less healthy or unhealthy. This then brings up a debate about what is health. In preparation for this meeting I did a lot of background reading on what constitutes health or poor health and again there is no agreement. For example the World Health Organisation (WHO) defines health 'as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity'. As a clinician this definition is unworkable. As part of preparation for my talk, which I am finding impossible to prepare, I read a very good series of article in a the latest issue (#7) of the NewPhilosopher; the whole issue is dedicated to the philosophy of health. For example, the best debate was on whether or not we should classify ageing as a disease and whether or not getting old causes you to become unhealthy. A quote from the issue that I plan to use in my talk later today is from David Seedhouse (New Philosopher 2015;7:97-99): 'Health is more than the opposite of disease'. This worldview and some of the other intellectual meanderings in the NewPhilosopher make me realise that health is more a state of mind that something that can be defined by the medical profession. Why can't you have MS and be healthy? A medicalised worldview is that disease and poor health or synonymous; this is clearly not the case. You can attend any one of my large MS follow-up clinics and you will see that a significant number of MSers are healthy or at least describe themselves as being healthy. " 


"I have also come to realise that the medical profession, clinicians and scientists, have a lot to learn from the philosophers. How to define illness, sickness, disease and health is a starting point. If we understand the impact of labelling people as ill, sick, diseased or unhealthy we may think twice about what our objectives are as neurologists treating MSers. Is it to simply relieve suffering? Do we have a responsibility to maximise health? Are we responsible for trying to help MSers age healthily? These are the sorts of questions that have been percolating in my mind. What is clear that I doubt I will be able to answer them at this meeting. What is clear we can't shirk our responsibilities when it comes to comorbidities; if want to treat MSers we need to approach MS holistically."

"I only give my talk late morning so any suggestions would be welcomed. As usual once I have given my talk I will share the slides with you on SlideShare." 




CoI: multiple

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