Monday, March 5, 2012

Multiple Sclerosis and CCSVI

There are many blogs and websites which look at the application of the scientific method in clinical medicine (Dr. Ben Goldacre's work is particularly prevalent) and the efficacy of carrying out clinical trails on patients with incurable diseases. There are very strong links between science and ethics in this field, but certain cases also touch on pseudoscience. Medical researchers often find themselves convinced that they have discovered the cause of or made a breakthrough in the treatment of medical conditions without carrying out the rigourous testing that is required, often finding very vocal support amongst the sufferers they set out to help. The most famous recent case was that of Dr. Andrew Wakefield who published his belief that a link existed between autism and childhood vaccination using the combined measles, mumps and rubella vaccine. He was later struck off by the British Medical Association after they concluded that he had willfully distorted his evidence, which was actually only for a very small cohort of children. In the meantime, vaccination rates dropped to dangerously low rates in parts of the US and Europe and there were well-publicized outbreaks of measles as a result.

A similar ongoing debate concerns the supposed  link between multiple sclerosis (MS) and Chronic Cerebrospinal Venous Insufficiency (CCSVI) - the blockage of veins which drain blood from the brain. This hypothesis was first proposed by Italian vascular surgeon Dr. Paolo Zamboni in 2008. It goes against the current scientific consensus, and there have been mixed results when other researchers have attempted to reproduce Dr. Zamboni's clinical findings. Opinions are polarised, perhaps because Dr. Zamboni has proposed fairly simple and inexpensive techniques to open veins in the brain, therefore giving hope to many thousands of MS sufferers.

In this article for the James Randi Educational Foundation, Dr. Steven Novella, an academic clinical neurologist at Yale University School of Medicine, looks at the evidence and discusses how ethical questions of this kind can best be decided: 
CCSVI and the Politics of Medicine

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