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A medical controversy 3 July, 2011

Posted by Simon Nickerson in Uncategorized.
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Let’s look at different kind of controversy – a medical one.  Multiple sclerosis (MS) is a disease that causes the body’s immune system to attack the central nervous system, leading to a range of neurological symptoms. There is no cure, only some drug treatments that attempt to relieve some short term symptoms. So when Italian researcher Paulo Zamboni proposed in 2008 that a relatively simple procedure could provide significant long term relief from MS, it caused a big reaction.

Dr Zamboni believed that decreased blood flow in veins in the neck and chest (known as chronic cerebro-spinal venous insufficiency – CCSVI) could be partly responsible for MS. He reported that MS sufferers were much more likely to have CCSVI than healthy people, and that balloon angioplasty and stenting (two slightly different techniques for stretching a vein to increase blood flow) could reduce MS symptoms.

This set off a rush by some patients and doctors to try the treatment, with people travelling around the world to countries where the treatment was offered. Meanwhile, many researchers were concerned that Dr Zamboni’s studies weren’t done properly. Recently the news has not been good for supporters of the treatment. The NY Times reported on the reluctance of hospitals to perform the procedure, fearing that it hasn’t been proven reliable enough, and the Wall Street Journal wrote about a research program at Stanford University that was halted after one patient died and another required emergency surgery.

From a strictly scientific point of view, there simply doesn’t seem to be any convincing evidence to say that the treatment works. Here is a particularly passionate blog arguing that Zamboni and CCSVI are a scam.

What makes this different from the other controversies I’ve looked at are the patients. A large, well-organised group of people who are (understandably) pushing for the widespread adoption of the treatment; the pressure they bring to bear on researchers and governments will keep this debate going for longer than it would otherwise.  From what I’ve read, I think it’s unlikely that CCSVI plays a role in MS, so I don’t think the angioplasty and stenting techniques will prove to have any positive impact – but if I’m wrong then the patients deserve credit for sticking to their guns.

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