How far are we from personalised medication and wellness plans and what role could biomarkers play in this?
So I think we are, we are to an extent somewhere with personalised medication and wellness, but I mean I think that lifestyle’s something we haven’t talked about and, you know, we’re fairly clear on the lifestyle factors that need to be addressed in multiple sclerosis. So I think when you’re talking about a wellness plan, I think it’s very important that everybody has those lifestyle factors covered, they think about their brain health, they stop smoking, they lose weight, they take vitamin D. So these are kind of generic, I guess, but you might get into specifics in terms of rehabilitation for somebody that has lower limb or upper limb impairment. You know, I mean there might be a specific physiotherapy goal or rehabilitation goal for individuals. You know, in terms of the kind of biomarkers and tests, I think that the concept of NEDA will remain a goal rather than, you know, rather than a sort of rigid target that must be achieved, I see it as a goal or a principle or a concept and it will evolve.
So it will take on new aspects, both clinical aspects, so rather than just using the EDSS score to monitor progression, we will use increasingly sensitive scores, such as cognitive tests, walking tests, mobility indices, trackers, things like this, to monitor people’s clinical outcomes. And then we will add in biological things such as MRI scans and biomarkers and so on to try and achieve disease control. But, you know, I mean always these things are going to have to be goals and principles because the reality is that sort of achieving full control of these factors in everybody is impractical, you know, you can’t do that and sometimes doing that involves too much risk. So I think people need a good doctor, is what I’m trying to say, to help them judge how far to take it and, you know, what the risk of the next step is, what the potential benefits of the next step is, and so that they find the right plan for them and I think everybody’s plan and schedule is going to have to be individualised. There are so many choices available, there’s so much confusion about what to do, I think you need somebody to guide you through it.
Yeah. And I think it’s like what you say, it’s good, a lot of the things obviously other than the clinical side of things, like the MRIs etc, the individual person can control, so taking, you know, leading a healthier lifestyle, you know, if they’ve got physio they’ve been given to do by their physio team and their neurologist, that they can kind of feel confident that if they follow those things from the other end they’ll be met from the clinical side, the MRI monitoring and monitoring the actual condition, disease, then they can plan it quite effectively, but it takes both parts to work with it.
Yes, yes, it does. And, you know, I think it, from our point of view, we need to integrate much better. You know, I mean neurologists need to integrate much better with rehabilitation and physiotherapy. We also need to integrate much more with our patients and enter contracts with our patients, because you know, I mean there tends to be a very disjointed approach where the doctor just looks after the drugs and the physio just looks after… You know, it needs to be much more holistic and integrated for the individual.
Yeah. Thank you very much, absolutely pleasure.