Robby: Will MS ever be cured?
Dr Giles Elrington, Consultant Neurologist: Tell me what you mean by cure.
Robby: A cure is stopping the progression, repairing damage done.
Dr Giles Elrington: Do you mean putting back to exactly where you were before you had MS?
Robby: Yes. I mean, is that a cure?
Dr Giles Elrington: I would see that as a cure, but then if I have appendicitis and go to a surgeon and have my appendix taken out, am I cured? I may not die, but I haven’t got an appendix and I’ve got a scar, and that brings problems. So if I have a tumour in my leg and you take my leg off, I haven’t got a tumour, am I cured? I don’t think so as I hop about. So cure is a difficult word. I think cure, I think your definition’s right, I think you restore the person to what they were like before with no sequelae. Now actually, if you think about it, it won’t take you very long to write down what doctors can cure. Now, why are we healthier now than we were, why do we live longer now than we did a hundred years ago. The answer is not getting ill, and that’s what matters, is not to get ill. So for me, a cure for MS, yes, I want to do that. If I’m honest, I’m interested in disease, I like seeing people with disease and trying to be helpful and nice and positive and send them out of my room happier and get better, but I don’t think I do cures.
What I think we might do, and this is my goal, is that we know why people get MS, and if you know why you get it then you might stop it happening. So it’s a bit like curing polio, what a waste of time, it’s gone away by vaccination. Now, we think that MS is caused by an infection acquired in teenage years by susceptible individuals. If that’s correct, the answer is not to get the infection. We can do that. We know how to not get infections and I think the answer is going to be not getting the infection that causes MS and therefore not getting MS, and I think that’s more important than finding a cure. In the meantime, before we can stop people getting MS, we have to find a way to help people with MS, but I regret that I think looking for a cure is a bit like wanting to win the lottery, only possibly slightly less likely. It would be a nice thing, but it ain’t gonna happen. You know, maybe we can get you a tenner, so to speak, you know, partly winning the lottery, making the MS less of an issue, that’s really the goal.
Robby: I mean for me, there are many drugs to halt the progression or slow the progression very much down.
Dr Giles Elrington: Are there?
Robby: Yeah. I mean there’s a medicine I’m taking – and I’ve forgotten the name… Tysabri and…
Dr Giles Elrington: Well, you see, the problem with Tysabri is, although the people that propose, the manufacturers, say that Tysabri slows the progression of MS, if you look at the data it’s a bit dodgy. And so the pivotal study on Tysabri says it slows the progression. If you look at the publication, it’s got the average disability score at entry to the study. Where’s the average disability score at exit from the study? Oh, it’s in the study. No, it’s not in the publication. Oh, we’ll send you the data. And they never sent the full data set.
Robby: Right. I mean for me, I had quite aggressive relapse remitting for three years and that’s put me in a wheelchair, maybe it’s not the Tysabri, but Tysabri is meant to decrease the incidence of relapses by 70%…
Dr Giles Elrington: Absolutely.
Robby: …and it works for me.
Dr Giles Elrington: There’s no doubt about that.
Robby: So I mean you haven’t got a cure, but you can slow the progression down very much.
Dr Giles Elrington: There is some room for doubt whether Tysabri truly slows the progression and I won’t believe that until I see the data. I want it to slow the progression, but I do worry about the industry and about their biases and until the people that make Tysabri show us the disability at entry and disability at exit, I won’t believe it.
Robby: Right, I mean the problems with their studies and stuff, they’re just completely biased aren’t they?
Dr Giles Elrington: There are biases.
Robby: When you get money, funding from pharma, it’s like selling your soul to the devil.
Dr Giles Elrington: Tell me.
Robby: So you have to deal with the devil.
Dr Giles Elrington: But what else have we got? What’s the government doing? Zero, in trials.
Robby: I mean, because it costs money.
Dr Giles Elrington: Hugely.
Robby: There’s 100,000 people in this country with MS, I mean how much does it cost the government to deal with these 100,000 people? It’s not cost effective is it?
Dr Giles Elrington: Well, the difficulty is that if we think in the bigger scheme of things in healthcare, you go back to 1940s – no, I don’t remember, but it’s all written down – people thought that by having healthcare you make everyone healthier, it saves money. What’s happened to healthcare costs? Up, up, up, up, up, up, up. And you don’t actually save money with healthcare. I regret to tell you that dying young is really cost effective. Do I want to do it? No thank you. And so it’s not about saving money, it’s about keeping people well.
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