Jack Burks, MD
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Chief Medical Officer, Multiple Sclerosis Association of America
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…comments from MSAA’s Chief Medical Officer
“The dark history of MS therapy has included snake venom, bee stings, malaria, colostrum, magical shoes, and rest (exercise was once thought to make MS worse). In 1970, in the beginning of my neurologic/MS career, many patients were not told that they had MS because the diagnosis was ‘too scary.’ They were told not to expect pain, cognitive problems, or depression. In fact, MS was thought to cause ‘euphoria.’ Now, we not only have disease-modifying medications, but we also have many therapies for MS symptoms – such as pain, changes in cognition, fatigue, spasticity, walking difficulties, emotional changes, bladder and bowel problems, as well as sexual dysfunction.
“Exercise and rehabilitation therapies, along with psychological help, have improved the Quality of Life (QoL) for many people with MS. The utilization of an interdisciplinary, comprehensive, healthcare professionals (HCP) ‘team approach’ has greatly augmented the pharmacologic advancements. We now have MS specialists in all aspects of MS care and a Consortium of MS Centers (CMSC) with healthcare professionals who all work together to advance the science and therapies.
“Many of these advances can be attributed to the implementation of the scientific principles of Evidence Based Medicine (EBM). Now, therapeutic trials are conducted with strict rules of conduct to reduce false hopes and missteps. Interestingly, false hopes, combined with EBM, may actually be helpful at times.
“For example, many of you may not know that the first FDA-approved MS treatment was stimulated by a false hope therapy that was rigorously pursued. In the 1970s and 1980s, MS was proposed to be a viral disease. Gamma interferon is an anti-viral agent, so it was tested in MS in the 1980s. It made the disease worse! Instead of ‘throwing up their hands’ in defeat, scientists went on to test beta interferon, which reduces gamma interferon. This successful clinical trial led to the first FDA-approved treatment for MS in 1993. Without the unsuccessful gamma-interferon trial, beta interferon might not have been tested.
“Another challenge of current and emerging therapies is balancing benefits versus potential treatment risks. If new therapies are stronger, will the risks be more daunting? Evaluating the benefits and risks from a neurologist’s perspective may differ from an individual patient’s perspective. Therefore, patients need to be very well informed on all treatment issues before any therapeutic decision is finalized.
“In summary, as new treatments are available, people with MS will be challenged to become more knowledgeable and to be able to actively share in the medical decisions, referred to as ‘shared management.’ This will provide each individual with his or her best therapy, increasingly referred to as ‘personalized medicine.’ The consumers of healthcare services, i.e., patients and their care partners, will have a better opportunity to share in their medical decisions in partnership with their healthcare professionals.
“Further therapeutic challenges include treatments for people with progressive MS and therapies to reverse the damage already present. Clinical research trials in both of these areas are underway and we look forward to a promising future for everyone with MS.”
Dr. Jack Burks is an international MS neurologist, writer, lecturer, and researcher, who assists with the development of new MS therapies and advises patients, families, MS organizations, and healthcare groups. Dr. Burks is a member of the Clinical Advisory Board of the NMSS. He has written and edited three MS textbooks, as well as numerous chapters and articles on MS. In recent years, he has lectured and evaluated patients in more than 40 countries.