During those emergency, life threatening instances Dr Sclafani had better things on his mind, wasn't looking for CCSVI, and a for the biggest part of his career wasn't even aware of the concept of CCSVI.
Here is his list of what forms of CCSVI he's seen so far (I've got it saved to look up what the heck some of these things are):
1. Anomalous confluens of jugular vein
2. Absent Jugular vein
3. annular stenoses
4. hypoplasia, isolated
5. hypoplasia, multiple tandem
6. duplications with stenosis
7. reversed valve
8. incomplete or fused valve leaflets
9. misplaced valve
10. false channels (may be incomplete jugular duplication)
13. abnormal drainage of external and vertebral veins
Don't these seem like things he'd notice if he were trying to stick a catheter through them, even in a gunshot-wound scenario?
I have complete appreciation of the conundrum but regardless of everything else, how well rounded is the knowledge when the "gold standard" is being used to find CCSVI in people with MS and not in people without MS?
Well, to continue using Dr. Sclafani as the example, he's not just sitting around while he's waiting for his IRB to pass, he's still doing his regular job, which I believe involves going into people's veins on a daily basis. None of whom have M.S. Not sure if he's doing much work that involves being up in people's necks as opposed to other parts of the body, but generally I think it's safe to say that, even after having become familiar with diagnosing CCSVI in MSers, he has been in the veins in the neck area of other patients without MS and, if he'd seen this there, it would have made an impression on him.