It is definitely not definitive, whatever those particular MRIs show. However, to my very untrained eye, it looks like there is *more* definition in the earlier ones. That might make sense if the action was recovering from the small to the large, or microscopic earlier, macroscopic much later.
About the notion of two treatments: that can be a double-edged sword. From the patient's point of view the more the better; taking a scatter-gun approach might have more chance of hitting a meaningful target.
From the scientist's point of view, changing only one variable at a time is the only approach likely to inform. So that is why clinical trials often insist that either the patient be treatment naive, never having been treated with so-called "disease-modification" drugs, or that a fairly lengthy wash-out period take place.
With that in mind, D. Zamboni is between a scientific rock and a medical hard place. One cannot insist on patients being in a well-designed clinical trial and insist that they stay on their medications, expecting to learn anything which is unassailable. "Evidence, evidence, evidence" is an approach which precludes staying on medication *if* the vein treatment is expected to affect the disease too.
I think he is trying to protect the well-being of the patient in taking this approach, which may be less scientifically sound, but more medically so.
I have had some experience in this ethical mine-field (explosions have not killed me yet). The research I have been involved with at the Ottawa General Hospital has always insisted on wash-outs. The last one I was on was a full year before I could participate, because the last 'DMD' I had been on was mitoxantrone, which was expected to have an effect on SPMS, as was the trial drug. Between that delay and other refusals to restart me on DMDs, and the current refusal based on the assessment that I am too far gone for any yet-discovered drugs to help me, I have been off DMDs for a very long time.
The other conflict one might see in this effort, from a scientific point of view, is in the choice of subject. Dr. Zamboni has said that the people most likely to be helped are those who are in the earlier "phases" of "the disease". Yet those people are also the ones who (if anybody should) should be on "DMDs".
Personally I think that it is convenient that later-stage patients are more likely to have been given up for a lost cause, because these people have the most to gain by being helped at all, in the complete absence of other help, with the extreme case being the dying patient. So they are ideally suited scientifically, having had no 'DMDs' prescribed to them, lately or ever.
The science of medicine has the most to gain by treating the untreatables. The patients have the most to gain by successful treatment. It is a marriage made in heaven.
The name "disease-modifying" brings with it a conundrum. How can a vascular treatment be a disease modification if veins do not cause the disease? If you do not believe the disease has any connection with veins, then a) this treatment does not need a drug wash-out, because they cannot be affected by work on the veins, and b) it cannot matter who receives the vein intervention, among 'MS' patients.
Personally, I believe all 'MS' patients, regardless of their 'progressivity' will benefit from treatment for CCSVI. I think the issue of who is likely to be helped needs more elucidation. The reason more progressive patients, 'primary' and 'secondary' should be first in line is precisely that they have no other hope.
If it is true that the younger ones of these do respond to 'DMD's, that is an argument I abstain from entering, in favour of the ones more educated in ethics than I. However, I think keeping the more progressive patients from this treatment, which has been proven to be safe, has NO justification whatever, and is merely cruelty for its own sake.
It might be said that avoiding cruelty is incompatible with science. If so, "I don't want to be right."
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience