Well, to close a loop on this thread, one of the aspects of having MS that makes one such an undesirable candidate for health insurance, from the insurers standpoint, is the cost of CRABs. Like Amelia says, people in the early stages of MS don't necessarily have a bunch of doctor visits or hospitalization, although some do. That is one of my big concerns about this neurological push to diagnose MS early, and get MS patients on CRABs early as possible, and keep them on them "for life". I've seen articles where the medical consensus is to get people with clinically isolated events on MS drugs for years, "just in case". Having a "clinically isolated event" with no actual MS diagnosis, would still be enough to send insurance underwriters running for cover once they see the cost of five years of Avonex; and in the U.S. insurance market that would lead to being blackballed for life.
No one (in publications anyway) seems to be discussing the impact of the earlier and earlier diagnosis on obtaining employment, obtaining medical insurance, obtaining life insurance, etc. From that standpoint, for early MSers with mild symptoms, the potential impact of the diagnosis is far greater than the disease or any advantage of getting earlier tratment. Thinking back, I've probably had symptoms, mild ones, for at least 20 years. In a lot of ways I'm GLAD I didn't get diagnosed sooner - an earlier diagnosis would have gained me nothing and cost me greatly in terms of being able to go to grad school (with affordable health insurance as a "healthy" student), to have good job mobility, to obtain medical insurance, etc and make COBRA insurance payments when I wasn't working, take a year off and travel, etc. If the whole impetus behind early diagnosis is to get people on CRABs as early as possible to slow disability progression, yet in the long run CRABs aren't shown to meaningfully slow disability progression, it begs the question of the whole paradigm. I haven't even touched the issue of the cost of the CRABs themselves in relation to efficacy, which was purpose of the Sheffield study and the start of this thread. I don't know how it is in countries like GB that have nationalized health care, where access to health care is not tied to employment, like it is in the U.S. In the U.S., people lose their job, they lose their health benefits. If they have a pre-existing medical condition, establishing health benefits again becomes very hard. I suspect that twenty years ago, before CRABs, doctors were a lot slower to diagnose MS in people with mild symptoms because of the fallout in their lives that were worse than their potential disease course, at least for a while. Without MRIs, it was also a harder diagnosis to make. Now we've got MRIs for diagnosis and CRABs for treatment, but CRABs don't work very well for a lot of people and/or some people can't take them. In some ways that hasn't made the situation better on the early end of the diagnosis, in spite of what all that pharma marketing says that people are better off now with an MS diagnosis than they used to be.
Sorry for the dark post, but this impact of diagnosis, and how the CRAB availability drives diagnosis, is something that I think should actually be studied, particularly in the U.S. I'm not advocating that people shouldn't get a diagnosis. It's just that the diagnosis has huge economic implications for the individual receiving it, particularly in the American medical health care system, and all the neuros and pharmas marketing early diagnosis and early treatment don't necessarily consider that. The fault is with the medical system itself.