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For multiple sclerosis patients who have transitioned to secondary progressive disease despite use of disease-modifying treatments (DMTs), their management must still rely on physicians' instincts and the patients' wishes, clinicians here agreed.

Evidence-based medicine has almost nothing to say about whether DMTs continue to offer a benefit to patients who have moved from relapsing-remitting to secondary progressive MS (SPMS) because the existing trials were badly flawed, said Olaf Stüve, MD, PhD, of the University of Texas Southwestern Medical Center here...... Read More - http://www.ms-uk.org/MStypes

ye, ye .... badly flawed....
you can smell there is change in the air.
neurologists become critical to DMTs.

will be interesting to see what this ACTRIMS/ECTRIMS conference will deliver: http://www.msboston2014.org/index.php/s ... ic-program

re: the last points
12.Society and MS: roles of the expert patient, social media, and health policy
8.Critically examine how the expert patient, news media, social media, and health policy affect the relationships between patients with MS, health care providers, and researchers.

I do not know how the agenda came together.
but I do see a much stronger reference to experts patients than ever before, the role of social media etc.
I think the professional world starts to take more serious this 'Citizen Science'.

it gets particularly interesting when health policy is mentioned.
I have always thought that health policy was the prerogative of the government and perhaps a bit the insurers.
but I haven't heard anything about a major swing in Europe or the US as regards MS related health policies.
so what is this? is this ECTRIMS/ACTRIMS being advocate and judge at the same time to make long overdue new policies?

in any event, I am quite happy with this joint US/Europe initiative.
in the US, when things show to be wrong, you are much better than we are in Europe in making a fast turn-around.
I hope this meeting will become a landmark event and indeed profoundly change the paradigm.
and that the US will take Europe along in its slipstream.