Friday, November 12, 2010

Doctors in Canada warn against controversial MS treatment

From The Globe & Mail in Toronto:

Multiple sclerosis patients should not travel abroad to undergo a controversial treatment and no doctor in Canada should offer to perform it, the body representing Quebec physicians said Nov. 9.

Until there is clear, solid evidence the treatment developed by Italian doctor Paolo Zamboni actually works, patients should avoid foreign clinics offering the procedures “prematurely with little regard for their effectiveness and side effects,” according to a statement from Charles Bernard, president and CEO of the Quebec College of Physicians. The treatment involves widening blocked neck veins to improve blood flow.

Quebec’s declaration is the latest in a string of pronouncements from politicians and medical organizations in the past year on the validity of Dr. Zamboni’s multiple sclerosis theory.

Despite calls for caution from the medical community, some politicians, including Saskatchewan Premier Brad Wall and federal Liberal MP Kirsty Duncan, have become strong advocates for funding the procedure to study its effects. Mr. Wall has promised his government will spend $5-million for clinical trials. Newfoundland announced similar plans to pay for research. And federal Health Minister Leona Aglukkaq said Ottawa may fund clinical trials as soon as preliminary research on vein blockages of MS patients is complete, which is expected next year.

Politicians have faced immense pressure to throw support behind Dr. Zamboni’s theory. A large and vocal community of MS patients have mobilized online to petition governments and hold rallies across the country.

The Quebec college said scientists don’t know whether the blocked veins cause the disease or are a symptom of it, and whether they have anything to do with the onset of symptoms.

Studies published in recent months have also found blocked veins in healthy people and shown a significant number of MS patients don’t have them.

Dr. Zamboni believes multiple sclerosis symptoms are caused by blocked veins, which lead to a buildup of iron in the brain. He says the symptoms can be alleviated or treated through angioplasty, to widen the veins.

In the year that has elapsed since Dr. Zamboni’s theory became widely publicized, scientific and medical organizations and experts across Canada have uniformly urged caution and rigorous study before the treatment is recommended for wide use.

The Canadian Institutes of Health Research said in September it’s too early to offer the treatment in clinical trial settings due to an “overwhelming lack of scientific evidence,” a position that has been supported by the Canadian Medical Association.

Even Dr. Zamboni, during a visit to Toronto in April, said patients should refrain from getting the treatment, except in the context of an approved clinical trial.

Although many patients who have had the treatment in countries such as India and Poland have posted videos and photos of themselves showing an improvement in symptoms, that anecdotal evidence is not strong enough to prove the procedure is safe and effective, said Yves Robert, secretary of the Quebec college.

“The problem with these testimonies is that it’s a photograph once in a time,” he said. “Some of them go back to their previous conditions after, but they don’t do a new YouTube [video] to say that.”

Evan Thornton, an Ottawa resident who travelled with his brother to Poland earlier this year to receive the vein-widening procedure, said he believes scientists should be studying the effectiveness of the treatment now, instead of waiting for results of research on the veins of MS patients.

“Medical science should proceed with caution, but it should also proceed with care and compassion,” said Mr. Thornton, who added that he has seen a major, lasting improvement in many MS symptoms since the procedure was done.

But one expert who is currently studying blocked veins said many patients don’t realize the vein-widening treatment is not a routine procedure. Ian Rodger, vice-president of research and academic at St. Joseph’s Healthcare in Hamilton, said there are just too many unanswered questions to immediately open the door to the treatment.

“I personally think the wait-and-see [approach] is correct,” he said.