Multiple Sclerosis Clinic

Today we saw a number of multiple sclerosis patients in clinic today. For the most part, these were young to middle-aged patients all doing well, coping well with the relapsing/remitting nature of this chronic illness. This - despite the lack of effective treatment or therapy and lots of trials/guesswork. Amazing how strong hope lives in people - is it denial or survival? The responses sure do vary, too - from patients who remain eternally optimistic despite the worst prognosis, e.g. primary progressive MS, to those who overly focus on their deficits to the point of creating new illnesses that lives only in their minds (yet I'll bet are just as real as a true disease process).

Most of these therapies, like insulin-dependent diabetes, require daily or every other day injections. Many bring with them serious side effects. And yet, for many, these therapies, like insulin, are preventative as opposed to frankly therapeutic. They are designed to prevent recurrence of MS (or in diabetes, prevent diabetic comas). For this promise (a promise which may remain unfulfilled - a realization that most of these patients are cognizant of) - they are ready to suffer injection site soreness, flu-like illness, and frequent self injections.

Yet - why should these patients trust us? We spew out data - regurgitate studies, etc., and for the most part the patients go along with the proferred promises - is it with hope on their part, or blind faith/trust? Does it matter?

For that matter - even when told about the serious potentially fatal yet rare risks - why would one choose one drug over another, safer, drug? It's true that one is more convenient - monthly dosing versus every other day, but is that worth the small yet finite risk of certain death from an adverse reaction? The choices these patients make confuse me - I can make no sense out of them, presumably because I can't fathom their motives - be it blind faith in science, medicine, or simple hope or instinct for plain survival?