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Editorial


distrusting the pharmaceutical industry, were naturally attracted to the possibility of a quick (and simple) fix rather than the long-term use of unpleasant (and often ineffective) drugs. The concept of CCSVI had been published in a respected peer-reviewed paper and followed by a report of “successful” therapy, which was given the politically-charged name “liberation procedure”. Furthermore, the paper’s principal author’s own wife has MS. The fires were fanned by the promulgation of the story by the mainstream media in print, television, and the Internet. The ease and rapidity of unfiltered communication through social media threw oil on the fire. Finally, the unavailability of the venoplasty procedure in some venues, as well as perceived initial insensitivity of MS Societies, fostered continued protest and demands.


As the CCSVI controversy continues, hopefully to be resolved with the time-tested methods of appropriate scientific investigation, how should physicians respond to patient inquiries and sometimes to their demands to undergo venoplasty? Physicians should always be


1. Zamboni P, Galeotti R, Menegatti E, et al., Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis, J Neurol Neurosurg Psych, 2009;80:392–9.


2. Zamboni P, Galeotti R, Menegatti E, et al., A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency, J Vasc Surg, 2009;50:1348–58.


3. Zivadinov R, Marr K, Cutter G, et al., Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS, Neurology, 2011;77(21):e124–6.


4. Doepp F, Paul F, Valdueza JM, et al., No cerebrocervical


respectful of patient’s views, but should not be reluctant to offer their professional opinion based on a thoughtful consideration of available evidence. This can dovetail with a discussion that emphasizes the importance of proper scientific research. The physician must always respect patient autonomy, avoid acting judgmentally, and emphasize that he or she will always be available to offer the patient continued care and support.


However the CCSVI story plays out, as it inevitably will, scientists, physicians, and patients should seek to benefit from what it teaches us. These lessons include recognizing the importance of empathy for those affected by serious illness, understanding the enormous power and speed of the social media, and comprehending the delicate balance between patient desire and the need for scientific rigor that will enable the utilization of relatively scarce financial resources in a way that maximizes patient safety while providing the best opportunity to understand and ultimately treat human disease. n


venous congestion in patients with multiple sclerosis, Ann Neurol, 2010;68:173–83.


5. Sundström P, Wåhlin A, Ambarki K, et al., Venous and cerebrospinal fluid flow in multiple sclerosis: A case-control study, Ann Neurol, 2010;68:255–9.


6. Wattjes MP, van Oosten BW, de Graaf WL, et al., No association of abnormal cranial venous drainage with multiple sclerosis: a magnetic resonance venography and flow- quantification study, J Neurol Neurosurg Psych, 2011;82:429–35. 7. Doepp F, Wurfel JT, Pfueller CF, et al., Venous drainage in


multiple sclerosis: A combined MRI and ultrasound study, Neurology, 2011;77(19):1745–51.


8. Laupacis A, Lillie E, Straus, et al., Association between chronic cerebrospinal venous insufficiency: a meta-analysis, CMAJ, 2011;183(16):e1203–12.


9. Canadian Institutes of Health Research, The Government of Canada launches a request for research proposals for clinical trial on Chronic Cerebrospinal Venous Insufficiency and MS. Available at www.cihr.ca/e/44561.html (accessed November 27, 2011).


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