3 Comments
author

An email from Unnameable:

'incidence curves by socioeconomic data suggest a slightly lower incidence in lower socioeconomic data.' I think that means poorer people are diagnosed less with MS? This is a matter of correlation vs causation. It doesn't mean poorer people are less likely to get MS, it means they're less likely to get access to a diagnosis.

MS is seen as a middle class disease and those with the lowest socioeconomic status are seen as mentally ill and lazy. That's what happened to me.

The NHS tested my blood for decades, for anaemia and thyroid problems, but never gave me what I needed: an MRI scan. Patients can self-refer to mental health services, but not neurology. The reality is, poor people are at the mercy of the NHS in a way wealthy people never will be.

HCP's did save money in the short-term by denying me access to an MS diagnosis and treatment. They destroyed my life, devastated my brain, and in the long run I will cost the state far more as I'm severely disabled. I used to think that at least if I died then the state denying me healthcare would at least have to pay for my inquest. But none of that matters to the HCP's who did save money from their own budgets. The system worked as it is designed to.

Expand full comment
founding

I’m not quite sure of all of the ramifications of this “the numbers are stable,” but I am, being from the states where health care is often lacking the “care” part, quite jaded. If it suits their purpose, the number of pwMS will be static. One thing I note is money is always the primary issue here and I also can’t help but conjecture if there is a bias due to women having the lion’s share of autoimmune disorders. Would a vaccine for EBV be as cost effective as DMTs? Would it eventually eliminate the need for DMTs? I know I’m rambling, but I recall thinking years ago “gee, cancer is a mighty huge industry.” I will hope, Prof G, that you can press on, because as a NEID SAW, I hate to see gains from DMTs go down the drain. I don’t know if I’m too far afield here. Thanks as always. 🌷

Expand full comment
founding
May 12, 2023Liked by Gavin Giovannoni

Incidence is static but

(1) You're catching and treating cases earlier and treating them more aggressively up-front. This creates a burden in terms of greater workload in monitoring and treating side-effects earlier on, in return for reduced long-term disability. Long term there will be less work and most of it will be treating the effects of the treatment (which can mostly be treated) as opposed to palliative care for MS-caused disability.

(2) Less disability means people live longer and need treating for longer. This is a good thing.

(3) Your workload should eventually reduce as MS becomes easier to manage and less worrisome for patients and their healthcare practitioners.

Expand full comment