Curing MS: How Science Is Solving the Mysteries of Multiple Sclerosis
Scientists, medical researchers, and academic physicians share a fundamental shortcoming: we consistently fail to translate and describe our professional world -- its struggles, its successes, and even its basic workings -- to the general public. In science, this flaw, lamentably, affects the people who direct funding policies, and in medicine it denies knowledge to patients who hope for improvements in and possible cures for their condition. As science rapidly grows more complex and technical, the gap widens between scientific realities and public perceptions of how science works. Indeed, the daily televised diet of medical breakthroughs fails to convey the complexities of medical progress and the difficulties involved in bringing a bench observation to the stage of useful therapy. (Figure) Enter Howard Weiner, a veteran neurologist with decades of experience in medical research on multiple sclerosis, with a monograph on the medical history of such research and the clinical realities of the disease. He draws a rich, fascinating portrait of important failures and successes in this difficult field of medicine. Almost an autobiography, this book is well written and detailed. It also appeals through down-to-earth language that avoids trivialization and places complex biology within the grasp of the interested but uninitiated reader. With mastery, Weiner mixes anecdote with the teaching of biologic, statistical, and medical processes, rendering a living tale that keeps the reader's attention. There is much passion here as the author highlights decades of continuing frustration in the search for causes of the clinically varied and elusive, chronically progressive condition of multiple sclerosis and its many subtypes. This book will be instructive and interesting for patients, their families, and many people with other chronic diseases. The book manages to entertain while drawing a clear picture of the evolving process that drives medical progress, however slowly and ponderously. Few issues remain untouched, from the need for (and danger of) ego as the investigator weathers the many frustrations before the rare successes occur to the stony path from bench observation to bedside use. The tone is inherently optimistic as the book highlights the development and regulatory approval of the small but slowly growing number of drugs approved or already used for the treatment of multiple sclerosis. By and large, the author avoids diving too deeply into science and technology, and he freely and frequently admits that an understanding of the mechanisms involved in multiple sclerosis (and in most other autoimmune diseases) is missing. Much of this book is about clinical trials in a difficult field. The trials suffer from a lack of predictive, surrogate markers of intermediate to long-term outcomes, as well as from a paucity of practical measures of effectiveness, with magnetic resonance imaging a difficult but irreplaceable tool. The author excels at illustrating these points and at emphasizing the need for proper controls, questions, and answers that can be interpreted with confidence in such trials. The title, Curing MS, is bold and misleading, but the author himself corrects the misconception about the likelihood of cures for this disease in the last chapter. The backbone of the book is the "Weiner list" of 21 hypotheses that describe the author's view of multiple sclerosis as a primary autoimmune disease that, possibly, is caused by unknown infectious episodes. Not all of these hypotheses are uniformly acknowledged in the field, but most are in the mainstream; some, such as a strong focus on cytokines, are somewhat dated, though not inappropriately for what is basically a history of the medicine surrounding multiple sclerosis. This book does not attempt to provide a critical assessment of the status of therapy for the disease -- it really does not explain "how science is solving the mysteries of multiple sclerosis," as the subtitle claims -- but it does provide a realistic look at the field, with its challenges, its origins, and the more recent achievements that have been made with a modicum of therapeutic tools.Shawn Winer, Ph.D.Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.--This text refers to an out of print or unavailable edition of this title.