 I tried to interest Dr. Novella in pursuing a possible cause, but he denies any possibility of effect without taking any investigatory steps. I contacted the Seattle neurologists, but no one has followed up on their hypothesis. Dr. Novella is ideally suited to pursue studies in this area. His credentials as a skeptic make any possibility of bias on his part a non-issue, and he has both the staff and the expertise to do some real good here.  Given Dr. Novella's dismissal of any possible bacterial link, I've moved on nutritional supplements as support for ALS patients. Given the short term data on Vitamin E and the study on creatine, I would think a short three month trial combining the two would be useful. If it is negative, it would refute the short term outcomes of the German study, and might convince patients not to experiment personally with vitamin megadoses.  As I point out, over half of Dr. Novella's ALS patients are likely to be using some form of alternative medicine so engaging in this sort of study would only involve organizing those who are already experimenting on their own.  My point in bringing up the range of nutritional supplements is that a number of things considered "alternative" have some data to support their use in ALS. We are talking about a disease process with a miserable outcome and a minimally effective drug protocol. I am truly interested if Dr. Novella is using any of the supplements in clinical practice, but I suspect that he is dismissive of any supplementation.  If Dr. Novella is consistently discouraging patients to try alternatives, and those patients are still using those alternatives without his knowledge, then the situation is not optimal. A much more functional doctor/patient relationship would be for Dr. Novella to engage in trials, so that he can say: "we tried that, but it doesn't help." As a skeptic, Dr. Novella can combine his hatred for quackery with his love of neurology and serve all of us by providing definitive data.