Anatomy of a smear job, part 2: Wrath of Khan

Welcome back to my rabble's eye view of the CCSVI/MS controversy.   Set your bullshit meters to "stun" and let's wade through this pile of dreck that Dr. Zamboni is being slimed with

Wayne State University School of Medicine neurologists are strongly cautioning against a potentially risky surgical procedure promoted by an Italian researcher as a potential cure for or alleviation of multiple sclerosis.

BZZZZZZT!  Wrong! Dr. Zamboni has never touted angioplasty of stenosised jugular and/or azygous veins as a cure for Multiple Sclerosis.   Irresponsible media who can't be bothered to fact check has said this, not Zamboni. 

I suppose angioplasty, which has been performed on a regular basis under local anesthesia since the 1970's, technically could be risky.  But I haven't heard of one person being harmed by it yet for CCSVI, and there have been probably hundreds of procedures performed at this point.  Unlike say, stem cell transplant studies in which 1 in 18 subjects died. 

Let's keep shoveling, shall we?

To combat the condition, called chronic cerebrospinal venous insufficiency, Zamboni suggests angioplasty and stenting of the veins, as therapeutic approaches.

Oopsie, wrong again.  Zamboni specifically advises against stenting at this time.  Liars.  Other doctors are using stents with great success, but never Zamboni.

Dr. Khan, director of the MS Clinic for Harper University Hospital, criticized Zamboni for being “overzealous” and “having no real expertise in neurology or looking after MS patients.” Zamboni, he noted, promoted his angioplasty findings to the media before publishing his results or presenting them at scientific meetings.

Dude if anyone here is overzealous it's guys like you who, though you immediately and vehemently dismiss the concept that slowly refluxing blood into the brain might be what contributes to the deposition of iron, and hence perhaps the process of MS, you have no better explanation.  If you do, I'm all ears.   I won't hold my breath though.  As for no real expertise in looking after MS patients?  His wife has MS.  If anyone "gets" MS patients, it's those who live with them and care for them.  Bonus for Mrs. Zamboni that her husband is a researcher who was determined to see if he could help her.   And just because he's not a neurologist doesn't mean he dusn't no medicn to gud.  He is a professor and an expert in vascular diseases - which is what CCSVI pertains to.  Plus, I'm pretty sure he knows how to read.  And that is how he found the prior research that led him to his theory. 

Being that Dr. Zamboni is Italian and not a neurologist, he likely goes to different scientific meetings than Khan.  However, he's seemed quite comfortable in front of the hostile audience at the recent American Academy of Neurology webcast.  Plus he's been publishing on this subject since 2006.  Duh. Moving on...

“The message is powerful, no doubt, but the real question is: Is the science powerful? Preying upon desperation always makes noise, but after a while one may question the ethics of such an approach,” he said. “Monetary incentives are usually the main motive in these instances. The trial they conducted was not controlled, not blinded, and all patients were on active disease-modifying therapy. It is ill-advised to embark upon such endeavors without conclusive studies from multiple sites with no conflicts of interest.”

I'm thinking maybe Khan missed the part where Zamboni was searching for a way to help his wife.  Plus, here's a little tidbit.  Zamboni suffers from a neurological disorder himself, leaving him unable to actually perform the ballooning procedure.  So that kinda blows that whole, "Hey I know, I'll get RICH and exploit desperate sick people by performing a procedure that's not that expensive and has been common for over 30 years, mwahahahahaha...." conspiracy, now doesn't it. 

It's true that Zamboni's patients remained on their disease modifying drugs if they were taking them.  And he did not do sham procedures on a control group.  Of course the patients who underwent the angioplasty knew they were receiving treatment. 

He did indeed have a control group for the imaging part of the study where they found the stenosis in the first place. 

Incidentally, Zamboni's group of 65 patients is 8x larger than our friend Dr. Freedman's avant garde stem cell implantation study, which I'm fairly sure wasn't blinded either.  Pretty easy to know or not know if your immune system has been completely nuked by chemotherapy, or at least I would suspect so.   Heh.

Several studies, Dr. Khan said, are under way and a number have already been completed that refute Zamboni’s findings. Those studies will soon be accepted for publication and then become public knowledge. Dr. Khan is initiating an Institutional Review Board-approved protocol at the Wayne State University MS Center to examine CCSVI in MS and other neurologic diseases. The study will start May 1.

Well isn't that incredibly interesting.  Studies under way and a number already completed and ready to publish refuting CCSVI.  I wonder where they got the money, because getting anyone to pay for studies to prove CCSVI have been like pulling fucking teeth, and what has been promised by the MS Society is not even going to make a dent in what is needed.   I will now anxiously anticipate these studies, and I just can hardly wait to see who paid for them. 

“We first need to determine if CCSVI even exists as a phenomenon, and if it does, does it cause the disease or is it a secondary phenomenon in an injured brain,” Dr. Khan said. 

Sigh. This again.  I direct you to the unanimous opinion of the International Union of Phlebology aka the people who know more about veins than neurologists:

A consensus conference on venous malformations[uip09]  – headed by Prof. Byung B Lee from Georgetown – and experts from 47 countries – studied the evidence and unanimously voted in favour of officially including the stenosing lesions found in CCSVI in the new Consensus document and Guidelines.

Glad we settled that.   On with the spin.

Dr. Khan and his co-authors – including Paula Dore-Duffy, Ph.D., professor, and Robert Lisak, M.D., professor and Chair of the WSU Department of Neurology, and Imad Zak, M.D., associate professor of the School of Medicine’s Department of Radiology -- conclude that it is critical not to compromise patient safety during the conduct of further research...

But it's OK to compromise patient safety by prescribing them Tysabri, which has killed 4 people so far.  No problem!  That risk is acceptable because patients and doctors demand it.   You do the math and tell me which is more cost effective and which is more risky.   

Tysabri, wholesale cost annually = $28,000 +, known risk of brain damage and death.

Angioplasty, from what I can find = $5500 - $8000.  Maybe once, maybe again if you restenosis.   No known or reported deaths in relation to CCSVI.

...They note that anecdotal reports indicate endovascular procedures, including placement of stents, have been carried out in patients as a clinical treatment procedure for MS. In some cases, that has led to serious injury. Potentially fatal outcomes, including migration of the venous stent into the heart and perforation of the ascending aorta, while not common, are known complications of venous stent insertions.

When are you brain doctors going to learn?  Endovascular procedures are being performed to address CCSVI, not clinical treatment of your precious cash cow MS.  That they happen to occur together is definitely a matter for research.   In the meantime, people have blocked veins that need fixing.  Again (and again and fucking again!), in ONE case someone required surgery, and he lived.  One out of many more than 18 who have now had stents put in.  A patient died but NOT because of the stenting.  So. In one case out of literally hundreds of CCSVI treatments up to this point, something went wrong becase of it.  Otherwise patients improve, even if it's only slightly.  But I'll tell you - if you had freezing cold hands and feet for 10 years, and suddenly they were warm again, you would say it was worth almost any risk to have normal feeling in you extremities after so long.  

“Any invasive endovascular procedures, including angioplasty and venous stent placement should be discouraged until there is conclusive evidence to justify their indication in MS,” they wrote.

And I'm supposed to take a neurologist's advice as to what to do with my stenosised veins?  Why would that be?  Just because I happen to have MS as well?  Should I run my birth control method by you too, or can I keep that between me and my gynecologist?  

What a childishly played game of "smear the doctor".  And what a classic example of repeating a lie over and over with the intention of making it true in unsuspecting minds.   Positively Rovian.  

Oh, heavens to Betsy, I almost forgot.  Dr. Khan  has received honoraria or research support from Acorda Therapeutics, Biogen Idec, Novartis, Sanofi-Aventis, and Teva Neuroscience.  All of whom make obscenely expensive MS drugs.   I'm just sayin'.