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	<title>Comments on: A CCSVI Meta-Analysis</title>
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		<title>By: LarryG</title>
		<link>http://theness.com/neurologicablog/index.php/a-ccsvi-meta-analysis/comment-page-1/#comment-38352</link>
		<dc:creator>LarryG</dc:creator>
		<pubDate>Mon, 14 Nov 2011 03:13:02 +0000</pubDate>
		<guid isPermaLink="false">http://theness.com/neurologicablog/?p=3692#comment-38352</guid>
		<description>@Kawarthaion: &quot;It has yet to be determined whether science or emotion will determine public policy in Canada (i.e. whether Provincial governments will cover the cost of the treatment).&quot;

The majority of Canadians are not in favor of politicians spending money on unapproved medical procedures when the wait lists for proven medical procedures are so long. The feds and most provincial governments are not generally moving in that direction.

I may be wrong but the last time I read news about this, only one province was paying part of the cost for some MS patients. Even if some MS patients want to see it paid for, the majority of voters are against it.

I agree that funding of a medical procedure shouldn&#039;t be decided on the basis of anecdotal evidence. But it added to the cynicism to see MS patients being told that they shouldn&#039;t depend on anecdotal evidence, and then the feds and their own &quot;advocacy&quot; group oppose funding clinical trials that would give those patients the hard evidence they need to make a more informed decision.

People always have decisions to make. Unable to make a well informed decision, they&#039;ll make a less informed decision. No doubt desperation plays a role for many people with MS, but so does risk analysis.

Thanks to the lobbying (for the clinical trials), perhaps we&#039;ll be able to get some more answers sooner rather than later. Then patients can make a more well informed decision, as can doctors, taxpayers, governments, insurance companies, etc.</description>
		<content:encoded><![CDATA[<p>@Kawarthaion: &#8220;It has yet to be determined whether science or emotion will determine public policy in Canada (i.e. whether Provincial governments will cover the cost of the treatment).&#8221;</p>
<p>The majority of Canadians are not in favor of politicians spending money on unapproved medical procedures when the wait lists for proven medical procedures are so long. The feds and most provincial governments are not generally moving in that direction.</p>
<p>I may be wrong but the last time I read news about this, only one province was paying part of the cost for some MS patients. Even if some MS patients want to see it paid for, the majority of voters are against it.</p>
<p>I agree that funding of a medical procedure shouldn&#8217;t be decided on the basis of anecdotal evidence. But it added to the cynicism to see MS patients being told that they shouldn&#8217;t depend on anecdotal evidence, and then the feds and their own &#8220;advocacy&#8221; group oppose funding clinical trials that would give those patients the hard evidence they need to make a more informed decision.</p>
<p>People always have decisions to make. Unable to make a well informed decision, they&#8217;ll make a less informed decision. No doubt desperation plays a role for many people with MS, but so does risk analysis.</p>
<p>Thanks to the lobbying (for the clinical trials), perhaps we&#8217;ll be able to get some more answers sooner rather than later. Then patients can make a more well informed decision, as can doctors, taxpayers, governments, insurance companies, etc.</p>
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		<title>By: JurijD</title>
		<link>http://theness.com/neurologicablog/index.php/a-ccsvi-meta-analysis/comment-page-1/#comment-37679</link>
		<dc:creator>JurijD</dc:creator>
		<pubDate>Tue, 04 Oct 2011 20:24:50 +0000</pubDate>
		<guid isPermaLink="false">http://theness.com/neurologicablog/?p=3692#comment-37679</guid>
		<description>The exact same thing is happening here in Slovenia, where Zamboni has successfully found allies in certain private clinics near the border between Italy and Slovenia that have begun a systematic campaign propaganda aimed at the public and legislators to have balloon angioplasties to &quot;relieve&quot; the supposed CCSVI in MS paid for by the regular government health insurance.

So far they have not succeeded but public pressure is mounting and the doctors who are pushing Zamboni&#039;s agenda have often publicly said they are conducting a clinical study to measure the effectiveness of balloon angioplasty to relieve the symptoms of MS.

When asked how the study is being conducted they specifically started to make up reasons why BLINDING is not at all necessary in their study.

I can see them coming out with a bogus blinded, poorly executed study in a year or so that they will proceed to use as a shield against all criticism.

If this indeed transpires, I don&#039;t think the general public will be swayed by &quot;academic&quot; contra-arguments about the finer points of clinical study design and blinding and these guys will get exactly what they want. - MONEY</description>
		<content:encoded><![CDATA[<p>The exact same thing is happening here in Slovenia, where Zamboni has successfully found allies in certain private clinics near the border between Italy and Slovenia that have begun a systematic campaign propaganda aimed at the public and legislators to have balloon angioplasties to &#8220;relieve&#8221; the supposed CCSVI in MS paid for by the regular government health insurance.</p>
<p>So far they have not succeeded but public pressure is mounting and the doctors who are pushing Zamboni&#8217;s agenda have often publicly said they are conducting a clinical study to measure the effectiveness of balloon angioplasty to relieve the symptoms of MS.</p>
<p>When asked how the study is being conducted they specifically started to make up reasons why BLINDING is not at all necessary in their study.</p>
<p>I can see them coming out with a bogus blinded, poorly executed study in a year or so that they will proceed to use as a shield against all criticism.</p>
<p>If this indeed transpires, I don&#8217;t think the general public will be swayed by &#8220;academic&#8221; contra-arguments about the finer points of clinical study design and blinding and these guys will get exactly what they want. &#8211; MONEY</p>
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		<title>By: Kawarthajon</title>
		<link>http://theness.com/neurologicablog/index.php/a-ccsvi-meta-analysis/comment-page-1/#comment-37678</link>
		<dc:creator>Kawarthajon</dc:creator>
		<pubDate>Tue, 04 Oct 2011 19:59:18 +0000</pubDate>
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		<description>Sorry, I meant Steve, not Bob, in my comment above.</description>
		<content:encoded><![CDATA[<p>Sorry, I meant Steve, not Bob, in my comment above.</p>
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		<title>By: sonic</title>
		<link>http://theness.com/neurologicablog/index.php/a-ccsvi-meta-analysis/comment-page-1/#comment-37676</link>
		<dc:creator>sonic</dc:creator>
		<pubDate>Tue, 04 Oct 2011 18:45:16 +0000</pubDate>
		<guid isPermaLink="false">http://theness.com/neurologicablog/?p=3692#comment-37676</guid>
		<description>Meta-analysis uses mathematics that have very strict limits on applicability.  It seems the data in this case are outside that limit.
Doing a statistical analysis in this situation can give a false impression of certainty.  The researchers make mention of that (lack of heterogeneity...) but do the analysis anyway.
And some will take that and get a false sense of certainty.

Once upon a time I thought it would be good to clean-up this area-- the misuse of statistics.
Perhaps this is a good example of where positive thinking is really wishful thinking.</description>
		<content:encoded><![CDATA[<p>Meta-analysis uses mathematics that have very strict limits on applicability.  It seems the data in this case are outside that limit.<br />
Doing a statistical analysis in this situation can give a false impression of certainty.  The researchers make mention of that (lack of heterogeneity&#8230;) but do the analysis anyway.<br />
And some will take that and get a false sense of certainty.</p>
<p>Once upon a time I thought it would be good to clean-up this area&#8211; the misuse of statistics.<br />
Perhaps this is a good example of where positive thinking is really wishful thinking.</p>
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		<title>By: Kawarthajon</title>
		<link>http://theness.com/neurologicablog/index.php/a-ccsvi-meta-analysis/comment-page-1/#comment-37674</link>
		<dc:creator>Kawarthajon</dc:creator>
		<pubDate>Tue, 04 Oct 2011 17:18:04 +0000</pubDate>
		<guid isPermaLink="false">http://theness.com/neurologicablog/?p=3692#comment-37674</guid>
		<description>This is a big issue in Canada, where MS patients have successfully lobbied the federal government to engage in a study to see if this approach to treating MS can be helpful.  

While I agree with Bob&#039;s approach to studying the question of whether CCSVI is a scientifically viable treatment, it is a hugely emotional issue.  Many MS patients, desperate for a reprieve from their illness, believe strongly that this treatment should be made available to them and are travelling all over the world to get it - India, Hungary, China, etc...  There are many anecdotal reports that it helps - which often is enough to fuel widespread lobbying for the treatment to be made available.  (There are also reports that it does not work and many patients have had their overall condition worsened by this procedure, although these reports do not sway the proponents of the treatment)  I believe a clinical trial is underway in Manitoba (or Saskatchewan?).  

Overall, I think that this is a very emotional issue and is one where the science will not necessarily sway public opinion about the treatment.  It has yet to be determined whether science or emotion will determine public policy in Canada (i.e. whether Provincial governments will cover the cost of the treatment).</description>
		<content:encoded><![CDATA[<p>This is a big issue in Canada, where MS patients have successfully lobbied the federal government to engage in a study to see if this approach to treating MS can be helpful.  </p>
<p>While I agree with Bob&#8217;s approach to studying the question of whether CCSVI is a scientifically viable treatment, it is a hugely emotional issue.  Many MS patients, desperate for a reprieve from their illness, believe strongly that this treatment should be made available to them and are travelling all over the world to get it &#8211; India, Hungary, China, etc&#8230;  There are many anecdotal reports that it helps &#8211; which often is enough to fuel widespread lobbying for the treatment to be made available.  (There are also reports that it does not work and many patients have had their overall condition worsened by this procedure, although these reports do not sway the proponents of the treatment)  I believe a clinical trial is underway in Manitoba (or Saskatchewan?).  </p>
<p>Overall, I think that this is a very emotional issue and is one where the science will not necessarily sway public opinion about the treatment.  It has yet to be determined whether science or emotion will determine public policy in Canada (i.e. whether Provincial governments will cover the cost of the treatment).</p>
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