In 1993, there were no approved M.S.-specific drug therapies; now there are 20. What could the remarkable progress mean for how we study other conditions?
“The other thing about Sadiq’s practice was that everything was there,” Storch said. Sadiq’s center, which he founded in 2006, has an unusual structure. Research, occupational therapy, social work, nutrition counselling, MRIs, physical therapy—they all take place on two floors of a building on Fifty-seventh Street, in Manhattan, and all are devoted almost exclusively to M.S.
The approach of housing all M.S. services together, as at Sadiq’s practice, can seem less than revolutionary, but at a recent “patients as teachers” session at the Barlo Multiple Sclerosis Center, at St. Michael’s Hospital, in Toronto, the patients spoke about the value of having care from different providers be coördinated. Providers want this, too—it is sometimes called comprehensive care—but the usual demons of funding and structural change are difficult to overcome.
Sadiq was born in Kenya, and graduated from the University of Nairobi’s medical school in 1979. He did his residency in internal medicine in Kenya and in the U.K. between 1981 and 1985, and so has witnessed the arc of how dramatically M.S. outcomes have changed in the past half century. “When I was in school, and in residency, M.S. was a dead-end disease.
Multiple sclerosis presents far more variously than most other illnesses; for that reason, it has been called “the great imitator.” Some of the conditions it can resemble are minor, and others are major. If you have ever Googled a random tingling or twinge or eyebrow twitch, you have probably spent at least one evening convinced that you have M.S. On the other hand, M.S. patients often think for a while that they don’t have much going on. One person’s first symptom might be numbness.
Jeffrey Cohen, the director of experimental therapeutics at the Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research, said, “The field does seem to be a little more organized. We have a well-developed set of diagnostic criteria, and a well-developed methodology for testing treatments and deciding whether they work. But another part of it may be that success begets success.” When something goes well, funding tends to come your way to do more such work.
Salpêtrière held some five thousand patients. They were affected by chronic diseases of many kinds, but especially those of the nervous system. “We are, in other words, in possession of some sort of museum of living pathology of great resources,” Charcot wrote. His great scientific move can seem, in retrospect, ordinary.
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