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Multiple sclerosis in the digital age: 'seeing through a glass darkly'
ECTRIMS Online Library. Compston A. Oct 10, 2018; 231787
Alastair Compston
Alastair Compston
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Abstract: 43

Type: Plenary Session

Abstract Category: N/A

A reasonable contemporary formulation would consider multiple sclerosis to be a prototypic immunological disease of the brain and spinal cord; with distinct demography and distribution that reflect the interplay of many genetic risk factors, individually exerting small effects but collectively favouring dysregulated adaptive and immune pathways, exposed by environmental triggers; mechanisms that engage inflammatory and degenerative processes, working in sequence or in parallel, expressed as a characteristic but evolving clinical and radiological phenotype; with availability of licenced therapies that modify the course but vary in their risks and benefits and which make for a complex prescribing algorithm modulated by social, economic and professional issues; and phenocopies defined by distinct clinical and laboratory biomarkers, with the expectation of further separation from the rubric of 'multiple sclerosis'. But in the context of this scientific analysis, it is the abruptly threatened hopes and fears of the affected individual that drive the endeavour to learn more.
Future technology and the ability to derive concepts through the manipulation of large numbers in the digital age will fill in the gaps and illuminate issues that now are 'seen through a glass darkly'. Before embracing these opportunities and moving forward it is as well to reflect, in the context of multiple sclerosis, on the nature and philosophy of knowledge and how ideas are generated, consolidated, communicated and archived: in short, the collective wisdom of learning, its inheritance and transmission.
It is safe to assume that many practical problems associated with impairment, handicap and disability will be eased by the march of smart technological progress. But life in the machine age with human activities increasingly delegated to the products of artificial intelligence will not necessarily bring uncomplicated benefits to the person with multiple sclerosis. There will be logistic advantages and socio-economic consequences. As uncertainty on the ethics of interference with the 'book of nature' and the security of big data come into focus, the challenge for those involved in neurological and other branches of medicine - be that the patient, carer, physician, healthcare administrator, pharmaceutical mogul, or political legislator - will be to protect the dignity of the affected individual and respect the distinction between what can be done and what should be done.
Disclosure: Alastair Compston was in receipt of occasional travel expenses and honoraria from Sanofi-Genzyme up to February 2017; between 2014 and 2019 he will receive an annual honorarium for scientific assessments on behalf the Lundbeck Foundation.

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