Alberta Health Services, the centralized corporate behemoth that runs the province’s healthcare system, disappointed advocates of “liberation therapy” for multiple sclerosis last week by putting out an amazing discussion paper [PDF] surveying the relationship between MS and “chronic cerebrospinal venous insufficiency”. It summarizes clinical knowledge in an accessible way and raises points that even CCSVI skeptics have overlooked. One simple example: “If proven, the association between MS and CCSVI may actually be explained by MS causing CCSVI.”
Given the logical and empirical problems with Dr. Paolo Zamboni’s theory and the special risks of venous angioplasty and stent insertion, Alberta politicians can feel comfortable in taking a hands-off attitude toward Saskatchewan Premier Brad Wall’s aggressive push for more trials of liberation therapy. If members of the Stelmach cabinet still want to pay for some risk-free research, though, I have a completely serious suggestion: why don’t we test Zamboni himself? We could do it live on cable TV. Actually, since CTV’s flagship W5 program (with synergistic assistance from the Globe & Mail) played such a large role in creating the furore over Dr. Zamboni’s theories, it’s possible the network would like first crack at the broadcast rights.
Zamboni claims to be able to tell MS sufferers apart from healthy individuals with virtually perfect accuracy just by looking at suitable medical images of the neck veins. There is no reason why the world should settle for his mere assurance that he can do so, since this ability ought to be simple to prove. And if he can do it he has no reason to be afraid to demonstrate it. It does not make much sense for the world to perform countless multi-million-dollar trials of his treatment before we check out the most basic, inexpensively verifiable element of his claims. (It certainly does not make sense to let people buy MRIs and other scans for “venous insufficiency” until we know whether that phrase has any practical meaning.)
So why not let Dr. Zamboni declare what images he requires, take 50 sets of snapshots of MS patients and 50 sets from healthy controls, and let him have at the pile of 100 file folders? Invite him to Alberta. Pay his expenses. Give him as much time as he needs. Have clinicians (and, preferably, some conjurors) present to establish proper, bulletproof double-blinding. The cost would probably come in at well under $100,000 and we would have our result instantly. Either he identifies the MS patients at a rate much better than chance or he doesn’t. If he scores close to 100%, as he has implied he can, then we would have strong reason to believe that vein structures are associated with MS. And we could justifiably move on toward establishing the proper direction of the causal arrow that those crotchety killjoys at AHS are so concerned with.
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