…there’s plenty of declarations of good will, compassion, energy to solve problems related to MS – that’s all great and laudable.

However, I can’t stop thinking there are some elephants in the room that keep getting ignored since people tend to jump on the next train before the one they sat on reaches its destination, or indeed requires quite a lot of ongoing attention over the foreseeable future.

The name of the new train is called “prevention”.

Prevention – what a wonderful idea. And since the new bug has embedded itself in people’s minds, everybody seems to be falling over each other in a race to bottom, to the root causes, to “prevent MS”. Grant panels may soon refuse applications unless that codeword is in the title of your submission, similar to the “COVID code” that had to be stuck in the headline to stir interest when the pandemic hit and research seemed to know only one disease.

At the same time, this new lingo is also a deflection from what has been a major part of medicine, certainly when chronic conditions are concerned, for decades. It’s called *secondary* prevention. You had a myocardial infarct? All going well, you take aspirin or clopidogrel or apixaban, lose weight, stop smoking, go to the gym 3 times/week and – hopefully – prevent another one. That’s prevention. And that’s what happens in MS. Once you have been diagnosed, all efforts are targeting rapid *secondary* prevention, enabling to *live a life hardly affected by MS* – my mantra for some time.

I understand there is space for everyone in the MS “community”, pwMS, clinicians, AHCPs, mice(!), data scientists, managers, social workers – everyone. And yet resources and time are finite, and the new – but distant – horizon of preventing MS altogether shouldn’t derail efforts to manage MS as early as possible, as effective as possible.

Now, as a more regular blog reader than even myself, you might say “but isn’t that what’s happening anyway? MD keeps feeding us this (evidence-based) gospel All The Time!” But in many places in the UK and in LMICs (you might have noticed a twinkling eye here), we’re still far off the target when it comes to early & effective intervention.

How do we achieve a degree of equity of MS care across the Globe? After all, it’s WorldMSDay? The MSIF made a great leap forward with the adoption on 2023 of three DMTs to the Essential Medicines List of the WHO. But how much difference does it make to pwMS on the ground? Do they now have equitable access to effective DMT? Is the introduction of new diagnostic criteria a little spanner in the works, making it harder in places to confirm the diagnosis and – thus – treatment (if available)?

Checking the preliminary programme of this year’s joint ECTRIMS/ACTRIMS conference (MSToronto2026) I couldn’t find a single dedicated panel/seminar/course dedicated to the issue of effective DMT across the planet. I’m confident more equitable access to this type of prevention (i.e. secondary) is possible given the number of compounds available, improved technology and networks. But there seems to be an eerie silence at MSToronto2026. Why don’t we talk about it at the largest Global MS meeting?

Source: multiple-sclerosis-research.org