After practicing medicine for three decades, two of which have been dedicated to understanding and managing MS, I thought I had broad exposure to cognitive, behavioral, societal, and biological variables. In other words, I thought I had seen it all. Not so.
MS is the epitome of variability and uncertainty. Gladly, the introduction and gradual sophistication of disease-modifying therapies (DMTs) have brought some sense of control and hope for better long-term outcomes. MS researchers and clinicians recognize there remain gaps in knowledge in areas such as prognosis estimation, DMT selection, longitudinal monitoring of function, better assessment modalities, and treatment of the progressive disease phenotypes. This recognition is not being approached with a shoulder shrug. On the contrary, it has resulted in a large body of high-quality research that is presented during scientific meetings such as ACTRIMS/ECTRIMS, which just concluded.
The ongoing pandemic has upended all aspects of life. Health care delivery is unique in that it cannot be placed in a suspended state like sports or education. Not only did we need to come up with solutions to a universal acute health crisis with repercussions on all aspects of individual and communal living, but we also had to become inventive and resourceful in continuing much-needed care for non-crisis related health issues, to include chronic diseases.
The swift pivot to modified approaches to patient care, including telemedicine, has been nothing short of remarkable. Telemedicine did not appear out of thin air, though. Many proponents have advocated for it for quite some time, but telemedicine as an alternative option to regular care would have taken a very long time to establish itself under regular circumstances. Yet here we are, using it extensively and productively.
Similarly, attending a large scientific meeting such as ACTRIMS/ECTRIMS via a virtual platform, aptly renamed MS Virtual 2020, proved to have positive results. Admittedly, missing the physical contact with friends and colleagues, the rush of joining a large crowd speed walking to a large auditorium to listen to the late-breaking results of a clinical trial, and the sights and cuisine of a new city, I have to say there were many positive aspects to this remote modality. First and foremost, the science was there. From better defining the temporal spectrum of the disease — opening with a review of the evolving understanding of the prodromal stage of MS while also highlighting approaches to the late progressive phase — to bridging basic and clinical science, the presentation of information was comprehensive. Entering and leaving virtual rooms is easier and faster, especially when one wants to catch presentations grouped in parallel sessions. The availability of revisiting certain talks or listening to those originally missed by going to the digital library is a luxury, and I will be reviewing material for several days following the end of the meeting. And the virtual connection was oddly personal and close. The speakers were right there in front of you, looking you in the eye, albeit across a computer screen. There was something about seeing both seasoned and young scientists perched in their home offices or living rooms presenting scientific data that colored the entire experience with cozy surrealism.
Over the years, I marveled at the resilience of my patients and their families. They deal with the limitations and tribulations brought on by MS every minute. From them, I learned about the human aspect of the disease, and this enhanced my ability to practice the art of medicine within the context of evidence-based science. Today, I marvel at the adaptability of the MS medical community, which leads me to believe that we can do even better by capitalizing on the current crisis. Leveraging digital capabilities, including machine learning and remote continuous monitoring of physical and cognitive performance, is not only feasible but needs to be grown exponentially to aid in timely treatment optimization in MS. The crisis showed us all it can be done. Let’s not let it go to waste.