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Research Article

Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States

  • Raymond N. Moynihan mail,

    raymoynihan@bond.edu.au

    Affiliation: Bond University, Robina, Australia

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  • Georga P. E. Cooke,

    Affiliation: Bond University, Robina, Australia

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  • Jenny A. Doust,

    Affiliation: Bond University, Robina, Australia

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  • Lisa Bero,

    Affiliation: University of California, San Francisco, San Francisco, California, United States of America

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  • Suzanne Hill,

    Affiliation: Australian National University, Acton, Australia

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  • Paul P. Glasziou

    Affiliation: Bond University, Robina, Australia

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  • Published: August 13, 2013
  • DOI: 10.1371/journal.pmed.1001500

Reader Comments (2)

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Thank you

Posted by cramot on 16 Sep 2013 at 07:21 GMT

I wish to congratulate the authors for their excellent work. I've been treating patients with multiple sclerosis (MS) for 20 years, and I've seen how we've gone from talking about clinically defined MS to talking about radiologically defined MS through MRI (MRI that increasingly requires fewer lesions for diagnosis), to then talking about isolated radiological syndrome when we casually discover MS characteristic lesions in an otherwise asymptomatic patient. Because when I started practicing medicine there was no treatment for MS, I was fortunate to be able to observe what the natural treatment of the disease is, and I have come to believe that interferon beta (IFNb) and glatiramer acetate (AG) are drugs that are not worthwhile. Opinion leaders urge us to diagnose as early as possible in order to start treatment as soon as possible. As the authors very clearly point out in this article, no one is measuring the psychological consequences of labeling a person with an MS diagnosis or the physical consequences of initiating a treatment whose effectiveness, as is the case of IFNb and AG, is at best modest. Finally, I'd like to point out something that is not addressed in the article, which is that there are also consequences for those physicians who do not adhere to this indoctrination. We end up feeling isolated and excluded. This article has given me the strength to continue to treat patients as I do without feeling guilty. Thank you

No competing interests declared.