The death of the first Canadian after a controversial multiple sclerosis treatment abroad has deepened the chasm between doctors and patients: Physicians are urging more caution than ever, and people with MS are demanding with increased fervour that doctors set aside their reservations and perform the operation in Canada.
The Italian doctor at the centre of what could be a groundbreaking method of treating MS - opening up neck veins in the hope of improving blood flow from the brain - offered his condolences to the man's family, and reiterated his message that patients should be cautious until further clinical trials are completed.
"Some patients with very aggressive disease, it is impossible to wait. I can understand this, of course," Paolo Zamboni told CTV on Friday, adding that people should opt for balloon angioplasty instead of stents to open up the veins.
Ontario resident Mahir Mostic died in October from complications after seeking treatment at a Costa Rican clinic. A balloon angioplasty was unsuccessful, so, at the request of Mr. Mostic, doctors inserted a stent, a riskier procedure because stents can migrate and can lead to blood clots. His family declined comment on Friday.
Doctors in Canada say that Mr. Mostic's death is a cautionary tale for patients assessing an unproven and experimental treatment. While the procedure has yet to undergo clinical trials in Canada, multiple sclerosis patients have shelled out thousands of dollars for the procedure in countries such as India and Poland.
The treatment is based on an unproven hypothesis advanced by Dr. Zamboni that some cases of MS are vascular disorders caused by vein blockages that lead to a buildup of iron in the brain, rather than an autoimmune disease, and can be treated by a simple surgical procedure - angioplasty. It remains unclear whether blocked veins cause the disease or are a symptom. The procedure is not performed in Canada, although Saskatchewan has indicated that it could start clinical trials as early as next year.
Anthony Traboulsee, a neurologist at the University of British Columbia Hospital, asked patients to wait until the research his completed. He is conducting a study of whether blocked veins are prevalent in MS patients.
Another researcher, Ian Rodger, vice-president of research and academics at St. Joseph's Healthcare in Hamilton, said that while patients have the right to choose their treatment, Mr. Mostic's death should be a reminder that there can be complications. "What it really does underscore for me is the absolute need for us to have the results of the studies that are ongoing to see if, in fact, the MS patients do have an increased prevalence of blocked veins or not," Dr. Rodger said. "That is so critical now."
But MS patients, who have become increasingly vocal and organized, said Mr. Mostic's death underlines the need for clinical trials to begin immediately. They remain steadfast in their belief that the operation is effective.
"We need to have it done here, there's no question," said Diana Gordon of Barrie, Ont., who received the treatment in the United States in June. "People should never have to travel out of the country in a country where we have universal health care."
With a report from Adrian Morrow