Advertising for Patients

In recent years, if you have used the Internet for more than five minutes you will have encountered one its most annoying features: "Ad by Google ." In today's post we will take a look at how Google plays an inadvertent role in the promotion of health scams targeted at those suffering from Multiple Sclerosis .

Admittedly, Google is not bound by law, statutory or moral, to reject any advertisement or to pass judgment on the efficacy of any medical therapy. That's why Google has a market capitalization of ~ $189 billion. But the fact that Google is being paid to advertise on behalf of those who have a financial interest in "unorthodox" treatments for MS, or any other condition, should alert the reader that such therapies should be viewed with skepticism.

As many readers already know, Multiple Sclerosis (MS) is a chronic, neurodegenerative, autoimmune disease that is found predominately in young women. Despite years of research, and hundreds of millions of dollars to finance that research, no potential cure for MS has been found and the few treatments available to MS patients are targeted at the disease's physical manifestations rather than the underlying disease process. It is therefore perfectly understandable that those with MS can be susceptible to "new treatments" and "miracle cures" that are marketed by unscrupulous individuals and businesses. One of the latest scams to target those with MS involves claims about a medical procedure known as Venous Angioplasty and its role in a condition known as Chronic Cerebrospinal Venous Insufficiency (CCSVI) . The "rationale" behind venous angioplasty in MS comes from a study published in 2009 by Italian researcher Paolo Zamboni.

Zamboni claims that CCSVI, which interferes with the drainage of blood from the brain, is a central factor in the symptoms of MS because "venous congestion" leads to the buildup of several "byproducts" produced by normal metabolic processes at the cellular level within the brain. There are several weaknesses in Zamboni's argument.

If CCSVI is a prominent factor in MS, then it should be present in all cases of MS. Unfortunately, the simple fact is that there are many cases of MS where this not the case. Also, if CCSVI is involved with the development of MS, then treating it should cause either a reduction in symptoms or at least stop the disease's progression. Again, the best available evidence indicates that this is not the case and that the number of MS patients who report a subjective improvement in their symptoms is very, very, close to the number of reported improvements that would be expected due to the placebo effect.n Finally, are there cases of CCSVI in those without MS? The literature is incomplete on this issue but seems to indicate that CCSVI can be present in those without MS.

Perhaps the greatest indictment of the CCSVI theory comes from an organization with no particular ideological, therapeutic, or financial axe to grind. In its annual summary of medical research for the year 2010, the (US) National Multiple Sclerosis Society notes that the initial claims regarding CCSVI and venous angioplasty "have been difficult to reproduce" (a term used in medical circles to politely note that no one, other than the original author / authors, is getting the same results).

Facilities offering Venous Angioplasty for CCSVI include Angeles Health International , a chain of 22 private hospitals located throughout Mexico. Venous Angioplasty for CCSVI is offered in several locations other than Mexico, such as PrivateScan / MS-CCSVI (Netherlands) and at the Ex-Cell Center (Dusseldorf, Germany) and is also available at a few locations in the United States, most notably Pacific Interventionalists, Inc . of Newport Beach, CA.

As you might expect, Venous Angioplasty for CCSVI carries a rather high cost. On their respective web sites, PrivateScan lists its charges as €7,500 (~ $10,000), Ex-Cell comes in at about the same as PrivateScan, and Pacific Interventionalists lists a cost of $8,000 ($1,000 cash deposit "up front"). All these facilities have additional charges for diagnostic testing. Angeles Health does not list its charges for the procedure, although it charges $25,000 for its "Two Treatment Autism Package" (whatever that is), $47,000 for a kidney transplant and $102,000 for a liver transplant. It is not clear whether you must BYOD (bring your own donor) or take your chances in the a la carte donor line.

As stated earlier in this post, Google (or Yahoo, or MSN, or anyone else selling online advertising) is bound by legal or moral duties to verify the veracity of an advertisers claims. We must therefore conclude that this responsibility lies with the well-informed individual. In that respect, caveat emptor.

Sources Consulted

Michaela Langgartner. The Patient's Journey: Multiple Sclerosis . British Medical J 2005; 330 : 885 .

Paolo Zamboni, et al. Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis . J Neurol Neurosurg Psychiatry. (2009);80:392-399.

Pacific Interventionalists, Inc. CCSVI and MS pages ( http://www.pacificinterventional.com/ ). Accessed December 12, 2010.