[neltnerb]

I'm not going to judge anyone (I have MS) but it's extraordinarily difficult to analyze evidence when the disease progression is random flares. If I have a flare, is it because a medication isn't working? Or is it working just fine and I would have had five otherwise? Not really any way to know.

I would not take anything my doctor didn't say would at least not cause harm. But the calculus is different for other people.

Among groups of people with MS I've chatted with there is kind of an unspoken rule to not advise treatment because we all know that we are all different in treatment, symptoms, probably cause... you can get off into the weeds pretty easily.

Lipolic acid, vinpocetine, curcumin, lots of things are anti-inflammatory or good for neuropathy. I've had people recommend getting controlled bee stings, hensbane, obviously meditation for reducing stress and cortisol, and if we go in the direction of alternative methods (which I know people with MS who have used) you get acupuncture and yoga and herbal medicines. CBD in Europe is a treatment, I'm sure other cannabinoids would help different people in different ways too. I just have to tune it out, I want to spend my attention on what I'm good at and enjoy, and trust my [MS specialist] doctor to let me know about new treatments.

Study says "inflammation decreased" which is great. But lots of things do that, so the question is how much... I wouldn't trust it without a fair bit of statistical evidence without my doctor telling me that whatever random supplement is safe enough to risk.

[zamnos]

Do what's right for you, but never mind Europe, CBD is an accepted treatment in all US states. More specifically: there are no longer any states outright banning the use of CBD. This is not any sort of comment on MS and CBD, mind you.

https://cfah.org/cbd-legal-states/

I'm glad you have a specialist doctor whom you trust. MS is a relatively known quantity, having being first described by a neurologist in 1868. Not all diseases and not sufferers have such a privilege. For something newer at the edge of medical sience, like AIDs was in the 1980s or like Long Covid is now, patients are finding doctors of only limited use, and the FDA an impediment rather than helpful. If there was a cure for MS available in Mexico, would you not start a Dallas Buyers Club for others afflicted?

[neltnerb]

Honestly, I trust the FDA to mostly do a good job and would wait -- unless the time involved would mean that waiting would render the treatment moot.

In that case it seems like there's more reason to try, at first, but there is a real cost. The cost of time spent focusing on enjoying what you have in the search for a better that may or may not come. And the cost of spending your days dissatisfied that it's not better than it is.

I don't think chasing medical miracles is a good way to spend my days. If the treatment is safe and works I'm confused why you believe the FDA would prevent it's use, is that a common scenario?

[zamnos]

Dissatisfied is one thing. Wouldn't you rather not spend your days having flares at all though? A trip down to Mexico and, like, $50k for a stem cell treatment (HSCT) could be the cure for your ills. It's definitely not got FDA approval, and your mainstream doctor definitely going to advise you against it. And I'm some random Internet commenter so definitely don't remotely read this as treatment advice. But next time you have a flare up, tell me what you wouldn't do to never have them again.

[neltnerb]

I think a lot of this is the feeling that one's own case is special or that you will get a better than median outcome. I want treatment that, for median cases similar to mine, improves things with a high enough success rate and low enough side effect rate that it's not a difficult call anymore.

And if the treatment is $50k in another country there's no reason that pharmaceutical companies in the US wouldn't pursue it as a treatment, so there's not the same argument as there is with supplements where they simply don't have funded studies. They'd want to upcharge it to $500k I'm sure, but I think the profit motive would be there for them to make it available.

If there's a complex and expensive surgery that might fix a problem, I guarantee there is funding available to make sure it's actually safe and won't give me a brain infection or something. If it could be solved with supplements, the issue is that there's no one funding such research but my doctor also doesn't object to taking stuff that might work. Like curcumin and R-Lipolic acid, and have been actively told to take D3. No harm likely, probably not helping but why not?

Neither of these cases seem like they involve the FDA, so I'm just super confused. The two people replying here seem to both be under the impression that the FDA drives the profit motives for pharmaceutical companies or stop people from taking random supplements so long as they aren't known to hurt you.*

I honestly do not have a problem trusting that the FDA uses a basically reasonable process to evaluate these things, and that if the treatment was available in the US I have vastly less objection to doing it elsewhere where it costs less.

But this is just me. I've lived through flare ups, and have had this since interferon was all we had to work with. I do not think it is a good idea to assume that you are somehow going to have a better outcome than median. Once my doctor agrees my prognosis is bad enough that the median outcome of a treatment is positive, my opinion changes.

I'm a scientist, maybe other people can't think this way. I think it is a very bad idea to think you are different from average, particularly about things that are certainly out of your control. It's just... it's gambling with your health, double or nothing... but if my family and doctor think it's worth the bet it's a much simpler choice.

I would not try to override my spouse or doctor or family if they felt it was too dangerous to be worth the potential benefit, I think they are much more objective than I am.

* Let's ignore DEA nonsense, it's important but tangential.

[mwbajor]

There is too much contradictory evidence from the medical community on the efficacy of vitamin supplements. However, enough circumstantial evidence exists to prove two things: 1) Diet studies are hard 2) Pharmaceuticals are not going to fund a study for a cheap supplement 3) If this is true then the FDA should fund a "good, big diet/supplement study" but they dont. For this, I would say the FDA can't be trusted with "doing a good job" when a possible cheap solution exists.

[neltnerb]

I completely agree about the incentives for supplement studies.

However, the FDA, critically, has totally different and vastly less difficult regulations for supplements as opposed to drugs. Where by drugs I mean things the manufacturer wants to sell as a treatment for a specific condition, for which they were required to provide evidence.

I totally agree that the funding incentives are not good for studying cheap supplements. I have no idea why you think that has anything to do with the FDA, just buy the supplements if you think the circumstantial evidence is good enough.

Edit: For instance, I have been trying R-Lipoic Acid lately. No one stopped me. No one advertised it as a treatment. I found some research papers that said it might help and my doctor said it wouldn't hurt. I don't think it helped, but certainly the FDA didn't get in the way.

[mwbajor]

" I have no idea why you think that has anything to do with the FDA, just buy the supplements if you think the circumstantial evidence is good enough."

Can the FDA turn the circumstantial evidence into real evidence? I think they can.

[neltnerb]

I've never heard of the FDA funding a drug study, that is more a NIH thing. If the FDA were sending out requests for proposals I would expect them to be about:

- testing food for contamination

- inspecting food facilities and farms for safety

- ensuring drugs are not contaminated and that safety reports are coordinated

The NIH is the one that provides funding for health studies... please understand that I'm not saying it's good or correct that studies of supplements aren't getting funding, I'm saying that the FDA is not involved. Direct frustration at the right target, pharmaceutical companies (i.e. capitalism) having no interest in unpatentable low cost treatments and NIH/government not funding such studies when they should.

I agree, the NIH should study all these things -- and does if you look at their budget, via tens of thousands of individual academic research groups with less incentive to not study supplements. Capitalism is still there, but if anywhere can study it without worrying as much about profit motive it'd be academia or a national lab.

I also agree that NIH should have more money targeted at low-profit drug studies. That's unfortunately the kind of thing that gets determined by congress unless they decide to do it on their own.

The best situation is one where the legislature requires a minimum amount be spent by an agency to support certain kinds of research (for instance, they do this across the federal government through the SBIR program for small businesses).

https://www.nih.gov/ABOUT-NIH/WHAT-WE-DO/BUDGET

> The NIH invests most of its $45 billion budget in medical research for the American people.

> Over 84 percent of NIH’s funding is awarded for extramural research, largely through almost 50,000 competitive grants to more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions in every state.

> In addition, over 10 percent of the NIH's budget supports projects conducted by nearly 6,000 scientists in its own laboratories, most of which are on the NIH campus in Bethesda, Maryland. The remaining 6 percent covers research support, administrative, and facility construction, maintenance, or operational costs.