Author Affiliations: The Sandra and Malcolm Berman Brain & Spine Institute, Adult Hydrocephalus Center, Sinai Hospital of Baltimore (Dr Williams), and Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, The Johns Hopkins University School of Medicine (Dr Venkatesan), Baltimore, Maryland.
We thank Dr Reekers for his comments. We recognize and respect that differing views regarding the ethical permissibility of clinical research in CCSVI exist. As we stated, a strong scientific case has been made against CCSVI as a causative factor in multiple sclerosis, and we shared our doubt regarding its validity. Nonetheless, published clinical research suggests that endovascular intervention may be effective in at least a portion of involved patients. Therefore, we argue that a vital prerequisite for research to be conducted (ie, equipoise) exists. Equipoise in this instance is not an individual's sense of ambivalence regarding the efficacy of a novel treatment, but rather the existence of uncertainty within the scientific community regarding its efficacy compared with existing therapies or placebo.
Williams MA, Venkatesan A. IDEAL for CCSVI Research—Reply. Arch Neurol. 2012;69(7):939-940. doi:10.1001/archneurol.2012.325