In reply
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.