MS (Neuroimmunology ) fellowship and personalized medicine

[mohdil23]

Hi guys,

I would like to ask for your opinions on getting MS fellowship, in terms of the:
1) salary
2) satisfaction of practice
3) opportunities for personalized medicine and basic neuroscience research .

I have done a masters in genomic medicine and a masters in translational neurology , and I m looking for a fellowship field that can match my background. I was thinking about doing neuro-oncology but I heard that the market is not doing well for neurologists at the moment, and genome based interventions might not be used in clinical field soon.

Also I was thinking about neuro-genetics fellowship but the field seems to focus mainly on pediatrics neurology, monogenetic diseases and intellectual disabilities.

please advice if you have any thoughts on that,
Thanks.

---

Members don't see this ad.

 

[Telamir]

Market not doing well for neurologists? Huh?

As far as MS fellowship...well there are people who love it but I personally wouldn't touch it. You OWN those patients and all their complications and other facets of their disease you might not even be accounting for (spasticity, depression, bladder dysfunction, sexual dysfunction, chronic fatigue, work issues, etc. etc. etc). That being said if you like that then go for it.

There are opportunities for neuroscience research though. I don't know what you mean by "personalized medicine".

 

[deathmerchant]

Hi guys,

I would like to ask for your opinions on getting MS fellowship, in terms of the:
1) salary
2) satisfaction of practice
3) opportunities for personalized medicine and basic neuroscience research .

I have done a masters in genomic medicine and a masters in translational neurology , and I m looking for a fellowship field that can match my background. I was thinking about doing neuro-oncology but I heard that the market is not doing well for neurologists at the moment, and genome based interventions might not be used in clinical field soon.

Also I was thinking about neuro-genetics fellowship but the field seems to focus mainly on pediatrics neurology, monogenetic diseases and intellectual disabilities.

please advice if you have any thoughts on that,
Thanks.

I think the best option for you if you are interested in translational work and genomics is Epilepsy (if you are a med student may be consider peds neuro). In my opinion that is currently the most advanced field amongst all neuro subspecialties in regards to what we know about its basic science. this field might be the best amenable to personalized medicine. You should go to AES annual meeting once. Neuro oncology has some scope for your area of expertise.

I agree with above, Im not too impressed with MS research at the moment. It is all focused on creating new MAbs, that are barely better than existing medications. We don't know much about the Etiopathogenesis. And most importantly for you, it is most definitely a multifactorial disease with exogenous factors like, mimicry, diet, environment etc playing a more important role than genetics.

Finally, Ill reiterate as Telamir above "Market not doing well for neurologists? Huh?"

 

[neglect]

I think the best option for you if you are interested in translational work and genomics is Epilepsy (if you are a med student may be consider peds neuro). In my opinion that is currently the most advanced field amongst all neuro subspecialties in regards to what we know about its basic science. this field might be the best amenable to personalized medicine. You should go to AES annual meeting once. Neuro oncology has some scope for your area of expertise.

I agree with above, Im not too impressed with MS research at the moment. It is all focused on creating new MAbs, that are barely better than existing medications. We don't know much about the Etiopathogenesis. And most importantly for you, it is most definitely a multifactorial disease with exogenous factors like, mimicry, diet, environment etc playing a more important role than genetics.

Finally, Ill reiterate as Telamir above "Market not doing well for neurologists? Huh?"

Wut?

MS reasearch and trials just gave us two oral meds for SPMS, the first meds to be approved for that classification! The “new” mab, ocrelizumab, is now about two years old and was found to be effective in primary progressive MS - also the first med for those folks, for which we could do nothing other than say sorry in the past. NMO has its first approved treatment aside from off label use of rituxan!

I guess I’m old enough to remember when MS was a really horrible disease that maimed and killed and NMO did it faster. I’m thrilled by the progress. See a dude with 5 enhancing lesions and hemiplegia while on first line therapy and knowing that you’ll be able to help him? 15 years ago you’d have been thought insane. Creating new mab’s that help people aflicted by MS - sounds like a worthy thing to get involved with! Sure, there are plenty of gaps, and if that’s your things, then run a lab and play a role in figuring it out. The immune system is obviously vast.

Epilepsy is also awesome. Many new drugs. The problem is that the refractory folks stay refractory and each iteration of keppra and CBMZ don’t do much to help them. But incremental steps.

To the OP, best luck. Personalized medicine is meh. Plays better for TED talks than for the next 10-30 years. We are not physiologically that unique. What works in you will probably work in me. Pharmacogenetics mostly seems to work for differences in pharmacokinetics, NOT dynamics.

 

[deathmerchant]

Wut?

MS reasearch and trials just gave us two oral meds for SPMS, the first meds to be approved for that classification! The “new” mab, ocrelizumab, is now about two years old and was found to be effective in primary progressive MS - also the first med for those folks, for which we could do nothing other than say sorry in the past. NMO has its first approved treatment aside from off label use of rituxan!

I guess I’m old enough to remember when MS was a really horrible disease that maimed and killed and NMO did it faster. I’m thrilled by the progress. See a dude with 5 enhancing lesions and hemiplegia while on first line therapy and knowing that you’ll be able to help him? 15 years ago you’d have been thought insane. Creating new mab’s that help people aflicted by MS - sounds like a worthy thing to get involved with! Sure, there are plenty of gaps, and if that’s your things, then run a lab and play a role in figuring it out. The immune system is obviously vast.

Epilepsy is also awesome. Many new drugs. The problem is that the refractory folks stay refractory and each iteration of keppra and CBMZ don’t do much to help them. But incremental steps.

To the OP, best luck. Personalized medicine is meh. Plays better for TED talks than for the next 10-30 years. We are not physiologically that unique. What works in you will probably work in me. Pharmacogenetics mostly seems to work for differences in pharmacokinetics, NOT dynamics.

I agree that we have many new medications in MS, and that has provided us and patients with more options than in the past.
And Im not uptodate on all the studies on these new medications, but I believe the difference in efficacy amongst these medicines is not that dramatic. And If I'm not mistaken, even if these medications lower the annual relapse rate, the difference in 15-20 year disability(EDSS) is negligible, compared to placebo- which most studies and ads and Reps sideline. Obviously they are also expensive and have significant side effects.
Also there was a paper few years ago from Europe that concluded that Rituximab is as effective and much cheaper than all other MS medications.

In addition, there are many neurologists who believe and have written papers on how MS is purely a dietary and lifestyle disease. There is another famous guy who believes MS is a vascular phenomenon and he does some kind of Shunting procedure, in europe!(I personally don't agree with that view point)

Either way the above is still an ongoing debate, but I wasn't making that specific point. I was talking about personalized medicine, genomic and translational neuro. In my opinion, Epilepsy is the most advanced subspecialty in that regard and actually 10-30 years is not that far!

 

[neglect]

I agree that we have many new medications in MS, and that has provided us and patients with more options than in the past.
And Im not uptodate on all the studies on these new medications, but I believe the difference in efficacy amongst these medicines is not that dramatic. And If I'm not mistaken, even if these medications lower the annual relapse rate, the difference in 15-20 year disability(EDSS) is negligible, compared to placebo- which most studies and ads and Reps sideline. Obviously they are also expensive and have significant side effects.
Also there was a paper few years ago from Europe that concluded that Rituximab is as effective and much cheaper than all other MS medications.

In addition, there are many neurologists who believe and have written papers on how MS is purely a dietary and lifestyle disease. There is another famous guy who believes MS is a vascular phenomenon and he does some kind of Shunting procedure, in europe!(I personally don't agree with that view point)

Either way the above is still an ongoing debate, but I wasn't making that specific point. I was talking about personalized medicine, genomic and translational neuro. In my opinion, Epilepsy is the most advanced subspecialty in that regard and actually 10-30 years is not that far!

1. Retrospective cohort reviews based on hospital claims are a type of evidence. And Rituxan is likely a very effective MS therapy. But it is not used in the US in part due to the uptake of ocrelizumab.

2. Differences in EDSS have changed MARKEDLY. The disease can essentially be arrested with proper management and titration upwards. So this is just at odds with current thinking.

3. The many neurologists who think MS is a lifestyle disease are usually quacks and charlatans and ‘Lyme literate.’

4. The famous guy: Paolo Zamboni came up with Chronic cerebrospinal venous insufficiency (CCSVI) pretty much out of his ass. It was then shown to be non-effective. Prospective randomized trial of venous angioplasty in MS (PREMiSe)

5. Personalized medicine, whatever that means, is great for orphan diseases like the different kinds of cystic fibrosis. It doesn’t seem as useful for polygenetic or acquired diseases like seizures. Take post-code seizures, give keppra; PD, sinemet; AD, Aricept; AM, coffee.

 

[deathmerchant]

1. Retrospective cohort reviews based on hospital claims are a type of evidence. And Rituxan is likely a very effective MS therapy. But it is not used in the US in part due to the uptake of ocrelizumab.

2. Differences in EDSS have changed MARKEDLY. The disease can essentially be arrested with proper management and titration upwards. So this is just at odds with current thinking.

3. The many neurologists who think MS is a lifestyle disease are usually quacks and charlatans and ‘Lyme literate.’

4. The famous guy: Paolo Zamboni came up with Chronic cerebrospinal venous insufficiency (CCSVI) pretty much out of his ass. It was then shown to be non-effective. Prospective randomized trial of venous angioplasty in MS (PREMiSe)

5. Personalized medicine, whatever that means, is great for orphan diseases like the different kinds of cystic fibrosis. It doesn’t seem as useful for polygenetic or acquired diseases like seizures. Take post-code seizures, give keppra; PD, sinemet; AD, Aricept; AM, coffee.

I actually agree with many of your points and Ive heard and studied very valid multiple sides/criticism of all points you mentioned at a recent annual meet, by so called ‘experts’ and probably some quacks. That’s the reason I mentioned it is a debate, although it does seem lopsided at the moment- favoring drug companies.
I can’t do an elaborate discussion here obviously.
I agree with points 1 and 4; partially agree with 2 and 3. Disagree with 5.

 

[Epic786]

You have some good questions, but it depends whether you want to be in academics or private practice (physician-owned). If you are thinking of doing research there are plenty of opportunities at big academic centers but the salary would not be great!

1) salary (depends upon academic vs non academic centers)
2) satisfaction of practice (MS patients have alot of complications including Depression but I feel that they are not as crazy has patients I have seen in epilepsy clinic)
3) opportunities for personalized medicine and basic neuroscience research .(alot of oppurtunities but it depends if you are at an academic center vs non academic one)