Rethinking Multiple Sclerosis: Why Everything We Thought We Knew Is Changing
But the real world is messy. And the clues that our story was wrong came from our own treatments. New therapies came along that absolutely hammered B-cells—another part of the immune army we'd mostly ignored in the MS story. And they worked. Frighteningly well [4]. That begged a huge question. If this was a T-cell war, why was taking out the B-cell infantry so brutally effective?
It forced a complete reset. Turns out, B-cells aren't just standing around. They're key players, maybe even the ringleaders that get the T-cells riled up and keep the fires of chronic inflammation burning [1] [2]. This wasn't some minor academic correction. It changed everything. It meant our entire working model of the disease was incomplete. We'd been staring at one piece of the puzzle, thinking it was the whole picture. The neat story was wrong.
This disease is a product of a murky conspiracy between a person's genes and some environmental trigger we still can't nail down [3] [10]. A virus from childhood? A chronic deficiency? We have a list of suspects, but no convictions. What we do know is that once it kicks off, it's a cascade of damage. And it's not just about the myelin anymore. It's about the nerve itself. The wire, not just the insulation.
First job is getting the diagnosis right. For that, we have the MRI. It's our window into the damage [9]. We hunt for lesions—the scars of past attacks—in the brain and spinal cord. But one picture isn't enough. To be sure it's MS, we have to prove the damage is happening in different places and at different times. Dissemination in space and time. That's the mantra.
The McDonald criteria are the rules of the game for this, and they've been sharpened over the years to be faster and more accurate [13]. The 2017 update, for example, cut down the waiting time for a diagnosis. Good. Because time is brain. The sooner we know, the sooner we can act. We even have advanced imaging now that lets us see past the obvious lesions to the subtle, fraying wires underneath it all [15].
But the sharper picture from our MRIs showed us something else. Something uncomfortable. The old textbooks taught us MS was a disease of white people with Northern European roots. That was the classic patient profile. Another part of our simple story. And another part that was dead wrong [8].
The data coming out now paints a very different picture. In the United States, Black individuals don't just get MS—they have the highest incidence of the disease [14]. Hispanic communities are also hit hard. This isn't a footnote. It's the headline. It tells us that MS risk is shaped by more than just ancestry. It's shaped by society. It's about where you live, your access to care, and the systemic biases baked into the world [14]. It's a humbling reality check. A disease doesn't happen in a biological vacuum. It happens in the real world [7].
The last two decades? An absolute explosion in treatments [2] [5]. We went from having almost nothing to a whole arsenal of drugs. The new high-efficacy therapies, especially those B-cell killers, can slam the brakes on relapses and new MRI lesions [4]. They are powerful weapons against the inflammatory part of MS.
But stopping the inflammation, we're learning, is only half the job. MS isn't one thing. It's two. A two-headed monster. It is an inflammatory disease, yes. But it is also a neurodegenerative one [2] [6]. From day one, nerve fibers are being quietly damaged and permanently lost. Axonal transection. That's the technical term. It means the nerve fiber is cut. It doesn't grow back. This is the stealthy process that drives progressive disability, the slow worsening that can happen even when a person feels fine.
For years, we saw this as a two-act play: an early, inflammatory stage, followed by a later, degenerative stage. Another simple story. Also wrong. We now know they are partners in crime. Inflammation and neurodegeneration are happening at the same time, a vicious cycle running from day one [12].
This changes the mission entirely. The new mandate isn't just to cool down the immune system. It's to protect the brain itself. Neuroprotection. That's the holy grail now [11] [12]. We need drugs that not only stop the attacks but also shield the neurons from the fallout and, maybe, help the brain heal itself. We aren't there yet. But that's where everything is headed. The goalpost moves. It's not just 'no new attacks' anymore. It's 'save the brain.' Preserve function for the long haul. It means we have to finally toss out the simple stories and face the complicated, challenging reality of what this disease truly is.
[1] Yamout, B. I., & Alroughani, R. (2018). Multiple Sclerosis. Seminars in neurology, 38(2), 212–225. https://doi.org/10.1055/s-0038-1649502
[2] Hauser, S. L., & Cree, B. A. C. (2020). Treatment of Multiple Sclerosis: A Review. The American journal of medicine, 133(12), 1380–1390.e2. https://doi.org/10.1016/j.amjmed.2020.05.049
[3] Ghasemi, N., Razavi, S., & Nikzad, E. (2017). Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell journal, 19(1), 1–10. https://doi.org/10.22074/cellj.2016.4867
[4] Galota, F., Marcheselli, S., De Biasi, S., Gibellini, L., Vitetta, F., Fiore, A., Smolik, K., De Napoli, G., Cardi, M., Cossarizza, A., & Ferraro, D. (2025). Impact of High-Efficacy Therapies for Multiple Sclerosis on B Cells. Cells, 14(8), 606. https://doi.org/10.3390/cells14080606
[5] Martin, R., Sospedra, M., Rosito, M., & Engelhardt, B. (2016). Current multiple sclerosis treatments have improved our understanding of MS autoimmune pathogenesis. European journal of immunology, 46(9), 2078–2090. https://doi.org/10.1002/eji.201646485
[6] McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis and Treatment of Multiple Sclerosis: A Review. JAMA, 325(8), 765–779. https://doi.org/10.1001/jama.2020.26858
[7] Kapica-Topczewska, K., Kulakowska, A., Kochanowicz, J., & Brola, W. (2025). Epidemiology of multiple sclerosis: global trends, regional differences, and clinical implications. Neurologia i neurochirurgia polska, 10.5603/pjnns.103955. Advance online publication. https://doi.org/10.5603/pjnns.103955
[8] Dobson, R., & Giovannoni, G. (2019). Multiple sclerosis - a review. European journal of neurology, 26(1), 27–40. https://doi.org/10.1111/ene.13819
[9] Elahi, R., Taremi, S., Najafi, A., Karimi, H., Asadollahzadeh, E., Sajedi, S. A., Rad, H. S., & Sahraian, M. A. (2025). Advanced MRI Methods for Diagnosis and Monitoring of Multiple Sclerosis (MS). Journal of magnetic resonance imaging : JMRI, 10.1002/jmri.29817. Advance online publication. https://doi.org/10.1002/jmri.29817
[10] Jakimovski, D., Bittner, S., Zivadinov, R., Morrow, S. A., Benedict, R. H., Zipp, F., & Weinstock-Guttman, B. (2024). Multiple sclerosis. Lancet (London, England), 403(10422), 183–202. https://doi.org/10.1016/S0140-6736(23)01473-3
[11] Thompson, A. J., Baranzini, S. E., Geurts, J., Hemmer, B., & Ciccarelli, O. (2018). Multiple sclerosis. Lancet (London, England), 391(10130), 1622–1636. https://doi.org/10.1016/S0140-6736(18)30481-1
[12] Coclitu, C. I., Constantinescu, C. S., & Tanasescu, R. (2025). Neuroprotective strategies in multiple sclerosis: a status update and emerging paradigms. Expert review of neurotherapeutics, 25(7), 791–817. https://doi.org/10.1080/14737175.2025.2510405
[13] Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., Correale, J., Fazekas, F., Filippi, M., Freedman, M. S., Fujihara, K., Galetta, S. L., Hartung, H. P., Kappos, L., Lublin, F. D., Marrie, R. A., Miller, A. E., Miller, D. H., Montalban, X., Mowry, E. M., … Cohen, J. A. (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet. Neurology, 17(2), 162–173. https://doi.org/10.1016/S1474-4422(17)30470-2
[14] Langer-Gould, A. M., Cepon-Robins, T. J., Benn Torres, J., Yeh, E. A., & Gildner, T. E. (2025). Embodiment of structural racism and multiple sclerosis risk and outcomes in the USA. Nature reviews. Neurology, 21(7), 370–382. https://doi.org/10.1038/s41582-025-01096-5
[15] Sbardella, E., Tona, F., Petsas, N., & Pantano, P. (2013). DTI Measurements in Multiple Sclerosis: Evaluation of Brain Damage and Clinical Implications. Multiple sclerosis international, 2013, 671730. https://doi.org/10.1155/2013/671730
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USA Today
14 hours ago
- USA Today
Her doctor said her tumor was harmless, common among Black women. It was cancer.
Tamron Little was 21 and pregnant with her first child. During a routine ultrasound, doctors found what they suspected to be a fibroid tumor. Little's tumor wasn't tested or treated – doctors told her this type of tumor was common among Black women and would resolve on its own, but they were wrong. Five months after giving birth, she was diagnosed with peritoneal mesothelioma, a rare and aggressive cancer that affects the lining of the abdomen and, in most cases, develops following asbestos exposure. Her misdiagnosis had delayed treatment, and just as she was starting her journey as a new mother, she was given 18 months to live. Little, now 39 and a contributor for the Mesothelioma Center at survived. But her misdiagnosis led to a distrust in the medical system. Each year, a misdiagnosed disease kills or disables about 795,000 people in the United States, according to a 2023 study published by BMJ Quality & Safety. In a July 2024 survey of 50 cancer survivors across the U.S. who were misdiagnosed, 92% said the misdiagnosis hurt their health, 64% had their treatment delayed, and 56% said their cancer advanced to a later stage. 'Not in a million years' could it be cancer When Little's tumor was first discovered and misidentified as a fibroid, she shared the news with her family. Her mom told her it was fine; she had them too. Her aunt, who also had fibroids, said, 'It's just something that you live with.' Instead, Little attributed her symptoms to her first pregnancy, even when she became severely anemic. 'I still thought, 'OK, pregnancy is brutal,'' she says. Her anemia symptoms became so severe that Little dropped out of college and moved back home. After she had her son, her OBGYN placed her on birth control in an attempt to shrink the suspected fibroid tumor. A few months had passed, and a routine ultrasound showed that the tumor was getting larger. That was the first time cancer crossed Little's mind. "Right in that moment, I asked the doctor, 'I know you're saying that this is a fiber tumor. Could this be cancer?'" she says. The doctor reassured her: "No, not in a million years," she recalls. "You're healthy, and for women of childbearing age, fibroids are very common." But out of caution, the doctor decided to take the tumor out. Finally, she was diagnosed with peritoneal mesothelioma. 'I looked at my family members, and their world just crushed,' she says. 'That is when I became the eye of the storm.' They called in the grief counselor. Little was given a prognosis of 18 months to live. She was in shock. All she wanted to do was hug her baby. 'I went in there thinking, 'Oh, this is just a routine procedure to get a fibroid tumor out,' and I came out with a cancer diagnosis of a cancer I've never heard of before,' she recalls. Her doctor had no treatment plan. She searched for a second opinion and found, at the time, one of the few doctors on the East Coast who specialized in HIPEC (hyperthermic intraperitoneal chemotherapy), a two-step procedure that involves inserting high doses of chemotherapy directly into the abdomen. Black women are more likely to die from multiple cancers, despite differing incidence rates Black women have a higher risk of death than their White counterparts when it comes to certain cancers, such as breast cancer and cervical cancer, which have been studied at length. In a 2022 study of 50 Black women who had experienced perceived discrimination in medical settings, 94% of participants felt like they were receiving poorer service during medical visits, and 92% believed they were not being listened to or 'taken seriously.' In 2025, an estimated 319,750 people will be diagnosed with breast cancer in the U.S., and an estimated 42,680 people will die from the disease. 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'It's something that is very disheartening,' Little says of her misdiagnosis. 'But it's something that as a woman of color, I've experienced time after time.' Misdiagnosis leads to decreased trust in the medical system From the Tuskegee Syphilis Study to the forced sterilization of Black women throughout the 20th century, race-based medical malpractice has been well-documented in U.S. history. In a 2024 study, 58% of Black women surveyed believed the medical system was "designed to hold Black people back." While Little survived, her trust in the medical system faltered. Eighteen years later, she's still 'very strategic' when it comes to choosing her doctors and sets high expectations for their standard of care. 'I've had doctors that, when I asked a question about my platelet counts, said, 'Black women are known to have lower platelet counts than White women,'' she says, referencing her anemia that went dismissed. 'I'm not going to take that for an answer.' Little's family relies on her now, too. When her grandma was diagnosed with colon cancer in 2023, Little was put on FaceTime with her doctors to ask the 'right questions.' 'I can just imagine my other counterparts, women of color, who go through that every day, but may not know how to respond to it, or may think that that's normal,' she says. 'You have a right as a patient to respectfully disagree with your doctor, and you have a right to lay those expectations down beforehand.'
San Francisco Chronicle
14 hours ago
- San Francisco Chronicle
S.F. schools spent $8 million to change the way they teach math. Here's what's new
Math will look and feel a lot different in San Francisco schools this year and that seems evident by the picture of the chilled-out chimpanzee on the cover of the new kindergarten textbook, with similar images on subsequent grades. These books, which came with the recently purchased k-8 math curriculum, the first in 16 years, offer a glimpse of what educators and district officials hope students will discover inside: Math is not only learnable and fun, but also incredibly relevant to the world around them. For generations of adults raised on the drill-and-kill math of decades past, 'fun' might not be a word they link to long division, the solving for X or those two trains traveling at different speeds toward Boston. The new curriculum, which cost $8 million, includes classroom math toys and digital practice problems with moving parts and instant feedback, making it feel more like a video game. But what schools and society expects kids to learn in math class has shifted in the past 15 years, in large part because of the Common Core standards, which provided an outline for the skills and knowledge students should have after each grade to prepare them for college and careers. That includes not the ability to do math, but also understanding when and why they would use it. 'If we're telling students how to do something, and they just do it they aren't internalizing,' said Renée Marcy, district director of STEM. 'They need to be able to make sense of it themselves.' Based on state standardized test scores, the district still has work to do. Less than half of its 48,000 students — just over 45% — were at grade-level proficiency or higher in math in the spring of 2024, the most recent data available. While that was well above the state average of 36%, a deeper look at the data shows subpar performance among subgroups in the district, with 11% of Black students and 17%of Latino students proficient in math. The goal, district officials said, is to get 65% of eighth graders to proficiency by 2027, up from 42% in 2022. San Francisco, for the most part, has been using in-house, teacher-developed instruction for nearly two decades, only now purchasing a comprehensive k-8 curriculum from two curriculum development companies — Imagine Learning for elementary schools and Amplify Desmos Math in middle schools. For k-5, that includes textbooks, workbooks and digital programs. It also provides hands-on games and math tools like blocks that click together, rulers, tiles and more, for each classroom, said Devin Krugman, assistant superintendent of curriculum and instruction. 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The program also allows teachers to see how each child is doing in real time on computer-based practice work. 'I could focus more on the kids who were having a harder time with the math,' Chiu said. In the spring, Presidio saw 'huge jumps' in sixth and seventh grade test scores, according to Chiu, while district officials said in a statement that 'early results from the pilot demonstrated promising outcomes: Students whose teachers used the new curriculum performed better on standardized testing than those whose teachers used the old one.' For Chiu, higher test scores are definitely part of the plan, but she has other goals too. 'I feel like all adults have math trauma,' she said. 'We have to break the cycle.'
Axios
15 hours ago
- Axios
Controversial full-body MRIs are expanding in Central Ohio
Depending on who you ask, a full-body MRI is either an early-detection breakthrough or an unnecessary procedure that harms more than helps. Why it matters: The scans have become popular in part due to wellness influencers, celebrity endorsements and a distrust of conventional medicine, and more MRI companies plan openings in Columbus. Zoom in: Columbus already has centers like ProScan Imaging and Craft Body Scan, and international wellness companies like Prenuvo and Ezra have Central Ohio locations on the way. By the numbers: Prenuvo has completed 50,000 scans since December and 150,000 total since 2018, CEO Andrew Lacy tells Axios. What they found: Prenuvo scans spotted cancer in 2.2% of mostly asymptomatic patients, according to an ongoing study conducted by the MRI company and presented at an American Association for Cancer Research conference in April. In the study, which included 1,011 patients in Canada in the early findings, roughly half of the biopsies prompted by scan findings turned out to reveal cancer. Yes, but: Just because a scan detected cancer, that doesn't mean the cancer was aggressive or that the detection extended someone's lifespan. In the study, two breast cancer cases were not detected by a whole-body MRI. Between the lines: The Ohio State University associate professor of radiology Mina Makary has researched and written about the topic extensively. He says the biggest issue with these scans is a lack of specificity. "No two MRIs are the same," he tells Axios. "The type of images we acquire during an MRI are tailored to the organ we're scanning and the disease we're looking for." Full-body scans are also likely filled with "incidental findings" that might otherwise never affect your life but could cause stress for everyone involved. "There's anxiety for the patient, cost to the patient and to the health care system, and the tests we do to figure things out add their own risks and complications," Makary says. What they're saying: Full-body scans are "the bane of my existence," says oncologist Marleen Meyers, director of NYU Langone's survivorship program at the Perlmutter Cancer Center. She says that most findings from full-body MRIs are false positives or benign, but "the knowledge, the stress and fact you start treatment then upends your life." "Studies with these scans so far have not shown any improved survival," she tells Axios. The other side: Collecting enough data to provide evidence that the tests improve survival would probably take decades, says Lacy.
