Time for a population based approach to multiple sclerosis care.

industry continues to support research to improve efficacy and tolerance, care providers must recognize that the impact of disease modifying therapy on the MS population will also depend on our ability to optimize use. We have all heard the quote from former US Surgeon General C. Everett Koop that ‘drugs don’t work if you don’t take them’ however we must also recognize that the impact of treatment on a population will be reduced if many who should benefit are not even given the opportunity. To ensure that all Canadians who should benefit from MS therapy are given the opportunity we must identify and reduce barriers to the use of evidence based treatment. These barriers include lack of knowledge regarding when treatment is indicated, geographic barriers which limit access to expert neurological opinion, and economic barriers that limit evidence based use of MS disease modifying therapy. This process will require optimizing education about MS and its management, facilitating access to neurologists with expertise in managing MS, and working with provincial governments to make appropriate therapies available to all patients in whom there is appropriate evidence to support therapy. This will also require that neurologists consider the entire MS population, not just people who fall under their care and governments must recognize the importance of this leadership activity. The existence of the Canadian MS Clinics over the past 30 years has been an important step toward population based care but not all Canadians with MS are served by these clinics. Neurologists from the Canadian MS clinics and from the community must continue to participate in the development of better systems of population-based care and must work together to identify and fill gaps in care. Population surveys will continue to be needed to document the overall impact of treatment on people with MS. Let us be sure we take up these challenges of influencing the health care system and of confirming our successes and ongoing challenges. It will be for the betterment of all people with MS.