Giancarlo Comi: devoted to multiple sclerosis

Abstract

It is 1950, and an Italian family is keeping an anxious vigil at the window of their home in the Lombardy countryside near Milan. Among them is Giancarlo Comi, just 4 years old, listening to his parents' worried conversation about his sister's severe pneumonia. They were waiting for a physician to arrive bearing a new miracle cure, penicillin, and when the doctor did finally come roaring into view on the back of a red motorbike, “it felt like God had arrived to save my sister”, Comi recalls. The experience left an indelible impression on him. Throughout the rest of his childhood all he could think about, he says, was becoming a physician. “There was and could be nothing better for me”, he says, “than to save people”. Fast forward 65 years and it is fair to say that Comi has fulfilled his ambition. As Professor of Neurology, Chairman of the Department of Neurology and Director of the Institute of Experimental Neurology at the Vita-Salute San Raffaele University in Milan, he has won renown for his contributions to the treatment of one neurological disease in particular: multiple sclerosis.In October this year, Comi's endeavours were recognised at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) congress in Barcelona, Spain, where he became the first Italian to be presented with the Charcot Award for multiple sclerosis research by the MS International Federation. His is a mantelpiece already replete with baubles and awards, but the Charcot is “a very emotional award” he says, as it is given on behalf of the patient organisations that make up the MS International Federation. Comi is strongly of the opinion that despite much progress in the treatments available for patients with multiple sclerosis over the past several decades, patients still often get a raw deal. “Every day I see patients who have not received the best available treatment based on the knowledge we have today”, he says. “If you ask me what the major problem is today, this is it. Of course we would still like to have new and better treatment, but what is really fundamental for me is to use what is already available in the best possible way, because it is really terrible to undertreat a person.” He first got interested in multiple sclerosis research in the 1970s after getting involved in an epidemiological study at the Department of Neurology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, in Milan, where he was working as a Clinical Assistant in 1974 immediately after graduating with his medical degree in 1973. “I was hit by the act that so many young people had their lives destroyed by this condition, and also by the fact that there was essentially no treatment at all”, he says. From that point on he devoted an increasing proportion of his time to multiple sclerosis until his appointment as an Assistant Professor in Clinical Neurophysiology made it an all-consuming preoccupation.“Giancarlo has been instrumental in the search for new therapies in relapsing remitting multiple sclerosis, in particular in identifying and validating new therapeutic strategies and advocating early interventions”, says Per Soelberg Sørensen, a Professor of Neurology at the Danish Multiple Sclerosis Center at Copenhagen University Hospital in Copenhagen, Denmark. This constant urge to push for progress has often left him at odds with the prevailing orthodoxy, particularly with regard to the timing of treatment. In the early 1990s, Comi became convinced that to influence the progression of multiple sclerosis it was fundamental to treat patients as early as possible in the course of their disease. “This became a bit of a fixation for me”, he recalls, and he used an invitation to speak at a WHO congress in 1998 to argue his case. “I said we have to treat very early because if we wait to treat we will have the same negative aspects—the side-effects—of treatment, but we will lose all of the advantages because we will be too late to influence the direction the disease may take.” But his pleas fell on deaf ears, with some of his counterparts insinuating that Comi's motives were clouded by a desire to increase the use of drugs for the benefit of pharmaceutical companies. Undeterred, Comi scraped together the funding to run a trial of interferon-beta in patients with a first clinical manifestation of multiple sclerosis. The results along with those of a parallel US study vindicated Comi, but slowly, he suggests, “because you know science requires time, most people have now come to accept the idea of early treatment”.Few of Comi's waking hours are not allocated to some activity related to multiple sclerosis. On top of his hectic clinical and research schedule Comi is also the President of the European Charcot Foundation (the organisation founded by the Dutch neurologist Otto Hommes), a member of the Board of Administration of the Italian Multiple Sclerosis Foundation and the Scientific Committee of Associazione Italiana Sclerosi Multipla, and Co-chair of the Scientific Steering Committee of the Progressive MS Alliance. He just about finds time to indulge a passion for food and wine, but he had to say goodbye to a side career as a restaurant critic for an Italian food guidebook because there simply were not enough hours in the day. Proof, if any were needed, that Comi's commitment to multiple sclerosis, is in his own words, “total”. It is 1950, and an Italian family is keeping an anxious vigil at the window of their home in the Lombardy countryside near Milan. Among them is Giancarlo Comi, just 4 years old, listening to his parents' worried conversation about his sister's severe pneumonia. They were waiting for a physician to arrive bearing a new miracle cure, penicillin, and when the doctor did finally come roaring into view on the back of a red motorbike, “it felt like God had arrived to save my sister”, Comi recalls. The experience left an indelible impression on him. Throughout the rest of his childhood all he could think about, he says, was becoming a physician. “There was and could be nothing better for me”, he says, “than to save people”. Fast forward 65 years and it is fair to say that Comi has fulfilled his ambition. As Professor of Neurology, Chairman of the Department of Neurology and Director of the Institute of Experimental Neurology at the Vita-Salute San Raffaele University in Milan, he has won renown for his contributions to the treatment of one neurological disease in particular: multiple sclerosis. In October this year, Comi's endeavours were recognised at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) congress in Barcelona, Spain, where he became the first Italian to be presented with the Charcot Award for multiple sclerosis research by the MS International Federation. His is a mantelpiece already replete with baubles and awards, but the Charcot is “a very emotional award” he says, as it is given on behalf of the patient organisations that make up the MS International Federation. Comi is strongly of the opinion that despite much progress in the treatments available for patients with multiple sclerosis over the past several decades, patients still often get a raw deal. “Every day I see patients who have not received the best available treatment based on the knowledge we have today”, he says. “If you ask me what the major problem is today, this is it. Of course we would still like to have new and better treatment, but what is really fundamental for me is to use what is already available in the best possible way, because it is really terrible to undertreat a person.” He first got interested in multiple sclerosis research in the 1970s after getting involved in an epidemiological study at the Department of Neurology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, in Milan, where he was working as a Clinical Assistant in 1974 immediately after graduating with his medical degree in 1973. “I was hit by the act that so many young people had their lives destroyed by this condition, and also by the fact that there was essentially no treatment at all”, he says. From that point on he devoted an increasing proportion of his time to multiple sclerosis until his appointment as an Assistant Professor in Clinical Neurophysiology made it an all-consuming preoccupation. “Giancarlo has been instrumental in the search for new therapies in relapsing remitting multiple sclerosis, in particular in identifying and validating new therapeutic strategies and advocating early interventions”, says Per Soelberg Sørensen, a Professor of Neurology at the Danish Multiple Sclerosis Center at Copenhagen University Hospital in Copenhagen, Denmark. This constant urge to push for progress has often left him at odds with the prevailing orthodoxy, particularly with regard to the timing of treatment. In the early 1990s, Comi became convinced that to influence the progression of multiple sclerosis it was fundamental to treat patients as early as possible in the course of their disease. “This became a bit of a fixation for me”, he recalls, and he used an invitation to speak at a WHO congress in 1998 to argue his case. “I said we have to treat very early because if we wait to treat we will have the same negative aspects—the side-effects—of treatment, but we will lose all of the advantages because we will be too late to influence the direction the disease may take.” But his pleas fell on deaf ears, with some of his counterparts insinuating that Comi's motives were clouded by a desire to increase the use of drugs for the benefit of pharmaceutical companies. Undeterred, Comi scraped together the funding to run a trial of interferon-beta in patients with a first clinical manifestation of multiple sclerosis. The results along with those of a parallel US study vindicated Comi, but slowly, he suggests, “because you know science requires time, most people have now come to accept the idea of early treatment”. Few of Comi's waking hours are not allocated to some activity related to multiple sclerosis. On top of his hectic clinical and research schedule Comi is also the President of the European Charcot Foundation (the organisation founded by the Dutch neurologist Otto Hommes), a member of the Board of Administration of the Italian Multiple Sclerosis Foundation and the Scientific Committee of Associazione Italiana Sclerosi Multipla, and Co-chair of the Scientific Steering Committee of the Progressive MS Alliance. He just about finds time to indulge a passion for food and wine, but he had to say goodbye to a side career as a restaurant critic for an Italian food guidebook because there simply were not enough hours in the day. Proof, if any were needed, that Comi's commitment to multiple sclerosis, is in his own words, “total”.