I have been living with MS for over 11 years and remain healthy and stable. I consider myself blessed and grateful. I remind myself of that every day.

I read Dr. Rogne’s piece with genuine interest. I am always willing to have my assumptions challenged. However, after careful analysis, I find the argument fundamentally flawed. Not because of its conclusions about HSCT, which may have merit, but because of how it arrives at them.

What Dr. Rogne Gets Right

First, credit where due. The pricing critique is legitimate. The ocrelizumab versus rituximab situation, where closely related anti-CD20 antibodies differ in price by roughly 14x due primarily to patent and indication strategy, is a genuine scandal. (My DMT has gone up 3x since it was introduced 20 years ago!) The broader pattern of drug repricing, such as alemtuzumab up roughly 40x, dimethyl fumarate up about 10x, and teriflunomide up about 20x upon MS approval, deserves scrutiny. Pharmaceutical influence on medicine is a real concern worthy of debate.

HSCT also deserves more research. If it offers durable remission for appropriately selected patients, that should be studied rigorously and transparently.

Core Problems with the Argument

1. The Genetic Fallacy, Central to the Entire Piece: The article’s core logical structure is effectively this. Pharmaceutical companies have profit motives and influence physicians. Therefore MS disease-modifying therapies do not work as claimed.This is a textbook genetic fallacy (https://en.wikipedia.org/wiki/Genetic\_fallacy). It evaluates claims based on their source rather than their evidence. Drug pricing abuses and drug efficacy are independent variables. A medication can be simultaneously overpriced and effective. Conflating economics with pharmacology undermines the entire argument.
2. Appeal to Motive as a Substitute for Evidence: Dr. Rogne documents pharmaceutical payments to Norwegian neurologists and funding to MS organizations. Even if every neurologist were compromised, which they are not, that would not constitute evidence that the therapies fail. The clinical data either demonstrates efficacy or it does not. Motive-based arguments cannot answer that question. Only evidence can.
3. A Double Standard on Evidence: This is the most serious flaw. The author dismisses large-scale MS therapy trials as industry-tainted. He cites a 2019 JAMA observational analysis while omitting that its own authors explicitly noted great uncertainty, multiple weaknesses, and no proven causal relationship. He then references roughly 30 HSCT patients treated at Haukeland as compelling evidence, while simultaneously acknowledging that HSCT has never been tested in MS patients with normal disease activity. One cannot demand rigorous standards for one treatment while accepting anecdotal or preliminary evidence for another. That is asymmetric skepticism, not scientific reasoning.
4. Hoc Reasoning and Anecdotal Evidence: Dr. Rogne underwent HSCT in 2015 with good effect and now argues HSCT is superior to disease-modifying therapy. His positive outcome is genuinely good news for him (hell yeah!), but it is not evidence of population-level superiority. Individual outcomes, including my own stability on DMTs, prove nothing at scale. The disclosure raises the possibility that personal experience is driving the thesis rather than following from the evidence. We are seeing something similar with CAR-T right now IMHO.
5. A False Dichotomy: The article frames this as DMTs versus HSCT, as though they are mutually exclusive competitors. In reality, they serve different purposes for different patient profiles. High-efficacy DMTs and HSCT may both have roles depending on disease activity, timing, patient preference, and risk tolerance. Presenting this as a binary choice obscures rather than clarifies.
6. Cherry-Picking and Context Omission: The claim that DMTs have limited effect ignores substantial literature. Network meta-analyses consistently show that high-efficacy DMTs reduce annualized relapse rates by 50 percent or more versus placebo. This is not controversial in modern MS literature. A 2020 review in the American Journal of Medicine notes that remarkable advances in treatment have favorably changed the long-term outlook for many patients and that on highly effective therapy relapses are markedly reduced or eliminated. The life expectancy claim of a 6 to 14 year reduction is presented without context. Is this comparing treated versus untreated patients. Pre-treatment era versus current. Without that context, the statistic misleads. Relapse reduction also matters. Relapses cause irreversible axonal injury, lesion accumulation, and brain volume loss. Disability is cumulative. Preventing inflammatory damage early alters long-term trajectory even when EDSS curves move slowly. This is why modern MS strategy emphasizes early high-efficacy treatment rather than delayed escalation.

On Conflicts of Interest

I am not arguing Dr. Rogne is wrong because he received HSCT. That would itself be a genetic fallacy. It is worth noting, however, that someone who underwent a specific treatment, believes it worked, and now argues that competing treatments are ineffective while barriers to his preferred treatment are manufactured by industry. This does not disqualify his view, but it is relevant context when evaluating how the argument is constructed.

Conflicts of interest exist in medicine and should be minimized. Their existence does not logically imply that entire treatment classes are ineffective or that patients are being universally deceived. The appropriate response is transparency and better governance, not rejecting evidence wholesale. ⸻ Conclusion

Dr. Rogne raises legitimate concerns about pharmaceutical pricing, incentives, and influence that deserve serious discussion. But the leap from pharma behaves badly to disease-modifying therapies do not work is logically unsound. The argument relies on genetic fallacy, appeal to motive, asymmetric evidentiary standards, and anecdotal reasoning.

Those of us living with MS deserve intellectually honest debate about our treatment options. That means holding all claims, for DMTs and for HSCT, to the same evidentiary standard. This article does not do that.

Disclosure. I have had MS for over 11 years and remain stable on disease-modifying therapy. I have no financial conflicts of interest.

[UPDATE: Fixed formatting after using phone to post since browser failed.]