NY1's Budd Mishkin continues his "One On 1" series with a profile of one of the leading doctors in the fight against multiple sclerosis, Aaron Miller.
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Some professions have very tangible signs of success; sports, the arts, and certainly business. But when you're trying to find a cure for a disease like multiple sclerosis, as Dr. Aaron Miller has for more than three decades, you take your victories whenever and wherever you can get them.
Miller is considered one of the foremost multiple sclerosis clinicians in the country.
"While there are many people, unfortunately, for whom we still haven’t solved the riddle and enabled them to have normal lives, for more people than not the disease follows a course that will enable them to be productive for very, very long periods of time," he says.
Since 2004, Miller has directed clinical affairs at the Center for Multiple Sclerosis at Mount Sinai. Before that, he headed the Division of Neurology at Maimonides in the Bronx.
His entire career has been about treating patients with MS, and holding clinical trials to test new medicines that offer some hope. And he's heard one question for far too long: Is a cure around the corner?
“I've been hearing about that corner for more years than I care to remember,” he says. “I don't really like that expression because I don't know where that corner lurks, and progress sometimes comes more slowly than we would like."
According to the National Multiple Sclerosis Society, MS is thought to be an autoimmune disease that affects the central nervous system. An exact cause is unknown, but it's believed to stem from a malfunction of the body's immune system.
Some 400,000 Americans acknowledge having MS. It's estimated that 200 people are diagnosed every week.
"We're not really sure whether MS is actually increasing or whether our diagnostic techniques have improved to the extent that we are able to diagnose people more quickly and more readily,” Miller says. "Until we get to the point where we can prevent the disease and then the statistics will really be important, right now I take care of a patient, not a statistic.”
But at least Miller can now offer his patients more than just a ray of hope, thanks to the use of several approved medications. When he was first starting, that was not the case.
“The attitude about dealing with people with MS that physicians often had was, ÎDiagnose and adios.’ You could make the diagnosis, but you had nothing to offer them in the way of treatment," he says.
That feeling changed in 1993 with the first MS drug, called Betaceron. One problem; there was an inadequate supply for the number of MS patients.
“It was one of the times in my life that as a doctor I was really asked to play God,” Miller says. “At the beginning they said, ÎOK, this has to be done by lottery.’ And I said to my nurse, ÎOK, we're going to put the names in a hat, literally, and draw the names out.’"
Eventually there was enough supply, and additional medications followed.
“It was really a dramatic change,” Miller says. “For the first time we really could offer hope to patients that we would do something about their disease."
Fighting a disease like multiple sclerosis requires money, and fundraising, which starts with increased public awareness. That's the reason Aaron Miller was actually pleased to hear about one case of MS, albeit in a fictional character.
“I think in general, raising awareness about MS is a huge plus. So when President Jed Bartlett [on ÎThe West Wing’] was diagnosed with MS or it was revealed that he had MS, I think that was great for the entire MS community."
Aaron Miller grew up in Baltimore in the 1940’s and 50’s. He went to high school with director Barry Levinson of "Diner" fame.
So, were any of the characters in the movie based on Miller?
“Absolutely not,” he says. “I can't remember if there was a real nerd, but if so, that would have been me.”
When he went off to Brandeis, this now preeminent physician in the field of MS wasn't even pre-med.
“I thought I might want to do journalism,” Miller says. “Actually, my parents discouraged that. They said, ÎThat's too hard a life.’”
Miller eventually found his calling in medicine, specifically neurology. What became clear was that he didn't want to do lab research - he wanted to see patients.
“People with MS have taught me a great deal. I think they've made me a much better doctor,” he says. “I've come to realize that people don't just have a disease. Most of us sort of wake up in the morning and have a reasonable expectation of what's going to happen. A person with MS lives with the fact that any given day they might have an attack of the disease that could really change their lives. So they're really very brave in dealing with that."
Many prominent and influential New Yorkers have had to sacrifice to succeed. But for Aaron Miller, the sacrifice he sees comes from his patients who are willing to take part in clinical trials testing new medicines.
"When people go into clinical trials they are really doing a service to society. They're doing a service for their fellow patients now and in the future who have a disease,” he says. “And of course they are hoping to benefit from the advance in science and the development of new treatments, but they're also putting themselves at risk because every time a person goes into a clinical trial, there are uncertainties."
Miller knows all too well of the long- term nature of fighting MS, when it feels like a losing battle.
“When we get beyond approved medications we move into medicines for which we have some inkling they may be helpful. Even though we don't have proof, we try those, and still there are some patients who just aren't making it,” he says. “Their disease continues to progress despite everything we do, and that's a terribly frustrating moment.”
Miller has some help in dealing with the psychological aspects of the battle, both for him and the patient. His wife Ellen is a clinical psychologist.
“She really reminds me of the emotional qualities that I might miss,” he says. “I think I try to see them as I talk to a patient all the time, but she is really tuned in and can help me see those things if I come home and talk about an issue. I met my wife the day she arrived in college and she's been a help for 40 years, still giving me good advice. I don't always listen. If I listened more I'd probably be better off.”
Miller and his wife have two grown daughters, one at the MD/PhD program at Yale. The other just graduated Michigan.
He's nationally respected in his field, which he's pursued passionately for some 30 years. And yet he knows that nothing is a lock. A cure may be around the corner, or may arrive long after his work is done.
“I like to let those scientists play their hand. We'll take it to the bedside and try it out in the clinic, and then I'm grounded in the fact that I'm taking care of patients all the time, and whatever is going to happen is going to happen,” he says. “I’ve got to take care of their everyday needs while we're waiting for new treatements."
- Budd Mishkin