Reviews PERSONAL VIEW

An unfinished trip through uncertainties

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7438.531 (Published 26 February 2004) Cite this as: BMJ 2004;328:531
  1. Alessandro Liberati, associate professor of medical biostatistics (alesslib@tin.it)
  1. Università di Modena e Reggio Emilia, Modena, Italy

    In mid-1997 I went for blood and other tests after an episode of back pain. A monoclonal electrophoretic peak and a spinal lesion of uncertain origin were found. After a few months of further tests I was given a diagnosis of monoclonal gammopathy of uncertain significance (MGUS). I was no longer a subjectively healthy man but a potentially ill person, with considerable anxiety. MGUS is one of those strange noso-logical entities of modern medicine—which is so good at creating “new diseases” without necessarily knowing how to cure them. The medical literature didn't help much. Several small studies reported a cumulative risk of malignant transformation of MGUSs of between 7% and 19%, with the likeliest estimate of annual risk of transformation around 1%, but without clear predictors.

    Could a second transplant improve results?

    I was prescribed blood tests every six months to monitor any such transformation. The years went by, during which my levels of anxiety varied, increasing at times of testing and whenever any personal or work …

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