Do we actually know what people at high risk of MS would want? And does labeling someone as a high risk for a condition that may never develop do more harm than good?

You know, the ethics are a pretty important part here.

We know, I mean, stepping aside from the Huntington's, for example, to just talk more generally, screening does have a psychological burden on individuals, right? So you're getting tested for a possible condition and for individuals who have a positive test it might be a true positive or a false positive so you usually need to get additional testing to evaluate that and there's a burden of that and if at the end of it you end up being told you may develop a condition so with MS we're talking about a possibility then there's a number of places where that can have an impact, right? So the individual who previously thought of themselves as well, may now think of themselves as ill.

And depending on how much information you have available to tell somebody about their probability, right, so there's a big difference between saying, You might develop MS one day and saying that you have a 10% chance in the next 50 years versus you have a 50% chance in the next two years.

Those are vastly different numbers, but we're not in a place yet to tell people that.

So it gives people a lot of burden without being able to contextualize it or use it to inform their decisions.

We're also not in a place yet where if we said you're at increased risk, we could tell people what to do about it beyond perhaps some lifestyle changes.

So I guess, Ruthanne, do you think that this type of screening program could widen the health disparity in MS rather than narrowing that sort of gap?