Michael Hutchinson, although a self-confessed “oldie”, is no reactionary. The experience of treating patients with multiple sclerosis (MS) for 35 years and observing the “consequences of the inadequacy of the present first-line therapies” has turned him into an aggressive therapist. He proposes that we focus on patients with early disease and monitor them frequently (at least 6-monthly), using clinical and MRI markers of disease activity, in order to introduce disease-modifying therapy quickly. And we should escalate therapy rapidly to second-line drugs if there is any clinical or radiological evidence of new lesion formation while on the interferons or glatiramer. All …