The senior consultant during my wife’s second period of hospitalization was Dr. Ramon and it is he whom we returned to see for the next appointment

I do not know why there was a change in the primary consultant but his treatment of Sherna’s condition was very different to that of Dr. Angel with more prescription drugs and three times the dosage of Myfortic. He also said that Sherna was going be his patient for the foreseeable future whereas Dr. Angel had implied that she would only need to consult with him if the leucocytes dropped below a certain level.

He prescribed amongst other medicines 3 x 1g Myfortic twice daily and another tablet called Bonviva once per month. The cost of the Myfortic was around $4 per pill ($25 daily) and the Bonviva a staggering $45 per pill. However, my wife's mother was able to buy a generic Myfortic in India for one-third of the price and a generic Bonviva for less than $5!

It was during this consultation that Dr. Ramon asked my wife to participate in the trial of a new drug, Ocrelizumab. Later that day I discussed it with my wife and her parents (who had arrived in Spain from India after she had been hospitalized for a second time) and we decided it was better for her to return with them to India to be treated, at least until her condition had stabilized. My wife was not entitled to Social Security in Spain and the hospitals and medication in India are much cheaper. We were also concerned that she would require dialysis or a kidney transplant, so at the next meeting with Dr. Ramon we explained the situation and our decision. Dr. Ramon told us that my wife’s kidney problem would not require either dialysis or a transplant. He then explained the importance of clinical trials in treating disease and the cultural obstacle in convincing conservative Spanish patients to participate. He said that because my wife came from a liberal Anglo-Saxon background, she should not be as influenced by the wishes of her family (actually she is Indian, has never lived in the UK, and her parents were not happy at her joining the trial of a new drug). He said that the trial was paid for by the sponsor, Roche, but in Spain it was illegal to pay people to participate in a clinical trial. We said we were not interested in being paid, only that we were not willing to pay for the treatment in Spain. On this basis we agreed in principal that my wife would participate but needed to talk to her parents before confirming our decision.