"Why are there no effective treatments for my condition? Why do researchers exclude patients with primary progressive multiple sclerosis from enrolling in clinical trials? Please let me know if you hear of studies that I might be allowed to enter or treatments that I could try for my condition. " Thus, in recent years, the sad lament of the patient with primary progressive MS (PPMS). This variant, often in the guise of a chronic progressive myelopathy or, less commonly, progressive cerebellar or bulbar dysfunction, usually responds poorly to corticosteroids and rarely seems to benefit to a significant degree from intensive immunosuppressive treatments. In recent years, most randomized clin ical trials have excluded PPMS patients on two counts. Clinical worsening devel ops slowly in PPMS and may not be recognized during the course of a 2-or 3-year trial even in untreated control patients. This factor alone adds to the potential for a type 2 error or, at the very least, inflates the sample size and duration of the trial. In addition, there is mounting evidence that progressive axonal degeneration and neuronal loss (rather than active, recurrent inflammation) may be important components of the pathology in this form of the disease. Although contemporary trials are evaluating whether PPMS patients may benefit from treatment with the ~-interferons and glatiramer acetate, preliminary, uncontrolled clinical experi ence suggests that the results may not be dramatic.

Marco Armiero is Senior Researcher at the Italian National Research Council and Marie Curie Fellow at the Institute of Environmental Sciences and Technologies, Universitat Aut(noma de Barcelona. He has published extensively on-Italian environmental history and edited Views from the South: Environmental Stories from the Mediterranean World. --

The “fierce, erotic, haunting, truthful” memoirs of an extraordinary artist, activist, and iconoclast who lit up late-twentieth-century New York (Dennis Cooper). One of the New York Times’ “50 Best Memoirs of the Past 50 Years” David Wojnarowicz’s brief but eventful life was not easy. From a suburban adolescence marked by neglect, drugs, prostitution, and abuse to a squalid life on the streets of New York City, to fame—and infamy—as an activist and controversial visual artist whose work was lambasted in the halls of Congress, all before his early death from AIDS at age thirty-seven, Wojnarowicz seemed to be at war with a homophobic “establishment” and the world itself. Yet what emerged from the darkness was a truly extraordinary artist and human being—an angry young man of remarkable poetic sensibilities who was inordinately sympathetic to those who, like him, lived and struggled outside society’s boundaries. Close to the Knives is his searing yet strangely beautiful account told in a collection of powerful essays. An author whom reviewers have compared to Kerouac and Genet, David Wojnarowicz mesmerizes, horrifies, and delights in equal measure with his unabashed honesty. At once savage and funny, poignant and sexy, compassionate and unforgiving, his words and stories cut like knives, leaving indelible marks on all who read them.

Images from a series featuring a lone figure with the visage of the poet Arthur Rimbaud in seedy Manhattan locations.

Collects the best of Anne Sexton's memoirs and prose reflections on her development as a poet