Risk communication in multiple sclerosis (MS) is structurally unbalanced. Patients receive detailed, regulator‑mandated information about the potential harms of disease‑modifying therapies (DMTs), yet no equivalent framework exists for describing the risks of untreated or undertreated MS. This asymmetry creates a misleading decision environment in which treatment risks appear concrete and quantifiable, while disease risks remain diffuse and poorly articulated. Drawing on natural‑history cohorts, contemporary registry data and relapse‑recovery studies, this article highlights four consistent findings: untreated MS frequently leads to disability accumulation; relapses often leave residual deficits; progression independent of relapse activity (PIRA) contributes substantially to long‑term decline; and delayed initiation of high‑efficacy therapy is associated with poorer outcomes. Together, these data show that "watchful waiting" is rarely neutral and may expose patients to irreversible harm. The article argues for a structured, patient‑facing disease‑risk summary to support genuinely informed, balanced treatment decisions.
Dominic Shadbolt (2026) studied this question.