"Never see in the patient anything but a fellow creature in pain.” So says the Oath of Maimonides, a document about the medical calling by the brilliant 12th-century physician and philosopher Moses ben Maimon, also known as Maimonides.

Unfortunately, we physicians have conscious and unconscious biases just like everyone else, and these biases may impede our ability to follow that oath and assess patients objectively. And that can adversely affect diagnosis and treatment. As with most biases, this is usually based on misinformation.

In the case of multiple sclerosis (MS), the dogma was that the disorder affected mainly White people, which meant that many Black people with MS were underdiagnosed and undertreated. Our feature “MS Is Color-Blind” sheds new light on the incidence of MS in Black people, which is higher than has been historically thought. It reports that the clinical course may be different in these patients and may require more aggressive treatment. It also highlights the critical need for more inclusion and diversity in clinical trials.

We hope this story increases awareness of MS among health care providers and in the Black community so Black patients are better able to advocate for prompt diagnosis and effective treatments—and doctors are more likely to look for it.

Fatigue is the most common and often most disabling symptom of MS. Because it's invisible, it may be poorly understood by those who don't have MS. When patients tell me they're tired, it usually prompts a discussion about what may cause fatigue, including the disease itself, poor sleep, depression, medication side effects, and even just the stress of everyday responsibilities. To learn more about the mechanism of fatigue and the ways to manage it, read “Expert Ways to Ease Exhaustion.” As with most MS symptoms, dealing with fatigue involves a combination of medication and lifestyle strategies.

In this issue, we also profile people who continue to enjoy adventures such as mountain climbing, sky-diving, and horseback riding in spite of mobility challenges. While these are disparate activities, they all share the common characteristic of pushing the envelope, even when walking is a challenge.

For some of my patients, just getting through the day is like climbing a mountain. But no matter where my patients are, I support them in doing all they can to stay as physically and mentally active as possible. Even for those “wuffos” (see “Multiple Sclerosis Doesn't Deter This Skydiver” for more about this term) who are not inclined to leap out of an airplane or scale a mountain, the message is that MS should not keep you from having the confidence to push boundaries in whatever you're doing.

And while doing that, please stay safe and be well.

Barbara Giesser, MD, FAAN, FANA, Issue Editor