You raise an interesting point. ALS, by definition, is of unknown cause. If, as the cases Patten mentions, what clinically appears to be ALS responds to treating some related finding or disorder (autoimmune problem, Gammopathy, etc.) than, by definition, neuros would say that the person did not have ALS. In most cases, of course, no other, treatable cause is found. But Patten's point was that ALS is a syndrome; really just a label for an end result of a disorder of certain motor neurons. He notes, under a subheading titled "Why ALS msut be a syndrome" that "ALS is no more a disease than renal failure is a disease." He goes on to use the analogy to state that the neurologist should not be content with merely diagnosing renal failure, but trying to find its cause. If more things were identified as causing ALS (the clinical picture) in more patients, than perhaps it would change how neuros and thus PALS view the disease, moving towards the view of it as a syndrome rather than a specific disease, with the implication of a singular, as yet unknown etiology.
Since doctors, clinics and hospitals seem to have more financial, time and resource constraints, I can't help but wonder if most neuros who diagnosed ALS go through the kind of hoops Patten speaks about in searching for, and aggressively treating, anything that might explain the clinical picture of ALS. I hope I'm wrong about this, as Rose suggests. But of course if one is predisposed to think of ALS as a disease, with an unknown cause, perhaps they would be less inclined to look for causes or treatable co-factors.
This issue reminds me of other so-called "diseases," particularly in mental health. ADD, for example, is a questionable disease. Really, it is a description of certain behaviors and characteristics. That doesn't per se make this a real disease; to leap to this inference is to engage in reification, a common cognitive error. The same can be said for some other "mental illnesses."
As Patten said in this article from the 80's, "it appears so obvious that there are many causes of ALS that reviewing the evidence seems trivial." Logically, then, it stands to reason that there are other, as yet undiscovered or unappreciated causes of ALS. For example, someone recently sent me a link for an article on a case of Celiac masquerading as ALS. Hence a reason for some of the questions about possible associations that I've posed. Now, if, say, Celiac can mimic ALS, even in one case, one has to wonder whether Celiac is screened for in the diagnostic work-up for ALS. If it is not or not carefully, there would be no way of knowing if there aren't more cases of ALS caused, triggered by or exacerbated by, for example, Celiac. If a neurologist has a mindset that there definitely isn't any connection and couldn't possibly be any connection, than of course they would be less likely to look for such a possibility. I consider such a mindset more one of dogma and ideology than of science and scientific inquiry, and I'm not sure this doesn't afflict many doctors, in all areas of medicine, based on my experience.
Apologies to those who don't like reading long posts or are totally uninterested in any of this. Please just simply skip over it in that case.