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This is a GREAT q: Why is there so much disagreement about using HCQ (or other drugs) for #COVID-19
Even among doctors!
My thoughts: [THREAD] https://twitter.com/balinoruo/status/1248328481097650176
Even among doctors!
My thoughts: [THREAD] https://twitter.com/balinoruo/status/1248328481097650176
1. We do a bad job in medical school teaching about all they hypotheses that never worked.
For good reason: many drugs DO work, for time sake, we naturally don't teach about the many missteps in medicine
Some of us tattoo them to our memory https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes-dp-1421429047/dp/1421429047/
For good reason: many drugs DO work, for time sake, we naturally don't teach about the many missteps in medicine
Some of us tattoo them to our memory https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes-dp-1421429047/dp/1421429047/
When you don't teach missteps-- many MDs walk around with distorted ideas of pre-test probability
They think pre-test prob. red curve, when anti-viral drug development and ARDS drug development is blue curve
They think pre-test prob. red curve, when anti-viral drug development and ARDS drug development is blue curve
2. We indoctrinate folks in the idea that pathophysiology -> treatments
Many successful drugs however were not 'rational' some were even 'contrary' to prevailing theories (e.g. b-blockade)
AND..
Most bioplausible Rx fail
Many successful drugs however were not 'rational' some were even 'contrary' to prevailing theories (e.g. b-blockade)
AND..
Most bioplausible Rx fail
Have written about this at length https://drive.google.com/file/d/1tTLiHspBKldS4DB9UjPjEEWhs_JPK9aT/view
3. Doctors are (surprise) also human, subject to the psychological frailties we all are
When we are scared, and uncertain, and desperate, we err on the side of "don't just stand there do something"
but like the goal-keeper diving on a PK, we may be making it worse
When we are scared, and uncertain, and desperate, we err on the side of "don't just stand there do something"
but like the goal-keeper diving on a PK, we may be making it worse
4. We overestimate how long *good* trials take https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2729389
5. We poison the very equipoise we need to test a Rx through our own hype and will to believe
6. Doctors genuinely want to have drugs to offer our patients. We didn't go into this business because we *want* to recommend supportive care and rest
And we *truly* want to offer some services
And we *truly* want to offer some services
7. The loudest, though perhaps not smartest voices get the most amplification https://twitter.com/vprasadmdmph/status/1243991028274610181
Apropos of nothing https://www.washingtonpost.com/opinions/2020/03/23/trumps-not-doctor-hes-only-playing-one-tv/
8. In short, everything about how we are trained, and who we are makes it hard to step back and say, lets test this first and fast, before we leap, even if an unvarnished look at medical history would say that is best.
@adamcifu and I see it this way: https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes-dp-1421429047/dp/1421429047/
@adamcifu and I see it this way: https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes-dp-1421429047/dp/1421429047/
