To the doctors advocating not treating patients with Recovery protocol/ Dex until the manuscript comes.

That is totally wrong
will lead to preventable death
is a gross misunderstanding of probability
and... i hate to say this.. is probably unethical

Why? [thread]

I have already outlined several reasons why this is a much more credible press release than the usual 'Eli Lilly announces...'

But let me summarize https://twitter.com/VPrasadMDMPH/status/1273028969718337536

1. You can read the protocol people!!!
HELLO! that never happens
A protocol is gold it answers many questions
https://www.recoverytrial.net/files/recovery-protocol-v6-0-2020-05-14.pdf

2. It's credible academics/ free of financial bias
3. It's a 20cent pill
4. It's all cause mortality
5. The effect size rivals the best things we do in medicine

Why are people saying the effect size is not good?

But let me offer you the best reason
#6
For the last 6 months, we have allowed doctors to give COVID19 patients all sorts of total-madness therapies

People are giving various antibiotics, tamiflu, histamine antagonists, HIV drugs, experimental agents, IL-6 blockers, TPA!!

Did you hear that

T.. P... A...

A drug with a therapeutic window as generous as the one in an interior room on a cruise ship

Docs have been giving unproven combinations-- making their own flavors of ice cream (blue cheese and coconut and rubber tires) that no one wants to eat

And.... what?

Silence

"you gotta do what you gotta do"

(I have been critical of this FTR)

And now, we have a press release from a randomized trial, where you can read the protocol, from a respected center for a 20cent medicine, with all cause mortality benefit, and you want to wait?

there is a 1/10000 chance this finding is not true and a 9999/10000 chance it is true

And the downside of giving a bunch of pts 6mg dex for 2 weeks (which many been doing for months BTW) while we wait for paper is what? nothing?

So what logic on earth says wait?

Yes, of course, they should have put a preprint out!

Yes, of course, you always learn things when you read a paper!

But the probabilities of a total reversal of this finding is really really low.

Yes, we need a new publishing model where this does not happen, and yes, covid literature has been a ton of garbage to date. I mean, I call it #classiccovid

But the risks/benefits of acting on this info now vs. when paper appears only favor acting now

Was this helpful?

PS: this is further evidence of my view that medical education is broken re: teaching critical appraisal

Step 1: we don't teach critical appraisal well
Step 2: some overcompensate and are too critical b/c we didn't teach it well

Update: Ok a couple of additional thoughts

1. To the folks not giving dex till the full paper comes out.
Please do not check the MAR for any patient hospitalized with COVID19 because you are NOT gonna like what you see (pss lots of drugs given and most don't even have trials!)

2. You all have my strongest sympathies that the authors OUGHT TO HAVE put out a pre-print this AM, but

you not giving dex to patients while waiting for preprint WILL NOT get them to write faster.

3. I will bet $100 (thats a lot for me, ok) that you will be giving dex after you read the paper. Please read the protocol today, and see what you think.

Thanks for all the comments today. I had a bunch of competing responsibilities so wasn't able to read them all, but read a lot

Appreciate the vigorous interactions!
Even though 13% of you are wrong ;)