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As someone who wrote a book on this topic
Ending Medical Reversal (2015) w @adamcifu
This article hurts
Unless you have a parachute-- and lets be clear-none of these drugs are parachutes--
RCTs & not off label, kitchen sink madness is the right call
https://www.nytimes.com/2020/08/05/magazine/covid-drug-wars-doctors.html
Ending Medical Reversal (2015) w @adamcifu
This article hurts
Unless you have a parachute-- and lets be clear-none of these drugs are parachutes--
RCTs & not off label, kitchen sink madness is the right call
https://www.nytimes.com/2020/08/05/magazine/covid-drug-wars-doctors.html
Seven years ago, in a paper, I described two medical world views:
Try first
Or trial first
Is it better to give it a shot-- when you have no evidence
Or better to test, to develop evidence, first?
I concluded that only trial first made sense
https://drive.google.com/file/d/1KkMkUrLxF34VCP-feccXtg7zVSBMf2kJ/view
Try first
Or trial first
Is it better to give it a shot-- when you have no evidence
Or better to test, to develop evidence, first?
I concluded that only trial first made sense
https://drive.google.com/file/d/1KkMkUrLxF34VCP-feccXtg7zVSBMf2kJ/view
In our book Ending Medical Reversal
@adamcifu and I catalogued decades of data to show that when doctors just try things, they hinder the ability to generate evidence, and often get things wrong
we concluded trial first (in all but rare cases CH18) https://www.nytimes.com/2015/11/03/science/book-review-ending-medical-reversal-laments-flip-flopping.html
@adamcifu and I catalogued decades of data to show that when doctors just try things, they hinder the ability to generate evidence, and often get things wrong
we concluded trial first (in all but rare cases CH18) https://www.nytimes.com/2015/11/03/science/book-review-ending-medical-reversal-laments-flip-flopping.html
If we tested full dose anticoagulation, convalescent plasma, dex, toci, HCQ etc first-- we would have ended trials earlier, learning what works (dex) and what doesnt (toci, HCQ) sooner-- Some questions would already be answered (Anticoag & plasma) and not still uncertain
The failure here is a medical education failure
We teach medicine from the textbook
As the old quote goes, "History is written by victors"
The textbook gives the false idea that all medicine is incremental advances
We teach medicine from the textbook
As the old quote goes, "History is written by victors"
The textbook gives the false idea that all medicine is incremental advances
The textbook omits all the false starts and grievous errors
We tried to resurrect that in Ending Medical Reversal
Studying those failures gives one a deep humility.
That humility makes one much more likely to be open to the idea that Toci does not help-- that HCQ may not work
We tried to resurrect that in Ending Medical Reversal
Studying those failures gives one a deep humility.
That humility makes one much more likely to be open to the idea that Toci does not help-- that HCQ may not work
In early April, I tried to point out that pre-test probability for these drugs is much more like this
This understanding lends itself to a 'trial first' and not 'try first' attitude, and comes from studying reversals https://twitter.com/VPrasadMDMPH/status/1247585163065753602
This understanding lends itself to a 'trial first' and not 'try first' attitude, and comes from studying reversals https://twitter.com/VPrasadMDMPH/status/1247585163065753602
Every facet of medicine is full of reversals
Smart folks who think bioplausibility is sufficient, only to have their idea tested years later by brave investigators to have it blow up in their face
Here are a few more papers that make this point https://drive.google.com/file/d/1dawzDulLKEpjwbNwt4CsLIJNV-gJpqv6/view
Smart folks who think bioplausibility is sufficient, only to have their idea tested years later by brave investigators to have it blow up in their face
Here are a few more papers that make this point https://drive.google.com/file/d/1dawzDulLKEpjwbNwt4CsLIJNV-gJpqv6/view
The very first paper from the Archives of Internal Med. https://drive.google.com/file/d/1W6GoS-DWmLeBYmpl9aXW5-eu7N5bgK8k/view
And our latest @eLife paper https://drive.google.com/file/d/1oLNMylEg6_bw0ZlAy857-a-VtrpHhLJ9/view
If you read these articles & the book then the truth is inescapable.
Progress depends on randomization
If an intervention is not a parachute (spoiler, few are, and we know them ASAP), Randomization is a must
http://cmajopen.ca/content/6/1/E31.full#ref-3
Progress depends on randomization
If an intervention is not a parachute (spoiler, few are, and we know them ASAP), Randomization is a must
http://cmajopen.ca/content/6/1/E31.full#ref-3
So, I fundamentally disagree that the most compassionate idea, the "what would you do if this were your loved one" idea is to try first
It is to test and prove it works.
I would enter myself or advise any loved one to participate in a well done, non conflicted...
It is to test and prove it works.
I would enter myself or advise any loved one to participate in a well done, non conflicted...
RCT powered for a meaningful endpoint
It is not only the most ethical thing to do, it is the only stance to take when one considers the full picture of medical history
It is not only the most ethical thing to do, it is the only stance to take when one considers the full picture of medical history
If you are not convinced, I encourage you to read Ending Medical Reversal...
We make the case, as best we can, in its pages
Half of what they teach you in medicine is wrong, the trouble is no one knows which half
In this case, we do
Trial first wins https://www.nytimes.com/2015/11/03/science/book-review-ending-medical-reversal-laments-flip-flopping.html
We make the case, as best we can, in its pages
Half of what they teach you in medicine is wrong, the trouble is no one knows which half
In this case, we do
Trial first wins https://www.nytimes.com/2015/11/03/science/book-review-ending-medical-reversal-laments-flip-flopping.html
Another article on the topic of Covid, kitchen sink madness
https://www.medscape.com/viewarticle/930755#vp_1
https://www.medscape.com/viewarticle/930755#vp_1
