It's not often that I disagree with Dr. P @netshrink but in this instance, I will.
Back story: As the C-19 wave 2 runs amok in India, medical management has become chaotic leading to shortage of #Remdesivir and patients' families rushing to the few chemists with stocks. > https://twitter.com/netshrink/status/1380357993984716803

A tweet from Dr. Pramesh @cspramesh (QTed by Dr. P) evoked some inappropriate response from some in the medical community accusing him of 'medical nihilism' for questioning the role of REM without taking into account the context - is REM being used in India strictly per EBM? >

> While not an easy Q to A, it has become evident on via SoMe the overreliance on drugs for C-19 in India for which there's scant evidence - India's apex med body and drug regulator have approved/recommended HCQ, favipiravir, itolizumab, etc. >

A similar shortfall in tocilizumab was reported in India last August and when demand spikes out of proportion with supply, overprescription is a reasonable suspect. In that context, Dr. Pramesh's observation is quite valid. So why the disagreement with Dr. Pathare's tweet? >

Dr. Pramesh is a highly respected and credentialed clinician. His follow-up thread on this storm-in-a-teacup explains his insights beautifully. >
https://twitter.com/cspramesh/status/1380194966551494664?s=20

So what's my beef? I disagree with Dr. Pathare's tweet simply because it employs two fallacies commonly used in any 'debate' on SoMe. >

The first, appeal to authority. This implies that anyone with a half dozen letters next to their name or in a top position or having won multiple awards is always correct. There's plenty of evidence to show that this is expressly not true, ranging from 'Nobel disease' >

to some amazingly egregious stands in recent years made by 'giants' such as Ioannidis, Gøtzsche, etc. Yes, we must rely on experts but must also not shy from engaging them in scientific debate and question them when their hypothesis doesn't fit the evidence. >

The second, poisoning the well/ad hom, at least on the second part of COIs.
Now COIs should absolutely be considered but the existence of COIs is not evidence of bias. The term itself is misunderstood enough to be used as a pejorative or to immediately disqualify someone. >

Hotez and Offit are two well-known vaccine scientists who collaborate with pharma industry for bringing out effective vaccines; the AV crowd seeks to dismiss their contribution under the accusation of COIs. >

Seeking to dismiss someone for COIs without presenting evidence on how the COI has introduced bias is a cheap shot and intellectually lazy.

And lest we forget, we all have COIs; they are not always monetary, they are not always evident. Which is why evidence is sacrosanct.

So when you ask who do you trust - let it always be evidence.