Discover and read the best of Twitter Threads about #EBM

Most recents (24)

Otra de las herramientas que ha popularizado la #EBM es la interpretación de los test diagnósticos.

Y para darle una vuelta a su explicación voy a volver a mis orígenes. Las ovejitas.

"Test de antígeno y COVID desde la EBM"

@drmiguelmarcos @boticariors @mpericacho

1/20
De forma simplista se tiende a pensar que un test que da POSITIVO es que uno tiene la enfermedad o condición a estudio.

Y si da NEGATIVO, pues que uno está “sano”.

Nada más lejos de la realidad

2/
La interpretación de un test diagnóstico depende de 2 cosas:

1) la probabilidad de padecer la enfermedad de la que partimos
Es decir, necesitamos valorar a nuestro paciente, sospechar una condición y entonces pedir una prueba para confirmarla

3/
Read 21 tweets
Word “racism” silenced, actively, by #MedEd #MedTwitter #healthcare#professionalism” & “communication” labels

Saying “racism” offends or “hurts feelings” > actual #BLM deaths

If #professionalism itself is racist -makes sense that word suppressed
@FutureDocs
What @ayshakhoury experienced pushes out & silences many

If the editors of @JAMA_current resist hearing word “structural racism” then they certainly are not publishing papers using that word

@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
Journal gatekeeping: men
Behavior gatekeeping: women/HR

#accountability only for white men
-> we miss “Amy Cooper” in #academia, #HR, #professionalism #compliance

insidehighered.com/advice/2020/06…

@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
Read 18 tweets
Important perspective below

When I was a foreign grad & trainee I bought into idea: I just needed to work 3x as hard to get 1/2 as far

At mid-career, my health gave out trying for:
“be the person you needed when you were younger”
& to protect students

this system does not work ImageImage
Editors of elite journal @JAMA_current question if medical racism is real

the business world gets it
@HarvardBiz
published this on #minoritiesinmedicine #blackexcellence #blm #BlackLivesMatter

#MedTwitter needs #transparency & #Accountability

hbr.org/amp/2018/08/re…
why can’t elite journals that define #EBM & #datadriven #healthcare
like @JAMA_current

focus on OUTCOMES
as experienced by PATIENTS

Why focus on LABELS certain physicians don’t like to hear?

Am a former regulator
we need quality #data by gatekeepers

medpagetoday.com/publichealthpo…
Read 8 tweets
#MedTwitter influencers show hypocrisy (advice vs actions on masks). Agree:

“unpleasant comments are ‘the nature of social media’ and holding public figures accountable is critical when they are setting an example for their ‘millions of followers.’”

insider.com/coronavirus-sh…
#tweetiatrician have even gotten death threats for pro-#vaccine #SciComm - most #MedTwitter influencers did nothing to protect vs these personal safety threats to #clinician & #doctor colleagues

@ZDoggMD & @DrToddWo did step up to help @NicoleB_MD

medpagetoday.com/special-report…
Compare above to Dr. Mike:
when medical influencers are “caught”

adds to public perception:
“doctors cannot be trusted”

“Another fan posted on Reddit: ‘I know it's your life and you can do what you want, but you have chosen to be a public figure.’”

mirror.co.uk/news/uk-news/w…
Read 11 tweets
@adamcifu - the idea that doctors should not be political is why the entire field of #pediatrics walked out on the rest of #medicine. Children don't have the luxury of "every man for himself" mindset. Also, Muslim patients' or atheist patients' autonomy at #endoflife : political
All of us are trained, in residency, on "political" dollars from #Medicare and much of our #EBM is funded by tax dollars from #NIH and elsewhere. Tax dollars are public money, managed by elected officials, who are put in place and held accountable by the political process.
Then there are seemingly extreme examples, but are they so extreme given how often horrific things happen in history & even uptick of violence in the U.S.? Should doctors opt out of protecting vs this? These camps, if formed, may utilize doctors/nurses

time.com/4574680/muslim…
Read 5 tweets
1/3 Just out: @RecheckHealth analysis and commentary Der seltsame Fall / le cas étrange / the Strange Case of the Swiss National COVID-19 Science Task Force @SwissScience_TF. Open access in Deutsch / Français / English. re-check.ch/wordpress/fr/s…
2/3 @SwissScience_TF is a group of scientists acting as a consultant to the Swiss authorities on #COVID19. Only his president should be talking to the media; is it really the case? And what are the rules of engagement of this very special board? @RecheckHealth
3/3 @RecheckHealth filed several #FOIA, and analysed ten months of communication and scientific work of the Swiss National COVID-19 Science Task Force. Spoiler alert: Houston, we have a problem. #transparenzstory #Öffentlichkeitsgesetz #PandemicScience #EBM
Read 4 tweets
1/9 Has #Gardasil approval ushered in an era of #overprevention? @RecheckHealth’s @CatherineRiva published on @thejospi an intriguing, original research piece co-signed by MD Jean-Pierre Spinosa: jospi.org/article/18180-… #HPV
2/9 The article tracks back the approval history of the first vaccine to have been granted the FDA’s accelerated approval and fast track. @CatherineRiva and MD @gipispinosa combined published documents with DAPs and correspondence obtained with a #FOIA #Gardasil #HPV
3/9 The authors of @thejospi piece sought to understand how the evaluation criteria were selected during #Gardasil approval and the impact of the FDA experts’ choices on the quality of the available evidence about the vaccine’s efficacy. #Gardasil #HPV
Read 9 tweets
Not only experience, which is important, but clinical #research does not parse out the Japanese man or woman from the South Asian man or woman on heart disease risk, epidemiology, treatment.

#EBM lacking for us then

#MedTwitter #AcademicTwitter #AcademicChatter
And then there is the question of who is white.

Iranian/Persian & Arabs are white on census.
Does the rest of America agree?

Racists & xenophobes tend to use loophole to say being anti-Muslim (whom they consider to all be Arab) is “not racist.”

latimes.com/projects/la-me…
Proving again: race is a social construct

Not until 2020 Persians really started to call selves “POC” (for self protection)

Have lots of Persian friends
Urdu culture has Farsi roots

But let’s be honest: Persians have seen selves as superior race, apart

wbez.org/stories/renewe…
Read 38 tweets
@BaeBielle @timnitGebru I was going to get there. Beat me to it.

This has never been “personal”

Cuz this is SO incredibly prevalent

People who are in the “model minority” role

Know on which side their bread is buttered

they discount the equity movement that THEY find too hard to do
they lack grit
@BaeBielle @timnitGebru another exact match
Put a name = optics

“Optics”
“Prestige”
Disdain for EBM

But
standards?
Consistency?
Transparency?
Ethics?

why *isn’t* consistent standards or ethics part of “professionalism”?

Why only optics?
Medicine is VERY real
life & death at stake
clinicians know ImageImage
@BaeBielle @timnitGebru All of these

are themes
that relate to
reputation
“optics”
control of others’ communication

silence those who ARE producing #EBM

Protect the business model & maintain a “brand” to sell a product

The issue with @timnitGebru was corporate censorship

technologyreview.com/2020/12/04/101…
Read 5 tweets
Frankly every single person has some kind of privilege. If you have sight or two functioning legs you lack certain barriers

Acknowledging the same about structural racism is not insulting

unless you have cultural chauvinism/superiority & believe your own culture faultless
Personally, as someone Muslim, what I was taught about my purpose on this earth is the every single thing I “have” is only loaned to me and nothing I am entitled to.

You have to pay interest on loans.

More you have, more you must give (back).

Of course I face barriers too.
I don’t talk about religion a lot. I am deeply spiritual. I do believe Islam is “a way of life.”

I am less worried about reciting the exact right dua/prayer when stepping in a room with the correct foot.

Hadith can be disputed but this one is beautiful. Mercy matters most.
Read 60 tweets
#EBPM 系の議論がもたらした弊害のひとつに、数学を使うとエビデンスレベルが上がる、みたいなのがたぶんあるんだよな。
たとえばガンの治療について考えるときに、そのガンの治療に長年携わってきた医師の見立てよりも、そういうことを知らない研究者が組み立てたエレガントな数理モデルにしたがったほうがよい、みたいな考えかた。
#EBM はそのあたりよく考えられていて、エビデンスの評価はあくまでも実証研究に基づく必要があるし、現場の医師の (たぶんに直観を含む) 判断にも大きな比重がある。 (いや実態がどうなのかはあんまりよく知らないんだど、教科書レベルの話)
Read 21 tweets
[Thread]
"No More Mr NICE Guy…" by Brian Hughes, a professor of psychology

thesciencebit.net/2020/11/21/no-…

An incisive blog that covers the NICE ME/#CFS guidelines, issues regarding trials of nonpharmacological interventions in general, appeals to authority, etc.

#MEcfs #MyalgicE
1/n
2/n

"The new [NICE] guidelines not only repudiate a heretofore favoured treatment approach for a particular illness, they also threaten to discredit an entire (albeit quirky) branch of medicine — and, for good measure, to cast clouds over significant swathes of psychology too"
3/n
"Here is an extract from expert testimony provided by Jonathan Edwards, professor emeritus of clinical medicine at University College London" [on the #PACETrial authors trying to justify their use of post-hoc criteria rather than their original criteria]

#MEcfs #CFS #CBT
Read 15 tweets
I find ppl have difficulty understanding #evidencebasedmedicine (EBM) & how Science works.
EBM doesn't try to "prove" anything but is focused on REFUTATION. Let's say u have a new medicine which you believe works better than previous medicine/no medicine. Thats your theory...1/n
#EBM sets out to refute this theory. Hence all trials start with a null hypothesis: New Treatment A is no better than placebo/treatment B.
You then use statistics to find out whether the difference between the two was likely to happen by chance. P < 0.05 only means that...2/n
there is less than 5% chance that the difference (if any) between the 2 treatments was likely to be due to chance, & is a real difference.
In this case, you reject the a priori Null hypothesis ( that there is no difference between 2 treatments) You accept...3/n
Read 4 tweets
Hmm..so have to say, the most misogyny I have encountered is on #MedTwitter mostly from anon account doctors or anti-vaxx.

& tho I repost "The Female Lead" I have rare to no trolls or harassers. I have found @LinkedIn pretty female-friendly, in fact. Rarely get a weird message
My first run in was an all male group of doctors discussing IVF and ridiculing acupuncture as not evidence based but they had fragility to any aspect of IVF itself at all questioned or perceiving even tolerance of acupuncture as "quackery"
My point then was more a people in glass houses should not throw stones. There is a difference between clinical trials existing and #EBM as I know from having been on the payer side where business-minded clinicians' narrative advances ahead of science: ncbi.nlm.nih.gov/pmc/articles/P…
Read 33 tweets
Please start to do this. If you find something not factual, take the time to highlight, cross out, write notes on the image. We are highly visual creatures and the red X will communicate much better than your facts or words.

Make the “wrong” or “not factual” a clear visual.
Further, think of unintended consequences. Will what you put out there take a life if its own?

I have seen too many of those paid to instruct #STEM professionals on #SciComm & #MedTwitter professionalism

fail to understand this aspect of #SciComm - how will others repurpose?
How often in re-sharing a conspiracy theory post are you merely driving traffic to that site or person? It is a numbers game. In your “OMG look at this!!!!” are you contributing to this?

Please stay away from those who share a new “look how bad” example

sciencemag.org/news/2018/03/f…
Read 11 tweets
Our invited expert review on #Ayurvedic #herbals and #liver #toxicity. #herbal #medicine is NOT safe. Review on #herbs used in #Indian #traditional #medicine & adverse events is lacking in #published #Literature
We deep searched, compiled
Full paper: bit.ly/35WkCmr
1/4 Image
This #review is important for #ayush practitioners and those interested in opting for #alternative #therapies as #knowledge regarding potential #toxic components is the #right of every #patient and #moral #duty of the physician. This 👇 list show names of imp toxic herbs.
2/4 Image
We give #real #life #patient data supporting our review: such as this example which shows that #Ayurveda #drugs cause severe #chronic #liver #damage that can lead to #cirrhosis in the short term.
The implicated agent here is Holarrhena antidysenterica (Tellichery bark)
3/4 Image
Read 5 tweets
1. Taking a dig at for fun.
This has nothing to do with the drug or the clinical outcomes or the role of mineral oil placebo or anything. Just for fun
Cc: @matthewherper
@MedResCol @MatthewTNatale
2.
I do not know patent laws so take everything with a grain of salt. This is just a statistical exercise purely on what Judge Du noted in her verdict regarding a specific patent that was claimed as obvious.
Again all non-technical ( I am quite dumb)
3. Specifically focusing on patent 715 and 677 regarding two claims.
EPA does not increase apo B -claim 13 and
EPA decreases APO after about 12 weeks claim 8 Image
Read 45 tweets
(1) Nun hat auch das ZDF das #EbM-Papier kritisch beleuchtet, das @ChanasitJonas mit den Worten "gut" & "ausgewogen" geteilt hatte

Zum EbM-Vorsitzenden - nicht ganz überraschend:
"In den vergang. Monaten trat er auch in Online-Sendungen v. überzeugten Corona-Kritikern [...] auf"
(2) Wie aus den 4 Screenshots ersichtlich ist, haben sich 7 einschlägige Experten sehr deutlich gegen das EbM-Papier ausgesprochen.

Auch in seinem seinem gestrigen Podcast geht Drosten kritisch auf die Stellungnahme ein:
(3) Bei den 5 Virolog*innen & 2 Epidemiologen in den Screenshots, die sich kritisch zum EbM-Papier geäußert haben, handelt es sich um:
@c_drosten, @EckerleIsabella, @TheBinderLab, @vmcorman, @beatesodeik;
@C_Althaus, @Karl_Lauterbach, wobei letzterer den Beruf nicht aktiv ausübt)
Read 8 tweets
Catch yourself when you say “risks vs. benefits” because you aren’t making a fair comparison.

In @JAMA_current ja.ma/336Lj4Y
& podcast ja.ma/2FAGKI2

@eliowa @drjohnm @d_spiegel @zeynep @VPrasadMDMPH

Why we say it and what we think is better below...
This building block of clinical decisions biases by framing uncertain harm vs. certain benefits and nudges towards treatment

Written with
@DKorenstein @ldscherer
(Over 2 years, i'm embarrassed to admit)
Clearly, the words physicians use have
a critical function in this communication

Referring to harms as “risks” emphasizes that
the unfavorable outcome may or may not happen,
whereas there is no parallel language that highlights
the equally probabilistic nature of “benefits.”
Read 8 tweets
#Alternativmedizin #Heilpraktiker #Arzt #EBM

Ich stehe dazu, dass ich #Medizin betreibe, keine #Schulmedizin, das ist nämlich ein Strohmannbegriff der #Homöopathie, um nicht die Standards der Wissenschaft erfüllen zu müssen.

#Thread #Rant

1/24
Es gibt viele Strategien von Heilpraktiker*innen, Homöopath*innen und sonstigen paramedizinisch Tätigen, um die wissenschaftliche Medizin zu verunglimpfen und eine falsche Balance herzustellen, die die "Alternative" attraktiv erscheinen lassen soll.

2/24
Viele dieser Strategien entsprechen logischen Fehlschlüssen und Denkfehlern. Da wären zum einen die vielen Strohmannargumente. Hierbei werden Eigenschaften und Prinzipien der Medizin falsch dargestellt, um sie leichter kritisieren zu können.

3/24
Read 24 tweets
In this thread, I'm live-tweeting @sgdambrauskas awesome talk for @AKUGlobal series on #COVID19 in #PedsICU

Critically important topic #Zentensivist #ICURehab #BacktoBasics #DoNoHarm
Defining iatrogenic via @sgdambrauskas #PedsICU
Critical Illness is an iatrogenic disorder- @sgdambrauskas highlights an important perspective by John Marshall in @CritCareMed #PedsICU
Read 16 tweets
#Ayurvedic treatment of fatty #liver – real world evidence: A #Thread
1/n
Overweight woman, early 40’s. Routine liver tests, mild enzyme abnormalities. Advised #ultrasound liver, showed grade 2 #fattyliver. GP advised vitaminE and #weightloss, review in 3mo
#livertwitter
2/n
Patient and husband doubtful. Hears fatty liver disease can lead to #cirrhosis. Seeks advice from #Ayurvedic practitioner nearby #home since #Herbal #DRUGS = safe. Assures complete #cure through #Ayurveda. Prescribes multiple #medicines, advises almost all foods restriction.
3/n
Lets look at medicines. #tablet APFIL. Packet mentions ‘for liver #diseases’. Which liver disease? There is #alcohol related, #hepatitis B/C, #NAFLD, primary biliary #cholangitis and more causes. Nine #herbs extract combo - clinical #evidence on safety and benefit ❌
Read 14 tweets
In the U.S. we have a "tough guy" attitude towards health that is seen in many outcomes across #populationhealth metrics. This false dichotomy between economy and health is not new. We have poor sick leave or parental leave. Healthcare a "benefit" of employment.
Not sure why my #MedTwitter peers are so shocked by the way the U.S. has responded to a preventable #publichealth crisis

US docs, selves, want individualism & personal financial gain
over
systems for a common good

@Health_Affairs on AMA vs Medicare

healthaffairs.org/do/10.1377/hbl… ImageImageImageImage
The “government can’t tell me what to do for the protection of others - I know best” is a common thread in U.S. history & culture of rugged individualism

I mean, this is a country that started by throwing others’ property in ocean to protest government. history.com/topics/america…
Read 14 tweets
So, I started at @MITSloan & @MITSloanFellows with a huge amount of faith & probably placing institution a bit excessively on a pedestal. (Also, it is ridiculously expensive)

Had to adjust expectations
Some is disruption from pandemic & online
Some is just reality
Assessment:
What this year allows me is to explore, expand, acquire new skills within a specific structure & with a cohort that is committed to each other.

I chafed when assigned teams. I have always been a self directed learner. Need to go at my own pace.

https://t.co/V9IwDr0kDU
Have some kind of neurodiversity (I was curious & got neurocog tested but they told me my results made no sense to them after they held a conference to discuss - it fit no pattern) - is one reason I chose @MIT, not establishment staid places
To be around:

Read 11 tweets

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