Discover and read the best of Twitter Threads about #EvidenceBasedMedicine
Most recents (11)
1/ The colonoscopy trial reported in @NEJM is being widely reported as suggesting that colonoscopy is not effective for colon cancer screening. This is not the correct interpretation of these results. #EBM #evidencebasedmedicine #epitwitter
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
2/ This study’s results do not demonstrate that colonoscopy is effective, but also do not demonstrate that it is ineffective. Why? Because only 42% of those in the screening arm actually had a colonoscopy!
3/ What *does* this study show? Only that a screening program involving an invitation to get a one-time colonoscopy modestly reduced colon cancer cases but did not reduce colon cancer deaths or overall mortality at a median of 10 years of follow-up.
Despite the importance of #blinding in medical research, most trials don't assess blinding integrity, partially because there is no method to adjust trial results for blinding integrity... until now! New preprint with implications for #microdose and #psychedelic research 🧪🧵👇
First, we define activated expectancy bias (AEB), which is an uneven distribution of expectancy effects between treatment arms due to patients recognizing their treatment allocation. AEB can be viewed as residual expectancy bias not eliminated by the trial’s blinding procedure.
The main idea behind AEB is that if treatment allocation can be deduced by participants, then, treatment expectancy can bias the outcomes in the same manner as it biases non-blinded trials, for example as in open-label trials. 
Daily Bookmarks to GAVNet 09/08/2021 greeneracresvaluenetwork.wordpress.com/2021/09/08/dai…
An Interview with Zeynep Tufekci about Lessons from the Pandemic and the Crisis of Authority
stratechery.com/2021/an-interv…
#COVID19 #PandemicResponse #authority #consequences #sociology #paywall
stratechery.com/2021/an-interv…
#COVID19 #PandemicResponse #authority #consequences #sociology #paywall
Archie Cochrane and the Early Days of Evidence-Based Medicine: Seeing Medicine through the Eyes of Philosophy
jmedic.medium.com/archie-cochran…
#EvidenceBasedMedicine #philosophy #ArchieCochrane #history
jmedic.medium.com/archie-cochran…
#EvidenceBasedMedicine #philosophy #ArchieCochrane #history
Points intéressants = l'ivermectine: (je résume et traduit)
-on accusait les détracteurs de cacher la vérité d'un traitement sûr et efficace à la demande des grandes sociétés pharmaceutiques ou de l'État profond.
- L'ivermectine est un agent antiparasitaire (gale, filariose)
-on accusait les détracteurs de cacher la vérité d'un traitement sûr et efficace à la demande des grandes sociétés pharmaceutiques ou de l'État profond.
- L'ivermectine est un agent antiparasitaire (gale, filariose)
- L'ivermectine se lie à certains canaux chlorure sur les cellules nerveuses et musculaires, paralysant l'organisme qui y est exposé. Ces canaux sont présents dans les systèmes nerveux des vers et des insectes.
- Les humains ont aussi les canaux, mais seulement dans notre cerveau et notre colonne vertébrale. Puisque l'ivermectine ne peut pas traverser la barrière hémato-encéphalique, nous sommes épargnés par ses effets.
Why is there a shortage of Remdesivir, with family members desperately trying to procure it when it has been proven that it is no better than routine care? #EvidenceBasedMedicine
There are two living meta analysis and systematic reviews that show it is not better than routine care. Close to 4000 patients in randomized trials showing no benefit, and patients & families desperate and buying in the black market because they believe it will save their patient
Wow! This tweet seems to have stirred up a lot of interest (and violent reactions). I'm glad there has been (some) discussion about the science, and the evidence, and justifiable disagreement. We've had experienced experts in the field weighing in, and I respect those views
1
Ok this is interesting #livertwitter #MedTwitter
26 yr old woman with jaundice+severe itching (a.k.a cholestatic hepatitis). Routine causes - viruses, prescription drugs, autoimmune liver disease blood tests - neg. No #ayurveda or #herbal drug use. Mysterious🤔
Liver biopsy👇
Ok this is interesting #livertwitter #MedTwitter
26 yr old woman with jaundice+severe itching (a.k.a cholestatic hepatitis). Routine causes - viruses, prescription drugs, autoimmune liver disease blood tests - neg. No #ayurveda or #herbal drug use. Mysterious🤔
Liver biopsy👇
2
#pathology expert says its #drug induced liver injury. But patient denies any drug use. She has #PCOD - polycystic ovarian disease (mayocl.in/34S2LMh) and hence, #overweight.
Deep dive into history again - says she's taking #vitamins for weight loss! Asked to show👇
#pathology expert says its #drug induced liver injury. But patient denies any drug use. She has #PCOD - polycystic ovarian disease (mayocl.in/34S2LMh) and hence, #overweight.
Deep dive into history again - says she's taking #vitamins for weight loss! Asked to show👇
3
Can you identify the culprit component that caused this woman's severe liver injury? #Pathologist is right! #PathTwitter
Culprit - Chromium picolinate in #health #supplement 4 #diabetes #weigthloss. #Chromium is micronutrient enuf in daily food intake bit.ly/3nYNeBB
Can you identify the culprit component that caused this woman's severe liver injury? #Pathologist is right! #PathTwitter
Culprit - Chromium picolinate in #health #supplement 4 #diabetes #weigthloss. #Chromium is micronutrient enuf in daily food intake bit.ly/3nYNeBB
[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
"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"
"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
"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
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 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
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
In this case, you reject the a priori Null hypothesis ( that there is no difference between 2 treatments) You accept...3/n
There's buzz about #Glenmark new drug #Favipiravir for #COVID__19
Do we have the data based on which approval was granted? @CDSCO_INDIA_INF
Given the desperate situation, physicians & patients are likely to flock to get this, but do we have some hard outcomes to show it helps?
Do we have the data based on which approval was granted? @CDSCO_INDIA_INF
Given the desperate situation, physicians & patients are likely to flock to get this, but do we have some hard outcomes to show it helps?
I tried to find published studies on #Favipiravir but haven't yet found supportive data in the searches I did. Would be grateful if someone could point out the evidence. And I hope it's not a single arm study where x% improved because x% could have improved anyway.
If our standards for other drugs are well conducted randomized trials, let's not lower the bar for #Favipiravir just because someone's marketing it, and we don't have any eligible candidates at hand. #EvidenceBasedMedicine
On a tweet-spree, sharing my 2-cent thoughts after 2 months of #COVID duty work:
🔸️ Different patient, different body response - management algorithm can guide you, but individualized care is a must
🔸️ Different patient, different body response - management algorithm can guide you, but individualized care is a must
🔸️Organ systems works hand-in-hand; Nutrition is just as important as ventilation, circulation, etc
🔸️Management is evolving (in a matter of hours); what you know now might not be applicable tomorrow. Keep yourself updated.
🔸️Management is evolving (in a matter of hours); what you know now might not be applicable tomorrow. Keep yourself updated.
🔸️Giving medications just so we have something to give, can be worse than not giving anything at all. #EvidenceBasedMedicine
🔸️Team work goes a long way - ask HELP, be it clinical dilemna or handy ward work. After all, We're on the same boat🛶
🔸️Team work goes a long way - ask HELP, be it clinical dilemna or handy ward work. After all, We're on the same boat🛶
So @getadrip deleted their tweet about IV and IM medicines for £50, after I asked about regulatory issues.
Emails from "Richard" @getadrip are bizarre.
"We are not currently CQC registered as we do not fall within their scope and have not been informed otherwise by the CQC."
Emails from "Richard" @getadrip are bizarre.
"We are not currently CQC registered as we do not fall within their scope and have not been informed otherwise by the CQC."
Again from @getadrip :
"All our products are MHRA approved and are prescribed by GMC Registered Doctors or Advanced Nurse Practitioners, all of whom have 10 - 25 years experience in the NHS individually.
"
"All our products are MHRA approved and are prescribed by GMC Registered Doctors or Advanced Nurse Practitioners, all of whom have 10 - 25 years experience in the NHS individually.
"
And:
"There are many Vitamin Drip providers within the UK, some of which have been operating for up to 10 years, they are also not regulated by the CQC ..., please see an example below:
cqc.org.uk/location/1-353…
"
#bonkersMedicine
This is the strangest @CareQualityComm report ever.
"There are many Vitamin Drip providers within the UK, some of which have been operating for up to 10 years, they are also not regulated by the CQC ..., please see an example below:
cqc.org.uk/location/1-353…
"
#bonkersMedicine
This is the strangest @CareQualityComm report ever.
