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My paper on the high cost of prescription drugs and possible solutions is out. I go into how US policies (or lack thereof) affect prices in other countries. #BCJ
#OpenAccess #CostVR #insulin4all @MayoClinic nature.com/articles/s4140…
There are no easy answers because the factors contributing to high prices are myriad, and come from all different directions. There are factors unique to the US, which are not operational elsewhere. We need many policy changes in order to have an impact. nature.com/articles/s4140…
Looks like a laundry list of things going on, because a laundry list of things is going on. Everything I mention plays an active role in high prices. We cannot control prices without looking at this 360°

There are things individual docs can do. So don’t wait for policy changes.
If you have 40 mins to spare check out this talk I gave last year. You will get a full picture of the problem.
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More from @VincentRK see all

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Vincent Rajkumar
@VincentRK
Thread on how COVID plays out in hotspots.

Look at Italy, UK, Belgium, USA. The USA looks very different.

However, when we examine the US as composed of many different “countries”, a different pattern emerges.

@ASlavitt @choo_ek @Rfonsi1
91-divoc.com/pages/covid-vi…

Thread 1/ ImageImageImageImage
Now look at the US as if it is composed of a few individual countries.

Northeast which was worst hit in March/April starts to look like Italy, Belgium, UK.

The West and South are behaving like countries where COVID is just now taking off; they are yet to peak.

2/ ImageImageImage
When we look at individual big Northeast States as individual “countries” they start to resemble European hotspots, Italy, Belgium, UK.

3/ ImageImageImageImage
Read 12 tweets
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Vincent Rajkumar
@VincentRK
Important insights from the Antarctica cruise ship story. @ThoraxBMJ. #COVID

217 on cruise
All asymptomatic before cruise, & for first 7 days

128 developed COVID (59%) despite precautions after 1 case

81% asymptomatic
19% symptomatic
3.1% Intubated
1 death (0.8%)

1/
Fascinating: There were 10 rooms shared by 2 people in which 1 developed COVID, & 1 didn’t despite sleeping & staying in same room for >30 days! @ASlavitt @Rfonsi1 @vmontori

- Is everyone susceptible?
- Will negatives be positive later?
- Will negatives get antibodies or not?
2/
In this study, everyone in the ship was tested & no external contact.

Many other insights.

-Screening for fever and symptoms not enough.
- First symptoms on Day 8 means long presymptomatic phase
-60% got infected despite good precautions; it’s a highly contagious virus.

3/
Read 10 tweets
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Vincent Rajkumar
@VincentRK
This thread will be an unpleasant reality check.

COVID in USA:
>2 million cases
Only 6 randomized trials (RCT) funded by NIH.
Accrual plan: 2500 patients.

What moral authority do we have to rebuke the UK NHS how they report or act on a 11500 person RCT which NHS funded?
In a country one-fifth the size, UK funded & enrolled 5 times more patients with COVID in RCTs than USA plans to accrue in a year.

RECOVERY trial compared usual care to antiviral, Dex, & HCQ

It found Dex saves lives. They did the right thing for citizens that funded the trial
I have been in this situation before, and this was absolutely the right call. We make this call frequently in oncology. People should look up history.

But that’s not the point of this thread. The point is the dismal investment we have in NIH funded randomized trials in the US.
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