Vincent Rajkumar Profile picture
Jul 3, 2020 5 tweets 4 min read Read on X
Stunning fact: Not even one single developed country has >1000 COVID cases per day. We have >50,000 per day in the United States.

Epic failure of leadership at National level, as well as at the State level in many states. @ASlavitt @choo_ek @MelissaJPeltier @jeremyphoward Image
Normalizing to million population underestimates the severity of the epidemic in large countries. Ultimately it’s about the numerator: >50,000 new persons with COVID every day

Except Sweden, which made the wrong decision not to lockdown, there are no developed countries near us. Image
In case people are wondering who are our neighbors in the first tweet. Brazil overtook is for a short while. But we blew past them.

I’ll say the #1 reason for our failure is that FL, AZ, GA, CA, and TX did not mandate #Masks4All. @jeremyphoward

CA, TX do so now. But late. Image
Overall doesn’t look very good.
One way of looking at COVID is to examine the US as multiple different countries and make appropriate adjustments for prevention, analysis, and mitigation strategies. It provides hope. Also supports plans by NY, Chicago to restrict entry. @chicagosmayor @NYGovCuomo

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More from @VincentRK

Apr 12
I see a lot of wrong analysis on accelerated approval and surrogate endpoints.

It’s always easy to criticize from the outside. The criticisms raised are well known to the FDA and investigators. They are considered. We go in eyes fully open. We try to do what’s best for patients
Without accelerated approval using surrogate endpoint of overall response rate in single arm trials, for 2-3 years lives would have been lost waiting for drugs like Velcade, Revlimid, pomalidomide, Daratumumab, carfilzomib and more.

My defense of accelerated approval in MM.
What kind of benefit are we talking about? How many years of life gained from accelerated approval pathway in MM?
Read 5 tweets
Dec 31, 2023
My year end endorsements.

1) @costplusdrugs — where you can get >2000 prescription meds at lower price than almost any other pharmacy in America. Has revolutionized the generic prescription drug market. @mcuban costplusdrugs.com
Image
2) @PayorDieFilm — the story of lives lost due to the high price of insulin in America. Likely contributed to why all 3 big insulin manufacturers have now cut the price of insulin by >70-80%. @scottaruderman @NSmithholt12

Watch on @paramountplus @mtvdocs Image
3) Inflation Reduction Act provisions to cap Medicare Part D copays.

For 2024, the out of pocket max for Part D drugs that a patient pays in copays is capped to a max of ~$3250. A huge relief to many.

This cap goes down further to $2000 in 2025.
Read 7 tweets
Dec 15, 2023
Updated treatment approach to newly diagnosed myeloma based on new #ASH23 data.

Explanation for changes in thread. #MedTwitter 1/ Image
What’s changed?

I’m ok with quadruplet induction for standard risk based on the 2 phase IIIs at #ASH23

Better PFS and MRD-
Limited duration induction.

OS will take a long time to emerge and risk/benefit is reasonable to incorporate Quads.
2/ Image
Which Anti CD38?

Either Daratumumab or Isatuximab are ok as the AntiCD38 antibody to add to VRd for the Quad

Decide based on cost and access.

We had data on both at #ASH23
3/ Image
Read 11 tweets
Oct 2, 2023
Two days ago I did 60 ABIM MOC questions in Heme and Onc (against my will).

Almost all were esoteric/ irrelevant questions. Rare things that doctors rarely see. #MedTwitter

What’s my opinion?

1/
I spend a lot of time in medical teaching and writing. I write for UpToDate for 20 years, and all of the major Hem Onc textbooks.

In my opinion, the MOC questions are useless for routine Hem Onc clinical practice. Useless to assess “walking/ essential knowledge”.

2/
What’s worse: Every 3 or 4 questions that I spent time and answered, I would get a note that it was a “test question”. No answer was given at the end, making it a complete waste of time and making me an unwilling partner to test questions for the ABIM. @DavidSteensma

3/
Read 6 tweets
Aug 11, 2023
US physicians almost unanimously oppose ABIM MOC. #MedTwitter

We have raised our voice in despair. What can we do to make change happen?

1) Urge our professional organizations to support us. More than words, we would like action.
2) Continue the pressure on social media.
3) Support the petition started by @AaronGoodman33

>12,000 have already signed.

change.org/p/eliminate-ab…
Read 13 tweets
Jul 31, 2023
Top 10 reasons why ABIM MOC should be abolished. #MedTwitter

10. It’s a bad life experience that physicians almost unanimously don’t like.
9. The questions asked in the MOC LKA or MOC exam are not what we face in practice. They are often vague zebras or designed to trip people up. (Experts get questions in their own field wrong)
8. MOC depresses morale. When you take a profession where people are committed to life long learning, do plenty of hours of CME each year, and force them to a multiple choice test every 3 months: You know what it does to morale.
Read 11 tweets

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