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Venk Murthy MD PhD Profile picture
@venkmurthy
Jul 17, 2020 • 12 tweets • 3 min read • Read on X
Major updates to NY Times COVID evidence tracker in first 24 hours.

But still lots of concerns.

**Thread**

nytimes.com/interactive/20… ImageImage
They have eliminated strong evidence category.

Ventilation & proning now called "Widely Used"

Dexamethasone & remdesivir are now the only 2 w/ "Promising Evidence"

Anticoag (previously strong evidence) moved to mixed evidence (two grades down) along with most everything else.
Dialysis is now gone.

Why list ventilation without dialysis?
Overall, this is still *deeply* problematic.

Why are "Widely Used" given a higher rating than RCTs?
They have also not separated strength of recommendation from quality of evidence.

Something can have really good data but a small effect and so get a weaker recommendation than something like dialysis in really severe AKI that would be hard to randomize.
Not clear why they have picked some things to rate and not others either.

There isn't much COVID specific evidence for some of these.
Also critically, the fact that there were such massive changes within first 24 hours shows how poorly thought out this was.

Rather than updating, this should have been taken down with a serious mean culpa.
Synthesizing studies like this is very hard work. It takes lots of time and study to build up the required expertise. Even then experts disagree and thus we often have many experts working together with special methods to build consensus and rate evidence.
Often having different types of expertise is required (different medical fields, allied health, stats, pharmacology, economics, etc).
Even then we get different ratings by different societies in some cases (consider European and American ratings).
Thus this is hard even for experts who spend months.

NYT reporters cobbling together something overnight without process or expertise is downright dangerous and seems from the outside to be arrogant.
H/t to @dnunan79 for pointing out the update.

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More from @venkmurthy

Venk Murthy MD PhD Profile picture
Jan 4, 2023
I am hearing from primary care colleagues that parents are concerned their kids are playing competitive sports without EKG/echos.

More valuable than that would be to mandate no games/practice without AED + CPR trained coach, trainer, and/or official present.

Here is why 👇

1/
Screening for underlying issues in fit teens and young adults is low value. The findings are almost always normal and even when they appear abnormal they are usually false positives.

2/
These kids will end up having lots of expensive & potentially invasive testing which will either lead nowhere or lead to an incorrect recommendation not to exercise at a high level. This is tragic and wasteful.

Imagine incorrectly being told you can't play a sport you love!

3/
Read 8 tweets
Venk Murthy MD PhD Profile picture
Jan 3, 2023
To be honest, this is even more complex than the factors in my initial thread. Been rounding so couldn't give it enough detail, but here are few more...

1/
A baseball will deposit that energy in a smaller surface area than a human head generally will. The concentration of that energy is required because if parts of it are not over the heart they won't cause a cardiac problem

2/
The deformation issue is also more complex.

Not only does deformation reduce the energy transferred, it spreads out the time over which the energy is transferred making it more likely part of the energy is deposited outside the vulnerable period.

3/
Read 8 tweets
Venk Murthy MD PhD Profile picture
Jan 3, 2023
Generally trauma to the chest from person-person deposits only a small amount of energy into the heart compared to small hard objects like a baseball or motor vehicle collisions.

The amount of energy is proportional to the square of the velocity of the impact.

1/
There is a huge difference in the square of 90+ MPH fastball (9025 mph-squared) version a 10 MPH person (100 mph-squared) - nearly 100x!

Mass also matters, but the effective mass is not necessarily entire mass of person impacting but unsupported mass, depending on geometry.

2/
Also, some energy can be lost to deformation. This is how padding works - it deforms, dissipating energy.

Humans are also somewhat deformable due to motion of joints, soft tissue, etc.

3/
Read 7 tweets
Venk Murthy MD PhD Profile picture
Jun 27, 2021
This is a *really* bad take.
Why is this a bad take:

1) The self-limited troponemia referred to is not a diagnosis. The diagnosis is myocarditis, post-COVID vaccine

2) The relative awfulness of these diseases is not the only issue. Their relative frequency is not the only issue.
3) Myocarditis is a spectrum. Can range from rapidly progressive to death to mild chest pain with no further consequence. Like most diseases, the mild forms are much more common than the severe.
Read 7 tweets
Venk Murthy MD PhD Profile picture
May 14, 2021
Excellent summary of the status of COVID heart & how it's mostly not a thing

Cardiologists who loudly hyped this should be explaining why they got it wrong & how they will do better

Here are a few tips in mini-thread 👇

Read excellent article first:

statnews.com/2021/05/14/set…
#1 Number one reason seems to be fear

#2 Is that few MRI experts were asked before/during hype. Sports cardiologists & celebrity docs dominated the scene with weak understanding of what these tests were showing & what they showed in normal people.

Selective credentialism sucks.
#3 Early closing of the Overton window is not science. But in this fact checking culture we are quick to determine what is truth and terminate further discussion.

In this case the estimated rate of CMR findings due to COVID was probably off by 100x or more at first.
Read 13 tweets
Venk Murthy MD PhD Profile picture
Dec 2, 2020
What does it mean to have a healthy metabolism?

How does it relate to CVD?

These are questions @RaviShah_MD & I explored in our latest paper!

Here's a tweetorial on methods & results, which take a bit of a different approach than many prior studies.

ahajournals.org/doi/full/10.11…
We started by applying metabolomics to ~2400 people from the CARDIA study

CARDIA is a study of young adults (age 18-30) recruited ~35 yrs ago to watch the development of CVD risk factors & events.

cardia.dopm.uab.edu
We obtained plasma samples from the year 7 exam from ~2400 individuals with good representation of Black & white races, men & women.
Read 39 tweets

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