Vincent Rajkumar Profile picture
Aug 7, 2020 5 tweets 3 min read Read on X
If we knew who is transmitting, and who’s not, we would have stopped COVID a long time ago with preventive measures.

COVID is a pandemic precisely because most people who get it are asymptomatic and transmission occurs silently. Now we have new data on viral shedding. See below
One of the best studies that informed up on the proportion of COVID that is symptomatic versus asymptomatic was the Antarctica cruise ship study.

217 people. Everyone tested; no one left the cruise or got in for 30 days. See below.
The other study is from Iquitos, Peru which was badly affected by COVID. Even assuming some confirmed cases had COVID, the vast majority were likely asymptomatic: 71% seroprevalence.
This is why a lot us started calling for universal masking for everyone, with or without symptoms, in late March— before the national task force, CDC, or WHO recommended it.

@zeynep @jeremyphoward @DrSidMukherjee were among the earliest to recommend #Masks4All — by mid March.
This is why we have to be careful with lots of people in indoor places especially when daily new cases are high: It’s impossible to know who has COVID by looking at them. Leaders have to take this into consideration whether it’s with regards to closing bars, or opening schools.

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More from @VincentRK

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
Jul 21, 2023
Myeloma drugs — Dosing and schedule

What I do in practice #MedTwitter

1. Dex: 40 mg once a week age <70; 20 mg if age >70 or frail

Stop Dex at around one year if good response.

Days 1-4, 8, 15, 22 schedule for 1st cycle only in cast nephropathy; or VDT-PACE type regimen
Velcade:

Once a week and SQ is my default.

Twice a week for 1st cycle only in acute in cast nephropathy, or with VDT-PACE type regimen
Revlimid:

25 mg standard. But reduce starting dose to 10-15 mg for the following groups: elderly, frail, patients with body weight less than 60kg, renal failure, and patients of Asian or South Asian descent.

Maintenance dose: 10 mg max.
Read 11 tweets

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