The common refrain from experts early on was that masks were not needed unless you are sick. I believed this till Mar 29. Then the evidence became too strong that masks were needed for everyone. But the message was that it was only to protect others from you (source control).
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But the high rate of serious illness in healthcare workers, the lower mortality in mask wearing countries and COMMON SENSE meant masks must protect the wearer also (work as PPE). People are also more likely to wear a mask of it helps themselves not just others. 3/
The other important message was that while completely preventing infection is hard, masks may preventing serious infection by reducing viral dose. And the whole concept of viral dose and severity that @DrSidMukherjee wrote about in mid March in @NewYorker. Even cloth masks help.
It takes much longer for private citizens (who have a day job) to analyze data & events & come to a conclusion. By late March, many of us were literally screaming for masks ahead of CDC & WHO. The wobbling made the public doubt the unequivocal importance of masks. @jeremyphoward
Any now the messaging should be clear and unequivocal. -Masks protect others from you (source control).
-Masks protect you from others (PPE)
-Masks reduce viral dose and may make the disease milder, & function analogous to a vaccine
-Any mask is OK, except ones with valves
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To my followers who wonder what MOC is, and why many doctors are tweeting about it. Thread.
1) Maintenance of Certification (MOC) is a redundant requirement thrust on US physicians by a private organization. We resent it.
2) MOC is causing frustration and burnout. Over the years, ABIM certification and MOC have become entrenched and institutions and insurers require it and will not accept any other alternative.
I am advocating on behalf of my colleagues in the US for change. To end MOC.
3) MOC requires us to pay fees imposed on us by a private organization and take multiple choice question tests irrelevant to our practice.
10 suggested action items for physician colleagues suffering under the burden of @ABIMcert MOC. #MedTwitter
1. If your institution allows it, stop participating in MOC. Personally, MOC has no value to me.
2. If your institution requires ABIM certification, advocate for @InfoNbpas as alternative option.
3. Do not participate in more than one ABIM MOC specialty, the one that’s required by your institution. Save your money. Don’t spend a penny more than you have to.
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.
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
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
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.
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?
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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”.
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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
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