I would like to lay out why this work is scientifically unsound and problematic. Note that my PhD was in a genetics/informatics lab, and I spent time working with population geneticists. This is a thread. #MedTwitter
One of the mistakes of my early training was conflating race and genetics. This is still done at every level of medicine and science. Race is a SOCIAL construct. It is not based on biology. Race is not a risk factor; racism is.
When you take a group of people of the same "race" and look at their genetics, it's incredibly diverse because again, race as a social construct is not capturing underlying biology, genetic ancestry. Race isn't biological.
Differences in genetic ancestry can affect differences in gene expression. You would need to actually genotype or sequence people and pair that information with differences in gene expression. Then you could say "people with this genetic variant are at higher or lower risk".
So this paper is methodologically unsound because the genetic differences within each self identified "racial" group could be as different as between groups. Because race is not biological. This paper shouldn't even be written.
But what's even more problematic is the lack of funding and effort to understand the role racism has played in COVID outcomes. Socioeconomic disparities and lack of access to care due to racist policies are known to affect health outcomes.
Since the entire study design was fundamentally flawed to begin with, I decided not to address the small sample size, the fact that gene expression doesn't always correlate with protein expression, and that we have no proof that TMPRSS2 expression has any effects on mortality.
Required reading for all reviewers and journal editors:
This is a valid point. Gene expression is influenced by the environment, but also influenced by underlying genetics. However, it was never made explicit that by using gene expression + race, they were focusing on environmental determinants.
Since I've seen so many in my field use gene expression as a proxy for underlying genetic differences (recognizing that environment plays a role, but hand waving its impact), this was my reading of it since it wasn't explicitly stated.
There are so many studies focusing on how genetic variation influences gene expression; far less on the role of the environment. Since most of medicine still treats race as biological, without it being explicitly stated otherwise here, I believe the paper perpetuates that notion.

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More from @RoxanaDaneshjou

10 Sep
Wow, many @StanfordMed faculty took a stand for science and truth in the battle against #COVID19 misinformation being pushed by Dr. Atlas. These faculty are respected infectious disease doctors, microbiologists, epidemiologists, and more. #MedTwitter
The number of signatories goes on and on:
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The next year, you have a different lecture, and these are the photos you see:
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In SAVI and CANDLE syndrome, which are mediated by the interferon pathway, Jak inhibitors help inhibit the positive feedback loop.
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I'm watching #PlandemicDocumentary. I am a physician and a scientist. This #COVID19 pandemic scares me. I am a mother; I have an 80 year old grandmother; I have friends on the frontlines. I'll be seeing patients in the next couple weeks. If you're willing, here's my perspective.
The #PlandemicDocumentary starts with a compelling story. The personal story draws you in. Here is someone who claims to know all the answers while the scientists we see on TV keep changing their tune. I can understand that the shifting narrative is confusing.
But science isn't about personal beliefs or a compelling story. When dealing with a new virus, we are still learning about the best way to treat. Doing a clinical trial where we compare people who got a medicine against people who didn't ensures a medicine isn't actually harmful.
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A Dermatologist's Survival guide to #COVIDー19 handwashing. Your hands are probably raw from water, soap, hand sanitizer. All of the above can be irritants, made worse if you already suffer from eczema. So here are some tips! #medtwitter #dermtwitter #CoronaVirusUpdates
1) Try to avoid scented products if possible. Many of the ingredients used in scented products can be irritated or cause an allergic reaction. Unscented Dove bar soap is a good place to start for sensitive skin.
2) Have thick emollient available - something that is thick and comes in a tub (Cetaphil, CeraVe are options). Personally, I go for GREASY because that is most protective. Yup, I go straight for the vaseline. Nothing that comes in a pump bottle or is runny.
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