Vincent Rajkumar Profile picture
Sep 13, 2020 11 tweets 5 min read Read on X
As I predicted a month ago the number of new COVID cases has decreased in the US. From a high of 70,000 per day to 35,000 per day now. It will likely continue to decrease for some more time.

This is due to many factors, but great national leadership is not one of them.

1/
Why are cases decreasing even though most of us are still susceptible?

2 reasons:
— Increasing proportion of persons at high risk of getting COVID (eg., jobs where u can’t social distance) have already had COVID
— Effect of masks & distancing

2/
But the proportion of people who have been exposed is very low even in hotspots. Less than 10%. Does this mean >90% of us are still susceptible? And if so, why are cases decreasing?
jamanetwork.com/journals/jamai…

3/
While we have to assume that we are all susceptible and continue to take preventive measures, seroprevalence studies likely underestimate the proportion of people who have been exposed to COVID. See article by @JoshuaPCohen1 @Forbes google.com/amp/s/www.forb…

4/
But even if we do some rough math, and double the seroprevalence we will still have only estimated 10-15% of population as having been exposed to COVID, far lower than what is needed for true herd immunity, but yet cases are decreasing, even in many hot spots. Why?

5/
Which brings us to the big question. Are we all equally susceptible to COVID? Or do some people have cross reactive immunity in which cases the disease is so mild that while you may get a PCR positive result, it doesn’t actually lead to symptoms or permanent seroconversion?

6/
An important caveat:

-What happens in Europe happens a month later in the US. In Europe there is a 2nd wave. Our cases can go up dramatically. We have to be careful & continue masks and social distancing because that may reduce viral dose and thereby the severity of COVID
7/
As cases come down leaders will naturally try to take credit. Or my worry is that they may tell people to relax. But to be clear the drop in cases is happening because of reduction in susceptible population and due to behavioral changes, specifically masks. @jeremyphoward

8/
The number of daily cases now is higher than I thought it would have been at this point. But the trend is there.
My feeling is that the drop in cases will be transient and we will have another peak in late fall. But my hope is that the drop in mortality is more enduring.

I also recognize that COVID has a lot of long term consequences. So it’s important we do everything to keep cases down

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More from @VincentRK

Apr 23
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.
Read 8 tweets
Apr 17
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.
Read 15 tweets
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

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