After the multiple problems and flipflops we have seen this year with recommendations and guidances in COVID, the public must be aware that medical recommendations are only of value if they come from real experts.
Here are some thoughts on how to evaluate medical expertise.
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First, recommendations should always list names of the experts on the panel so that we can evaluate whether or not guidelines or determinations are made by people with genuine expertise. Anonymous posts are not helpful & lack accountability. If names are not listed, I move on.
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Second, do not fall for fancy leadership titles. While some titles reflect true expertise and academic leadership, some people with glowing titles may be far removed from research or patient care for a long time. Things change fast in medicine. Look past administrative titles.
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Third, assess actual academic and research output on pubmed.gov — paying attention to papers written as first or last author, & whether they are recent. Alternatively for clinical medical judgment calls, determine whether or not they actually see & treat patients.
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Fourth, try to find video or audio of experts speaking or giving a lecture. Usually you can tell people who know their stuff from those who don’t, once you hear them speak. For Eg., When Dr. Fauci speaks we know he is on top of things, and that he is well informed & wise.
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Fifth, assess the composition of the panel for depth, but also breadth of knowledge. Some people with great depth lack the ability to see the big picture.
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Finally, assess whether there are conflicts of interest. This is not easy. But sometimes it obvious. In recent months, a little too obvious.
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AQUILA trial for high risk smoldering myeloma published in @NEJM today.
@thanosdimop
Personally for me, it is a huge milestone along 25 years of work that started in 1998. #ASH24 #ASH24VR
This story below may help those interested in a clinical trialist career. 1/
In 1998, as a fellow @MayoClinic I was keen to determine if early intervention delayed progression and improved survival in SMM. #ASH24
In 1999, with the help of Tom Witzig, I led a small phase II trial of thalidomide for SMM. @LeukemiaJnl 2/
I was then so fortunate to examine the natural history of SMM, with the legendary Bob Kyle. Honored to be last author on @NEJM paper that also provided data that most progressions occur in the first 5 years of diagnosis.
The start of the concept of high risk vs low risk SMM. 3/
FDA approval doesn’t necessarily mean standard of care.
Thread.
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For example FDA approved Dara VMP for frontline therapy in myeloma in 2018.
Literally no one used the regimen in the US.
Literally no one felt the regimen was standard of care in the US.
Before or after approval!
Why?
FDA adjudicates a sponsors submission on whether a given drug/regimen has met the burden of proving safety and efficacy.
Standard of care in clinical practice is a different standard: judgment of risk/benefit of available alternatives, and assessment of trial design/end points.
Cure is a simple word. But there is confusion when it comes to cancer. What cure is in cancer, and what we should aspire for?
When can we say that a given type of cancer is curable?
Thread
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There is a difference between when we can say a particular cancer is a curable type versus whether individual patients with a given cancer can be considered potentially cured.
They are not the same.
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To call a cancer curable we must be able to treat the cancer for a finite duration, stop all therapy, and know that a certain % of patients will never relapse
Early stage solid tumors, Hodgkin lymphoma, DLBCL, ALL, AML are curable. Real cure. The definition of curable cancer
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The 4 big myeloma randomized trials to watch out for @ASCO #ASCO24
1. Isa-VRd vs Isa-Rd newly diagnosed
2.Isa-VRd vs VRd (IMROZ)
3.DREAMM8 Bela-Pd vs Pd
4.Ven Dex vs Pom Dex (Canova)
See thread for why they are important.
1) The Triplet vs Quad trials with will define role of quads in elderly patients with newly diagnosed myeloma. They also provide frontline phase III data with Isatuximab— and a choice between Dara and Isa. For some patients Isa will be more cost effective. @Myeloma_Doc #ASCO24
2) Belantamab will make a comeback.
Corneal toxicity is low with reduced frequency dosing. The drug works very well. And in many patients with refractory myeloma belantamab may be safer and easier to do than bispecifics. We need options. #ASCO24
2/ Even though CART (cilta-cel) is approved for first relapse we are NOT including it in our main algorithm. Reserved only for special circumstances in this population. We have a long track record with standard triplets, and we are concerned about CART side effects.
3/ The current approach for second or higher relapse continues to define 3 specific types of Triple Class refractory. This makes it easier for clinicians to consider options.