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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In the year 2000, a few of us attended an angiogenesis meeting in Boston. We were there to discuss thalidomide
But a side meeting that evening led to trial that went on to get Velcade FDA approved for myeloma. @NEJM
Story in thread.
Velcade (bortezomib) was first introduced to cancer research by the name PS-341.
It was a novel proteasome inhibitor developed by Julian Adams and colleagues a a potential anti cancer agent. @CR_AACR @AACR aacrjournals.org/cancerres/arti…
The ubiquitin-proteasome garbage disposal pathway in cells is a Nobel prize winning discovery.
Proteins that need to be degraded are tagged with ubiquitin tails. Tagged proteins are degraded by the proteasome complex. (This review has details )
The fascinating story of Thalidomide: how this most notorious drug on the planet, banned in the 1960s, made an incredible comeback and revolutionized the treatment of myeloma.
I will also highlight one person whose role is not recognized: Without Dr. Leif Bergsagel there will be no thalidomide for myeloma.
Read on #MedTwitter
The thalidomide story has many takeaways and lessons.
It shows drug development from bedside to bench and back to bedside.
It shows the power and impact of astute clinicians
It shows the power of investigator courage
The role of serendipity
But let’s start at the very beginning.
Thalidomide was synthesized in 1954, and then developed as a sleeping pill by the German company Chemie Grünenthal in the 1950s.
At the time the only sedatives available were barbiturates which had risks of intentional or accidental overdose.
Because thalidomide was felt to be a drug that cannot cause death due to overdose it was marketed as one of the safest sedatives.
By 1961, it was sold in over 40 countries as a sleeping. It was also tragically used to control morning sickness of early pregnancy.
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/