Vincent Rajkumar Profile picture
Sep 23, 2020 14 tweets 4 min read Read on X
Amazing exchange between @RandPaul and Dr. Fauci.

1) As one of the first people to raise the possibility that not everyone may be susceptible to COVID, and that cross reactive immunity may be protecting some people from severe infection, I agree with those points by @RandPaul
2) I’ve also been on record that seroprevalence underestimates the proportion of people who are immune & that we may be closer to herd immunity in prior hotspots than the 5-10% seroprevalence indicates. But that number (~2 times seroprevalence) is still far short of herd immunity
3) Having said here are 3 comments I disagree with.
-The comparison of NY to Sweden is not correct.
-The statement that flattening the curve does not reduce number of deaths is not correct
-We are doing as well as S. America & so mitigation strategies don’t help is not correct
Sweden as Dr. Fauci pointed out did not do anywhere as well as Denmark, Finland, or Norway—its neighbors. Those are the comparators. Sweden also had warning that NY didn’t have. So we cannot compare. Both Sweden and the US have done equally badly in terms of deaths per million.
Flattening the curve will spread CASES over time and so the area under the curve for cases may be similar whether you flattened or now. But not DEATHS. In fact, the whole idea of flattening the curve is to reduce high number of deaths that occurs when the system is overwhelmed
In fact NY, NJ and the east coast were hit BEFORE the flattening happened. The high death tolls there reflect what happens when the curve is NOT flattened. There is a lag between issuing mitigation orders and flattening to occur. Same thing happened in Lombardy.
We made a lot of mistakes. I have catalogued things we could have done better in hindsight. An earlier recommendation for universal masks would have helped. And a uniform bipartisan recommendation on that. We have fared really badly compared to most developed countries.
The reason why S. Korea, Vietnam, Japan, Taiwan, and China have done so well is far less likely to be related to cross reactive immunity but rather related to strict border control for entry into country, testing, tracing, masks. They followed the science. We didn’t.
I agree that it’s possible that S. America, Africa, India, Pakistan have lower mortality because of cross reactive immunity from prior corona viral infections. But we likely have much less cross immunity. So if we had less social distancing like them, we would have 400,000 deaths
Some links. On susceptibility and cross reactive immunity.
On seroprevalence being an underestimate. @JoshuaPCohen1 google.com/amp/s/www.forb…
What could we have done better to reduce mortality. 10 factors in this list.
*now = not

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Vincent Rajkumar

Vincent Rajkumar Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @VincentRK

May 24
The remarkable story of Velcade.

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. Image
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…Image
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 )

PS-341 was a proteasome inhibitorascopubs.org/doi/10.1200/JC…Image
Read 13 tweets
May 18
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 serendipityImage
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.Image
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. Image
Read 20 tweets
Dec 9, 2024
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/ Image
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/ Image
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/ Image
Read 12 tweets
Aug 24, 2024
Why are prescription drug prices are far higher in the US that other developed countries.

I’ll break it down. A full 360.

1/ We don’t negotiate prices at launch of a new drug. Others do. Image
As a result, we spend billions on common drugs that other countries spend a fraction of the price on.

Some drugs we pay 10 or 100 times more!! Image
2) Generic and biosimilar entry, adoption, and utilization is slower in the US, and there are many barriers.

Timely and adequate free market competition is critically important for lowering price. Image
Read 21 tweets
Jul 8, 2024
FDA approval doesn’t necessarily mean standard of care.

Thread.
1/
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.
Read 13 tweets
Jun 25, 2024
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
1/
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.
2/
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
3/
Read 13 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(