For benign interventions (eg., masks for COVID) if we say masks work & they donβt, consequence is small. If we say they donβt when they truly do, itβs tragic
For any intervention we have to always consider the consequences of a Type I error relative to the consequences of a Type 2 error.
For many medicines, the consequences of a Type 1 error in terms of toxicity, harm, & cost usually outweighs those of a Type II error. We need RCTs.
Sometimes there are interventions where consequences of erroneously concluding something is effective when it is not (Type I error) is small compared to concluding itβs not effective when it actually is (Type II error). Eg., hand washing to prevent COVID. Masks are like that.
Now with data from lab & clinical studies, hospital experience, as well as observational data, there is no question masks work. They protect others if you happen to have COVID. They also protect you from getting COVID, & decrease chance of serious disease by reducing viral dose.
β’ β’ β’
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#4 Identification of a potential mechanism for frequent relapses after CAR-T therapy for myeloma: Bi allelic loss of BCMA locus at 16p. Important work. #ASH20#ASH20VR@DanaFarber@NoopurRajeMD
Iβm happy that we rapidly found stuff that works:
-Masks
-Proning
-Dexamethasone
-Monoclonal antibodies
-Upcoming vaccine
Iβm disappointed about the many mistakes:
-Lack of a comprehensive strategy
-Mixed messages
-Politicization of masks
-PPE shortage
As a result of our success we have lowered the number of deaths. But the daily death toll is unacceptably high: ~1000 per day. How can we possibly lower it when the number of new cases is skyrocketing?
If you compare to Europe, you could come to the conclusion that nothing matters. Itβs just the way COVID is. But we have to ask, have they made the same mistakes as us?
Individuals
-Wear a mask when indoors with people u donβt live with
-Social distance as much as possible
-Good ventilation indoors
Governments
-Communicate above 3 measures clearly
-Provide tests & PPE
-Leaders set examples
This is my judgment call. These are basic things essential things. There is a lot more we can do as individuals and governments. But first things first. And also these are the realistic measures possible with such a high incidence of new cases compared to lockdowns.
What more can you do if you are already doing the Top 3?
Hereβs what Iβm doing.
- Iβm wearing a mask even outdoors if Iβm talking to people I donβt live with
- Hand sanitizer outside of home, periodically but not obsessively
- Limiting social gatherings greatly
Why I call it an epic failure of leadership in the US.
-Some countries had great leadership & are winning.
-Other countries failed despite trying their best.
We failed but didnt even try. Instead leaders mocked masks, disobeyed rules, insulted scientists, & tarnished CDC
We can live with an all out strategy that failed. Where we tried our best to test, trace. Where we clearly told people about important of masks once it became obvious that masks were important. Where we provided PPE & resources to hospitals.
But we donβt have a plan in November
But we have a unrelenting series of mixed messages.
A never ending stream of leaders minimizing the pandemic. Multiple events where safety rules are broken by people who should be implementing and promoting them.
Thatβs the difference between not trying and trying.
This investigator-initiated, @NIH@theNCI funded trial addresses the role of quadruplets in myeloma. It tests the hypothesis that adding a 4th drug will mainly benefit patients who are MRD+ after triplet induction, and may not be needed in those who are MRD-