Mark Toshner Profile picture
Nov 17, 2020 7 tweets 2 min read Read on X
More on vaccines. I'm going to get boring and geeky on this (no apologies) on the 10 year thing. Vaccines "normally take 10 years". This is being use as a reason to be fearful (ie rushed job). I'm a clinical trials doc. I can tell you most of that time is spent doing...1/n
.... nothing. It's spent submitting funding requests, then resubmitting them, then waiting, then submitting them somewhere else, then getting the money but the company changes it's mind or focus, then renegotiating then submitting ethics, then waiting for regulators...2/n
...then having problems with recruitment and having to open other sites, then dealing with more regulatory issues, then finally when you eventually get to the end of all of this you might have a therapy...3/n
... or not. At this point it may not be deemed profitable or any number of other obstacles.

However we have collectively now shown that with money no object, some clever and highly motivated people, an unlimited pool of altruistic volunteers and sensible regulators...4/n
That we can do amazing things (necessity being the mother etc). These trials have been nothing short of miraculous, revolutionary but in the context perhaps it is not surprising given our ability to innovate when we REALLY need to...5/n
and we really needed to. Safety hasn't been compromised. 100s of thousands of great people volunteered for experimental vaccines. The world watched closely. The press reported every serious adverse event. There have so far been a handful. A triumph of good people/good process.
I am confident that when regulators and scientists pour over the safety data (and we will because we are a bit that way inclined) that vaccines will only be used if we are confident that the risk is definitively outweighed by benefit. This should give you confidence too.

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More from @mark_toshner

Sep 21
In amongst the carnage of the workforce plan there is an obvious thing hiding in plain sight. Let’s solve the PA crisis in one 🧵… (spoiler I won’t)
First thing is I think most of the debate on Twitter is terrible quality right now. Like most of the rest of Twitter it has degenerated in the loudest voices in 2 opposed camps insulting each other. Bullying online is rife.
This was predictable. History repeats if nobody listens-“medical auxiliaries in Algeria and elsewhere confronted a limited career ladder and inferior employment..They were locked into subordinate roles and faced workplace harassment. theconversation.com/physician-asso…
Read 28 tweets
Sep 1
This paper on thromboinflammation is everywhere this week. Unfortunately nobody commenting on it seems to have read it!

I have, and it definitely doesn't say what commentators are suggesting. 🧵nature.com/articles/s4158…
Quick summary. Spike interacts with fibrinogen and drives a thromboinflammatory cascade. In the paper, this is tied most closely to lung & brain pathology. I am not going to dissect the figures- take it on face value as true; this is not my problem with the paper/messaging.
My problem is the explicit link to long covid present in the paper (from the abstract on) & prominent/signal boosted in most of the media.
Read 12 tweets
Aug 1
Long form 🧵on lung clots, chronic complications and Covid. Data is emerging that call into question how prevalent and important this really is. I think we are in a better place now to be clearer.
To begin with-we undoubtedly saw high acute post-Covid thrombosis at the beginning of the pandemic. Here is my starting contribution to this literature (ie I have looked at this a lot)-
national self-case control approach
ICU study pubmed.ncbi.nlm.nih.gov/34607634/
pubmed.ncbi.nlm.nih.gov/34582412/
systematic review I will post more recent work at the end to show how it has changed with timepubmed.ncbi.nlm.nih.gov/35942076/a
Read 22 tweets
Sep 24, 2023
🧵on PAs in UK NHS. Bit of both-sideism but from a skeptic viewpoint. Strap in. This will not be short!
Starting point- can some of clinicians work be done by others? Simple answer is yes. Our jobs can be discretely broken into domains (pick your own schema)
- admin
- clinical assessment + treatment
- procedural
- leadership
- teaching
- holding risk
The list goes on
A quality trained doctor does all of this but no reason bits can’t be broken up and done by others or amalgamated with new roles. In fact it happens all the time & without controversy. So why the brouhaha over PAs?
Read 43 tweets
Aug 16, 2023
Are you sitting on Twitter wondering why doctors are on one hand complaining about being understaffed & simultaneously incandescent with rage about mushrooming non-doctor roles? 🧵 for you.
We will start off with the simple bit we can all agree on. There are not enough healthcare workers (in any part of the system, not just doctors). UK Workforce plan is clear on this and everybody agrees. …england.nhs.uk/publication/nh…
This is btw a global and not local problem which means usual developed world plan to just asset strip human resources from elsewhere is harder,
kpmg.com/xx/en/home/ins…
Read 19 tweets
Jun 27, 2023
If you want to understand why doctors strikes will not end any time soon and why this is a disaster, take the temp of doctors from contemporary surveys 🧵
First up GMC. Absolute historic levels of every flashing red light possible, from doctors taking steps to leave, through concern over ability to give safe care to burnout levels.
RCP survey is also consistent with this and workload a major concern in both surveys.
Read 12 tweets

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