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Alex John London Profile picture
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8 Dec, 4 tweets, 2 min read
1. I want to make one more point about #vaccine #RCTs and I’m open to being corrected here by someone like @nataliexdean who has worked on these trials. The point has to with being in a situation in which we have estimates of efficacy so early on in the planned 2 year trials.
2. When these trials were designed it wasn’t a sure thing that we would have efficacy estimates this early. During the #ebola vaccine trials in 2014-15 the outbreak was waning by the time the vaccine trial was underway. If we had a coordinated public health response to #COVID
3. ...then lower rates of transmission at trial sites would have meant a longer time to the relevant number of infections. As I said, I’m open to correction, but having this information so quickly seems unprecedented to me.
4. Also, we don’t usually start manufacturing a vaccine at scale before studies are completed. So it is unusual to be in a situation where we have signal of efficacy so early on in trials that will themselves overlap with the deployment of the vaccine in question at scale.

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More from @AlexJohnLondon

Alex John London Profile picture
8 Dec
I like to give my kids #philosophy problems. My son and I agree: if you were a person in the #StarTrek universe it would be a bad idea to use the teleported. Because once you are disintegrated, your existence ends. But from a second person standpoint, there is no difference.
The version of you that walks off the transporter on the other side thinks they were transported, because they remember getting on the platform and waking up or whatever in the new place. So the version of you that survives has a consciousness contiguous with your past.
So everyone thinks that transporters don’t harm people. But you are not the very of you that walks off the platform. After all, we could copy you and reassemble you in the same room without destroying you. In that case there is a second version of you...
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Alex John London Profile picture
2 Aug
When you make an argument like this, please show your work. Let’s think of the cases

1. So we deploy an investigational vaccine that doesn’t actually confer immunity or strong immunity. If people think it provides protection, & take more risks MORE people get sick and die.
2. Imagine vaccine provides some protection, but a subgroup of people who access it outside of an RCT have a serious adverse reaction. If people think the vaccine is harmful, fewer take it or enroll in trials and MORE people die.
3. Why should we believe that outside access to an investigational vaccine and speed at which a clinical trial completes are independent? If outside access slows accrual in a RCT MORE people could die in the long run since (a) pre-approval production rate will be smaller than...
Read 13 tweets
Alex John London Profile picture
18 Apr
1. One of the best parts of my corner of twitter is watching incredibly smart people like @mlipsitch @nataliexdean @trvrb carry our peer review in real time. And as Marc says in this thread, it’s important to remember that spending time critiquing work is a mark of respect....
2. But watching their work, and @CT_Bergstrom as well, has made me even more skeptical of the value of medical preprints. Yes, science often advances through the accumulation of many contributions in which few single studies are definitive. But in the current environment...
3. Preprints making striking claims are almost immediately reported to the wider public prior to the kind of rigorous and thoughtful review in the link above. And at that point, the toothpaste is out of the tube....
Read 5 tweets
Alex John London Profile picture
10 Apr
1. I’m going to try to be a better twitter user. And that means bringing a little more charity to this platform than it tends to induce and avoiding snappy tweets that makes people feel like things are worse than they really are. So what to make of these two reports?
2. Here is the conclusion of the NAM report. There are no direct studies of the question at issue. We have to make inferences from the other data They suggest fabric masks might reduce transmission of larger particles but net benefits depend on make and use, so benefit uncertain.
3. The BMJ piece says, “Although good quality evidence is
lacking, some data suggest that cloth masks may be
only marginally (15%) less effective than surgical
masks in blocking emission of particles, and fivefold more effective than not wearing masks.”
Read 6 tweets
Alex John London Profile picture
2 Apr
1. I’m not going to lie, I’m still grappling with the fact that 1,049 people died in the US just today from #COVID19. At this rate it will be 2k per day by the weekend. Each one of those people was unique. They were someone’s lover or crush...
2. They were a bearer of someone’s secrets, a witness to someone’s failure and grief, to deep sorrow and merciful joy. They wore glasses and worried about tomorrow and in a drawer or a notebook they had a list of things to do tomorrow, places to go, vacations to take...
3. And most of these people were enmeshed in the warp and woof of other lives, the people whose names were on those lists, whose pictures were on their phones, whose names were on their minds when there was tea to tell.
Read 9 tweets
Alex John London Profile picture
12 Mar
1. I want to share some thoughts about how I’ve been feeling lately, in part because I suspect that many of you are feeling the same way and, for me at least, there is comfort in solidarity. #COVID19 #academic #AcademicChatter #medicine #healthcare
2. This has been a tough week, and I’m afraid that it is only the beginning. We are on spring break and I had a long list of tasks I’ve needed to accomplish but it has been difficult with everything that has been going on.
3. It isn’t just the trip cancelations and the challenge of having to move two highly interactive seminars into some sort of online format. It is the growing recognition that we are in the midst of an outbreak...
Read 20 tweets

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