Thread by @letsthinkdeeply

@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic The facts:
1) Dr. Fauci and NIH/CDC have actively interfered with the evaluation and advocacy of off label use of safe existing drugs. The reasons are multi fold including a bad EUA framework during a true emergency.
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 2) Early disease parameters were poorly understood and RCTs during this time were often off-mark or suffered from poor design. But a mythology has arisen due to hyped studies that were later discredited. And the perceptual damage had not been corrected.
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 3) The nature of politics in academic medicine overlaid with governmental politics; all amplified by social media have affected doctors, virologists, epidemiologists, infectious disease specialists. We are rapidly substituting politics for science. Anger replacing judgment.
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 4) This should have been approached as emergency triage instead of as an FDA risk avoidance equation. Mistakes are made but rapid examination and iterative approaches to treatment improve treatment rapidly, deploying tools we have while waiting for better ones.
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 5) We rejected exploration of relatively safe treatments seeking the holy grail of Vaccines and Cures. There should have been two questions asked of the repurposing:
- is it safe on balance?
- is there reason to believe it might work?
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 6) Strong observational studies are indications something might work. RCTs poorly designed(often due to early uninformed hypothesis), are not proof something does not work or is dangerous.
7) When people are injured/dying marginal improvements before a cure are important.
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 8) We wasted the opportunity to do large scale RCTs on repurposed drugs and variation in standard of care during the seasonal spike. Vaccine work has sucked the oxygen out of the room. We have allowed many to die by not recommending safe, possibly effective changes in SOC.
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 9) Examples:
-Ivermectin, first work came out in 3/20
-Hydroxychloroquine still appears to have efficacy but is not a cure
-Colchicine, a strong inhibitor of certain inflammatory reactions appears to confer survival benefit
-Unresolved questions on antibiotic choice
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic -anti inflammatory treatment appears critical but choice and dosing are not getting a lot of attention, inhaled steroids have mostly been ignored
-exotic interactions anecdotally observed like antidepressant inhibition is only being studied at small scale
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic -early treatment is still discouraged
-Vitamin D, C, zinc and B1 are all safe at reasonable dosages but COVID19 studies are not prioritized
-period of contagion is not well studied and would inform isolation decisions
-definitive characteristics of transmission still unknown
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 10) The lockdowns have severe economic and secondary health effects. Where are the open academic debates, detailed studies and competing models exploring the offsets? Is protecting the vulnerable more cost effective? It is obvious they have only temporary benefits, relevant?
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic 11) Triage, emergency management, incremental improvements in care, study of secondary effects and virus characteristics have not received the attention that they should have from the NIH/CDC. This needs to change, immediately. What if we had saved 10-80% of those that died?
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@BuckSexton @gummibear737 @Covid19Crusher @EthicalSkeptic @Threadreaderapp unroll