A brief 🧵 about RECOVERY: In addition to lots of people on the internet, the authors themselves make this claim in the preprint... but it is not true—and it's not a matter of opinion, it's quite clearly false. 1/
If we were concerned with whether toci's effect were neutral or beneficial it might be a fair claim; but we are concerned with whether toci helps *or harms*. 2/
We don't have data about the 269 patients who were randomized to toci and didn't receive it. Remember RECOVERY treatment teams were not blinded—they knew they were deciding whether to give toci to their patient. 3/
For example: objective evidence of secondary infection was part of the exclusion criteria for randomization. But what if you merely suspected your patient might have an infection? Maybe you wouldn't give the immunosuppressive agent they were just randomized to receive. 4/
If we acknowledge that there's any element of clinical judgment involved—and there's no evidence I've seen to suggest otherwise—then this doesn't mean the effect size is underestimated, it means the study's confidence is overestimated. 5/5
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I'm reviewing the history of how care for patients with ESRD came to be a Medicare entitlement. Many people have heard the story in broad strokes concerning "God panels," rationing of dialysis machines, etc journalofethics.ama-assn.org/article/god-pa… ...
In 1971, Shep Glazer testified before the House Ways and Means Committee in favor of the legislation. As a 43 year old with ESRD, he gave stirring and memorable testimony...
... perhaps overshadowed, however, by his receiving a hemodialysis session in the hearing room itself. Physicians and politicians alike were strongly opposed out of fear that Glazer would die during the session and taint the proposed bill...