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Vincent Rajkumar Profile picture
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5 Mar, 6 tweets, 1 min read
List of medical treatments that are associated with absolutely dramatic benefits. Please add to list.

1. Antibiotics for infections
2. H2 blockers and proton pump inhibitors for gastric and duodenal ulcers
3. Serotonin 5HT3 receptor agonists for nausea and vomiting
4. MOPP and ABVD for Hodgkins
5. CHOP for diffuse large cell lymphoma
6. Tyrosine kinase inhibitors for CML
7. Chemo for childhood ALL
8. Steroids (many indications)
9. Insulin for diabetes
10. Cladribine for hairy cell leukemia
11. Polio, measles, small pox vaccines
12. Acetaminophen (Tylenol) for fever
13. Morphine (and related drugs) for pain relief
14. B12 for pernicious anemia
15. Hepatitis C antivirals
*5HT3 receptor antagonists. Not agonists.
Lots of great replies coming to last tweet in thread. Trying to link them. Not sure if this will work.
Lots of treatments work in medicine. This list is about those where the effect is truly dramatic and has a profound impact on outcomes. Where you don't need an RCT to recognize the night and day type of effect that the intervention works.

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More from @VincentRK

Vincent Rajkumar Profile picture
2 Mar
What if?

When I wrote this thread we had 5 million COVID cases in the US. Since then: 23 million more.

150,000 deaths then.
350,000 more since.

Had we greatly expanded vaccine access then, in retrospect, how many lives could we have saved? @StevenSalzberg1 @DrEricDing
Some who supported the idea had t take down their posts due to the pushback. I didn't. Because I felt comfortable this was a good discussion on risk benefit to have. So I let it stand.

The reason I post this is for experts not to be too sure, and hide under "follow the science"
COVID has surprised us many times and will continue to surprise us.

There are many unknowns about the science of the immune system.

Better to have healthy debate. Whether it's on expanded use of vaccines or delaying time between shots or adding boosters. Don't silence people.
Read 5 tweets
Vincent Rajkumar Profile picture
2 Mar
Myeloma Drug Costs per month:
Bortezomib $6000
Elotuzumab $10500
Ixazomib $11000
Panobinostat $12000
Isatuximab $13500
Daratumumab SQ $15000
Lenalidomide $16000
Carfilzomib $16000
Pomalidomide $20000
Selinexor $22000
Belantamab $24000

Patients need 2-3 of these in combination.
I'll be watching and posting the cost of Melflufen and CAR-T

Myeloma treatment is often continuous. Myeloma patients even with insurance can have substantial co-pays. Middle class patients who don't qualify for very low income assistance programs are affected a lot.
For more on the high cost of prescription drugs, especially cancer drugs and what we need to do about it, please check out this article. nature.com/articles/s4140…
Read 9 tweets
Vincent Rajkumar Profile picture
28 Feb
Progress towards herd immunity in the US:

~30 million have had COVID
~50 million have received at least 1 dose of vaccine
~70 million are children; not eligible for vaccine.

After considering some overlap in 3 groups: ~140 million to go to get 80% of eligible population immune
With J & J approval, this goal is achievable within 3-4 months.

Things then will be remarkably good considering how good the vaccines are in preventing deaths & hospitalizations. It will relieve the huge stress many frontline health care workers have endured for the last year.
Here is information on vaccines by state. @Forbes forbes.com/sites/joewalsh…
Read 4 tweets
Vincent Rajkumar Profile picture
26 Feb
In randomized trials with 6 different COVID vaccines involving ~175000 persons:

0 hospitalizations for COVID in persons who received the recommended schedule of vaccine.

That is ZERO.
Astra Zeneca Oxford
Pfizer
Moderna
Novovax
Sputnik V
J & J
Source: I read each FDA guidance document for Pfizer, Moderna, and J & J. The @TheLancet papers for Astra Zeneca (most recent) and Sputnik V. And press release for Novovax interim analysis.
Read 5 tweets
Vincent Rajkumar Profile picture
25 Feb
If you had any doubts about the efficacy of vaccines: Marked reduction in deaths in vaccinated persons in nursing homes than in overall US population. #VaccinesSaveLives @nytimes @mathisonian @smervosh @danielle_ivory
If you don't believe this, and the data from randomized trials and other real world data we already have, then your aren't gonna believe.
This is why I'm confident that vaccines will get us back to normalcy.

This is why I don't this March will be terrible.

This is why I think we can be near normal by summer as proportion of people who have been vaccinated and those with prior COVID inches close to herd immunity
Read 7 tweets
Vincent Rajkumar Profile picture
25 Feb
Mutants or not this is what's happening. Update. #COVID

What we can control: Vaccines
What we can't control: Mutants
(Except through Vaccines).
Same story in Israel where more than half the country has received at least 1 dose of vaccine. And real world data show marked protection from vaccines.
This is pretty good sustained reduction since my earlier tweet from over 2 weeks ago.
Read 4 tweets

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