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Vincent Rajkumar Profile picture
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27 Mar, 5 tweets, 3 min read
As Congress announces it will look into the price of insulin, here are slides from a talk I gave in 2018 on the problem. #Insulin4All @RepKatiePorter

Prepare to be shocked.
If you would rather read the paper. Here it is in @MayoProceedings published Jan 1, 2020. I've summarized the problem. mayoclinicproceedings.org/article/S0025-…
Or you can watch or listen to my lecture. Insulin an Beyond.
Explain this. Or defend this. #insulin4all
Summary Table with reasons why prescription drugs are so high and solutions. No one solution. Needs determination. nature.com/articles/s4140…

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Vincent Rajkumar Profile picture
27 Mar
Breaking News: lde-cel (Abecma; idecabtagene vicleucel), approved by FDA for multiple myeloma.

This is the first CAR-T therapy for myeloma. Many patients have been waiting for this good news. @agarwalonc @BMS_Myeloma_US @bluebirdbio news.bms.com/news/corporate…
Here is the data that led to the FDA approval published in @NEJM

73% response rate; 33% CR rate; 26% MRD-
Median PFS 9 months

Congrats everyone. Nikhil Munshi, @ldandersonjr @ninashah33 @DMadduri @BerdejaJesus @SagarLonialMD @NoopurRajeMD @YiLinMDPhD nejm.org/doi/full/10.10…
Side effects: Milder in my experience than approved lymphoma CAR-Ts. Grade 3 or higher cytokine release syndrome (CRS) in 5% of patients. Grade 3 neurotoxic effects in 3%.

Overall well tolerated.
Read 5 tweets
Vincent Rajkumar Profile picture
26 Mar
You must concede this is pretty amazing. Epidemiological principles work, even if the pandemic starts in your own backyard with 70,000 cases.
In response to China is not a democracy and so it works argument: No it can be done in a democracy too. S. Korea did it despite starting with 10,000 cases by April 1.
There were countries like Australia and N. Zealand that did it by preventing COVID entry (border control)

But countries like China and S. Korea did the amazing job of containing a highly transmissible respiratory pandemic that already infected thousands within their borders.
Read 4 tweets
Vincent Rajkumar Profile picture
26 Mar
Hindsight is 20/20. But if we don't recognize our mistakes, we can't learn from them.

Mistakes of the Pandemic (somewhat chronologic):

1) Underplaying the seriousness
2) Not seeking advice from other countries
3) Failure to implement border control
4) Delay in recommending universal masks
5) Delaying the roll out of private lab tests
6) Inadequate contact tracing
7) Insufficient PPE at start of pandemic
8) Leaders failing to set an example
9) Politicizing masks
10) Promoting useless treatments
11) Failure of scientists in leadership positions to call out even egregious errors
12) Erosion of trust in the CDC
13) Failing to approve Astra Zeneca vaccine in January

Please add if I'm missing stuff.
Read 4 tweets
Vincent Rajkumar Profile picture
25 Mar
For the public to know about Data Safety Monitoring Boards (DSMBs).

Ive been on DSMBs for trials led by colleagues. Those colleagues have been on DSMBs for trials led by me. People in DSMBs don't necessarily have some special superior skills to the study team. And vice versa.
DSMBs in randomized trials get to see data ahead of the study team investigators and decide if any safety concerns and to decide when to stop the trial/release results either because the endpoint was met or there was futility or a safety issue.
The DSMB is independent of the study team and does what is in the best interest of the trial participants and the public.

Their advantage comes from access to data early and without the bias that a study team may have.
Read 5 tweets
Vincent Rajkumar Profile picture
25 Mar
Friends in India: Please get COVISHIELD or COVAXIN whichever is available to you. Whichever is offered to you. They are both excellent highly effective vaccines.

Ignore the recent drama over the Astra Zeneca press release. Much ado about nothing. @nramind
The initial press release said 79% overall efficacy, with 100% efficacy against hospitalizations and severe disease based on interim analysis.

The primary efficacy analysis shows 76% overall efficacy, with 100% efficacy against hospitalizations and severe disease. @GargiRawat ImageImage
COVAXIN has reported 81% overall efficacy. @BharatBiotech
Read 4 tweets
Vincent Rajkumar Profile picture
25 Mar
Updated progress towards herd immunity in USA:
~30 million have had COVID
~85 million have received at least 1 dose of vaccine
(~70 million are children)

~100 million to go to get 80% of eligible population immune —an overestimate coz it excludes people who had undiagnosed COVID
I'm excluding people who have had COVID by seroprevalence because 1) it's hard to get a good idea of the % for the whole country; 2) the immunity from mild COVID may not be as robust; 3) Im excluding children so it compensates on the other end; 4) meant to be worst case scenario
At the rate we are vaccinating we are within 1-2 months of where we need to be. Which is good news.

I've said for months that we are closer to herd immunity than we think we are. Because of other factors. But that was a soft call. This time with vaccines I'm more confident.
Read 5 tweets

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