I'm convinced India needs a nationwide shelter-in-place order to minimize devastating loss of life from COVID. This must be implemented with adequate support to the poor. Agree with this article in @scroll_in@Lakshmi_RKGscroll.in/article/993572…
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2/ The first lockdown was harsh. But it showed COVID can be controlled.
The first lockdown had many mistakes. We can avoid repeating them.
The first lockdown had no endgame. Now we have vaccines.
With good support for the poor, shelter in place can save a huge number of lives
3/ India has about 3000 confirmed daily deaths due to COVID. Given the complete breakdown in testing, reporting, and healthcare delivery, the true death count is much higher.
To control COVID quickly and reduce loss of life now a stay at home order & universal masking is needed
4/ Will a lockdown work? Yes.
It worked last year. It is showing signs of working even in the current situation in Maharashtra.
5/ With exponential rise in cases, people are getting COVID while just trying to get medicines and oxygen for their loved ones as they navigate huge lines everywhere.
People are not able to get to the hospitals on time. A planned shelter in place will also help with this.
6/ When hospitals are overwhelmed the mortality of severe COVID increases dramatically. A nationwide shelter in place will help flatten the curve.
When you have >380,000 cases a day, and are 155th rank out of 167 countries in hospital bed capacity— you need to flatten the curve
7/ Shelter in place must be planned and nationwide. Cases are rising exponentially nationwide. What happens in Delhi is a few days before other places in the south. As @samanth_s writes, disorganized rules give pain but no good benefit. @qzqz.com/1999650/would-…
8/ This has to be a nationwide shelter in place which has the benefits of the first lockdown (control of COVID) and avoids its mistakes. This article has the framework of how this can be done. @Lakshmi_RKG@scroll_inscroll.in/article/993572…
To my followers who wonder what MOC is, and why many doctors are tweeting about it. Thread.
1) Maintenance of Certification (MOC) is a redundant requirement thrust on US physicians by a private organization. We resent it.
2) MOC is causing frustration and burnout. Over the years, ABIM certification and MOC have become entrenched and institutions and insurers require it and will not accept any other alternative.
I am advocating on behalf of my colleagues in the US for change. To end MOC.
3) MOC requires us to pay fees imposed on us by a private organization and take multiple choice question tests irrelevant to our practice.
10 suggested action items for physician colleagues suffering under the burden of @ABIMcert MOC. #MedTwitter
1. If your institution allows it, stop participating in MOC. Personally, MOC has no value to me.
2. If your institution requires ABIM certification, advocate for @InfoNbpas as alternative option.
3. Do not participate in more than one ABIM MOC specialty, the one that’s required by your institution. Save your money. Don’t spend a penny more than you have to.
I see a lot of wrong analysis on accelerated approval and surrogate endpoints.
It’s always easy to criticize from the outside. The criticisms raised are well known to the FDA and investigators. They are considered. We go in eyes fully open. We try to do what’s best for patients
Without accelerated approval using surrogate endpoint of overall response rate in single arm trials, for 2-3 years lives would have been lost waiting for drugs like Velcade, Revlimid, pomalidomide, Daratumumab, carfilzomib and more.
1) @costplusdrugs — where you can get >2000 prescription meds at lower price than almost any other pharmacy in America. Has revolutionized the generic prescription drug market. @mcuban costplusdrugs.com
2) @PayorDieFilm — the story of lives lost due to the high price of insulin in America. Likely contributed to why all 3 big insulin manufacturers have now cut the price of insulin by >70-80%. @scottaruderman @NSmithholt12
Watch on @paramountplus @mtvdocs
3) Inflation Reduction Act provisions to cap Medicare Part D copays.
For 2024, the out of pocket max for Part D drugs that a patient pays in copays is capped to a max of ~$3250. A huge relief to many.
Two days ago I did 60 ABIM MOC questions in Heme and Onc (against my will).
Almost all were esoteric/ irrelevant questions. Rare things that doctors rarely see. #MedTwitter
What’s my opinion?
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I spend a lot of time in medical teaching and writing. I write for UpToDate for 20 years, and all of the major Hem Onc textbooks.
In my opinion, the MOC questions are useless for routine Hem Onc clinical practice. Useless to assess “walking/ essential knowledge”.
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What’s worse: Every 3 or 4 questions that I spent time and answered, I would get a note that it was a “test question”. No answer was given at the end, making it a complete waste of time and making me an unwilling partner to test questions for the ABIM. @DavidSteensma
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