Thread by @drabbyphilips

1
I challenge ur narrative tat alternative medicine works
It doesnt/#neem studies tat u keep quoting, are NOT peer-reviewed, NOT published/has been collecting dust in preprint server since Apr 2020
Tis makes ur argument invalid
But #science is kind, so lets discus
#MedTwitter

https://twitter.com/Ramanean/status/1391224069190610948

2
indiarxiv.org/pyqx4/ This is UR molecular docking study u uploaded to preprint. Y was this never published? Bcoz this is highly flawed from methods to results to conclusions. Molecular docking was blind - hence ligand optimization is not accurate...
#ayush

3
...and grid coordinates wer computer generated. Hw did u correct for tis? U cud hav used predicted binding sites 2 improve accuracy/efficiency
ncbi.nlm.nih.gov/pmc/articles/P…
Predicted binding sites 4 #SARSCoV2 is widely published/ use of grid-based docking wud be better...

4
...and u did not use a better benchmarked docking bioinformatics pipeline like FRODOCK (validated in blind docking) bmcbioinformatics.biomedcentral.com/articles/10.11…
Ur unpublished #molecular study in neem compounds is replete with methodological flaws and lack of proper methods description and...

5
...quoting it is just bad #science and one must refrain.
So lets throw this out of the window and come 2 ur case report. This one bit.ly/3baCig4
This is also NOT published, NOT peer-reviewed and uploaded to a preprint server since JULY 2020.
1st, its poorly written. Y?

6
..bcoz it doesnt follow CARE statement guidelines for reporting care-statement.org and is replete with confounders. Lot of bias in description of patient characteristics and measured outcomes. This is classical #quackedemics
C hw 2 write case report care-statement.org/writing-a-case…

7
But the biggest issue with ur case report? - u mention case report, but included 9 patients. This makes it case series. So title itself is wrong.
So both ur molecular study and case report are not peer reviewed, remain unpublished
V wil nevr discuss these on @Twitter again.

8
Now the published study of #neem in #COVID19
pubmed.ncbi.nlm.nih.gov/33891569/
Single center
Sample size calculation absent
Underpowered
Proprietary #neem used - preclinical/phase1&2 studies missing
Efficacy-safety of particular preparation missing
Treatment endpoint 28d - no rationale

9
Outcome measure end point at 56th day - no rationale
He many wer infected beyond 56 days - missing
Proportion of patients testing positive for #CoronavirusIndia at endpoint via per protocol, p val is insignificant
Wich is Y authors conveniently avoid discussion at face value...

10
...authors use RR not HR - 2 confuse reader
Main difference btwn risk ratio/hazard ratio is risk ratio doesNOT care abt timing of event but only abt occurrence of event at end of study (whether they occurred or not: the total number of events by the end of the study period)

11
This makes ur unpublished molecular study and the unpublished case report fall to the LOWEST level of evidence in clinical medicine. This also makes the poorly conducted heavily method-flawed RCT also classical #quackademics.
None of thes studies shudB brought into an argument

12
Finally, u mention doses in this tweet.
Hw did you come to dose calculation?
Hw did you come to assess safety in children?
Hw was safety and efficacy assessed per dose in adults/children. What was NNT?
Y do u give medical advice based on untested data?
#pseudoscience #quackery

13
This SINGLE tweet is enuff 2 realize that #neem has absolutely NO clinical benefits.
So much preclinical data and action on viruses BUT none of these are at any point confirmed to have clinical utility in rigorous studies thereafter.
Quoting these actually weaken ur argument.

14
#Neem or any such herbals have been shown to have antiviral/anti-inflammatory actions in a petri dish in a lab. Not in rigorously conducted clinical studies.
A lot of hype but no hope.
@just1doctorwala @pash22 @Neurophysik @thewittydoctor_ @omlakhani @deralteGaukler