You don't get much credit for editorials in academic promotions. But I have found them quite useful to advance a new concept, make an argument for change, or for advocacy. #MedTwitter
Here are 5 editorials that I hope highlight how you can make it work.
See thread.
1/ Redefining Myeloma
We wrote this to make the case that the disease definition for multiple myeloma was outdated, and made suggestions on how it should be revised. Few years later the definition was changed. @NatRevClinOncol@DianaNrco nature.com/articles/nrcli…
2/ Strategic Clinical Trials
In this editorial, we called for disclosure of the true purpose of a clinical trial which is often different than the primary objectives, & also for strategic investigator initiated randomized trials. @TheLancet@jocalynclarkthelancet.com/journals/lance…
3/ The high cost of insulin in the US: An urgent call to action. An advocacy piece.
I try to make the case that we should screen for myeloma in high risk populations. It's not an easy call. @Naturenature.com/articles/d4158…
5/ Treatment of myeloma: Cure versus control.
In elderly patients with potentially incurable cancer should we try to take risks and go for the cure, or try to maximize quality of life and control the disease like hypertension? @MayoProceedingsmayoclinicproceedings.org/article/S0025-…
• • •
Missing some Tweet in this thread? You can try to
force a refresh
As the report indicates, the risk from countries with moderate to high data data quality range from 1 in 26,500 to 1 in 127,300 of first doses.
My previous estimates are in this thread from April. There are relatively smaller number of J&J doses. So erring on side of caution for now I would consider risks to be similar.
What a difference a month makes. India in Feb, March, April, and May.
What exponential spread of COVID looks like: 10k to 400k in 4 months.
As I watch cases rise in Scotland, Taiwan, Malaysia, Columbia, Chile, Suriname, Dominican Republic, Portugal: Worried about how quickly things can change. We need vaccinations to speed up dramatically. More vaccine producers. More tech transfer.
And 2 doses for all coz of B1.617
In India cases are decreasing as almost every state is in lockdown. But with 97% or the population not fully vaccinated, I worry about the next wave if restrictions are relaxed without maintaining adequate precautions and speeding up vaccination.
~60% of eligible population (166 million of ~280 million age >12) have had at least 1 dose of COVID vaccine
To reach herd immunity:
100 million more to go. (80% threshold)
(60 million if we consider recovery from COVID as immune)
What can disrupt the math?
Factors that affect the math and goals:
1) Extent of protection from current vaccines in immunocompromised individuals and very elderly. Neutralizing antibody levels can be a biomarker that helps predict extent of protection from vaccination. See thread.
2) Extent of protection from current vaccines against the B.1.617 variants. Thankfully data so far indicate that current vaccines are highly protective against symptomatic disease from B.1.617 variant. See thread. 👇
Everyday I hear about someone very young in India, in the best of health, dying or critically ill with COVID. In many, the clinical course is one of rapid progression.
Added to what's going on in the UK, makes me nervous about B.1.617 variants.
Get vaccinated. That does work.
Ask anyone in India, and most will know of someone like this. It's real.
In some one can blame lack of resources or steroid related complications. But in most it's pretty significant lung damage due to COVID.
Important to realize that we use steroids like dexamethasone as anticancer drugs (for myeloma) to kill the same cells that make antibodies & help us fight infection.
They are not antivirals. They are anti immune system. They help the COVID virus if given early or inappropriately
When treating the cancer multiple myeloma, we have found that giving high doses of dexamethasone cause more deaths than low doses. More steroids is NOT better. Less is more. @TheLancetOncolthelancet.com/journals/lanon…
Dexamethasone and other steroids will make any kind of fever disappear and make people feel better, but behind the scenes they cause harm when used incorrectly.
We found all kinds of side effects are higher with higher dose of dexamethasone. From blood clots to infections.