First off, I’m sorry that you got COVID and I’m glad you recovered. I respect that you have the integrity to admit that ivermectin wasn’t able to prevent your illness. 1/
I’ve read the same studies & I disagree with your assessment of IVM; A few small methodologically flawed studies are just not compelling in light of negative results from large high quality RCTs. @cochranecollab & many experts have likewise concluded that IVM is ineffective
2/
What I find alarming is your failure to use your platform to advocate for vaccination. You claim to follow the evidence. Do you really think there is more evidence for daily mouthwash use than for vaccination to prevent COVID?
You cite 10k pts in low quality studies of IVM. What about the 100s of thousands in RCTs of vaccines? What about the billions who have been safely vaccinated?
If you spent any time at all in an ICU you would see that virtually none of the COVID patents there are vaccinated.
4/
It’s OK for us not to see eye to eye on the IVM data. Thoughtful debate over medical evidence is how we advance the field.
There are more studies ongoing. Perhaps future high quality studies will show benefit, though I am skeptical.
5/
But at this point, I think you must admit that many of your followers are taking IVM as an "alternative to vaccination."
I doubt this was your original intent. You may not have intended for your drug repurposing work to be used by anti-vaxxers, but that is what's happening.
6/
If you really follow the evidence, I call on you to change your I-MASK prevention protocol to V-I-MASK. Put vaccines front and center. Use your platform and that of the FLCCC to help get people vaccinated.
7/
Instead of attacking experts and insinuating vast global cabals to suppress IVM, use your platform to promote evidence-based therapies, including vaccination.
8/
We’re all fallible. The best we can do is course correct when we’ve made a wrong turn, especially when lives depend on it. People will listen to you, and you can save countless lives by doing this.
9/
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The last few weeks have been tough. For those in need of a light hearted thread, here’s a brand new 3rd #tweetorial in my extremes of #physiology series. What can the animal kingdom teach us about our physiology?
Buckle up for some fun animal pulmonary facts 🫁!
1/
CASE 1:
You are performing a bronchoscopy. Upon reaching the main carina instead of the usual TWO airways (right & left mainstem bronchi) you see THREE.
Your assistant says “Whoa! That’s weird”
You say no it’s totally normal because the patient is a:
2/
Answer: 🐖
In pigs, the RUL lobe bronchus originates from the supra-carinal trachea (e.g. before the R & L mainstream branches). The view from the trachea looks like this (see the tracheal bronchus on the right).
The #COVBARRIER RCT now published @LancetRespirMed & it looks like we have a new COVID tx: Baricitinib
-n=1525 hospitalized COVID pts not on IMV
-lower mortality w/ Bari compared to placebo (10% vs 15%) (NNT = 20) & larger benefit in sicker pts!
-bit.ly/3yDmJ9r 1/
COV-BARRIER was a 101 site, double blind RCT performed in 11 countries.
It enrolled hospitalized COVID patients who were hypoxemic (but not on IMV) and had evidence of inflammation.
It had many exclusion criteria including monoclonals, immunesuppression. This is a🔑 point. 2/
The intervention was 4mg of baricitinib, an orally available JAK1/2 inhibitor, dosed once daily for 14 days or until hospital d/c. (It can be crushed and given by FT).
Bari is an FDA approved treatment for RA. It costs ~$50-75 per pill (thus a 14 day course is ~$700-1000). 3/
As the evidence supporting ivermectin as COVID treatment collapses, you might expect *less* certainty from the drug’s evangelists.
Instead they’ve doubled down on ivermectin.
It’s worth reading this passage from Festinger’s Theory of Cognitive Dissonance to understand: 1/
For context, Festinger & colleagues joined a cult (“The Seekers”) who believed the world would end on December 21, 1954 & that true believers would be rescued by a UFO
The researchers wondered how the Seekers would react to “disconfirmation” when this didn’t happen.
2/
As the date approached, the researchers watched many “Seekers” take irrevocable steps because of their belief: they quit their jobs, severed ties to loved ones, & disposed of possessions.
What would happen when their beliefs were discredited? 3/
A few weeks ago I tweeted about the rising cases due to #DeltaVariant. I was surprised by the number of people who replied saying essentially “they did this to themselves.”
A short 🧵about why we ought to look at this situation differently 1/
Seeing the #DeltaSurge among the un-vaccinated, I'm reminded of an adage I learned in my residency: “The trauma ICU is filled by man’s cruelty to man & the medical ICU by man’s cruelty to himself.”
2/
It’s true.
Without tobacco, alcohol, & opioids, there would be less COPD, cirrhosis, & endocarditis.
Without dietary indiscretions & "noncompliance”, we would not see fewer complications of DM or exacerbations of chronic illness.
Pre-print of the #COVIDSTEROID2 RCT comparing dexamethasone 6mg vs 12mg in hospitalized patients on high flow O2 or MV:
- no difference in survival or days free of MV with higher dose dex but…
- interesting “trend towards benefit” w/ higher dose dex
📄medrxiv.org/content/10.110… 1/
🔑 Question: we know from #RECOVERY that steroids are beneficial in severe COVID, but what’s the ideal dose?
#COVIDSTEROID2 was a large DB multi center RCT to answer this. It randomized patients on high flow O2 or MV to either 6mg or 12mg of dexamethasone for up to 10 days. 2/
The 1° endpoint was days alive free of lifesupport (MV, ECMO, RRT). 2° endpoints included 28 day mortality.
Based on prior studies, they powered for a 15% relative mortality reduction (ARR ~4.5%) combined w/ a 10% reduction in life support duration.