As a vaccinated, liberal infectious disease doctor, who believes virtually all US adults should be vaccinated...

I'm bothered by people blaming the unvaccinated for the ongoing pandemic

There are a few reasons:

@sdbaral @VPrasadMDMPH
1) The unvaccinated are the biggest victims--99% of COVID deaths are unvaccinated

They put themselves at the most risk--much more than they harm me

We don't punish IVDU or prostitutes for the HIV epidemic although they spread an infectious agent
2) People not vaccinated are misinformed by the media, by celebrities and largely because of the failure of the deeply unequal US Education System that set them up to not know how to navigate these confusing times and evaluate information
3) Blaming is punching down. Groups less vaccinated are more likely to be of color and poor (the winners in this take care of yourself economy are savvy enough to choose vaccination)
(i'm all for criticizing leaders who promote misinformation--the Jenny McCarthy's on the left and Fox News on the right--who get a gold star for hypocrisy with their reasonable pro-vaccine work policies… )
4) healthcare workers complaining, I get you, but I'm an Infectious disease MD, seeing COVID patients, & busy days are nothing new.
As infection control director, COVID is a headache w/ freq. policy changes & re-education.
But 1/2 problem is nat'l leadership not being pragmatic
5) Blaming doesn't work
Blaming unvaccinated pushes them further into their isolation. I want more people vaccinated so I talk w/ them.
Hear their reasoning, share mine.
Show I respect them and rec. vaccination mostly because I don't want them to get sick or die
6) if blaming unvaxx for US policy decisions...grow up. We don't have to react to numbers one way or another.
The country is opening--people are making that decision.
People are vaxx'd or not.
If leaders can be aware of where the people are we could have reasonable approaches.
7) by blaming a group we are further tribalizing our broken country--and that is the biggest reason for our failures during the pandemic.
If we want to re-build and be able to handle the next challenge we have to find some mutual respect and understanding
There was a comment about being a liberal = not believing in natural immunity.
I believe in natural immunity--but just that it is risky to get the real COVID when a great vaccine is available for your first experience w/ this virus

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More from @dr_dmorgan

9 Aug
Do doctors understand how well treatments work?

We asked >500 clinicians in 8 US states

Chance that common treatments help an individual patient with
atrial fibrillation
high cholesterol

Open access: via @JAMANetwork

Recently we examined clinician understanding of probability in DIAGNOSIS

The current question was similar but for TREATMENT

In the works, are numeracy, acceptance of uncertainty and other clinician personality factors associated with decisions?

Appreciate past interest from @tylercowen on probability in diagnosis.
In some ways, economists like him and @profemilyoster or statisticians like @natesilver538 have a better framework than doctors for assessing real life data, risk and tradeoffs…
Read 56 tweets
12 Apr
How good are doctors at diagnosis?

This is the most relevant paper I have written. Not perfect but addresses a huge issue I think could change medicine if acknowledged
…it has changed how I think about diagnosis
Clinicians widely overestimated chance of disease especially after testing

Cardiac ischemia after + ECG—EBM 2-11%, median answer 70%
UTI after + urine cx—EBM 0-8.3%, answer 80%
Breast CA after + mammo—EBM 3-9%, answer 50%
Pneumonia after + CXR EBM 46-65%, answer 95%
Gerd Gigerenzer, David Eddy, @StevenWoloshin @arjunmanrai & others asked how well doctors do at the math of understanding diagnosis, and found they aren’t great.

Many of issues w/ real life tests covered by @deeksj @d_spiegel @dan_diekema
Read 20 tweets
8 Jan
Like @BenMazer, I was bummed to have a op-ed during the riot

In it, I describe the reality that most medical treatments have very marginal effects.

A reality with big implications

d/w @VPrasadMDMPH @lowninstitute @AndrewFoy82 @drjohnm…
2/ If clinicians understood small chance of benefit with most Rx, I feel we would make very different decisions for most patients

Thanks @MikeMadden editor

By taking a medication daily we buy a lottery ticket with a payout often as low as 1% or 2%.
3/ And we can’t know if we won or not…as winning usually means "nothing" happens.

Of course, we assume no bad outcome = benefits,

so 95% or more appear to benefit, not the 1-2% who truly benefit from RCTs
Read 10 tweets
21 Dec 20
We set out to identify the sensitivity & specificity of common tests for #COVID19 along w/ @dan_diekema , @Anthony98947615 w/ @CDCgov support

A simple enough task, right?

I’ve seen tweets by @DrSidMukherjee @drjohnm @BenMazer @PaulSaxMD @BradSpellberg and others interested
Looking for comments/criticism

What are we missing? No industry adverts please!

Important papers?
The @US_FDA has a test comparison site that is incomprehensible to me… but @ASMicrobiology types tell me it reports on analytical sensitivity and LoD for tests
Read 20 tweets
15 Sep 20
Catch yourself when you say “risks vs. benefits” because you aren’t making a fair comparison.

In @JAMA_current
& podcast

@eliowa @drjohnm @d_spiegel @zeynep @VPrasadMDMPH

Why we say it and what we think is better below...
This building block of clinical decisions biases by framing uncertain harm vs. certain benefits and nudges towards treatment

Written with
@DKorenstein @ldscherer
(Over 2 years, i'm embarrassed to admit)
Clearly, the words physicians use have
a critical function in this communication

Referring to harms as “risks” emphasizes that
the unfavorable outcome may or may not happen,
whereas there is no parallel language that highlights
the equally probabilistic nature of “benefits.”
Read 8 tweets

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