First, the best thing an adult can do to lower their own risk of bad covid outcomes is get vaccinated
Second, over the next decade it is inevitable that all people on earth will encounter the virus. Just a matter of time, but cannot be avoided
Third, after vaccination, you will have as good chances as you can possibly have
Fourth, life is not zero risk; never has been, never will be
We have always accepted risk, and we will yet again (many already are)
Fifth, the more you postpone or delay things that make us human (after vaccination) the more you suffer, spiritually and mentally, and may not even recognize it
Sixth, cloth masks did not work in an unvaccinated population in bangladesh, only surgical masks worked
Seventh, this RCT does not generalize to vaccinated cohorts, but if you wish to generalize, I would not cloth mask
Eight, professors reluctant to teach b/c vaccinated students unmasked should consider that they cannot control the environment in all aspects of life...
They will get exposed.
And since cloth masking failed, whether or not kids cloth mask will not even change time to exposure.
Ninth, difficulty in resuming life is why nearly all pandemic guidance prior to 2015 warned to engage in the least disruptions possible...
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Tenth, testing asymptomatic, vaccinated people and finding sars-cov-2 is unlikely to be useful in most settings, and certainly not young people who are vaccinated
These companies should be running RCTs, instead they got market share easily
Eleventh, the more you disrupt life for PCR or antigen positive results without significant numbers of ill people, the more you pay the price of restrictions without possibility of countervailing benefit
Twelfth, you can screw up many parts of life, but screwing up school for young kids any longer is untenable
Thirteenth, if you distort risk perception, then society will be unable to think clearly about myocarditis, boosters and vaccinating kids...
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There's not a single randomized controlled trial that shows people who undergo a coronary artery calcium test live longer than those who do not undergo it. Everyone will benefit from increasing exercise and eating better and the score is irrelevant
Maybe the only cancer screening test that has any utility under 35 is the pap smear. Mammography doesn't improve survival at any age, and has no data in this age group. Totally crazy recommendation
Glad that we @vkprasadlab have published over 20++ peer reviewed papers on COVID19 policy to date & many more to come
I will share them here & a free link to all of them at end
We see policy failure
#1 visitor restriction
It was sad to separate family from dying people, & had no data
Cloth masking 2 year olds was an unforced error by @cdcgov and @AmerAcadPeds, who pushed this policy with no credible data, and despite its obvious silliness
Long COVID is an evidence based disaster
There is a strong narrative that is not well supported by the evidence.
To date, besides anosmia, there is no evidence COVID has any more long symptoms than being equally ill with any other respiratory virus. period.
A new 22 page essay by Mariana Barosa, @ID_ethics and me!
"We argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies"
🧵 link.springer.com/article/10.100…
Our essay reimagines the status quo. Instead of implementing and deimplementing and never knowing the answer, Public health must work to reduce uncertainty.
Shown nicely in Figure 2
We discuss many Non pharmacologic interventions tried and their limited evidence
This table represents an evidence based disaster. Nearly none of these were tested with proper trials
Forget beach closures and taking the swings out of parks
When I read an #ASH23 abstract that asks whether PFS or MRD is a surrogate endpoint in FL (L) or CLL (R), I know instantly the person on the left did it right and the person on the right messed up
Small cell lung cancer is a horrible diagnosis, and I feel sadness for anyone who has it
A double lung transplant for small cell lung cancer is complete nonsense. @VUMChealth is just making things up. This story is so sad bc doctors want to practice on the island of Dr Moreau
Just OUT! By @DavidBenjaminMD
We discuss evidence for STARTING & STOPPING cancer drugs!
What do I mean?
Currently in cancer med, we ~always start treatment at first sign of metastatic disease, and stop at progression, but....
🧵 (follow)
free link authors.elsevier.com/a/1i2MQ7tJEDS6…
... does this make sense?
The table shows trials testing early starting vs. delayed starting of systemic Rx.
For many diseases, there is no advantage to treating even widespread, asymptomatic disease
For most disease, however, there is no study at all!!
We truly don't know
But generally we assume. In many tumor types, we treat even asx or mildly symptomatic metastatic diseases (denovo or recurrent)
Now, lets consider the flip side of the coin. When should we stop treatment....