Vincent Rajkumar Profile picture
Oct 12, 2021 12 tweets 3 min read Read on X
What about natural immunity? A thread.

I'm not a virologist or vaccinologist. I'm addressing this issue as someone whose career has been focused on plasma cells, the cells that make antibodies, for over 20 years. 👇
1) When first exposed to an antigen, virus or vaccine, the immune system produces a primary immune response. On exposure to same antigen again, it produces a better, bigger, and more durable secondary response. Basic immunology. microbiologynotes.com/differences-be…
Sometimes the first infection gives a long enough exposure to the antigen to stimulate the secondary response. Sometimes it's not. Depends on the virus and duration of infection.
So even if someone had COVID, it's better to get the vaccine also to ensure a better, durable secondary immune response. More IgG producing cells, more long lived memory cells.
Given the rate of reinfections we are seeing, it is worrying that COVID doesn't seem to produce an enduring immune response in everyone.

It's possible that 2 vaccine doses given too close to each other may also not produce a durable secondary response. (Why some need boosters).
2) If someone has not yet had Covid, then between getting immunity from the vaccine versus virus, even if the virus induced response is for argument sake better, it is much more risky to acquire immunity that way. It is far safer to get it through a vaccine.
3) Testing for antibodies and then deciding who to vaccinate and who not to is not realistic when we have 70 million eligible left to vaccinate in the US.

4) The virus is also mutating. The more infections we have, the more risk of mutants. Hence the push for vaccinations.
5) There are side effects with the vaccines as there are with any medicine. But truly serious ones are very rare compared to risk of COVID related complications or death. 215 million people have been vaccinated in the US. 3.75 billion people in the world: Almost half the world.
6) There will always be people who doubt the efficacy of vaccines because they hear someone got severe Covid despite vaccines and therefore why bother. Actually vaccines reduce your risk of severe Covid by 90%. They work: Randomized trials and Real world data.
More here on clarifying doubts about vaccine efficacy.
So yeah whether you had COVID or not better to get vaccinated. This is the advise I have given my own family.
Update: We know now from the omicron wave 2 important things.

1) Boosters help. More exposures to same antigen increases protection. Get the booster.

2) Prior Covid "natural immunity" doesn't protect fully. Better to get vaccinated. Including booster. bbc.com/news/health-60…

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More from @VincentRK

Apr 17
10 suggested action items for physician colleagues suffering under the burden of @ABIMcert MOC. #MedTwitter

1. If your institution allows it, stop participating in MOC. Personally, MOC has no value to me.
2. If your institution requires ABIM certification, advocate for @InfoNbpas as alternative option.
3. Do not participate in more than one ABIM MOC specialty, the one that’s required by your institution. Save your money. Don’t spend a penny more than you have to.
Read 15 tweets
Apr 12
I see a lot of wrong analysis on accelerated approval and surrogate endpoints.

It’s always easy to criticize from the outside. The criticisms raised are well known to the FDA and investigators. They are considered. We go in eyes fully open. We try to do what’s best for patients
Without accelerated approval using surrogate endpoint of overall response rate in single arm trials, for 2-3 years lives would have been lost waiting for drugs like Velcade, Revlimid, pomalidomide, Daratumumab, carfilzomib and more.

My defense of accelerated approval in MM.
What kind of benefit are we talking about? How many years of life gained from accelerated approval pathway in MM?
Read 5 tweets
Dec 31, 2023
My year end endorsements.

1) @costplusdrugs — where you can get >2000 prescription meds at lower price than almost any other pharmacy in America. Has revolutionized the generic prescription drug market. @mcuban costplusdrugs.com
Image
2) @PayorDieFilm — the story of lives lost due to the high price of insulin in America. Likely contributed to why all 3 big insulin manufacturers have now cut the price of insulin by >70-80%. @scottaruderman @NSmithholt12

Watch on @paramountplus @mtvdocs Image
3) Inflation Reduction Act provisions to cap Medicare Part D copays.

For 2024, the out of pocket max for Part D drugs that a patient pays in copays is capped to a max of ~$3250. A huge relief to many.

This cap goes down further to $2000 in 2025.
Read 7 tweets
Dec 15, 2023
Updated treatment approach to newly diagnosed myeloma based on new #ASH23 data.

Explanation for changes in thread. #MedTwitter 1/ Image
What’s changed?

I’m ok with quadruplet induction for standard risk based on the 2 phase IIIs at #ASH23

Better PFS and MRD-
Limited duration induction.

OS will take a long time to emerge and risk/benefit is reasonable to incorporate Quads.
2/ Image
Which Anti CD38?

Either Daratumumab or Isatuximab are ok as the AntiCD38 antibody to add to VRd for the Quad

Decide based on cost and access.

We had data on both at #ASH23
3/ Image
Read 11 tweets
Oct 2, 2023
Two days ago I did 60 ABIM MOC questions in Heme and Onc (against my will).

Almost all were esoteric/ irrelevant questions. Rare things that doctors rarely see. #MedTwitter

What’s my opinion?

1/
I spend a lot of time in medical teaching and writing. I write for UpToDate for 20 years, and all of the major Hem Onc textbooks.

In my opinion, the MOC questions are useless for routine Hem Onc clinical practice. Useless to assess “walking/ essential knowledge”.

2/
What’s worse: Every 3 or 4 questions that I spent time and answered, I would get a note that it was a “test question”. No answer was given at the end, making it a complete waste of time and making me an unwilling partner to test questions for the ABIM. @DavidSteensma

3/
Read 6 tweets
Aug 11, 2023
US physicians almost unanimously oppose ABIM MOC. #MedTwitter

We have raised our voice in despair. What can we do to make change happen?

1) Urge our professional organizations to support us. More than words, we would like action.
2) Continue the pressure on social media.
3) Support the petition started by @AaronGoodman33

>12,000 have already signed.

change.org/p/eliminate-ab…
Read 13 tweets

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