Vincent Rajkumar Profile picture
Oct 25, 2021 9 tweets 4 min read Read on X
On Jan 24, 2020 @DrEricDing posted a massive warning about the impending pandemic: The Holy Mother of God thread.

"We are now faced with the most virulent virus 🦠 epidemic the world has ever seen," Eric wrote.

As I read his thread again today, all of it has sadly come true
1/
He wrote:

"possibly an unchecked pandemic that the world has not seen since the 1918 Spanish Influenza. Let’s hope it doesn’t reach that level but we now live in the modern world 🌎 with faster ✈️+ 🚞 than 1918. @WHO and @CDCgov needs to declare public health emergency ASAP!"
2/
People quarreled with the R0 that was in @DrEricDing's thread, but most epidemiologists and leaders and organizations missed the forest for the trees.

We know what happened since:

240 million cases worldwide
5 million deaths

46 million cases in the US
>750,000 deaths

3/
It required quite a bit of analysis, judgment, and guts to issue that kind of warning.

Of course people didn't like to hear this kind of prediction. @dwallacewells has written about the criticism and pushback Eric faced. And how few listened.
nymag.com/intelligencer/…
4/
Looking back it was not one lucky prediction. Throughout the pandemic @DrEricDing has been right numerous times while many other experts who were a lot more optimistic ended up being wrong.

From duration of vaccine efficacy to variants to issue of masks.
5/
I remember CDC deciding in June that fully vaccinated can take off their masks. I like many thought it was a reasonable call. Eric disagreed strongly. Turned out he was right.

He is one of the people I'm glad I follow coz he is up to date on everything COVID. Thanks Eric.
6/
Note that on the day he made the call, Jan 24, 2020 all of Europe had reported 3 cases. US had reported 2 cases. And @OurWorldInData doesn't start tracking till Jan 28, 2020. That's how early this warning was. Image
And now, on omicron: On Dec 7, 2021, Eric sounded the alarm that omicron was pandemic 2.0.

A month later, our daily new cases have gone up >4 fold. Hospitals overwhelmed.
In 45 days, omicron has caused massive problems. With 20 million cases and 60,000 deaths. Pandemic 2.0. Image

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More from @VincentRK

Apr 23
To my followers who wonder what MOC is, and why many doctors are tweeting about it. Thread.

1) Maintenance of Certification (MOC) is a redundant requirement thrust on US physicians by a private organization. We resent it.
2) MOC is causing frustration and burnout. Over the years, ABIM certification and MOC have become entrenched and institutions and insurers require it and will not accept any other alternative.

I am advocating on behalf of my colleagues in the US for change. To end MOC.
3) MOC requires us to pay fees imposed on us by a private organization and take multiple choice question tests irrelevant to our practice.
Read 8 tweets
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

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