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Vincent Rajkumar Profile picture
@VincentRK
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

Vincent Rajkumar Profile picture
Aug 24
Why are prescription drug prices are far higher in the US that other developed countries.

I’ll break it down. A full 360.

1/ We don’t negotiate prices at launch of a new drug. Others do. Image
As a result, we spend billions on common drugs that other countries spend a fraction of the price on.

Some drugs we pay 10 or 100 times more!! Image
2) Generic and biosimilar entry, adoption, and utilization is slower in the US, and there are many barriers.

Timely and adequate free market competition is critically important for lowering price. Image
Read 21 tweets
Vincent Rajkumar Profile picture
Jul 8
FDA approval doesn’t necessarily mean standard of care.

Thread.
1/
For example FDA approved Dara VMP for frontline therapy in myeloma in 2018.

Literally no one used the regimen in the US.

Literally no one felt the regimen was standard of care in the US.

Before or after approval!
Why?
FDA adjudicates a sponsors submission on whether a given drug/regimen has met the burden of proving safety and efficacy.

Standard of care in clinical practice is a different standard: judgment of risk/benefit of available alternatives, and assessment of trial design/end points.
Read 13 tweets
Vincent Rajkumar Profile picture
Jun 25
Cure is a simple word. But there is confusion when it comes to cancer. What cure is in cancer, and what we should aspire for?

When can we say that a given type of cancer is curable?
Thread
1/
There is a difference between when we can say a particular cancer is a curable type versus whether individual patients with a given cancer can be considered potentially cured.

They are not the same.
2/
To call a cancer curable we must be able to treat the cancer for a finite duration, stop all therapy, and know that a certain % of patients will never relapse

Early stage solid tumors, Hodgkin lymphoma, DLBCL, ALL, AML are curable. Real cure. The definition of curable cancer
3/
Read 13 tweets
Vincent Rajkumar Profile picture
Jun 1
The 4 big myeloma randomized trials to watch out for @ASCO #ASCO24

1. Isa-VRd vs Isa-Rd newly diagnosed
2.Isa-VRd vs VRd (IMROZ)
3.DREAMM8 Bela-Pd vs Pd
4.Ven Dex vs Pom Dex (Canova)

See thread for why they are important.
1) The Triplet vs Quad trials with will define role of quads in elderly patients with newly diagnosed myeloma. They also provide frontline phase III data with Isatuximab— and a choice between Dara and Isa. For some patients Isa will be more cost effective. @Myeloma_Doc #ASCO24
2) Belantamab will make a comeback.

Corneal toxicity is low with reduced frequency dosing. The drug works very well. And in many patients with refractory myeloma belantamab may be safer and easier to do than bispecifics. We need options. #ASCO24
Read 12 tweets
Vincent Rajkumar Profile picture
May 31
Just out: Updated mSMART recommendations for treatment of relapsed refractory myeloma. #MedTwitter @MayoMyeloma

1/ CART is now included as an option for second or higher relapse. msmart.org/mm-treatment-g…
2/ Even though CART (cilta-cel) is approved for first relapse we are NOT including it in our main algorithm. Reserved only for special circumstances in this population. We have a long track record with standard triplets, and we are concerned about CART side effects. Image
3/ The current approach for second or higher relapse continues to define 3 specific types of Triple Class refractory. This makes it easier for clinicians to consider options. Image
Read 6 tweets
Vincent Rajkumar Profile picture
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

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