Great article, but I fear the CDC director is doomed. Here's why.
In the next few months, we will have to accept the inevitable, that all people will be infected with the virus at some point in the future. Better to be vaccinated/ or have nat immunity when you meet it...🧵
Draconian mitigation efforts to delay the time to meet the virus make no sense.
Makes no sense for a vaccinated person to wear an n95 or equivalent. Certainly makes no sense, and is borderline insane, to make a child wear such a mask.
It is also borderline insane to make college students who have already had multiple vaccines keep getting more, or sit all day in their dorm room to avoid meeting it.
It is coming for them.
They're sacrifice won't change broader dynamics.
Mandating booster after booster is a fool's errand. It will target low risk populations, younger people who are working, and won't be the people you need to boost: nursing, home residents, and very old people.
You have no power over 80-year-olds to mandate.
By not having coordinated boosting in nursing homes, however, you are making a huge error.
What a screw up.
Boost nursing homes NOW!!!
If you feel fine, you will be asked to go to work. It doesn't matter if you would test positive by some test.
Some amount of infection is inevitable and cannot be avoided.
Collapse of social services & hospitals cannot happen.
So the CDC director will increasingly have to communicate policies that engage in trade-offs.
Balancing continuing society with trying to prevent local health care system collapse.
In many cases the right answer will be to ease up on your mandates, ease up on draconian policies, not double down on them.
This is when the CDC director will be in a jam
You see the CDC directors base is a group of online zealots who think the virus can be eliminated.
I'm worried they're going to take up hunting deer when they learn how many have SARS-CoV-2
The CDC director, who signed the John Snow memo, will have to communicate to them that the dream is dead. They won't like that. Just like they don't like 5 vs 10 days..
Thankfully, outcomes among young people are terrific. And yet, they are incredibly concerned with spread in young populations. So much so that they're willing to close schools. The only tattered ladder of opportunity left in this country.
Closing schools is catastrophic error
The CDC director is going to increasingly have to tell these people the truth.
That the virus will never be eliminated.
That it will eventually reach all people.
As such making a child wearing n95 or equivalent is a delusion.
It, at best, delays an inevitability, with loss of speaking and social cohesion, with no great gain. Should not be pursued.
Mandatory booster policies will also be unable to contain the virus. And thus the CDC director will have to eat crow.
Someone may someday ask if it made sense to boost 12-year-old boys with essentially no efficacy data...
Did it make sense to make the moderna booster 5 months with no day at all?
So the CDC director is in an impossible position. Having an embraced an ideology of zero COVID (John Snow), the CDC director will have to abandon it, and communicate policies that make compromises.
And thus, it is likely that the White House will sacrifice her. And they will be more infighting among the zero covid crowd
How can the CDC director save herself? The answer is clear: just tell the truth. That was always the secret.
If we told the truth about the efficacy of cloth masking, we would have had a lot more public trust.
If we told the truth that vaccines are tremendously effective for older people, but the risk benefit profile of multiple doses of younger people is dubious, we'd have had trust
More randomized trials and not fewer were the answer. We needed more randomized trials of masking in school. It's likely would have failed. But doubling down on rhetoric without doing studies is no good.
Even though Omicron is super contagious, it is possible that rich people are still making behavioral changes that will delay the time until they meet the virus. This will just lead to another peak in a few more months when they fatigue. Eventually all people will be exposed.
Optimize your medical problems, lose weight, get vaccinated, and get on with life. That was always the right answer. Everything else is a fools errand.
Good luck CDC director, you will need it.
Here is a long form explanation of why the n95 is pointless for a vaccinated person
Lots of prior studies show many psychological findings don't reproduce. Obviously that's because so much of this science is bullshit. Small sample size, weak methods. Entire fields struggling to justify their existence & people p hacking and exaggerating to be on @HiddenBrain
How do you fix this problem? No one really knows. All of academia is incentivized for hype and discovery, actually being a thoughtful student, criticizing things, pushing for better methods that's unpopular.
Thank you @Erman_Akkus for ur reply it is a good learning opportunity for #ESMO24
In 15 tweets, I will summarize the trial, my criticism, and why this reply contains 3 common errors that oncologists make because our training doesn't teach these ideas.
First, the trial...
The trial is #LEEP-012 and randomizes pts with INCURABLE (see pic) liver cancer to TACE (embolization) plus costly drugs or embolization alone.
These 2 drugs are TOXIC (lenva is horrible) and cost a FORTUNE 200-300k per annum per person
#ESMO24
Every single person has the cancer return. It is non-metastatic, as @Erman_Akkus says, but it is not curable.
Here is the time until measured lesions grow 20% or new lesions present or the patient dies
That's what he and others are excited by #ESMO24
a 4 months PFS
Just out on @medrxivpreprint and @CityJournal
We analyzed all COVID19 corrections in the @nytimes
We show that 2:1 the Times OVERSOLD covid risk or FALSELY HYPED the benefit of restrictions
1 reporter alone was 7% of all corrections
Let's take a look 🧵
Naturally, in times of crisis, newspapers won't get everything right
Corrections are inevitable and forgivable
But corrections should occur at random
Sometimes they are too high and sometimes too low
If they tend to be in one direction...
That's bias
Here is the key figure
When the New York Times made mistake those mistakes were TWICE as likely to OVERSTATE the harm of COVID, particularly to kids, than UNDERSTATE
This is evidence of systematic BIAS in their reporting
Just out
Led by @mmb03966692 Mariana B
We argue that annual flu shots and covid shots have a VERY WEAK evidence base and there are TONS of things we can do better.
The status quo for annual flu shots is little good premarket evidence and some post market surveillance.
Shown in figure
We think that is suboptimal.
One reason is...
The CDC uses a flawed method to calculate flu vaccine effectiveness. (test neg. case control, for e.g.) If anything, this will be biased upwards-- towards bigger effects, but even with that method, effectiveness can be very poor.
As a doctor, I find this @nytimes essay IDIOTIC
This is abusing medicine to evade political choices
Let me explain why whether it is Trump, Biden, Harris or any other politician, asking for health records is STUPID
Here is why...
🧵
First, remember: When you vote for a president you don't just vote for 1 person. You vote for 1 person and a backup (their VP)
The next back up to that is the speaker of the house, for whom you indirectly vote for via congressional elections
You vote for politicians because of their policy positions and preferences, and we must all admit that VPs are closer in policy preference to the president than the opponent.
I.e. if any president dies their VP is closer to them than the opponent
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