The two biggest failures in COVID19 policy were 1. Hubris to think humans were all powerful & could entirely change mother nature 2. Not subjecting our interventions to empirical testing, creating bitter tribal disputes, based on no credible data & never learning the answer 🧵🧵
Zero randomized trials on masking in school
Zero randomized trials on masking kids
Zero randomized trials on masking adults in high income nations
Zero randomized trials on masking anyone in cities
Zero randomized trials of school closure
Zero randomized trials business closures
Zero randomized trials of 3 vs 6 ft
Zero randomized trials of cohorting
Zero randomized trials of installing HEPA filters
Zero randomized trials of masking, post vaccine
Zero randomized trials testing alternative dosing strategies of vax (post phase 3)
Zero randomized trials of whatever foolishness we are doing on college campuses
Zero randomized trials of asymptomatic testing
Zero randomized trials of quarantine duration
Zero randomized trials of testing for preschool/ school
Zero randomized trials of plexiglass
Zero randomized trials of wearing your mask from the door to table, and table to bathroom, but at no other points during your restaurant experience
And lesser errors of evidence generation:
Randomized trials of boosters that were severely underpowered to assess clinical endpoints
& underpowered to assess effect modification by age
Randomized trials of kids (5-11) that were severely underpowered to assess clinical endpoints
Here's what they are not saying
Vaccine hesitancy has been rising for some time. This includes preventable illnesses like measles. There will be measles outbreaks in the future! Covid policy accelerated hesitancy. The question is: how many extra outbreaks will occur bc of RFK...
... If RFK is HHS secretary, versus if RFK is not HHS secretary. That's the question.
Even though he has tremendous administrative authority, he has already stated he's not going to withdraw these vaccines. I also suspect it's not going to be the first topic he touches...
Moreover, I and others have repeatedly provided compromised positions where we can improve safety detection of current vaccines. The current system can be honest and admit that our vaccine surveillance is abysmal. Companies don't want safety discovered.
Every single one of these garbage papers use the denominator of PCR+ covid infections, and not the actual denominator of people who had covid-- many do not present to the doc. Every single one of these papers is shit. I would be embarrassed to be an author. Incompetent work.
People with covid who are so sick they have to go to the doctor have poorer health than people who don't. That should be in the journal of obvious things. All of these authors are extrapolating beyond the evidence. They're creating a body of trash calling itself science
Is there a single paper that uses a sero prevalence denominator? Is there a single researcher in this field whose brain is working? Just one. That's all I ask for.
Totally wrong. Because Vincent is not thinking about the counterfactual correctly.
*Teachable moment*
1 These drugs were approved by accelerated approval in the LAST line. Some later improved survival & others didn't in an EARLIER line.
2 The counterfactual to AA... 🧵
is demanding RCTs powered for say, OS (survival). If a company couldn't use RR to get AA, they wouldn't run a trial in the 2nd line or 3rd line setting powered for OS, they would run it in the 7th or 8th line
Why? more dire = faster result
3. We have proven that in these v late lines RR and median DOR (the current AA criteria) result just as fast as OS pubmed.ncbi.nlm.nih.gov/30933235/
Many people want covid to be worse than it is. They imagine it has long-term consequences that are worse than other respiratory viruses. Adjusting for severity of illness, it doesn't. Only anosmia is unusual. Why do they want it to be worse than it is? 🧵
For some reason, some people want to live with perennial precautions. They don't want to take off the mask, they want their children to mask, they want to keep getting booster after booster. I don't know why but they want to live in fear.
They have...
A mountain of retrospective observational data that they think supports their claim that covid has long-term disability. That it's a vascular disease. And all sorts of other claims. Nearly all these studies are flawed. They don't have good controls.
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