Nick Mark MD Profile picture
Jan 21, 2022 9 tweets 6 min read Read on X
The ivermectin crazies are now recommending hydroxychloroquine too.

Their “protocol” includes a dangerously high dose of diuretics & recommends high dose steroids in people not on supplemental O2.

This has crossed the line from (mostly) harmless nonsense to actual harm.
Supporting Evidence:

A 2021 Cochrane meta-analysis (the 🥇standard) concluded that HCQ “has little or no effect on the risk of death and probably no effect on progression to mechanical ventilation. Adverse events are tripled compared to placebo…”

cochranelibrary.com/content?templa…
A more recent meta-analysis in @NatureComms that included unpublished studies went further, concluding “that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients”

nature.com/articles/s4146…
Regarding steroids:
The UK RECOVERY trial found that among hospitalized inpatients w/ COVID, dexamethasone 6 mg PO/IV reduced mortality

They also found a HARM signal among people NOT on supplemental Oxygen. That’s why we ONLY use Dex in inpatients on O2!
nejm.org/doi/full/10.10…
A Cochrane MA concluded “there is no evidence for [steroids in] asymptomatic or mild disease (non-hospitalised participants)”
pubmed.ncbi.nlm.nih.gov/34396514/
Another MA examined steroids in people not on O2 & found INCREASED duration of fever, DELAYED time to viral clearance, & LONGER hospital length of stay, concluding “steroids in non-O2 requiring COVID-19 patients can be more detrimental than beneficial.”
pubmed.ncbi.nlm.nih.gov/34347106/
The spironolactone label shows a big potential harm: hyperkalemia

The recommended starting dose is lower & checking serum K+ levels is advised.

Caution is advised in people taking ACEi, NSAIDS, & other meds.

The “protocol” doesn’t mention any of this!
accessdata.fda.gov/drugsatfda_doc…
Bottom line: several aspects of FLCCC’s new I-MASK+ protocol are potentially very dangerous.

This is way worse than just presenting ivermectin as a “vaccine alternative.”

Based on the evidence & clinical practice guidelines, these recommendations are likely to cause real harm.
To put it another way:
If a person died while being treated with these meds (especially if they died from an arrhythmia), I would list the “I-MASK” protocol as a contributing factor.

It is truly malpractice to encourage this. Medical boards take notice. @ABIMFoundation @TheFSMB

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More from @nickmmark

Sep 5
Lots of news articles reporting "Smartphone use on the toilet increases risk of hemorrhoids" citing a small single center study.

Great headlines but also a textbook example of *reverse causation* - a common methodological flaw in observational studies

A 🧵 Image
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Reverse causation occurs when we flip the arrow of cause→effect.

Protopathic bias is a subtype: An exposure (often a treatment/behavior) is started because early symptoms are already present, making it look like the exposure caused the outcome.

2/ Image
A common example of reverse causation/protopathic bias is increased inhaler use --> increased risk of asthma hospitalization.

Did the inhaler use cause the hospitalization?

No! The person was developing symptoms which is why they were using the inhaler...

More examples:

3/ Image
Read 12 tweets
Aug 19
This is a fascinating case:

A 60 yo man presents with paranoia, new-onset facial acne & cherry angiomas, fatigue, insomnia, ataxia, and polydipsia.

He has an extremely unusual diet.🧂

His labs are👇 (note that anion gap!):

What could be going on?
1/ Image
Turns out he was inspired by a conversation with chatGPT to eliminate all sodium chloride from his diet.

🧪 He decided to replace sodium chloride with sodium bromide instead.

This had some unusual effects…

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Bromide toxicity - or bromism - is extremely rare today, but it was once quite common.

Prior to modern alternatives, lithium and potassium bromide were widely used as sedatives, with frequent side effects.

At one point 5-10% of the psychiatric admission were due to bromide!
3/ Image
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Read 6 tweets
Jun 1
Well designed RCT shows patients randomized to an exercise program had substantially improved survival after adjuvant chemotherapy for colon cancer.
- 5 yr disease-free survival 80.3% vs
73.9% (HR 0.72)
- 8 yr overall survival 90.3% vs 83.2% (HR 0.63)

This is groundbreaking!
1/ Image
Some deets on the CHALLENGE trial

A 55 center trial done over 15 years (2009-2024) that randomized n=889 people with resected colon cancer after adjuvant chemotherapy to either:
- participate in a structured exercise program
- or to receive health-education materials alone

2/
The intervention was pretty comprehensive:
Personal activity consultant (PACs) - essentially trainers - got to know the participant 1:1, introduced them to the gym and came up with personalized activity goals
Regular every 2 week sessions helped participants reach the goals

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Read 16 tweets
May 18
Tragic news today about former president Biden's prostate cancer diagnosis. I wish him well.

As someone who follows presidential health reporting, I noticed something odd: unlike his predecessors, Biden's physician's never reported PSA.

How to interpret this absence? A🧵
1/ Image
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There are two possibilities:
1️⃣ Biden’s PSA was never checked
2️⃣ Biden’s PSA was checked but it wasn't reported

Strictly speaking, not checking PSA could be a medically correct option. Whether or not to test PSA is a complex question and is not the topic of this thread.

2/
Like many VIPs, presidents tend to have excessive testing that is not always strictly evidence-based.

For example, Bush 43 had an exercise treadmill test and a TB test for no apparent reason.

3/ Image
Read 13 tweets
May 4
In honor of #MayThe4thBeWithYou let's consider the most difficult airways in the Star Wars universe:

1. Darth Vader
Species: human
Vader presents several challenges: Vent dependent at baseline, airway burns from Mustafar, limited neck mobility.
Discuss GOC before saving him Image
2. Fodesinbeed Annodue
Species: Trog
All airways require teamwork, but intubating Fodesinbeed Annodue's two heads really will require two operators.
Consider double simultaneous awake fiberoptic intubation
Be sure to consent both heads. Image
You will never find a more wretched hive of scum & challenging airways than Mos Eisley (except maybe at Jabba's)

3.Greedo
Species: Rodian
Micrognathia, posterior airway, no nasal intubation, green skin so no pulse ox
Approach: VL + bronchoscope. Intubate quickly (shoot first) Image
Read 23 tweets
Mar 9
Every year, there is a predictable spike in fatal car accidents, medical errors, & heart attacks.

It’s estimated that there are thousands of excess deaths, a 1% increase in energy consumption, & billions of dollars in lost GDP.

The cause? Daylight savings transitions.

🧵

1/ Image
Earth's axis of rotation and orbital axis are not precisely aligned. The 23.5 degree difference - 'axis tilt' - gives us our seasons and a noticeable difference in day length over the course of the year.

2/
For millennia this seasonal variation was an accepted fact of life.

In 1895, George Hudson, a New Zealand entomologist, was annoyed that less afternoon light meant less time for bug collecting.

He realized that clocks could be adjusted seasonally to align with daylight.

3/ Image
Read 27 tweets

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