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Michael Lin, MD PhD 🧬 Profile picture
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Feb 7 • 5 tweets • 3 min read
Essentially type 2 statistical errors are errors. And relying on those errors to hold back useful interventions led to deadly lack-of-recommendations by public health agencies

As @DLeonhardt reports

nytimes.com/2022/02/07/bri…
@DLeonhardt Good to see inaction on boosters for J&J cited as one of the examples. Seems the CDC would like to ignore #JnJers so it's good to be reminded that they have been treated badly.

Also good to mention again the FDA officials opposed to boosters (who still insist they are correct!)
Only thing I'd add: anti-intervention messages get traction citing "lack of solid data" precisely because newspapers, including (especially?) the @nytimes, publishes articles featuring them. Often these are news articles citing "experts" with a track record of being wrong.
Just found this excellent essay by @Bob_Wachter from September demolishing each of the anti-booster arguments. It has aged well.

Too bad journalists must write news stories that report controversies rather than logical essays that settle them.

elemental.medium.com/what-the-boost…
@Bob_Wachter Note the anti-booster arguments were political, not medical, and were loudly promoted by WHO (which has completely corrupted the cause of PH with politics) and several medical celebrities in the US.

But just takes one doctor with a cool look at benefit/risk to refute them.

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More from @michaelzlin

Michael Lin, MD PhD 🧬 Profile picture
Feb 6
Just out: a new study of immunity against Omicron after vaccines or infection + vaccines.

Simple takeaway: you need 3 hits, whether vaccine or infection, for high antibodies

Interesting nuance: infection has a head start over vax but dose #3 closes it

nature.com/articles/s4159…
This study aims to address what is necessary for high levels of Omicron immunity. As we should define adjectives quantitatively if possible (thinking of a particular big pharma), we can define "high levels" as those associated with >75% disease protection in clinical observations
So let's take a look at the findings. They're very comprehensive, so there are a lot of comparisons to parse. Unfortunately graphs are arranged by # of vax doses, not # of immunity events (ugh). I hope you like brainteasers.

Let's start with Fig 1a vs Fig 1b.
Read 18 tweets
Michael Lin, MD PhD 🧬 Profile picture
Feb 4
Today in Science, two prominent viral drug experts express concerns about molnupiravir, Merck's mutagenic COVID pill:
1. Mutating patient DNA not ruled out
2. Mutating viral genomes for sure, risk unknown

Common theme: We're gambling when using this drug

science.org/doi/10.1126/sc…
Raymond Schinazi is a well known antiviral drug developer, called the "King of the Pills". His wikipedia page lists the many marketed HIV and HCV drugs he has developed based on nucleoside analogues like molnupiravir.
science.org/doi/10.1126/sc…
In fact Schinazi is the one person who has the most knowledge of molnupiravir (MOV). He's been studying its active metabolite NHC as an antiviral since 2003 (PMID 12499198). He didn't push it to clinic because of mutagenesis concerns. That comes out clearly above, but also below
Read 7 tweets
Michael Lin, MD PhD 🧬 Profile picture
Feb 3
Thank you @LauermanJohn for revealing the untold origin story for Pfizer's Paxlovid COVID-19 pill.

The interesting part: Merck's drug boceprevir provided an essential backbone structure for Paxlovid, and boceprevir is still under patent.

bloomberg.com/news/articles/…
The article reveals many things not publicly known earlier.

First, Merck had (like my own lab and others) found boceprevir to have some activity against SARSCoV2. Not too surprising, as boceprevir is a HCV protease inhibitor, and SARSCoV2 protease is homologous to HCV protease.
I had emailed Merck to let them know in case they didn't already. But I expected the to know, and this confirms it. They determined that is was unlikely to work well for COVID19 on its own, but Merck was in a good position to modify it to work better, but they didn't.
Read 6 tweets
Michael Lin, MD PhD 🧬 Profile picture
Feb 2
A recent study by Novavax suggests it may be able to provide broader protection across variants than other vaccines so far. That has interesting implications for vaccine design, if true.

This seems to have escaped analysis entirely, so we'll take a look.

medrxiv.org/content/10.110…
The study came out on 12/25. It contains the data behind Novavax's 12/22 announcement that 3 shots of their vaccine provided Omicron protection. That got into the news, but nobody came back on Christmas to write about the actual findings (I wonder why).
ir.novavax.com/2021-12-22-Nov…
Sorry, Novavax, but you might benefit from hiring a science communication consultant for advice on publication strategy and writing. Besides the poor decision to release your article on 12/25, assuring no one will analyze it, the abstract is a disaster. Because there isn't one.
Read 29 tweets
Michael Lin, MD PhD 🧬 Profile picture
Feb 2
This study flew under the radar (only 1 news article): Omicron antibodies in participants of the NIH mix and match trial

Results: 3xRNA ~ 2xRNA+JJ ≥ JJ+RNA >> JJ+JJ

JJ+JJ ends up 10x worse than 3xRNA

medrxiv.org/content/10.110… @PaulSaxMD Image
Also confirms JJ is a poor booster for JJ, for either "original" D614G or Omicron. Image
Above, the JJ+Pfizer looked about 2x worse than 3xPfizer. Confidence intervals are wide, but another underreported Omicron study found JJ+Pfizer was ~3x worse than Mod+Mod+Pfizer. So this effect size seems consistent.

Great graphics BTW

medrxiv.org/content/10.110… Image
Read 11 tweets
Michael Lin, MD PhD 🧬 Profile picture
Jan 31
🙄 Count on some "researchers" to claim the obvious answer isn't the answer.

Did we want a vax to the original strain? We did?

Is SARSCoV2 now mostly Omicron? It is?

Okay then...
Chances are nonzero that the next variant will come from the currently most widespread and most contagious variant, i.e. Omicron. Good to be prepared.
Basically in this epidemic, if the question is "should we .... just in case?" the answer is yes. Just do it.
Read 4 tweets

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