Vinay Prasad MD MPH Profile picture
Feb 17, 2022 20 tweets 8 min read Read on X
Dazzling, daring, stunning piece by JH Russell and @DmpPatterson in @tabletmag tellin the true story of masking during COVID 👇

"The overselling of policies began in the early days of the pandemic with the problematic #masks4all movement...."
must read
🧵
tabletmag.com/sections/scien…
First, they are spot on. Many don't see it, but Trump is so influential, He sets the sides!

When he was for schools, Liberals lost their mind and worked to keep them closed; AAP did a bizarre flip flop & sided with unions to keep them closed.

And the same for masks 👇
Absolutely right again 👇

Inexperienced & naive twitter pundits kept saying the pandemic would vanish if we all worse a mask or n95 for 14, 21 days, a claim....

"neither true nor possible"
Yes! The CDC & FDA have made so, so, so many blunders, and most during 2021

Political appointees have cut the legs out from under the agency; In the next ten years, it may topple entirely
"The arbitrariness of the resulting policy recommendations and mandates is etched into the many photographs of masked kids, sometimes posed with unmasked politicians, that will likely come to represent much of our badly flawed pandemic response."
I tried to warn that going beyond WHO and UNICEF to mask 2 year olds-- against global guidance was absolute madness. It was too young; too scant data.

CDC & AAP further cut their own legs
Authors, are spot on👇👇

Since the summer it was clear that vaccination with mRNA products in young men required nuance & Paul Offit advised his son not to be boosted

But White House pushed so hard FDA vax directors quit!
The authors are right that the reason Fauci went on 60 mins and said community masking doesn't work is that was the best consensus of the totality of data pre-pandemic, including multiple RCTs from influenza

We detailed the evidence in a working paper
cato.org/working-paper/…
"While studies of aerosols on masked mannequins may tell us something about fabric quality, they do not tell us much about the effect of a mask mandate—the actual policy—in reality."

Yes! I saw the train wreck as it happened on a double mask mannequin
medpagetoday.com/opinion/vinay-…
Absolutely right; This group & twitter activists effectively poisoned efforts to run RCTs, polluting equipoise

Misdirected activism is harmful

Activism without evidence generation is catastrophic

A scientific q needed an RCT; now it is political
YES! people say with straight face that there are ZERO downsides; if that was true you should have been wearing it for years, and never take it off
"...little was known about the effects of masking on childhood development, which is part of the reason why the WHO and most European countries recommended against masking 2-year-olds."

Yes, indeed...
theatlantic.com/ideas/archive/…
And the delusion deepened with time....

tabletmag.com/sections/scien…
Absolutely right, and John @NaudetFlorian and @IoanaA_Cristea

tried hard to teach us that RCTs were possible for masking

pubmed.ncbi.nlm.nih.gov/33109299/
"Some say it is unfair to criticize PH for... flip-flops—whether about cloth masks, herd immunity, natural immunity, or the vaccines’ effects on transmissibility—because they were just “following the science”.... But in many cases, what evolved was politics, not science"
Everything we feared has come true
Totally, "the rules seemed not to apply to them"

True for all these hypocrite politicians who mask 6 year olds while they party with celebrities at football games
A beautiful ending
Pls, pls, pls read their full essay here
Its a work of genius
Historians should frame it
It is what really happened
@ID_ethics

tabletmag.com/sections/scien…

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More from @VPrasadMDMPH

Apr 10
Everything in this thread is incorrect. Literally every recommendation. Here's a thread why. 1/7
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
Read 8 tweets
Jan 9
Glad that we @vkprasadlab have published over 20++ peer reviewed papers on COVID19 policy to date & many more to come

I will share them here & a free link to all of them at end

We see policy failure

#1 visitor restriction
It was sad to separate family from dying people, & had no dataImage
Cloth masking 2 year olds was an unforced error by @cdcgov and @AmerAcadPeds, who pushed this policy with no credible data, and despite its obvious silliness Image
Long COVID is an evidence based disaster
There is a strong narrative that is not well supported by the evidence.

To date, besides anosmia, there is no evidence COVID has any more long symptoms than being equally ill with any other respiratory virus. period. Image
Read 23 tweets
Dec 28, 2023
A new 22 page essay by Mariana Barosa, @ID_ethics and me!

"We argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies"
🧵
link.springer.com/article/10.100…
Image
Our essay reimagines the status quo. Instead of implementing and deimplementing and never knowing the answer, Public health must work to reduce uncertainty.

Shown nicely in Figure 2 Image
We discuss many Non pharmacologic interventions tried and their limited evidence

This table represents an evidence based disaster. Nearly none of these were tested with proper trials
Forget beach closures and taking the swings out of parks Image
Read 9 tweets
Dec 10, 2023
When I read an #ASH23 abstract that asks whether PFS or MRD is a surrogate endpoint in FL (L) or CLL (R), I know instantly the person on the left did it right and the person on the right messed up

Want to learn how?
& diff btw
Prognostic, predictive & surrogate
#Tweetorial Image
When it comes to biomarkers there are 3 categories
Prognostic
Predictive &
Surrogate
#ASH23
jamanetwork.com/journals/jama/…
Image
A prognostic marker means that the marker is associated with a better or worse prognosis in a cohort of patients

For, e.g. HER2 is a poor prognostic feature in metastatic breast cancer

& in this CLL analysis
Having MRD is bad! (unsurprising)
#ASH23
ash.confex.com/ash/2023/webpr…
Image
Read 16 tweets
Nov 22, 2023
Small cell lung cancer is a horrible diagnosis, and I feel sadness for anyone who has it

A double lung transplant for small cell lung cancer is complete nonsense. @VUMChealth is just making things up. This story is so sad bc doctors want to practice on the island of Dr Moreau
Read 4 tweets
Nov 8, 2023
Just OUT! By @DavidBenjaminMD
We discuss evidence for STARTING & STOPPING cancer drugs!
What do I mean?
Currently in cancer med, we ~always start treatment at first sign of metastatic disease, and stop at progression, but....
🧵 (follow)
free link
authors.elsevier.com/a/1i2MQ7tJEDS6…
Image
... does this make sense?
The table shows trials testing early starting vs. delayed starting of systemic Rx.
For many diseases, there is no advantage to treating even widespread, asymptomatic disease
For most disease, however, there is no study at all!!
We truly don't know Image
But generally we assume. In many tumor types, we treat even asx or mildly symptomatic metastatic diseases (denovo or recurrent)

Now, lets consider the flip side of the coin. When should we stop treatment....
Read 10 tweets

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