Nick Mark MD Profile picture
Mar 3 4 tweets 2 min read
The FLCCC’s “data analyst” (who has no pharm training) is dosing ivermectin horse paste

Only problem: he makes a FATAL math error

A tube of horse paste contains 6gm (6080 mg) of ivermectin at a concentration of 18.7 mg/ml

@TwitterSafety suspend this guy before he kills someone
This guy actually got both calculations completely wrong.

In the ACTIV6 trial an 80 kg person receiving 0.6 mg/kg of ivermectin would receive:
80 kg * 0.6 mg/kg = 48 mg per day

(Somehow he calculated 0.24 mg so he was off by 200x; another huge error 😱)
Bottom line:
- don’t take animal meds EVER; it’s very easy to make a fatal mistake
- don’t take medical advice from a guy with zero training who can’t multiply two numbers correctly
I deleted a fourth tweet in this series because I made a math error. This is a great reminder of why pharmacists are absolutely life saving!

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More from @nickmmark

Mar 3
New embarrassingly bad study of ivermectin is a textbook example of “confounding by indication”

In short a retroactive database review found that people w/ COVID did worse if given remdesivir (only given to sick inpatients) than ivermectin (only given to well outpatients)🤔
1/
There are many problems with this “study”.

First it’s generous to even call it a “study.” It’s an *abstract* of a retrospective database review. The whole “article” is less than a page (see below).

It wasn’t pre-registered.

sciencedirect.com/science/articl…
2/
The methods are weird.

They found 1.7 million people w/ COVID. Out of this group they identified 1,072 who received ivermectin (not exactly widely used) & 40k who received remdesivir

The groups were very dissimilar: IVM was 10 yrs younger. They don’t report any comorbidities
3/
Read 9 tweets
Feb 12
In confronting COVID misinformation I’ve mostly focused on inpatient treatment (this is my area of experience).

Recently I saw the FLCCC Long COVID “protocol” & oh boy is this some crazy non-evidence based prescriptions: HIV meds, steroids, diuretics, & of course ivermectin…
1/
First off, Long COVID is definitely “real” & can be severe.

Many studies have found persistent changes in immune cell phenotype & function, months after COVID infection.

Many great docs (@WesElyMD & others) are actively researching long COVID to improve our understanding.
2/
What concerns me is FLCC presenting “protocols” as proven treatments for long COVID.

Throwing 20 medications (9 are prescription 🟥) at a problem with minimal (or no) evidence is irresponsible.
nature.com/articles/s4159…

As we will see, this is both unethical & likely harmful.
3/
Read 34 tweets
Feb 2
Do you want to improve working conditions for residents/fellows in WA?

The WA legislature is voting on HR1764 which would allow interest arbitration in collective bargaining.

This would go a long way towards correcting the power imbalance between administration & residents.
1/
Under the current system of negotiation, residents can *request* certain changes: safe working conditions, sufficient PPE, hazard/overtime pay, etc.

Administrators (who are often non-clinical) just say NOPE.

Because residents can’t/won’t strike they don’t have much leverage.
2/
When we formed the UWHA/@RFPU_NW resident union we spent YEARS fighting with administrators over these issues.

Ultimately we got lucky. Pressure from the city council & media attention helped us break the logjam.

There ought to be a better way.

3/
dailyuw.com/news/uw-medica…
Read 8 tweets
Feb 1
Instead of proposals to cap RN pay I’d love to see legislation that:
1️⃣mandates safe RN staffing ratios nationwide
2️⃣enacts a “50 state medical license” w/ straightforward reciprocity
3️⃣imposes limits on executive compensation for any hospital/org that bills CMS
For those doubting these reforms are possible. A couple points:

There already is a federal law calling for “adequate numbers of licensed RNs” 42CFR 482.23(b) The issue is that this is too vague.

15 states have passed laws that go further. CA & MA explicitly stipulate RN ratios
The CA law, enacted in 2004, mandates 1 RN to 5 med/surg patients & 1:2 for ICU patients.

After implementation RNs cared for one fewer patient on average. There was a decrease in hospital mortality & increased RN job satisfaction. ncbi.nlm.nih.gov/pmc/articles/P…
Read 6 tweets
Jan 21
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…
Read 9 tweets
Jan 20
Just 3️⃣simple acts of compassion can go a long way

Important RCT just published in @TheLancet shows that a family support strategy consisting of 3 extra family meetings can substantially reduce family grief 6mo after the death of a loved one in the ICU
thelancet.com/journals/lance…
1/
Pre-pandemic, ICU mortality was often ~20%

In the US, 30-60% of ICU deaths were preceded by a decision to withdraw life support

We are experts at providing comfort focused care for patients but in many cases, families feel grief months afterwards

What can we do about this?
2/ ImageImage
The COSMIC RCT studied this.

The intervention was 3 family meetings held following a decision to withdraw life support:

1️⃣family conference to prepare relatives for the imminent death
2️⃣ICU-room visit to provide support
3️⃣meeting after death to offer condolences & closure

3/ ImageImage
Read 7 tweets

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