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Nick Mark MD

@nickmmark

Mar 22

@K_Sheldrick

Remember that Vitamin C cures sepsis paper that could never be replicated in 9 RCTs?

Turns out there is a good reason why: it’s very likely fraudulent.

More brilliant statistical sleuthing by @K_Sheldrick.

kylesheldrick.blogspot.com/2022/03/eviden…
1/

To understand the proof you should read Dr Sheldricks post.

To summarize, he observed that in this non-randomized study the baseline characteristics of the pre & post intervention groups are far too perfectly matched. This perfect matching is unlikely to occur by chance.

2/

Specifically, you’d expect to see a range of p values for each baseline characteristic.

(This is especially true in a tiny trial with only n=47 patients)

Instead the range of p values for almost every variable was exactly 1.

This is *extremely* unlikely to occur by chance.
3/

Read 16 tweets

Nick Mark MD

@nickmmark

Mar 22

Here’s an idea for an ID board game: Guess Who Bacterial Pathogens

A: “is your bug rod shaped?”
B: “Yes”
A: “is your bug Gram Positive?”
B: “weakly”
A: “does your bug have catalase!?”
B: “Yes!”
A: “You’re Nocardia!!!”

A: “are you monotrichous?”
B: “yes”
A: “are you a facultative anaerobe?”
B: “yes!”
A: “are you Vibrio cholera?!?”
B: “yes!!!”

Ok I’ve decided to make this game in my garage.

Hopefully Hasbo won’t sue and my kids won’t be too mortally embarrassed to play.

Read 4 tweets

Nick Mark MD

@nickmmark

Mar 8

Here’s a situation many of us have seen in the ICU or ED: “It looked like there was ST elevation on the monitor but when I took a 12 lead it was gone?!”

A STEMI went MIA? Here’s a #tweetorial all about why ST segments look different on monitors.

#FOAMed #FOAMcc
1/

@smithECGBlog

First, here’s another great example of "disappearing ST elevation", from Dr. Smith’s ECG Blog @smithECGBlog

(If you don’t already you should definitely follow Dr Smith & bookmark his site; hqmeded-ecg.blogspot.com IMO it's the best site for ECGs; you can thank me later)
2/

In order to understand *WHY* the ST segment looks different, we need to know how an ECG works & understand just a little bit of electronics & math.
(Don't worry, I promise no equations or circuit diagrams 🤞)
3/

Read 18 tweets

Nick Mark MD

@nickmmark

Mar 3

@TwitterSafety

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

Read 4 tweets

Nick Mark MD

@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

Nick Mark MD

@nickmmark

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/

@WesElyMD

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

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