Nick Mark MD Profile picture
Mar 22 4 tweets 1 min read
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.
My bad: Nocardia is gram positive but I should have said “is your bug acid fast?”

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More from @nickmmark

Mar 22
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/ ImageImage
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/ ImageImage
Read 16 tweets
Mar 22
Yet another excellent post by @jbcarmody.

The fact I found most shocking: AAMC made $116m in profit last year. Seems like a lot of profit for administering the MCAT & running ERAS.

This got me thinking… what is the point of AAMC?

A 🧵
1/
Business is good when there’s no competition & AAMC is worth a whole LOT.

I found their IRS 990. In 2020 they had $482m in assets.

That’s right, apparently this overpriced application service has a half BILLION dollars in assets!

Source: @propublica
projects.propublica.org/nonprofits/org…
2/
They made a whole lot of money in 2020. This included:
$84.9m in revenue from ERAS
$32.7m from the AMCAS
$27.1m from the MCAT
$14.4m from membership dues
$10.3m from workshops

3/
Read 8 tweets
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/ ImageImage
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/ Image
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
Mar 3
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
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

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