Nick Mark MD Profile picture
Mar 31 5 tweets 3 min read
The #CultOfIvermectin has invented new excuses. Let’s address those:

“eVeRyOnE iN bRaZiL wAs AlReAdY TaKiNg IvErMeCtIn OTC!”

While Ivermectin use in the 30 days prior to screening wasn’t an absolute exclusion criteria, they appear to have de facto excluded those patients.
1/
It’s also worth wondering *why* someone who was taking ivermectin would enroll in a RCT of ivermectin vs placebo.

Also - if ivermectin prophylaxis was so effective - why would so many people on ivermectin be getting COVID in the first place?
2/
“tHeY dIdN’t UsE ZINC!!!!”

The original in vitro studies of ivermectin (Caly et al) didn’t use zinc.

None of the fraudulent “positive” RCTs of ivermectin combined it with zinc.

There has been *one* RCT of early zinc in COVID and it was *NEGATIVE*.
jamanetwork.com/journals/jaman…

3/
Claiming that a highly effective “treatment protocol” is a combination of therapies that are individually useless is bizarre.

Continuously adding more meds to the protocol is really just moving the goal posts. Every time a new RCT is negative they claim it didn’t include “x.”
4/
It takes time to do a RCT.
FLCCC updated their “protocols” dozens of times to stay ahead of the negative studies.

Recently they added hydroxychloroquine - another disproven therapy. No doubt they will next claim that IVM & HCQ are both necessary to “miraculously cure COVID.”
5/

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More from @nickmmark

Apr 1
Q: What do🐍 snakes have to do with ICU pharmacology?
A: A lot! We use 💊medications derived from snake venom every day in fact!

Buckle up for a fun 🧵of #UnusualDrugDiscovery & #HistoryOfMedicine about medications derived from from 🐍☠️snake venom! #FOAMed #FridayFun
1/ ImageImageImageImage
First a question: which of the following snake venoms have been used to develop medical therapies?

(don't worry we’ll go over the answer at the end)
2/
It was long known that workers in banana plantations would collapse due to low blood pressure if they were bitten by the Brazilian Arrow Headed Pit Viper Bothrops jararaca.

A Brazilian graduate student - Sergio Ferreira - thought this could be useful...
3/ ImageImage
Read 17 tweets
Mar 30
The largest trial of #ivermectin in early #COVID is now published @NEJM & the results are *NEGATIVE*

#TOGETHER randomized n=1358 outpatients with COVID in 🇧🇷 to IVM vs placebo. No difference in hospitalizations, mechanical ventilation, or death.

nejm.org/doi/full/10.10…

A 🧵
1/
I’ve written about the #TOGETHER trial before (see my fluvoxamine 🧵below)

Briefly #TOGETHER is a large double blind multi-arm platform RCT. Pretty much the 1st 🥇 gold standard for high quality medical research.

2/
TOGETHER enrolled high risk people with COVID from 12 outpatient clinics in Brazil.

Patients could be enrolled up to 7 days after symptom onset (more on this later).

They were randomized to either placebo or to ivermectin 0.4mg/kg daily for 3 days. (Also more on dose later)
3/
Read 16 tweets
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/
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
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
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

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