Here is a recent RCT of ivermectin in COVID, published in @JAMAInternalMed: jamanetwork.com/journals/jamai… I have screenshotted why I think are key elements:

Working as a scientist in industry, it took me a long time to understand the differences between the research I do now & the research I did as an academic.

A good framework is the differences between pharma & academic research is “Finite & Infinite Games” en.m.wikipedia.org/wiki/Finite_an… What do I mean?

Briefly, pharma research is directed at answering specific questions to move a drug development program forward—or kill it.

Academic research is directed at answering questions—sure. But the productive questions are those that lead to more interesting questions.

Now it’s time for me to weigh in on the “COVID vaccine-associated myocarditis” preprint.

https://twitter.com/TracyBethHoeg/status/1435796377188003841

I have tweeted on many occasions that VAERS ought not to be used for analysis, but rather for signal detection.

My view on that remains the same.

Too many of my colleagues, facing the reality of vaccine-associated myocarditis, are either burying their heads in the sand or throwing up their hands.

In an effort to promote vaccination, they are making what I believe are misguided actions. I believe vaccination for COVID is our best way back to a normal life. And we need to be honest with people about what we know.

We also need to acknowledge that there is a great deal we can do to minimize the harms of our interventions.

Let’s be clear: 2 months of safety data for a new drug or vaccine is at best marginally better than 1 month for identifying acute AEs. And it has almost no power in identifying chronic/long term AEs. A 2-month cutoff is not a routine cutoff for evaluating AEs in drug or vaccine development.

Of course, all cutoffs are arbitrary to some degree, but there are typical timeframes that are routinely used: eg 1 month, 1 year.

Time for another takedown.

Today, it’s the editors of @NEJM for today’s editorial.
nejm.org/doi/full/10.10… I will start with the references: 2 database queries, and 2 newspaper articles.

Definitely typical for an editorial in arguably the world’s top medical journal.

Now that folks have had a chance to digest the two reports on in-hospital cardiac arrest in COVID patients, let’s break them down.

Starting with the British study. bmj.com/content/371/bm… First, a mea culpa.

Even though this study is published in the “British Medical Journal”, is is actually a cohort study in *American* hospitals. 🤦‍♂️

One thing I love about ET is that he identifies the best COVID studies. These studies are looking at in-hospital cardiac arrest (IHCA) in COVID.

If you want to understand unique aspects of IHCA in COVID, who should you compare COVID arresters to?

Okay. A kind soul had sent me screenshots of @EricTopol’s thread explaining his letter to Pfizer.

I have highlighted a few sections, which I will comment on. For those not familiar with the abbreviations, “DSMB” stands for “Data Safety Monitoring Board”. There are a couple of statements that deserve comment.

Here is a link to the @US_FDA guidance on DSMBs: fda.gov/regulatory-inf…

I am definitely biased, but I trust the judgement of companies that have successfully developed vaccines over docs who by and large have little experience in drug or vaccine development. I happen to know personally some of the signatories to the Pfizer letter. I respect their intelligence and honestly.

And I also know that they don’t understand what they signed, in that key underlying assumptions are at best questionable.

According to ET’s piece in Science, “diffuse inflammation of the heart… that can extend throughout the three layers of the human heart to the pericardium… is a typical finding at autopsy after SARS-CoV-2 infections.”

Can anyone verify this—through literature or experience? Thanks to @fitterhappierAJ, who tweeted this European autopsy series: academic.oup.com/eurheartj/adva…

Okay, I need a separate thread to talk about the figure in @EricTopol’s @ScienceMagazine Perspective article. First Panel, SARSCoV2 & a heart cell. And an ACE2 receptor. Nice.

I am reading the latest perspective piece in @ScienceMagazine by @EricTopol on COVID & the heart.

I promise I am keeping an open mind…
science.sciencemag.org/content/early/… Okay, spurred on by @bogdienache, I will “live tweet” my reading. I had a light lunch of coffee cake & @Starbucks blonde roast. Black, of course.

SARSCoV2 as a cause of widespread myocarditis is pure, unadulterated FUD.

Everything is “possible” or “a sign of”. Nothing substantial. Nothing that hasn’t been discussed ad nauseum. Thanks, @nytimes!

nytimes.com/2020/09/23/mag… Okay, let’s break this down…

This claim of frequent heart complications in severe COVID cases is unsupported. I am not aware of this being the case.

And even if true, it says *nothing* about the potential for widespread, silent heart damage.

Well, I just read the COVID piece in @TheAtlantic by @dcopaken so you don’t have to.

As soon as I am able to unroll my eyes back to their normal position, I will walk though the piece. First, I want to sympathize with @dcopaken’s illness. It totally sucks to be sick, and I understand where she is coming from with POTS.

As a pediatric cardiologist, I have seen many, many folks with POTS and similar conditions with symptoms of syncope & presyncope. Very common.

Inspired by this comment on “fake jobs”, I will commence naming “fake organs” and “fake cells”.

Ritualized inefficiency is not just a product of human society.

https://twitter.com/SamoBurja/status/1290394700067659776?s=20

So, of course we have to start with @DGlaucomflecken’s punching bag—the spleen.

Let’s expand that to the entire immune system.

Well, my COVID-denying medical school classmate just sent me the “5G viral induction” paper, very excited by the findings. Before you poo-poo this, please keep in mind that the lay-press interpretation of the paper was *way* off.

First, what “traditional science” calls viruses are actually “exosomal particles”, similar to what may be called “microvessicles” describes in flow cyrometry.

This seems to be going well so far…

https://twitter.com/AngryCardio/status/1268521487058665473

There are reasons I asked about specific, concrete physical steps I could do immediately.

First, there is an assumption by many that our thoughts drive our actions. Not so! Much (nearly all?) of the time, our actions drive our thinking.

Wanna *be* anti-racist? Act anti-racist.

Even before #COVID19, suicide was unfortunately common among doctors. During this pandemic, suicide among doctors has… Just to frame this poll, according to a 2018 APA abstract, ~300-400 physicians commit suicide each year.
medscape.com/viewarticle/89…

Why is arterial hypoxia bad? For those voting “less oxygen to tissues”, are you saying that kids with CHD and says in the 80’s for weeks or months (or years) are not delivering enough oxygen to their tissues?

Excellent—Fauci will be on @cspanwj tonight at 8:00pm ET.

I will plan to call in. Any question you would like me to ask him? Here is my planned question for Dr. Fauci: