Fantastic article JAMA-IM, required reading for docs & policymakers

Meta analysis of screening RCTs; aside from sigmoidoscopy, uncertain if many screening tests result in significant lifetime gained

Worth reading the entire paper. Some choice quotes:

jamanetwork.com/journals/jamai…


"...some individuals prolong their life due to these screening tests"

This is very important; some people absolutely benefit from screening!

Selecting those most likely to benefit is critical & difficult

Age, risk factors, pt preferences all very important

Epic editorial just published in @jrheum re:@ACRheum 2019 osteoarthritis recommendations

In short, ACR took the (correct!) stance that we should recommend AGAINST hyaluronic acid

This somewhat understandably upset companies that produce this voodoo. So they wrote an editorial! Right up front, we get the "I'm not biased, you're biased!" accusation

It's pretty rich for authors who literally worked for and actively own stock in OrthogenRx (a purveyor of fine hyaluronic acid) accuse others of "bias"

Oh, also, OrthogenRx "funded" this editorial

ORAL Surveillance, open label RCT of tofa vs. TNF, published @NEJM, aka Sword of Damocles has finally fallen

In short, TOFA associated with ⬆️ risk of major adverse cardiac events (MACE) (HR 1.33, CI 0.91-1.94) & ⬆️ risk of cancer (HR 1.48, CI 1.04-2.09)

Much to unpack, a 🧵 1/This was an OPEN label RCT of tofacitinib (JAKi), which randomized pts to 10mg tofa : 5mg tofa : TNFi (ada or etn) in a 1:1:1 ratio

Included patients had RA, were mostly female (80%) / white (75%), & all had at least 1 RF for cardiovascular disease

HCQ for COVID-19 prophylaxis RCT, @NEJM

Self reported exposed patients received HCQ or PLBO

No significant difference in rate of developing COVID-19 (11.8% HCQ vs 14.3% PLBO, p = 0.35)

Overall suggests HCQ for post exposure trophy does not work. But I have some concerns... 1/ KUDOS to the authors for doing this, but when subjects were asked if they got HCQ or PLBO:

HCQ grp: 47% guessed HCQ, 10% PLBO, (others unsure)
PLBO grp: 17% guessed HCQ, 36% PLBO, (others unsure)

That's a fair bit of unmasking, threatens validity of randomization