Steven Phillips, MD Profile picture
Yale-trained physician, researcher, & bestselling author. Tweets don't contain medical advice.
RCCS Profile picture The White Knight is talking backwards Profile picture 2 added to My Authors
12 Sep
This is enraging, scandalous, & pathetic.

And it's close to happening here in the US--Pharmacists have been cracking down on ivermectin prescriptions over the past month in an orchestrated fashion. 🧵👇

theguardian.com/australia-news…
Before Covid politics:
Ivermectin excites scientists: "help improve global public health by treating a diverse range of diseases, with its unexpected potential as an antibacterial, antiviral and anti-cancer agent being particularly extraordinary.🧵👇
pubmed.ncbi.nlm.nih.gov/28196978/
Before Covid politics:
"Ivermectin has continually proved to be astonishingly safe for human use"

Now most media refer to it as an "unapproved animal de-wormer" & have flooded the public with hundreds of false & exaggerated overdose stories. 🧵👇

pubmed.ncbi.nlm.nih.gov/21321478/
Read 5 tweets
17 Aug
Study evaluating treatment with various combos: azithromycin, hcq, ivermectin, & nitazoxanide

"Subjects with early COVID-19 treated with two-to-four drug combinations showed overwhelming improvements compared to untreated patients."

sciencedirect.com/science/articl…
"Improvements remained massive even when underestimating benefits of proposed treatments and underestimating risks of non-treated COVID-19."
"Differences were sufficient to raise ethical concerns regarding the conduction of randomized clinical trials full-placebo in early COVID-19."
Read 5 tweets
29 Nov 20
I'm disappointed that there are no RCT's of the old, cheap, safe, supplements rutin & procyanidin for #COVID.

They're active in so many in-silico models, including a prescient study from the start of the pandemic which found activity for ivermectin. Little 5 tweet thread.👇
This article from March accurately predicted antiviral activity of such notables as ivermectin, which hit 2 of the 3 #SARSCoV2 targets evaluated.

Both rutin and procyanidin each hit 2 targets as well.

who.int/bulletin/onlin…
Rutin:

"the binding affinity of Rutin was much higher than Chloroquine and Hydroxychloroquine, and the reference drug Remdesivir"

pubmed.ncbi.nlm.nih.gov/33200697/
Read 6 tweets
20 Jul 20
Designing valid retrospective reviews is like putting lipstick on a pig. But RCT's have no porcine roots. They start out with racehorse potential, which made it even more sad when the major design flaws in this study rendered this horse lame. Analysis:👇 acpjournals.org/doi/10.7326/M2…
To test whether #HCQ works for #COVID19, subjects must have had proof that they actually had it, not just clinical suspicion. Without this evidence, we can't draw reliable conclusions. But only 1/3 had positive COVID tests. And maybe that's why the following didn't add up:👇
Case fatality rate (CFR) for the placebo group was about 0.5%, but the observed US COVID19 CFR at the time of study enrollment was 5.58%. Could this discrepancy have been in part due to many in the study never having had COVID19 in the first place?👇cebm.net/covid-19/globa…
Read 12 tweets
7 Jun 20
My Dad's recent #COVID19. Not an academic document-just sharing a human experience of outrage & triumph.

My Dad is almost 90, frail as can be, in a nursing home. I went to visit him 3 months ago & wore a mask before it was fashionable to protect him just in case I had it.
I sent an email to 5 people at the nursing home the next day saying that I was shocked that none of the staff or visitors were wearing PPE. I warned them that the now infamous Seattle nursing home which had massive deaths early on in the #COVID pandemic was a sentinel event.
I warned them that they needed to "act now" to prevent a "major tragedy," but not a single one of the recipients responded to my email, silence. I reached out to my Dad's doctor to discuss the situation. She felt that he was a sitting duck and that prophylaxis was appropriate.
Read 12 tweets
4 Jun 20
I think the authors put forth a good effort, but there are significant issues with this study, which was intended to evaluate #COVIDー19 post-exposure prophylaxis with #HCQ. My two cents:👇nejm.org/doi/full/10.10…
Planned enrollment threshold was within 3 days of exposure due to the average incubation period of 5.5 days. But then the threshold was changed to 4 days. Cutting it close. One can argue that the study nearly misses its basic premise of being a PEP trial. And then this: 👇
Authors wrote that the "vast majority of the participants" couldn't get diagnostic testing for #Covid. Instead, they looked at symptoms and labeled some cases as "probable," about which they admit, "predictive power of this case definition is unknown." Is this OK?👇
Read 10 tweets
30 May 20
Subconscious biases are ubiquitous and powerful. We all have them, so what are going to do about it? "Confirmation bias—probably the most pervasive and damaging bias of them all—leads us to look for evidence that confirms what we already think." theatlantic.com/magazine/archi…
Physicians are vulnerable to bias just like other humans and it can lead to diagnostic errors. "The culture of medicine has never been one that encourages discussion of physician vulnerability."
beckershospitalreview.com/hospital-physi…
This article details how researchers are blind to their own bias but can easily point it out in others, including when it comes to how receiving gifts from pharmaceutical companies affects decision making. cmu.edu/news/stories/a…
Read 6 tweets
25 May 20
Chronic illness in #LymeDisease is shockingly common. This occurs more frequently if #Lyme is first diagnosed and treated at a later stage, but occurs at every stage of the disease.👇@Lymenews @BayAreaLyme @LymeChallenge @danaparish @ProjectLyme @lymelegacy @LymeOntario
Even for early #Lyme (erythema migrans stage illness), a study by Johns Hopkins demonstrated that about 40% did not get regain their health at 6 months after treatment.👇@LymeAlliance @Lyme_Connection @liv_lyme @UKLyme @AdvocatLyme @LymeDiseaseLDA pubmed.ncbi.nlm.nih.gov/23462300/
A study from Danbury Hospital in CT demonstrated that 61% of patients still had their initial Lyme symptoms 6-12 months after treatment for early Lyme, (erythema migrans stage illness). @LymeDiary @LymeDiseaseAus @LymeAction @LymeDiseaseNYC pubmed.ncbi.nlm.nih.gov/24970880/
Read 14 tweets
22 May 20
Another poorly designed interpretation of a #HCQ data set for #COVID19. A larger poorly designed "trial" only leads to larger erroneous conclusions. For analysis, see the thread👇@JamesTodaroMD @niro60487270 @danaparish @marybethpf thelancet.com/journals/lance…
This study implies that it's an early treatment study because hospitalized patients were treated within 48 hours of diagnosis. It's a late treatment study, and here's why: 👇
About 2/3 of patients were from N. America. Unlike Asia and Europe, we haven't had access to early #C19 testing & quick turn around times. By the time patients get to the hospital, 5-7 days have typically gone by, results have been taking about 4 days, & add 48 hours to that. 👇
Read 7 tweets
15 May 20
A very poorly designed hcq study. A study is like a house: Only as strong as its foundation. Analysis of why this study is unacceptable can be found in this thread. @danaparish @niro60487270 @SamParkerSenate @lymenews bmj.com/content/369/bm…
Not a prospective, randomized study. No p-values provided to assess differences between treatment and control groups at baseline, ie "control" group had almost twice as much azithromycin treatment as hcq group, higher CRP, and lower lymphocyte counts. Statistically significant?
These patients were not treated early in their illness, when an antiviral effect would be most helpful. The average duration of symptoms before admission was 7 days and hcq was begun within 48 hours after that, so patients were treated from 7-9 days after symptoms had begun.
Read 5 tweets
9 May 20
#Lyme and #MultipleSclerosis can be clinically indistinguishable, with some docs differentiating them based on 40 year-old, inaccurate Lyme antibody tests. See thread. @danaparish @BayAreaLyme @Lymenews @lymehopecanada @ProjectLyme @LymeChallenge pubmed.ncbi.nlm.nih.gov/28480854/
Spirochetes had been found in human MS autopsy tissue since the early days of medicine. They called it Spirochaeta Myelophthora. Many researchers have published the same findings. pubmed.ncbi.nlm.nih.gov/13118387/
Lyme bacteria (back then called cystic forms, now called round bodies or persisters) was isolated from spinal fluid of MS patients but not from healthy controls apart from one who had a history of Lyme. pubmed.ncbi.nlm.nih.gov/11787831/
Read 10 tweets