Vinay Prasad MD MPH Profile picture
Prof @ucsf, Physician-Scientist, IG @vprasadmdmph @vkprasadlab @plenary_session, YouTube, #vpzd podcast & @Sensible__Med; Views mine
Hecate's Crossroad #QVArmy Profile picture Κασσάνδρα Παρί پری Profile picture Norris Battin Profile picture Amy at ThreadReaderApp Profile picture Rogier v Vlissingen 🇳🇱 Profile picture 47 subscribed
Jan 9 23 tweets 7 min read
Glad that we @vkprasadlab have published over 20++ peer reviewed papers on COVID19 policy to date & many more to come

I will share them here & a free link to all of them at end

We see policy failure

#1 visitor restriction
It was sad to separate family from dying people, & had no dataImage Cloth masking 2 year olds was an unforced error by @cdcgov and @AmerAcadPeds, who pushed this policy with no credible data, and despite its obvious silliness Image
Dec 28, 2023 9 tweets 4 min read
A new 22 page essay by Mariana Barosa, @ID_ethics and me!

"We argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies"
🧵
link.springer.com/article/10.100…
Image Our essay reimagines the status quo. Instead of implementing and deimplementing and never knowing the answer, Public health must work to reduce uncertainty.

Shown nicely in Figure 2 Image
Dec 10, 2023 16 tweets 6 min read
When I read an #ASH23 abstract that asks whether PFS or MRD is a surrogate endpoint in FL (L) or CLL (R), I know instantly the person on the left did it right and the person on the right messed up

Want to learn how?
& diff btw
Prognostic, predictive & surrogate
#Tweetorial Image When it comes to biomarkers there are 3 categories
Prognostic
Predictive &
Surrogate
#ASH23
jamanetwork.com/journals/jama/…
Image
Nov 22, 2023 4 tweets 2 min read
Small cell lung cancer is a horrible diagnosis, and I feel sadness for anyone who has it

A double lung transplant for small cell lung cancer is complete nonsense. @VUMChealth is just making things up. This story is so sad bc doctors want to practice on the island of Dr Moreau
Nov 8, 2023 10 tweets 4 min read
Just OUT! By @DavidBenjaminMD
We discuss evidence for STARTING & STOPPING cancer drugs!
What do I mean?
Currently in cancer med, we ~always start treatment at first sign of metastatic disease, and stop at progression, but....
🧵 (follow)
free link
authors.elsevier.com/a/1i2MQ7tJEDS6…
Image ... does this make sense?
The table shows trials testing early starting vs. delayed starting of systemic Rx.
For many diseases, there is no advantage to treating even widespread, asymptomatic disease
For most disease, however, there is no study at all!!
We truly don't know Image
Oct 13, 2023 5 tweets 3 min read
Sorry, no way.
There's no reliable evidence this vaccine lowers the risk of covid. FDA did not ask for any randomized studies.
There is no evidence that repeated boosters lower the risk of long COVID
No other nation recommends boosters for young healthy people who have had covid
Even mild adverse events can outweigh a gain of zero
Maybe get the shot if you're in a nursing home, but definitely not if you're young and healthy. It would be crazy too.
Allowing the company to sell the shot without running randomized studies is totally crazy. It only makes sense if you consider that the people making the decision are soon going to be working for the company, just like Scott gottlieb, former FDA commish and current Pfizer board member
The fact that the USA gave such a broad marketing authorization is not because our experts are smart, it's because they're more corrupt. And financial conflicts of interest to drive this system.
The uptake for the booster is going to be as close to 0% as you can imagine. No one will want this.
I would never give it to a child who had COVID. That's so crazy in my mind

In a normal world, you have to generate evidence to support your claims. You don't just get to say that your annual COVID-19 shot is a net benefit, and anyone who disagrees has to prove otherwise. The manufacturer, who is making billions of dollars, has to run a controlled clinical study to prove their claim. They have never done so. The FDA is not even making these decisions. They're being made at the White House. That is so objectionable. No one has ever wanted the white house to make these decisions. The White House does not care if the vaccine works or not. They only care if by approving the vaccine they improve their political prospects. Of course they want to improve their political prospects above all else; giving a vaccine, even an ineffective one, to people who don't need it, is what the Democratic base wants. Asking the company that has made 100 billion to run a controlled clinical study is what FDA would have called for. Let's not forget, that the people who work at FDA have resigned over this decision. Including Marion Gruber and Phil krauss. Even Paul offit is not getting this booster. You really have to be deranged to think that anyone wants an unproven booster for a disease they already had.
Oct 12, 2023 15 tweets 8 min read
This 8000 word paper by brilliant @UCSFMedicine M3 @anushka_walia4 is going to be the most interesting thing you read about PFS, EFS, DFS in oncology this year

Even if you think you know these endpoints well, I promise you will learn something new
🧵🧵
nature.com/articles/s4157…

Image In the paper, we explain what composite outcomes in oncology are
What they mean
How they vary (by disease, trial and over time)
Why pooling can be challenging
Why the ratio of events is never reported
Whether therapies can affect the components differently
& much more Image
Aug 23, 2023 8 tweets 3 min read
Here is the complete list of concerning COVID variants I am tracking 1/8 Image And here is the list of precautions wise people are taking 2/8 Image
Jul 20, 2023 8 tweets 4 min read
OUT NOW in @JAMAOnc
Led by great @pharmatinib

We calc. the cost of the PILL WASTE that happens when patients DOSE REDUCE or DISCONTINUE and throw out rest of bottle!

An entirely novel approach
tl;dr
For some drugs this is 10% of drug cost!

🧵 https://t.co/s8ue1Kyo7cjamanetwork.com/journals/jamao…
Image Basically, cancer drugs come in certain size pills and have certain sized dose reductions if you have side effects

Also, lots of people have side effects

Ergo, the dose reductions take on a big role

We have written about this before
@Timothee_MD https://t.co/U1OfuGhzWlpubmed.ncbi.nlm.nih.gov/35830842/
Image
Jul 1, 2023 6 tweets 2 min read
New paper out in @JAMANetworkOpen @vkprasadlab
A SCOPING review of oncology meta-analyses

Of 21 studies w author funding from pharma, 17 (81.0%) were +
Of the 63 studies that did not have author or study funding from industry, 30 (47.6%) were +
🧵

https://t.co/PTlGDZfi7sjamanetwork.com/journals/jaman…
Interesting results by sponsorship
Jun 17, 2023 9 tweets 3 min read
Disgusting, unethical PLACEBO control trial in colon cancer just so Fruquitinib can win

I will show you that placebo should not have been the control arm, & the IRBs & FDA failed 🧵

First, this trial tests a new drug vs. placebo (sugar pill) in patients dying of colon cancer Image Even against sugar pill; No one is cured, benefit is modest.

We are paying 200k/ yr for drugs like this
pubmed.ncbi.nlm.nih.gov/28290490/
What are we doing as a society?

But giving the control arm a sugar pill is unethical.
Here is why.... Image
Jun 8, 2023 4 tweets 1 min read
This is so stupid. If you randomized neighborhoods to free n95 masks or nothing, nothing would be different in one week, one month or one year

There's no actual human behavioral data for forest fire n95.

Just empty signaling by people who don't understand behavior You really have to be naive to think that people are going to wear this consistently enough to prevent long-term particulate inhalation.

Please try to study that so I watch your power calculation reveal your ignorance.
Apr 30, 2023 16 tweets 3 min read
Here's what's under appreciated about Chat GPT paper🧵
PCP panel can be 2 to 5k
Doc in clinic 40 hours++ already
Doc not good at typing
Chat GPT can reply instantly
Chat GPT never fatigues
Can keep replying
Can reply day&night
Can read chart
Can type pleasantries, doc too busy 4 PCP may remember thousand people off the top of their head, but not 5k.
PCP's nearing total burnout
PCP is not paid for messaging
No one wants to be PCP already
Chat GPT is the first good news PCP has heard in a long time
Current system in busy practices is to have nurse take
Apr 29, 2023 4 tweets 1 min read
Most physicians and trainees consent to their own exploitation. The greatest exploitation is of time. Training is way longer than necessary. Medical school could be 2 years shorter, residency a year shorter, and even fellowship prolonged to keep big call pool. Junior faculty... ... are also mistreated with low pay. And no real potential for advancement. Entire system self-perpetuates by preventing trainees from seeing private practice opportunities as @jeff_sharman notes. To top it all off, system tries to add more years. Recently...
Mar 26, 2023 15 tweets 6 min read
Our LATEST in @JAMAInternalMed
FDA was aware of a SAFETY signal for Idelalisib in 2016. The drug remained on market till 2023!

Meanwhile trials failed & were halted, millions earned, & safety signal mounted.

Horrible @FDAOncology failure 👇
See 🧵
jamanetwork.com/journals/jamai… The story of idelalisib began btw 2008 and 2014 when multiple, (mostly) uncontrolled trials led the @FDAOncology to approve the drug for CLL and FL based on shrinking tumors on CT scans and not living longer or better
Mar 23, 2023 8 tweets 5 min read
Just OUT @SSRN
By @KelleyKga, AH, @TracyBethHoeg @vkprasadlab

An Analysis of Statistical and Numerical Errors Made by the US @CDCgov

The errors are damning. Basic counts of dead kids, causes of childhood death.

Unacceptable incompetence 👇
papers.ssrn.com/sol3/papers.cf…
see 🧵 Here are the errors by year
2021
papers.ssrn.com/sol3/papers.cf…
Mar 22, 2023 4 tweets 1 min read
Reasonable to feel frustrated, but inaccurate statistics for 3 years, 0 randomized trials, misleading MMWR analyses-- the frustration was channeled into complete failure. Even when the president changed, the failure intensified. I still don't see how anyone can justify not running any studies at all. They didn't even study n95 versus surgical mask recommendations to the public. (Or variations of n95 type for the believers) Nothing. Literally nothing was studied properly.
Mar 15, 2023 6 tweets 2 min read
A few thoughts on Cochrane's statement by Soares-Wiser

I agree with Jefferson & @carlheneghan that Cochrane's behavior is inappropriate.

It is not their role to issue statements on how the data should be interpreted out of fear of NYtimes opeds
🧵
open.substack.com/pub/trusttheev… It seems clear that the statement was issued after criticism of Cochrane's masking analysis by people who have staked their reputation on community mask mandates (even for children)

This type of response fueled a counter-narrative that Cochrane's mask SR was 'retracted'
Mar 14, 2023 5 tweets 3 min read
New PAPER with @TracyBethHoeg
The Double Standard for COVID19 evidence

MANY RCTs of HCQ, Plasma and Ivermectin, nearly none of school/sports/ business closure, & masking

NPIs are blindly assumed to work, why?
The worst is...🧵
doi.org/10.1016/j.conc… Image CO2 monitors
You have 'experts' recommending people carry a CO2 monitor and mask when levels rise. This entirely concocted idea has NO SCIENTIFIC JUSTIFICATION.

Also masking above certain levels. All is just theory without verification

All sounds 🥜 to me Image
Mar 11, 2023 22 tweets 7 min read
It's embarrassing to watch those who pushed masks & mandates, even cloth, now retreat to "Cochrane is inconclusive" & we need RCTs, when they were the very same people who opposed RCTs w vehemence.

As one of the few who called for RCTs (e.g.)👇, some thoughts
🧵 This whole mask question only makes sense PRE-vax. If masks work (probably not, but..) & you delay covid from pre to post vax, that is a big improvement in outcome if you are old or frail. IFR lower

But delaying it from a little post vax to a bit post vax makes ZERO sense.
Mar 6, 2023 9 tweets 4 min read
OUT Now!
Our paper providing a visual surgical atlas for a proposed, Randomized, SHAM controlled trial of Total Knee Arthoplasty TKA

This is the 7th paper @audreyamadean did with me in her year off at OHSU & she illustrated it!

Check it out 👇
🧵

becarispublishing.com/doi/full/10.57… To date, there have been 14 randomized sham controlled trials we are aware of in orthopedics (full table in supplement)

Ten out of 14 studies (71%) failed to demonstrate that the proposed intervention improved outcomes compared with the sham arm.