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Vinay Prasad MD MPH Profile picture
Vinay Prasad MD MPH
@VPrasadMDMPH
These posts were issued before my FDA employment and do not necessarily represent the views of the FDA or the United States. The account is now inactive.
47 subscribers
Nov 29, 2024 • 9 tweets • 2 min read
Here's what they are not saying
Vaccine hesitancy has been rising for some time. This includes preventable illnesses like measles. There will be measles outbreaks in the future! Covid policy accelerated hesitancy. The question is: how many extra outbreaks will occur bc of RFK... ... If RFK is HHS secretary, versus if RFK is not HHS secretary. That's the question.

Even though he has tremendous administrative authority, he has already stated he's not going to withdraw these vaccines. I also suspect it's not going to be the first topic he touches...
Nov 22, 2024 • 7 tweets • 2 min read
Every single one of these garbage papers use the denominator of PCR+ covid infections, and not the actual denominator of people who had covid-- many do not present to the doc. Every single one of these papers is shit. I would be embarrassed to be an author. Incompetent work. Image People with covid who are so sick they have to go to the doctor have poorer health than people who don't. That should be in the journal of obvious things. All of these authors are extrapolating beyond the evidence. They're creating a body of trash calling itself science
Oct 3, 2024 • 10 tweets • 3 min read
Totally wrong. Because Vincent is not thinking about the counterfactual correctly.
*Teachable moment*

1 These drugs were approved by accelerated approval in the LAST line. Some later improved survival & others didn't in an EARLIER line.

2 The counterfactual to AA... 🧵 is demanding RCTs powered for say, OS (survival). If a company couldn't use RR to get AA, they wouldn't run a trial in the 2nd line or 3rd line setting powered for OS, they would run it in the 7th or 8th line

Why? more dire = faster result
Sep 29, 2024 • 15 tweets • 3 min read
Many people want covid to be worse than it is. They imagine it has long-term consequences that are worse than other respiratory viruses. Adjusting for severity of illness, it doesn't. Only anosmia is unusual. Why do they want it to be worse than it is? 🧵 For some reason, some people want to live with perennial precautions. They don't want to take off the mask, they want their children to mask, they want to keep getting booster after booster. I don't know why but they want to live in fear.
They have...
Sep 25, 2024 • 17 tweets • 3 min read
I spent a lot of time today reading this paper, the criticism, the rebuttal, the retraction notice. OMG! My head hurts.

But... An important point no one has said is that the entire premise of the study & criticism is flawed. 🧵 Here is a short summary Lots of prior studies show many psychological findings don't reproduce. Obviously that's because so much of this science is bullshit. Small sample size, weak methods. Entire fields struggling to justify their existence & people p hacking and exaggerating to be on @HiddenBrain
Sep 14, 2024 • 16 tweets • 6 min read
Thank you @Erman_Akkus for ur reply it is a good learning opportunity for #ESMO24

In 15 tweets, I will summarize the trial, my criticism, and why this reply contains 3 common errors that oncologists make because our training doesn't teach these ideas.

First, the trial... Image The trial is #LEEP-012 and randomizes pts with INCURABLE (see pic) liver cancer to TACE (embolization) plus costly drugs or embolization alone.

These 2 drugs are TOXIC (lenva is horrible) and cost a FORTUNE 200-300k per annum per person
#ESMO24 Image
Sep 11, 2024 • 11 tweets • 4 min read
Just out on @medrxivpreprint and @CityJournal
We analyzed all COVID19 corrections in the @nytimes
We show that 2:1 the Times OVERSOLD covid risk or FALSELY HYPED the benefit of restrictions
1 reporter alone was 7% of all corrections
Let's take a look 🧵Image
Image Naturally, in times of crisis, newspapers won't get everything right

Corrections are inevitable and forgivable

But corrections should occur at random

Sometimes they are too high and sometimes too low

If they tend to be in one direction...

That's bias
Aug 2, 2024 • 6 tweets • 3 min read
Just out
Led by @mmb03966692 Mariana B
We argue that annual flu shots and covid shots have a VERY WEAK evidence base and there are TONS of things we can do better.

For e.g.... 🧵
onlinelibrary.wiley.com/doi/epdf/10.11…
Image The status quo for annual flu shots is little good premarket evidence and some post market surveillance.

Shown in figure

We think that is suboptimal.

One reason is... Image
Jul 28, 2024 • 18 tweets • 4 min read
As a doctor, I find this @nytimes essay IDIOTIC
This is abusing medicine to evade political choices

Let me explain why whether it is Trump, Biden, Harris or any other politician, asking for health records is STUPID

Here is why...
🧵 Image First, remember: When you vote for a president you don't just vote for 1 person. You vote for 1 person and a backup (their VP)

The next back up to that is the speaker of the house, for whom you indirectly vote for via congressional elections
Apr 10, 2024 • 8 tweets • 3 min read
Everything in this thread is incorrect. Literally every recommendation. Here's a thread why. 1/7 There's not a single randomized controlled trial that shows people who undergo a coronary artery calcium test live longer than those who do not undergo it. Everyone will benefit from increasing exercise and eating better and the score is irrelevant
Jan 9, 2024 • 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