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... 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

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 🧵
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

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…
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...

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...
🧵 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

Everything in this thread is incorrect. Literally every recommendation. Here's a thread why. 1/7

https://twitter.com/FitFounder/status/1777720881709560293

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

https://twitter.com/FitFounder/status/1777720892073587058?t=oVc9vHhNzNwg9zN8s1jsUg&s=19

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 data 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

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…
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

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 When it comes to biomarkers there are 3 categories
Prognostic
Predictive &
Surrogate
#ASH23
jamanetwork.com/journals/jama/…

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

https://twitter.com/brian_goldstone/status/1727093750688895078

https://twitter.com/nicholasklemen/status/1727158935562367053?t=-FKkDIrS14UPeVJDDO1YSQ&s=19

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…
... 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

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.

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…

https://twitter.com/NatRevClinOncol/status/1712497894329045058

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

Here is the complete list of concerning COVID variants I am tracking 1/8 And here is the list of precautions wise people are taking 2/8

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…
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/

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

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 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....

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

https://twitter.com/MarkLevineNYC/status/1666559651272376320

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.

Public health 'experts' went on Twitter in Summer 22 to say we should mask kids and close schools because of Monkeypox.

We analyze the spread of this misinformation & wonder why it happened in our paper (thread)
- paper

- blog medrxiv.org/content/10.110…
sensiblemed.substack.com/p/public-healt…
First, a lay summary of the preprint is on substack now @Sensible__Med

The short story is that in the Spring and summer of 22, people were worried about Monkeypox. By June 22, the epi was clear. It was being spread overwhelmingly by men who have sex with men.

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

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...

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