TY @statnews I make two nerdy points:
1) Cancer screening has hard math vis-a-vis benefits vs harms
2) Last week's study with its booming conclusion that screening does not lengthen life is, at best, frail; for sure, misinterpreted; at worst, tilted. 1/n
statnews.com/2023/09/07/can… What’s that hard math? It starts with us inviting healthy people to be checked. That then:
- burdens those w/o cancer... time, money, false scares, overtreatment
- benefits a handful, through detection of early cancers that have better outcomes with less toxic treatment. 2/n

NORDICC study in @NEJM: it’s NOT negative. But it is a test whether you are an (amateur) frequentist or a (mid-level) Bayesian, and whether screening is an individual or population health intervention. (Worst lede ever, I know: 1/n) nejm.org/doi/full/10.10… Amateur frequentists are busy recording podcasts and posting substacks that "colonoscopy doesn’t reduce CRC mortality".
They are hanging their hats (and their cognition a little) on P-values/CI's. Gives a quick, click-worthy answer.

But Bayesian consider ‘priors’: 2/n

Intriguing @theNCI @NCIDrDougLowy @NEJM study showing lung cancer mortality rates falling since 2013 faster than incidence rates. Study title claims they observed the impact of improved treatments. I think that may be an overly strong conclusion. 1/n nejm.org/doi/full/10.10… To my read, the 'new Rx's reduced mortality" conclusion is built on on this (and only this) logic: 1) survival improved; 2) new Rx's were intro’d; 3) ergo new Rx's caused improved survival. They could have done so much more. (Warning, fractions appear in subsequent tweets) 2/n

So, news about dexamethasone out of UK RECOVERY trial. Large and statistically significant reduction in mortality for Covid-19 patients. Only have press release now, but there is a lot of good news here, and some questions 1/n Pause for a moment to appreciate that the UK (1/5th US population) running a multi-arm trial Covid Rx study 10x size of US govt (NIAID) study of Covid Rx's. This read-out includes 6x the US trial of Remdesivir. Merit of having a health care "system" I guess. 2/n

FWIW I think @statnews @adamfeuerstein @matthewherper did what they shld as journalists once they had @uchicago broadcast re: $GILD #remdesivir study. But I'd have preferred a different lede focused on @uchicago's sloppy scientific thinking, such as: statnews.com/2020/04/16/ear… 1/n “In a stunning deviation from standards of human subjects rsrch, investigators at 1 of 152 sites involved in an uncontrolled trial of Gilead’s remdesivir therapy for Covid-19 discussed early findings in a widely broadcast meeting that STAT received nearly instantly [tk]" 2/n

So, I posted an article in the @BostonGlobe last night suggesting we temporarily ban alcohol sales until home confinement is over. I have a two layer reason 1/n bostonglobe.com/2020/04/02/opi… a) alcohol use exacerbates domestic violence; c) confinement is undermining our domestic violence safeguards such as in person surveillance by professionals and sobriety maintenance through AA. It spurred some intense negative responses. 2/n

On @Health_Affairs, me on how @Novartis broke health economic analysis rules to justify Zolgensma’s price, rather than saying “Hey, @US_FDA gave us a monopoly and we are using it!” They say @icer_review supports $2.125MM per dose, not so fast. 1/n healthaffairs.org/do/10.1377/hbl… 4 places @Novartis strayed: cherry picking a sub-group, ignoring quality of life effects on value, comparing to over priced alternative rx, short pay over time horizon relative to long expected benefit time horizon, all detailed in @Novartis release novartis.com/news/media-rel… 2/n

1/x We asked @millimaninsight to analyze the financial impact of point of sale (POS) rebates in Medicare Part D, following on the HHS RFI on this notion. Once you start reading, you won’t be able to put this one down! s3.amazonaws.com/public-inspect… drugpricinglab.org/our-work/impac… 2/x. POS rebates = drug costs for pts reduced by the rebate negotiated by the PBMs, not how done today. POS rebates are also different from eliminating rebates as @SecAzar just proposed, discussed by @dusetzinaS and me @JAMA_current jamanetwork.com/journals/jama/…