Chief Med Officer @DELFIdiagnostic. Pulmonary & ICU doc. Tweets about health policy and grammar. Viewpoints my own.
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Sep 7, 2023 • 7 tweets • 3 min read
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
Oct 10, 2022 • 8 tweets • 3 min read
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
Aug 13, 2020 • 10 tweets • 4 min read
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
Jun 16, 2020 • 7 tweets • 2 min read
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
Apr 17, 2020 • 4 tweets • 3 min read
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
Apr 3, 2020 • 12 tweets • 3 min read
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
Jun 18, 2019 • 9 tweets • 7 min read
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
