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Is there a difference between Jay Varma for tecovirimat and Ashish Jha for Paxlovid?
Ashish Jha used a media campaign to push paxlovid, just as SigaTech wanted Varma to do. Ashish exploited the lay press, and was part of an administration that spent over 10 billion dollars on the drug— without randomized data it helps Americans who had already had covid, had vaccines or against prevailing strains, i.e. most of us.
Ashish Jha is just like Jay Varma— a public health figure pushing a corporate product based on propaganda and not science. If anything Jha’s advocacy of Paxlovid is worse than Varma’s advocacy of tecovirimat for 4 reasons
Monkeypox is rarer than covid, which makes randomized trials harder.
Monkeypox is mostly isolated to Africa, while COVID was widespread (easier to run trials)
Tecovirimat is often given to sicker pts than outpatient paxlovid (less dire)
Tecovirimat spending will be less than 10 billion.
Jay Varma admits that SigaTech wanted him to create a media narrative around tecovirimat to approve and sell it, even while randomized trials were ongoing and evidence unclear. Ashish Jha actually did create a media narrative around a costly pill with horrific drug-drug interactions to millions of Americans when the best data showed it would not help them. He did so because his boss spent billions on the drug, and had political advantage to push it, even if it were nothing better than placebo, in order to reassure his supporters who were still afraid of covid because they created exaggerated fear in young people.
An overdose of second opinions
To me we live in a bizarre world. Doctors take hundreds of thousands of dollars from pharmaceutical companies and then recommend those costly, toxic drugs to patients for uses that lack good randomized data. The same doctors help the companies design the trials that repeatedly fail to run the right comparisons— which help ensure that their unproven recommendations remain unfalsifiable (you can’t say they are wrong, just that there is no proof they are right). The hospitals make money from autotransplant, and refuse to heed evidence saying it has no survival benefit (DETERMINATION). The doctors make money from second opinions, and don’t care if they confuse the patient while indulging their fantasy of being the best doctor. The system is fundamentally broken. It won’t be reformed from within. Only external pressure can crack it.
The first step you can do: is search your oncologist for drug company payments on open-payments and be skeptical when they take money from Abbvie and recommend venetoclax maintainence.
An overdose of second opinions
The patient printed out information on all these regimens and sought guidance. Each ‘expert’ was adamant. What should she do?
The answer was, of course, every ‘expert’ was making shit up. There was no right answer. Among all these options, we only have a few large randomized studies to provide lamplight in the darkness.
Acetazolamide for OSA and Central Sleep Apnea: A Comprehensive Systematic Review and Meta-Analysis - PubMed
Overall, acetazolamide vs control lowered the AHI by -0.7 effect sizes (95% CI, -0.83 to -0.58; I2 = 0%; moderate QoE) that corresponded to a reduction of 37.7% (95% CI, -44.7 to -31.3) or 13.8/h (95% CI, -16.3 to -11.4; AHIControl = 36.5/h). The AHI reduction was similar in OSA vs CSA, but significantly greater with higher doses (at least up to 500 mg/d). Furthermore, acetazolamide improved oxygen saturation nadir by +4.4% (95% CI, 2.3 to 6.5; I2 = 63%; no evidence of effect modification; very low QoE) and several secondary outcomes that included sleep quality measures and BP (mostly low QoE).
Kaiser Permanente brings new AI tool to help doctors focus on patients
“By reducing administrative tasks, we’re making it easier for our physicians to focus on patients and foster an environment where they can provide effective communication and transparency while meeting the individual needs of each patient who comes to them for care,” he said. “Creating space for the patient and the physician connection is what inspired us to implement this technology. And we hope that those connections and improved efficiencies will help with the sustainability of the practice of medicine for many doctors.”
The ChatGPT chatbot powered by GPT-4 scored better than the panelists on measures of diagnostic and treatment accuracy when it analyzed 20 real-life cases and considered 20 possible patient questions, reported Andy S. Huang, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in JAMA Ophthalmology
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Physical interventions to interrupt or reduce the spread of respiratory viruses - Jefferson, T - 2023 | Cochrane Library
The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection.
Opinion | The Mask Mandates Did Nothing. Will Any Lessons Be Learned? - The New York Times
But when it comes to the population-level benefits of masking, the verdict is in: Mask mandates were a bust. Those skeptics who were furiously mocked as cranks and occasionally censored as “misinformers” for opposing mandates were right. The mainstream experts and pundits who supported mandates were wrong. In a better world, it would behoove the latter group to acknowledge their error, along with its considerable physical, psychological, pedagogical and political costs.
Hospital Bills Inflated by Surgeons Double Booking - Bloomberg
The University of Southern California’s hospital system is accused of billing for thousands of cases - costing taxpayers “hundreds of millions of dollars” - where the teaching physician left residents unattended to perform even spine and brain surgeries. When one doctor confronted a department head about an “embarrassingly high” rate of surgical injuries at one of its facilities, the administrator responded, according to the lawsuit:
“Well, that’s where the residents go to practice on the poor folks.”
Doctors watching pharma TV ads in ‘blue jeans moments’ often search to find out more, Roku survey says – Endpoints News
More than two-thirds (67%) of physicians said they researched a product after seeing a pharma ad while watching TV.
Is Doctor Pay Too High? NIH Pulls Plug on Misinfo Research; FDA and EPA Butt Heads | MedPage Today
Previous NIH Director Francis Collins, MD, PhD, publicly proposed the project idea in 2021, saying, "We basically have seen the accurate medical information overtaken, all too often, by the inaccurate conspiracies and false information on social media," and "I do think we need to understand better how -- in the current climate -- people make decisions."
America’s Love Affair with Adderall | The Free Press
Each maintained their childhood prescriptions throughout high school and college, and into their professional lives. Each had a wake-up call that prompted them to get off the drug. For Sloan Tate, it was realizing she lacked the emotional capacity to mourn when her grandmother died. Alex Cosec, a 32-year-old guitar player, real estate photographer, and fitness coach from Minneapolis, told me he decided to join Narcotics Anonymous after his ex-girlfriend called the cops on him when he took too much Adderall, among other substances, and began throwing things in their apartment.
“I’m the Adderall addict,” Cat Marnell told me. She has a claim to the title. At one point she was taking 120 milligrams of Adderall a day (60 milligrams is a high prescription dose). She wrote a book about it. She’s been in rehab for Adderall five times. Marnell was prescribed Adderall at 19 after being on Ritalin for most of her life. Adderall was different for Marnell. “Adderall was much more of a narcotic experience, and so at age 19 that was very appealing to me to be flying high from it. And that very swiftly turned into sleepless nights, dependency, obsession, a celebration of it. I was absolutely in love with Adderall,” she told me.
America’s Love Affair with Adderall | The Free Press
Many TikTok videos list ways to get an Adderall prescription online and how to self-diagnose ADHD (three symptoms cited by the CDC include being “easily distracted,” acting as if “driven by a motor,” and having “trouble organizing tasks and activities”). Studies have found that watching TikTok increases self-diagnosis for ADHD. The hashtag #ADHD has 14 billion views, and #ADHDdiagnosis has 46.1 million views.
Last year the company Cerebral, which provides online therapy and medication, was the third largest advertiser on TikTok after Amazon and HBO. After filling out a questionnaire, followed by a 30-minute video call with a “licensed prescriber,” Cerebral can provide an ADHD diagnosis and prescription for medication.
America’s Love Affair with Adderall | The Free Press
Over the past few months, however, things have changed. James has been waking up around 1:00 p.m. “I don’t really ever start my day,” he says. He has to make to-do lists to keep himself on track and to remember basic chores like laundry and homework.
The cause is the nationwide shortage of Adderall, which the FDA declared about eight months ago. Without his daily pills, James is unraveling: “I no longer have the self-motivating chemicals to go outside,” he told me. “I’m definitely feeling really down.”
The results show that in about half of the cases where researchers were able to closely mimic the design of the corresponding RCT using RWD, the RWE study came to a similar conclusion as the analogous RCT. In many cases where RWE and RCTs did not come to a similar conclusion, the RCT design itself did not align with real-world clinical practice, creating a challenge for emulation of the trial using RWD. In these instances, RWE and RCTs may both be reaching meaningful conclusions, but to subtly different research questions.
Exercise Is Even More Effective Than Counselling or Medication for Depression - Neuroscience News
When comparing the size of the benefits of exercise to other common treatments for mental health conditions from previous systematic reviews, our findings suggest exercise is around 1.5 times more effective than either medication or cognitive behaviour therapy.
FDA vaccine advisers 'disappointed' and 'angry' that early data about new Covid-19 booster shot wasn't presented for review last year | CNN
It found that 1.9% of the study participants who received the original booster became infected. Among those who got the updated bivalent vaccine – the one that scientists hoped would work better – a higher percentage, 3.2%, became infected. Both versions of the shot were found to be safe.
This infection data was far from complete. The number of study subjects who became infected was very small, and both the patients and the researchers were aware of who was getting the original shot and who was getting the new booster.
Despite these imperfections, the data was included in a preprint study that was posted online in June, again in September in an FDA document and then later that month in a top medical journal – and advisers to the FDA and the CDC said the data should have been shared with them, too.
FDA vaccine advisers 'disappointed' and 'angry' that early data about new Covid-19 booster shot wasn't presented for review last year | CNN
“I was angry to find out that there was data that was relevant to our decision that we didn’t get to see,” said Dr. Paul Offit, a member of the Vaccines and Related Biological Products Advisory Committee, a group of external advisers that helps the FDA make vaccine decisions. “Decisions that are made for the public have to be made based on all available information – not just some information, but all information.”
How Some Parents Changed Their Politics in the Pandemic - The New York Times
Ms. Longnecker and her fellow objectors are part of a potentially destabilizing new movement: parents who joined the anti-vaccine and anti-mask cause during the pandemic, narrowing their political beliefs to a single-minded obsession over those issues. Their thinking hardened even as Covid-19 restrictions and mandates were eased and lifted, cementing in some cases into a skepticism of all vaccines.
Nearly half of Americans oppose masking and a similar share is against vaccine mandates for schoolchildren, polls show. But what is obscured in those numbers is the intensity with which some parents have embraced these views. While they once described themselves as Republicans or Democrats, they now identify as independents who plan to vote based solely on vaccine policies.
Why are antidepressants so overprescribed? And what to do about it? - HealthSense
Withdrawal symptoms are most likely to occur when medications are stopped abruptly, after prolonged use, and at higher doses. Withdrawal can be very unpleasant and scary, causing lethargy, sadness, anxiety, irritability, trouble concentrating, sleep problems, nightmares, ’flu symptoms, nausea, dizziness, and strange sensations. They can also go on for a long time. Twenty-five per cent of users are still experiencing some symptoms after 3 months, and for some withdrawal can last 6 months.(4) Withdrawal occurs when doctors fail to deprescribe slowly enough or patients stop on their own. Partly because of the widespread misconception that antidepressants don't cause withdrawal, patients and doctors routinely misinterpret the symptoms as relapse – triggering what is often unneeded long term treatment.
BMJ fights back against Facebook fact-checkers - The Post
Despite being fully evidenced and error-free, Lead Stories, a company that conducts around half of all fact-checking on Facebook, said the article was “missing context” and stated that a whistle-blower at the heart of the investigation failed to “express unreserved support for covid vaccines”. The fact-checking company later commented that it was concerned about who was sharing the article online. In other words, the documentation of research and investigation in some areas is not permitted if it risks causing the infantilised public to stray from their designated path.
Matt Taibbi’s TK News Joins the List of Media Outlets Alarmed at Facebook Censorship
Then I went to the “fact check,” and it was just insane. It looked like it’d been written by high school students. It describes the British Medical Journal as a “blog.” I was joking with my editors about how they work. They pick some proposition out of the blue and then they debunk it, and it’s like, “Aha, win!” Bullshit. It’s like, “Did the BMJ prove that the vaccine kills Martians? No! Fact check: wrong.” And you’re thinking, “Wait, what?”
Here’s what they do. They’re not fact checking facts. What they’re doing is checking narratives. They can’t say that your facts are wrong, so it’s like, “Aha, there’s no context.” Or, “It’s misleading.” But that’s not a fact check. You just don’t like the story.
By the mid-1950s, Lazarsfeld’s group had extended their argument into medicine, through a study contracted by Pfizer about the factors that influenced doctors in the USA to adopt a new drug. In this landmark study5, the authors asked the fundamental question that continues to drive every pharmaceutical marketing operation to this day: “What were the social processes that intervened between the initial trials of the drug by a few local innovators and its final use by virtually the whole medical community?” The simple answer: the implementation of a new drug is all about promoting and expanding “the effectiveness of interpersonal relations at each stage of the diffusion process”.
A moratorium on strong recommendations is needed | The BMJ
Medicine is addicted to so-called hopium, an unwarranted confidence in the value of its tests and treatments. Clinicians overestimate their value,1 while experts on guideline panels make strong recommendations about care backed by untrustworthy evidence.2 Rigorous guideline methods can highlight this problem, but they are far from a perfect antidote—it is time for a moratorium on strong recommendations.
In a linked paper (doi:10.1136/BMJ-2021-066045),3 Yao and colleagues report that almost half (1246 of 2528) of the recommendations issued by the leading American cardiology and oncology professional societies were strong, “just do it” recommendations.4 About a quarter (354 of these were based on low certainty evidence. Compared to a consensus process, an evidence based guideline process reduced the risk of issuing such inappropriately strong recommendations, but not completely: the evidence based approach produced about a third (105 of 354) of the inappropriately strong recommendations in this study. Most of them simply conveyed the panels’ overconfidence in the benefit of following their recommendation.
Looking to Tackle Prescription Overload - The New York Times
One way is for patients themselves to combat polypharmacy, by regularly asking their doctors to reassess their medications — sometimes bringing every pill bottle, including supplements, to an appointment for a “brown bag review.” A short list of potentially inappropriate drugs, published by the American Geriatrics Society, can help them spot problems.
That is essentially what Leslie Hawkins did for her mother, Dr. Nothelle said. “Every time she had a health care interaction, she asked, ‘Do we need this? Can we lower this? Can we stop this?’”
Ten months passed before Ms. Harrison could see her geriatrician again, and by then, “she was a completely different person,” Dr. Nothelle said. “She was awake, she answered my questions. It was night and day.”
Ms. Harrison’s score on the 30-question cognition test jumped from three to 25. She is starting physical therapy to improve her mobility. And she is taking four drugs — insulin, a blood pressure medication and two anti-depressants — instead of 14.
How Big Pharma Finds Sick Users on Facebook – The Markup
Ads for Latuda, an antipsychotic from the company Sunovion used in the treatment of bipolar depression, were shown to users with an interest in the Depression and Bipolar Support Alliance, a nonprofit support group. We also found it targeted at users interested in therapy and the National Alliance on Mental Illness.
