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AdamRodmanMD's profile
Adam Rodman
Adam Rodman
Adam Rodman
@AdamRodmanMD

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Adam Rodman

@AdamRodmanMD

Internal medicine physician, educator, co-director @iMEDEducation @BIDMC_IM, host of #histmed podcast @BedsideRounds @ACPInternists. Opinions my own. He/him/his

Boston, MA
Joined March 2010

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    Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

    Reading more about the Tuskegee syphilis study, and I think there's a little nuance that makes the study even MORE ethically horrifying. The normal take is that the original rationale of the study (holding aside informed consent issues and the obvious racism) was legitimate.pic.twitter.com/9xvty91DXL

    8:30 AM - 17 Feb 2019
    • 10 Retweets
    • 19 Likes
    • second-class borough dweller Nicholas A. DeFilippo, PharmD (He/Him) Markian Gooley Miguel Galán de Juana 🏳️‍🌈 Judy Diraddo tas tā Ozymandias Q. Jones XXXIII⅓® Helen Alexander 3.5% 🏴󠁧󠁢󠁳󠁣󠁴󠁿 Take That, Medicine!
    2 replies 10 retweets 19 likes
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      2. Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

        The logic goes, in 1932, when the study was started, there were no safe or effective treatments for syphilis. Therefore, things don't get ethically mushy until penicillin is introduced during WW2.pic.twitter.com/esn8au7BrA

        1 reply 0 retweets 4 likes
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      3. Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

        The study was, after all, based on the Oslo syphilis study, starting in 1891 when Dr. Boeck withheld treatment from ~2000 patients based on that logic -- that the treatment was worse than the disease. Bruusgard's initial 1923 paper shown; here is 1955: https://www.sciencedirect.com/science/article/pii/0021968155901399 …pic.twitter.com/VH0yKqrv04

        2 replies 0 retweets 1 like
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      4. Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

        The problem? In 1891, standard of care was mercury, iodine, and (less commonly) bismuth. Boeck's hypothesis -- that the cure was worse than the disease -- was not unreasonable. And he stopped his experiment in 1910 -- the year that Salvarsan became commercially available.pic.twitter.com/ju8dJD0ZMi

        1 reply 0 retweets 4 likes
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      5. Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

        In 1932, the standard of care was arsenicals (Neosalvarsan, or more commonly mapharsen) in addition to Bismuth. And they appeared to work! Take this follow up from a study done in the early 30s of mapharsen + bismuth in the early 1930s (https://jamanetwork.com/journals/jamadermatology/article-abstract/517894 …)

        1 reply 0 retweets 2 likes
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      6. Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

        Follow up was not great, but ~80% of patients with 1o and 2o syphilis remained asymptomatic with neg serology. Doctors were also starting to experiment with mapharsen infusions, with allowed for a cure rate of 86.5% in a far shorter period of time (https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.31.6.545 …)

        1 reply 0 retweets 0 likes
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      7. Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

        So even WHEN the Tuskegee syphilis study was launched, there was reasonably effective and reasonably well-tolerated therapy for primary and secondary syphilis (though obviously nothing like penicillin) that was being offered to patients across the world.

        2 replies 0 retweets 7 likes
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      8. Adam Rodman‏ @AdamRodmanMD 17 Feb 2019

        Even its very rationale was ethically damning. Anyway, let me know your thoughts! I've been reading a lot about syphilis in preparation for the history of syphilis presentation I'm doing with @tony_breu.

        6 replies 0 retweets 5 likes
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      9. End of conversation
      1. Lindsay McNair‏ @lindsaymcnairmd 18 Feb 2019
        Replying to @AdamRodmanMD

        I’d have to find source, but remember reading that there was a tx program that was defunded. The natural hx study was started to show the bad outcomes of untreated syphillis and to persuade whomever was making decision to refund the tx program. Will try to find ref.

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