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GidMK's profile
Health Nerd
Health Nerd
Health Nerd
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@GidMK

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Health NerdVerified account

@GidMK

Epidemiologist. Writer (Guardian, Observer etc). "Well known research trouble-maker". PhDing at @UoW Host of @senscipod Email gidmk.healthnerd@gmail.com he/him

Sydney, New South Wales
theguardian.com/profile/gideon…
Joined November 2015

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    1. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Ok, so, what did the authors actually do? Well, they took a bunch of people who were given remdesivir while very sick with COVID-19 and followed them up for at least 1 day afterpic.twitter.com/cwiIdFKAOd

      2 replies 5 retweets 17 likes
      Show this thread
    2. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Given that the protocol is dated a month after the enrolment of the last patient, we can assume that this was a RETROSPECTIVE trial I.e. all of this treatment was done, then the authors decided to look at the datapic.twitter.com/nWmGWJGyqn

      2 replies 10 retweets 28 likes
      Show this thread
    3. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Nothing wrong with retrospective observational trials, but it means we have to be REALLY cautious about causal conclusions

      1 reply 5 retweets 31 likes
      Show this thread
    4. Health Nerd‏Verified account @GidMK 12 Apr 2020

      The study design was very simple - extremely sick people were given the drug on compassionate grounds (i.e. we don't know if it works but they might die anyway), and then their records were examined to see what happenedpic.twitter.com/ZRbmLhdKiY

      1 reply 4 retweets 16 likes
      Show this thread
    5. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Halfway through the methods, we get this wonderful gem It seems the paper was ghostwritten by a Gilead employee (who is NOT an author) That's an amazing thing to have published in a @NEJM paper!!!pic.twitter.com/e4NAiDaWnR

      3 replies 22 retweets 67 likes
      Show this thread
    6. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Don't get me wrong, it happens all the time, but rarely is it acknowledged so blatantly in the text It also appears to go against @NEJM editorial guidelines which...isn't great?pic.twitter.com/yGnjNV9fXr

      2 replies 7 retweets 31 likes
      Show this thread
    7. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Statistical analysis appears reasonable, except for this gem Seems like they're basically saying "because the analysis method we chose couldn't easily accommodate best practice, we didn't do it"pic.twitter.com/oZCk7lD4TS

      1 reply 5 retweets 22 likes
      Show this thread
    8. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Given that this was a RETROSPECTIVE study, it seems likely that they could've just...used a different analysis methodology if they thought that multiple comparisons would be an issue? Weird

      1 reply 4 retweets 19 likes
      Show this thread
    9. Health Nerd‏Verified account @GidMK 12 Apr 2020

      Anyway, on to the results, and this delightful first paragraph Titled "patient randomization" but doesn't talk about randomization (because there wasn't any) The perils of extra-short peer review perhaps?pic.twitter.com/2HffuB5Vw5

      2 replies 6 retweets 32 likes
      Show this thread
    10. Health Nerd‏Verified account @GidMK 12 Apr 2020

      The paragraph also isn't good news for the study's rigor Of 61 total patients, 8 were excluded because of missing information Of the remaining 53, only 40 received the full course of the drug

      1 reply 4 retweets 15 likes
      Show this thread
      Health Nerd‏Verified account @GidMK 12 Apr 2020

      Worth pointing out at this point that there's NO CONTROL GROUP That's a huge problem for inference - how do we know if any improvement seen in this trial had anything to do with the drug?

      8:42 PM - 12 Apr 2020
      • 6 Retweets
      • 34 Likes
      • 🌎 Richard Alexander Unni Gopinathan Peter A. Carr 𝐏𝐚𝐨𝐥𝐚 𝐂𝐮𝐛𝐢𝐥𝐥𝐨𝐬 𝐌𝐃 🇨🇴🇨🇦 Cactuar512 Bobby Blue Byrd kanluran || el oeste || west || 西 Kevin Folta Dr. Robert Josphine
      2 replies 6 retweets 34 likes
        1. New conversation
        2. Health Nerd‏Verified account @GidMK 12 Apr 2020

          On to the patient demographics It's a relatively young, although fairly unhealthy population About what you'd expect given the inclusion criteria (although a bit younger perhaps)pic.twitter.com/TKCQ04GwFC

          2 replies 1 retweet 7 likes
          Show this thread
        3. Health Nerd‏Verified account @GidMK 12 Apr 2020

          And here we get to the main results Of the patients (53) treated with remsevidir, most improved! The death rate also appears to have been pretty low at only 13% (7/53)pic.twitter.com/8VogvKfDxU

          1 reply 1 retweet 7 likes
          Show this thread
        4. Health Nerd‏Verified account @GidMK 12 Apr 2020

          Remember, these were VERY sick people. In groups admitted to an ICU for #COVID19, the median death rate is usually around 30%

          2 replies 1 retweet 11 likes
          Show this thread
        5. Health Nerd‏Verified account @GidMK 12 Apr 2020

          The authors have constructed an arbitrary ordinal scale here from 1-6, where 6 is the worst (death) and 1 is the best (discharged) Based on this scale, most patients improved on remdesivirpic.twitter.com/UtcUDlTvzX

          1 reply 1 retweet 5 likes
          Show this thread
        6. Health Nerd‏Verified account @GidMK 12 Apr 2020

          HOWEVER, there was a huge issue here Most patients didn't have the follow-up required to perform this calculation. In fact, based on the IQR presented here, less than 25% had 28 days follow-up data to analyze!pic.twitter.com/asI1gDSlEV

          1 reply 2 retweets 15 likes
          Show this thread
        7. Health Nerd‏Verified account @GidMK 12 Apr 2020

          Younger people did better than older, people who were not mechanically ventilated did better than those who were (not surprising perhaps)pic.twitter.com/2gHltBjWHt

          2 replies 1 retweet 7 likes
          Show this thread
        8. Health Nerd‏Verified account @GidMK 12 Apr 2020

          There were also a large number of reported side-effects, although given the lack of a control group and how sick these people were it's very hard to know if they had anything to do with remdesivirpic.twitter.com/9YS5cmlhxm

          2 replies 2 retweets 10 likes
          Show this thread
        9. Health Nerd‏Verified account @GidMK 12 Apr 2020

          As a fun statistical point, the confidence intervals for some of these regression analyses were, uh, pretty wide Older patients had between 35% and 9417% increase risk of death!pic.twitter.com/HMsGPPYXfs

          1 reply 3 retweets 20 likes
          Show this thread
        10. Health Nerd‏Verified account @GidMK 12 Apr 2020

          So what does this all mean? Well, the authors talk about it in their discussion Apparently, the mortality rate was lower than expected, which is "noteworthy"pic.twitter.com/VCSblvjbs5

          1 reply 1 retweet 7 likes
          Show this thread
        11. Health Nerd‏Verified account @GidMK 12 Apr 2020

          Health Nerd Retweeted Health Nerd

          Now, I'd argue that this is...problematic It is extremely difficult to compare patients across trials, and absolutely NOT best practice We also saw a high dropout rate in the trial, with 20% of patients not receiving the complete treatment!https://twitter.com/GidMK/status/1249547200834580485?s=20 …

          Health Nerd added,

          Health NerdVerified account @GidMK
          So what does this all mean? Well, the authors talk about it in their discussion Apparently, the mortality rate was lower than expected, which is "noteworthy" pic.twitter.com/VCSblvjbs5
          Show this thread
          1 reply 3 retweets 10 likes
          Show this thread
        12. Health Nerd‏Verified account @GidMK 12 Apr 2020

          We also have very few patients in this trial, and no control group Also, the patients were selected by their doctors - perhaps picking the patients that they thought had a fighting chance? We can't really say whether the death rate was low or high from the data we have!

          2 replies 2 retweets 13 likes
          Show this thread
        13. Health Nerd‏Verified account @GidMK 12 Apr 2020

          To the author's credit, the final paragraph acknowledges most of this!pic.twitter.com/0TdO2drS1C

          2 replies 2 retweets 12 likes
          Show this thread
        14. Health Nerd‏Verified account @GidMK 12 Apr 2020

          Let's sum up: ❌very small retrospective trial ❌no control group ❌written by pharma funder ❌high dropout ❌short timeframe ❌missing data ❌poorly written/edited ❌somewhat odd stats ❌highly selected patient cohort ✅no causal conclusions!

          6 replies 29 retweets 95 likes
          Show this thread
        15. Health Nerd‏Verified account @GidMK 12 Apr 2020

          Basically, it was a very small study with HUGE caveats that showed an interesting possibility Hard to say anything more than that without a proper trial of some kind

          5 replies 4 retweets 28 likes
          Show this thread
        16. Health Nerd‏Verified account @GidMK 12 Apr 2020

          Some might argue that this should not have been published as a research trial, given the many caveats and huge conflicts of interest this study seems to contain I guess that's a question for @NEJM, who appear to have garnered millions of reads on the article in the last few days

          5 replies 6 retweets 34 likes
          Show this thread
        17. End of conversation

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