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GidMK's profile
Health Nerd
Health Nerd
Health Nerd
Verified account
@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 8 Jun 2020

      9/n So, for example, a retrospective analysis of routinely collected data was rated down because it was lead by a public health physician, but another almost identical piece of work was given a green square because a pulmonologist was in charge 🤔

      2 replies 0 retweets 27 likes
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    2. Health Nerd‏Verified account @GidMK 8 Jun 2020

      10/n The "detailed treatment" rating was similarly biased - many of the green studies in this chart had far worse descriptions of the treatment regimen than the JAMA study, which is redpic.twitter.com/0Xe8PV4UVg

      3 replies 0 retweets 17 likes
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    3. Health Nerd‏Verified account @GidMK 8 Jun 2020

      11/n There is also a column detailing which studies have rated HCQ/CQ as beneficial or not, which definitely shouldn't be included in a risk of bias segment This is INCREDIBLY misleading

      1 reply 2 retweets 35 likes
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    4. Health Nerd‏Verified account @GidMK 8 Jun 2020

      12/n Moreover, there is basically no discussion of how the final measure - conflict of interest - was actually collated. It wasn't from the disclosures on the studies (I checked)

      1 reply 0 retweets 16 likes
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    5. Health Nerd‏Verified account @GidMK 8 Jun 2020

      13/n So, all in all, the rating of the studies makes very little sense and is at best entirely inconsistent. It's hard to know what to make of this except that it doesn't help us understand the included research at all Moving on

      1 reply 0 retweets 22 likes
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    6. Health Nerd‏Verified account @GidMK 8 Jun 2020

      14/n The primary results are presented in this forest plot There are a number of issues herepic.twitter.com/eySEa84CWw

      1 reply 1 retweet 13 likes
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    7. Health Nerd‏Verified account @GidMK 8 Jun 2020

      15/n Firstly, different results from THE SAME studies on THE SAME patients have been aggregated together This is guaranteed to bias the results, and makes the aggregated estimate largely worthless (red box = repeated)pic.twitter.com/cEeG2Ojd7A

      1 reply 4 retweets 29 likes
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    8. Health Nerd‏Verified account @GidMK 8 Jun 2020

      16/n (N.B. some of these estimates are not the SAME patients, they are different groups from the same study. This is also bad practice, and likely to bias the estimate, but not quite as problematic)

      1 reply 0 retweets 17 likes
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    9. Health Nerd‏Verified account @GidMK 8 Jun 2020

      17/n But there's an even bigger issue here Some of these numbers are almost certainly wrong

      1 reply 0 retweets 11 likes
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    10. Health Nerd‏Verified account @GidMK 8 Jun 2020

      18/n Now, the authors report very opaquely on how they derived the odds ratios that are used in this table (essentially "we plugged it into the software"), but some of these figures are enormously divergent from the actual reported outcomespic.twitter.com/qildjuRiOy

      1 reply 2 retweets 21 likes
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      Health Nerd‏Verified account @GidMK 8 Jun 2020

      19/n For example, let's look at this preprint that was included in the research The odds ratio for "Persistent viral shedding" is 0.75 (0.42-1.35), with lower values favoring HCQ/CQ I.e. 25% LOWER odds of persistent viral shedding for HCQpic.twitter.com/cBAnMtdfUz

      8:39 PM - 8 Jun 2020
      • 11 Likes
      • HopeInTheUSA🌸 GrosNiᐰis 💉💉 🌿⌬ArSchi⌬🌿 2/2💉 Xypocat Amaras Tosh`iki zenutopia Dr Tharin Blumenschein 💙
      1 reply 0 retweets 11 likes
        1. New conversation
        2. Health Nerd‏Verified account @GidMK 8 Jun 2020

          20/n But if we look at the paper, this doesn't make sense Of the HCQ group, 22/75 had a persistent viral load Of the control, it was 19/75 If you work the odds ratio out, you get 1.22, i.e. 22% HIGHER FOR HCQpic.twitter.com/UcUqyc7t0x

          2 replies 0 retweets 23 likes
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        3. Health Nerd‏Verified account @GidMK 8 Jun 2020

          21/n In other words, not only is the figure in the meta-analysis wrong, it seems to be in entirely the opposite direction to the true result That's very worrying, and hard to explain

          1 reply 2 retweets 38 likes
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        4. Health Nerd‏Verified account @GidMK 8 Jun 2020

          22/n (One thing that gives you an answer more similar to the number they've got is calculating odds based on the %s given in the KM curve rather than the crude figures, but that has its own issues)

          1 reply 0 retweets 12 likes
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        5. Health Nerd‏Verified account @GidMK 8 Jun 2020

          23/n There's also no reasoning given for including multiple different outcomes from the SAME PATIENTS in a meta-analysis This is very concerning

          1 reply 1 retweet 15 likes
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        6. Health Nerd‏Verified account @GidMK 8 Jun 2020

          24/n For example, they've got some studies where they included numbers on the likelihood of a "clinical cure" AND "death" from the same patients These are obviously related, so aggregating both in the same model is...problematic

          1 reply 3 retweets 12 likes
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        7. Health Nerd‏Verified account @GidMK 8 Jun 2020

          25/n It's also worth noting that several of these retrospective clinical audits were from the same places at overlapping times, and so probably included some of the same patients anyway

          1 reply 0 retweets 10 likes
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        8. Health Nerd‏Verified account @GidMK 8 Jun 2020

          26/n There are, somehow, even more issues to examine here For one thing, the review protocol was poorly described and hard to followpic.twitter.com/AVrJ50Kx6s

          1 reply 0 retweets 6 likes
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        9. Health Nerd‏Verified account @GidMK 8 Jun 2020

          27/n Remember; this is the pre-proof version of the study In other words, the final, slightly unedited, publishable version In that context, this methodology is FAR too opaque

          1 reply 1 retweet 11 likes
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        10. Health Nerd‏Verified account @GidMK 8 Jun 2020

          28/n The results show you what I'm talking about There is NO WAY that searching with those search terms gets you only 23 studies Even just plugging in the search terms to PubMed gives you >100 studiespic.twitter.com/73Qn7v1x9u

          1 reply 0 retweets 13 likes
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        11. Health Nerd‏Verified account @GidMK 8 Jun 2020

          29/n It took me less than 5 minutes to find a study that matches the inclusion criteria but was not included That's...worrying

          1 reply 2 retweets 28 likes
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        12. Health Nerd‏Verified account @GidMK 8 Jun 2020

          30/n On top of that, in some cases the authors have included older versions of the included studies That's less than ideal (newer versions CORRECT mistakes!)

          1 reply 0 retweets 15 likes
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        13. Health Nerd‏Verified account @GidMK 8 Jun 2020

          31/n There is so much more I could look at here, but honestly you have to stop somewhere This study is riddled with flaws and almost certainly does not present an accurate estimate of the effect of HCQ or CQ

          4 replies 3 retweets 21 likes
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        14. Health Nerd‏Verified account @GidMK 8 Jun 2020

          32/n If you want a decent summation of the evidence for/against HCQ, a good source is CEBM: "Current data do not support the use of hydroxychloroquine for prophylaxis or treatment of COVID-19"https://www.cebm.net/covid-19/hydroxychloroquine-for-covid-19-what-do-the-clinical-trials-tell-us/ …

          2 replies 5 retweets 22 likes
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        15. Health Nerd‏Verified account @GidMK 8 Jun 2020

          33/n I forgot to mention, the paper was received, revised, and accepted within a month While not unheard of, that's very quick for academic publishing!pic.twitter.com/UgR3WO2BPB

          2 replies 2 retweets 14 likes
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        16. Health Nerd‏Verified account @GidMK 8 Jun 2020

          34/n In summation, the paper: - inadequately rates risk of bias - inappropriately combines estimates... - ...that may have been miscalculated It is hard to know what to make of this, except to say that the paper itself is not very useful in any way

          2 replies 6 retweets 29 likes
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        17. End of conversation

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