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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 Feb 14

      Health Nerd Retweeted David Davis

      This vitamin D/COVID-19 study has gone viral, because the results appear to be impressive and people love promoting vitamin D Unfortunately, the study itself is...problematic Some peer-review on twitter 1/nhttps://twitter.com/DavidDavisMP/status/1360647462197878791 …

      Health Nerd added,

      David DavisVerified account @DavidDavisMP
      This is a very important study on vitamin D and Covid-19. Its findings are incredibly clear. An 80% reduction in need for ICU and a 60% reduction in deaths, simply by giving a very cheap and very safe therapy - calcifediol, or activated vitamin D. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3771318# …
      Show this thread
      51 replies 652 retweets 1,686 likes
      Show this thread
    2. Health Nerd‏Verified account @GidMK Feb 14

      2/n The study itself is here https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3771318 … At first glance, it appears to be a randomized controlled trial comparing calcifediol (vitamin D metabolite) to a control for severe COVID-19 with amazing outcomes (60% mortality reduction 👀)pic.twitter.com/CsaNlB69ZB

      1 reply 10 retweets 111 likes
      Show this thread
    3. Health Nerd‏Verified account @GidMK Feb 14

      3/n So, if you only glance at the abstract, you get the picture of an amazing positive result for vitamin D But reading further, the problems start almost immediately

      2 replies 15 retweets 118 likes
      Show this thread
      Health Nerd‏Verified account @GidMK Feb 14

      4/n Firstly, the study type. People are talking about this as "randomized" because the authors use that word in the abstract But the authors didn't actually randomize patients!pic.twitter.com/e5BVM9cLgC

      1:23 PM - 14 Feb 2021
      • 16 Retweets
      • 158 Likes
      • Knight in rusty armour Animammalia John Bhupinder Thakur 𝖙𝖆𝖘𝖍𝖆 Gerardo Perrotta Caitlin Pentland 💫 Randolf Richardson 張文道 🇨🇦 Rachael Priddle
      2 replies 16 retweets 158 likes
        1. New conversation
        2. Health Nerd‏Verified account @GidMK Feb 14

          5/n What the authors describe doing is, depending on how you read it, either a cluster-randomized trial with a sample size of 8, or a completely uncontrolled observational trial I think it's almost certainly the latter

          3 replies 14 retweets 177 likes
          Show this thread
        3. Health Nerd‏Verified account @GidMK Feb 14

          6/n Why? Well, a big clue is that this is what the authors got ethics approval to do. Another clue is that nowhere in the study is an actual method for randomization described!pic.twitter.com/8kG103qNlG

          2 replies 12 retweets 153 likes
          Show this thread
        4. Health Nerd‏Verified account @GidMK Feb 14

          7/n If the authors did indeed do a randomized trial on participants who consented only to a cohort study, it is a decidedly non-trivial issue Where I live, there would be firings, lawsuits, and potentially criminal proceedings

          1 reply 10 retweets 157 likes
          Show this thread
        5. Health Nerd‏Verified account @GidMK Feb 14

          8/n More likely, in my opinion, is that this is simply as the authors describe an observational cohort study of people in hospital who were either given calcifediol or not. They just use the word randomize incorrectly

          2 replies 11 retweets 132 likes
          Show this thread
        6. Health Nerd‏Verified account @GidMK Feb 14

          9/n But even then, there are massive issues For example, the PRIMARY ANALYSIS (60% mortality reduction) excludes ~20% of their total sample because of missing baseline data on vitamin D statuspic.twitter.com/jPDvuCHBrZ

          2 replies 17 retweets 131 likes
          Show this thread
        7. Health Nerd‏Verified account @GidMK Feb 14

          10/n And we get no information whatsoever on these missing people. Were they from the treated group? The control? Did they die, go to ICU etc? We have no idea!

          3 replies 10 retweets 116 likes
          Show this thread
        8. Health Nerd‏Verified account @GidMK Feb 14

          11/n Another issue is that there were 8 presumably quite different COVID-19 wards, but the authors basically ignore these differences. There is no discussion of the purpose of the wards, and no correction for it in the statistical model

          3 replies 10 retweets 132 likes
          Show this thread
        9. Health Nerd‏Verified account @GidMK Feb 14

          12/n Could the results be explained by different wards having different admissions protocols? Potentially, but we are given no information to make this assessment at all

          2 replies 8 retweets 116 likes
          Show this thread
        10. Health Nerd‏Verified account @GidMK Feb 14

          13/n This is even more troubling when you consider that the baseline vitamin D levels are different in the treated and control patients (for whom there was vit D information) So we know that the wards were different, but we don't know how much or whypic.twitter.com/Zr4TFceOOE

          6 replies 10 retweets 124 likes
          Show this thread
        11. Health Nerd‏Verified account @GidMK Feb 14

          Health Nerd Retweeted Neil O'Leary

          14/n There's more. If this WAS indeed a cluster RCT (I'm skeptical), then the authors did the wrong analysis and the results are probably actually non-significant Excellent thread here:https://twitter.com/lycraolaoghaire/status/1360765704849481731?s=20 …

          Health Nerd added,

          Neil O'Leary @lycraolaoghaire
          A cluster-randomised trial with 5 wards in the treatment arm and 3 wards in the control arm. Only it's not described as such. Did they control for the correlation of outcomes within ward? https://twitter.com/DavidDavisMP/status/1360647462197878791 … pic.twitter.com/cHYBI9j4zc
          Show this thread
          2 replies 10 retweets 111 likes
          Show this thread
        12. Health Nerd‏Verified account @GidMK Feb 14

          Health Nerd Retweeted F. Perry Wilson, MD MSCE

          15/n There are also numerous issues I haven't covered that @fperrywilson does a great job dissecting here:https://twitter.com/fperrywilson/status/1360944814271979523?s=20 …

          Health Nerd added,

          F. Perry Wilson, MD MSCE @fperrywilson
          Folks, we need to talk about this Vitamin D trial. I have no stake in this game - take Vitamin D if you want but this pre-print is super sus. (THREAD) https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3771318 …
          Show this thread
          2 replies 11 retweets 107 likes
          Show this thread
        13. Health Nerd‏Verified account @GidMK Feb 14

          16/n There are other odd inconsistencies with the study. For example, they had 93 patients die and 110 ICU admissions That's a startlingly high ICU mortality rate, unless a majority of patients who died were not admitted to ICU

          3 replies 10 retweets 98 likes
          Show this thread
        14. Health Nerd‏Verified account @GidMK Feb 14

          17/n For some context, the average ICU mortality was about 30% in Spain at the time, which is still really high but not "almost 100%" highhttps://www.sciencedirect.com/science/article/abs/pii/S2341192920300986 …

          2 replies 6 retweets 80 likes
          Show this thread
        15. Health Nerd‏Verified account @GidMK Feb 14

          18/n The timelines are really weird. The study is reported as going for 91 days (1st March-31st May) but the K-M curves have 100 days for the treatment group. Probably a minor error, but still strangepic.twitter.com/SH9NKeiVgG

          2 replies 5 retweets 79 likes
          Show this thread
        16. Health Nerd‏Verified account @GidMK Feb 14

          19/n The K-M curves are also just bizarre. My guess is that they've confused the outcome death with the inverse for the second graph, but even then they really make little sense

          4 replies 5 retweets 75 likes
          Show this thread
        17. Health Nerd‏Verified account @GidMK Feb 14

          20/n Also, the study ran until May 31st. This magnificent, amazing, literally earth-shattering result (60% REDUCTION IN MORTALITY) took...8 months? And no news, barely any press, for a treatment that could save 60% of people with COVID-19?pic.twitter.com/UEwDfFLqB3

          2 replies 5 retweets 90 likes
          Show this thread
        18. Health Nerd‏Verified account @GidMK Feb 14

          21/n The study also wasn't pre-registered, which is an issue considering it started on March 1st 2020. When was the treatment protocol (HCQ+azithro and dexamethasone) decided on?pic.twitter.com/sRvMutWu9k

          1 reply 4 retweets 84 likes
          Show this thread
        19. Health Nerd‏Verified account @GidMK Feb 14

          22/n Also, how in the world did one relatively modest-sized hospital have 8 fully-dedicated COVID-19 wards open in Barcelona, at a time when Spain itself only had a handful of COVID-19 cases? Any Barcelonian followers who can elaborate?

          6 replies 5 retweets 97 likes
          Show this thread
        20. Health Nerd‏Verified account @GidMK Feb 14

          23/n The same author group wrote another paper on the same patient population in January. Why was there no mention of this trial, or the MASSIVE mortality reduction anywhere? None of this is necessarily disqualifying, it's just really odd!pic.twitter.com/n6J8ihD9S3

          1 reply 4 retweets 78 likes
          Show this thread
        21. Health Nerd‏Verified account @GidMK Feb 14

          24/n I should specify that none of this makes the study totally sketchy, it's just all really weird and they are things that the authors should have explained in the paper

          2 replies 2 retweets 58 likes
          Show this thread
        22. Health Nerd‏Verified account @GidMK Feb 14

          25/n Overall, what we have is a study that, if run as specified, was a non-randomized prospective cohort study that gives us very little/no new information on vitamin D for COVID-19

          2 replies 6 retweets 81 likes
          Show this thread
        23. Health Nerd‏Verified account @GidMK Feb 14

          26/n This doesn't mean that you shouldn't take vitamin D, it's relatively low-cost and the harm is mostly to your wallet, but the jury is still out whether it will have any benefit at all to COVID-19 🤷‍♂️

          10 replies 12 retweets 128 likes
          Show this thread
        24. Health Nerd‏Verified account @GidMK Feb 15

          27/n Update: the authors have confirmed that this was not a randomized trial on PubPeer. They are still using the word "random" in a very confusing way, but what is described here is not an RCT by any descriptionpic.twitter.com/epHN075OA7

          2 replies 6 retweets 47 likes
          Show this thread
        25. Health Nerd‏Verified account @GidMK Feb 15

          28/n And I wrote a piece about this trial and COVID-19 and vitamin D in generalhttps://gidmk.medium.com/vitamin-d-and-covid-19-an-update-59fb2f9cceb5 …

          5 replies 12 retweets 53 likes
          Show this thread
        26. End of conversation

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