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adamcifu's profile
Adam Cifu
Adam Cifu
Adam Cifu
@adamcifu

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Adam Cifu

@adamcifu

Internist, Professor. Author: Ending Medical Reversal, Symptom to Diagnosis. S2D Podcast. Despises gifs, loves baseball, attempts humor. Views fully my own. He.

Chicago, Illinois
adamcifu.com
Joined October 2011

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    Adam Cifu‏ @adamcifu 10 Apr 2018

    I would love to hear a grand rounds speaker, speaking about clinical therapeutics, say: “I’m not going to say anything about mechanisms of action because that has no bearing on your decision to use or not use a drug.”

    10:22 AM - 10 Apr 2018
    • 40 Retweets
    • 176 Likes
    • Micki & Charles CD Berman Vicki Braund Prof Darrel Francis ☺ Mk CardioFellows Great Again John Humphreys jorgelina alvarez Juan Pablo Botero A G Butler CookieScience 2/n 🏡 (Martin Vuillème)
    14 replies 40 retweets 176 likes
      1. New conversation
      2. Victor Montori, MD‏Verified account @vmontori 10 Apr 2018
        Replying to @adamcifu @VinayPrasadMD

        I believe this is one reason endocrinologist dont take up EBM, because knowledge of mechanism differentiates them from internists. Focus on outcomes that matter to patients reduce the value of that difference.

        1 reply 0 retweets 15 likes
      3. David C. Norris, MD  😷N95‏ @davidcnorrismd 11 Apr 2018
        Replying to @vmontori @adamcifu @VinayPrasadMD

        How will doctors deliver “careful and kind care” after their Grand Rounds have debunked them as unthinking transistors switched deterministically by EBM guidelines? [Source: #KarlPopper’s “Realism & the Aim of Science” §33 pp. 258-9]pic.twitter.com/bSRdq7QeyD

        2 replies 0 retweets 5 likes
      4. Show replies
      1. New conversation
      2. Steve Pitts‏ @chowkydar 10 Apr 2018
        Replying to @adamcifu

        mechanism of action is the focus of all quackery

        0 replies 0 retweets 4 likes
      3. This Tweet is unavailable.
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      1. New conversation
      2. David Steensma, MD‏ @DavidSteensma 10 Apr 2018
        Replying to @adamcifu @vmontori

        One of my wise senior oncology colleagues, Rich Stone, says “There is virtually no drug for which someone can’t make up a story about how one of its proposed mechanisms of action means it will work in your tumor of interest - so take all that with a grain of salt”.

        1 reply 2 retweets 16 likes
      3. Adam Cifu‏ @adamcifu 11 Apr 2018
        Replying to @DavidSteensma @vmontori

        Perfect. It's like explaining why the market fell, after it has fallen.

        0 replies 0 retweets 4 likes
      4. Show replies
      1. New conversation
      2. Prashanth Francis, MD PhD‏ @liverazzi 11 Apr 2018
        Replying to @adamcifu

        I hate this idea. Mechanisms of action aren't just hand wavy explanations of effect, they let us know/predict side effects, drug interactions, and class effects. We can't do an RCT to answer all of the relevant questions to prescribe.

        1 reply 0 retweets 3 likes
      3. Adam Cifu‏ @adamcifu 11 Apr 2018
        Replying to @liverazzi

        Not my point. If you are talking about drug development, give me 60 minutes on mechanisms. If you are telling me how I should treat a patient, spend time on the data that proves that something works rather than on an explanation of why it might work.

        0 replies 0 retweets 4 likes
      4. End of conversation
      1. New conversation
      2. Ictal Post‏ @txbandageman 11 Apr 2018
        Replying to @adamcifu

        No. In epilepsy, mechanism of action is absolutely necessary not only due to different mechanisms having different efficacy on different types of epilepsy, but also due to frequent need for polypharmacy for intractable epilepsy and to make sure different meds play well together

        1 reply 0 retweets 1 like
      3. Adam Cifu‏ @adamcifu 11 Apr 2018
        Replying to @txbandageman

        Not to me snarky but: I imagine you have never had a clinical outcome that you did not predict based on your understanding of the mechanism of action of the drugs...

        1 reply 0 retweets 1 like
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