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s_r_constantin's profile
Sarah Constantin
Sarah Constantin
Sarah Constantin
@s_r_constantin

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Sarah Constantin

@s_r_constantin

Math/ML/data-science person now working on solving aging...and helping with COVID19?! Founder, LRI and Daphnia Labs. Married to @oscredwin

Be
srconstantin.posthaven.com
Joined February 2019

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    1. Sarah Constantin‏ @s_r_constantin May 6
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      Derek Lowe is always the high-quality skeptic on all things pharma, and that’s a valuable role. Still, I feel like this isn’t really engaging with the issues:https://blogs.sciencemag.org/pipeline/archives/2020/05/01/why-are-clinical-trials-so-complicated …

      1 reply 1 retweet 19 likes
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    2. Sarah Constantin‏ @s_r_constantin May 6
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      “Clinical trial regulations are completely unnecessary & don’t improve the quality of research at all” is a strawman. There might be some that are absurd, but in general, these rules are made by smart people, for actual reasons.

      2 replies 0 retweets 4 likes
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    3. Sarah Constantin‏ @s_r_constantin May 6
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      Yes, CGMP rules ensure pure & stable drug samples. Yes, rigorous study designs make study results more credible. The question is: how much more credible, relative to the cost?

      1 reply 0 retweets 4 likes
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    4. Sarah Constantin‏ @s_r_constantin May 6
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      Part of the problem is, once you have an FDA, it becomes *trusted*. Lots of doctors will immediately go out and prescribe any drug that’s FDA approved. People expect “approved” to mean “I can trust it.”

      3 replies 0 retweets 6 likes
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    5. Sarah Constantin‏ @s_r_constantin May 6
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      As long as that’s true, the case for high standards is a lot more sympathetic. Crappy studies are, indeed, crappy, and rarely worth betting a patient’s health on.

      1 reply 0 retweets 3 likes
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    6. Sarah Constantin‏ @s_r_constantin May 6
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      But take a different extreme, for perspective. It’s totally legal to write a blog post saying “this drug worked for me!” The fact that this is legal tells you *nothing* about how much credence to put in the post. Free speech doesn’t come with a quality guarantee.

      2 replies 0 retweets 6 likes
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    7. Sarah Constantin‏ @s_r_constantin May 6
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      It’s possible that if we allow more crappy studies *and amp up skepticism accordingly* there will be valuable signal amid the noise. Signal that we’re not allowed to generate today.

      1 reply 0 retweets 3 likes
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    8. Sarah Constantin‏ @s_r_constantin May 6
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      I actually *agree* with @Dereklowe that most attempts to make medicines that bypass the regulatory system are crap. And I appreciate his work in explaining to the public *why* they’re crap.

      1 reply 0 retweets 4 likes
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      Sarah Constantin‏ @s_r_constantin May 6
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      The *ethical* position I take (which I know most people don’t agree with) is that you have a right & responsibility to decide for yourself what is crap. And if you want to take risks with your own health, that’s your business.

      8:15 AM - 6 May 2020
      • 3 Retweets
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      • Stephen Malina Basil Marte Michael Keenan Benjamin A Heredia David Pecchia Hasi henryaj Adam Marblestone Tiste Belema [ N. ]
      5 replies 3 retweets 10 likes
        1. New conversation
        2. Sarah Constantin‏ @s_r_constantin May 6
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          The *empirical* hypothesis I’m making, which I *do* expect to be a question even skeptics should care about investigating, is that the “optimal” minimum standard for clinical trials is looser than the present standard.

          2 replies 0 retweets 8 likes
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        3. Sarah Constantin‏ @s_r_constantin May 6
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          In other words, if there were a proliferation of sloppier trials, would the benefit of getting true positives sooner (& thus faster, cheaper drugs) outweigh the harms of people getting sick from ineffective or dangerous drugs that were reported as good?

          2 replies 0 retweets 3 likes
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        4. Sarah Constantin‏ @s_r_constantin May 6
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          I could imagine a world where lower-quality trials were so useless that nobody intelligent believed them. In that case, legalizing them would be morally correct according to me, but a loss from a societal benefit perspective.

          1 reply 0 retweets 2 likes
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        5. Sarah Constantin‏ @s_r_constantin May 6
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          Fortunately we have a great natural experiment right now! COVID19 drug & vaccine development is moving at much faster than usual speeds and skipping a lot of typical precautionary steps.

          2 replies 0 retweets 5 likes
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        6. Sarah Constantin‏ @s_r_constantin May 6
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          If this “works” for generating drugs or vaccines that actually work, faster or cheaper than average, then we’ll know that there can be value in streamlining these processes.

          4 replies 0 retweets 6 likes
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        7. End of conversation
        1. New conversation
        2. mrgunn‏ @mrgunn May 6
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          Replying to @s_r_constantin

          Thanks for giving @Dereklowe a deserved signal boost. My thoughts have gone in a similar direction as yours, but with a bit of collectivism on responsibility for making information available for deciding what is crap.

          1 reply 0 retweets 0 likes
        3. mrgunn‏ @mrgunn May 6
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          Replying to @mrgunn @s_r_constantin

          Conditional on many people being unable or unwilling to decide for themselves (maybe they'd rather spend their time thinking about other stuff!), my ethical position is that it's not right to leave a guidance vacuum, because there's any number of hucksters that will fill it.

          2 replies 0 retweets 1 like
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        2. Dr. Joel (AT-AT) Walker‏ @Chem_Walker May 6
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          Replying to @s_r_constantin

          This is the same kind of argument people use to say seatbelt laws are bad. However, the gen pop is many orders of magnitude less equipped to decide what is crap and what isn't in clinical studies than searbelts. It's absolutely unethical to let people make that decision

          1 reply 0 retweets 1 like
        3. Dr. Joel (AT-AT) Walker‏ @Chem_Walker May 6
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          Replying to @Chem_Walker @s_r_constantin

          Mainly because snake oil salesmen will 100 % abuse that decision. We already see that with people like "Drs" Oz and Phil.

          2 replies 0 retweets 0 likes
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        2. Augustin "Gus" Péneau‏ @GusTheChemist May 6
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          Replying to @s_r_constantin

          Yes, but are "we" all capable to take these decisions ? By that, I mean do we, like common people, have the knowledge to distinguish "good" from "crap" medecines in this very case ?

          1 reply 0 retweets 1 like
        3. Sarah Constantin‏ @s_r_constantin May 6
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          Replying to @GusTheChemist

          Not everyone has to know about medicine themselves; they just have to decide which sources they trust.

          1 reply 0 retweets 0 likes
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