Vinay, I was one whining about locking previous threads -- even though you almost never read these comments, the banter among the commenters has always been interesting. Thanks for clarifying that.
Are you in a position to do the oft-referenced masking study? I expect I have funding if you are. So far I have not been able to get anyone to take it on, and my institution won't support it. Just curious.
All of this stupidity started with the masking NPI, then moved on to the cleaning NPI ,the barrier NPI, the antisocial distancing NPI and then the lockdown NPI. All known to most of us to be prima facie useless, but that did not stop anyone. A decent RCT for each of those would likely still be mostly ignored, but would make an excellent starting point for a better battle against the next round of idiocy.
Dr Prasad, I am a 69 year old family doctor of 43 years of practice. I am retiring at the end of next month. Yours is the first substack subscription I have purchased because I have appreciated your videos and op eds on research and looking at the data with a critical eye to the methods used to obtain the data. Over the years I have tried to be courteous to drug detail people talking about new drugs and have not critically analyzed the research data supporting the use of any new drugs. Generally I would try to stay behind the curve in using new drugs until my specialist colleagues are using them. I wonder now how critically they would look at the research data supporting the use of new drugs.
Thank you for your critical approach to research and I look forward to following more in your substack.
Leaving aside that vaccine mandates breach the Nuremberg Code and no-one should ever be forced to have a medical treatment (including ‘vaccines’ and masking) on ethical grounds, what I have never understood is the failure of mandate advocates to recognise the practical argument - ie if the vax protects you, why do I have to be vaxed and if the vax doesn’t protect you why do either of us have to be vaxed? Some argue that the vax could reduce the load on hospitals from unvaxed Covid patients but this is clearly rubbish when public health data show the majority of Covid patients are overwhelmingly vaxed and boosted. And again, on ethical grounds, do we discriminate against people who make poor lifestyle choices which lead to obesity, diabetes, drug and alcohol abuse, heart disease and cancer, who are the vast majority of all hospitalisations? No - because we live in a free society that respects the rights of individuals to live their lives as they choose - except when it comes to the forced jabbing of the entire population with an experimental product which doesn’t even prevent the disease it was designed for. Crazy.
Maybe if more of us patients asked "What was the outcome of the randomized trial on that?" It might trickle down to demanding such research. I will try to remember to ask that.
I think I am also going to be taking a statistics course.
Excellent point. Unfortunately, all these useless observational studies serve not only to provide gainful employment for scores of navel-gazing researchers, but also to generate countless media headlines, every week a striking new finding or a magical new solutions. Incentives are skewed. We need a more scientifically and ethically sound approach - scientific communities should do a better job at setting sounder standards along the simple lines you are suggesting. And coming from economics, where we rarely even have the luxury of a randomized trial, i am especially dismayed.
Good line from you about the Pfizer guy's pants pocket and any change in there. I share your dismay about crap "science" being done, especially the epidemic of faux epidemiology studies over past two decades. Thanks to personal computer technology, it is the case that damned near anybody can round up a bunch of data, hatch some null hypothesis, and proceed (as they say at the University of Minnesota) to "shoot a bunch of P-values". Somewhat depressing actually.
Please keep writing. For me, you are one of the more sane voices. In a hurry-up culture, you need not apologize. As an excellent writer of opinions, you excel. Hope you remain healthy.
We need to take the monopoly protection away from the drug companies. The expensive thing about inventing new drugs is the testing they have to do in trials, not coming up with the ideas of what to try in the first place. So now we have drug testing firms such as ICON whose customers are the pharmaceutical industries and who advertise that they have the expertise to hold trials which will produce results that will get your drugs approved ....
It takes freedom of information requests to find out what the trials actually produced in the way of results, because only the results that look good will be presented, and in a way that makes them look better than they are. Nobody gets the answers to the questions that actual doctors have about the new drugs.
Do they work better than the old things we already use, or is this just a shiny new way to make money because the patents on the old thing expired? Unless there is significant improvement, it is better to stick with the one we are familiar with, having used it for so many years. Do they work on the patients we want to give them to? Too many studies are on the young and healthy, when what we need to know is what happens when we give them to the seriously unhealthy.
It's not as if we don't know what we want to know about new drugs. And it is not as if we couldn't get clinical trials to find this stuff out -- if only the people working the trials worked for us, instead of the drug makers. So get rid of the monopolies, and instead fund testing trials out of taxes on successful drugs.
We are never going to get a better chance to do this, because it means the destruction of the pharmaceutical industry as we know it. We thought giving the drug companies a monopoly would
let them fund the expensive trials, and it would all work out for the best. This is not the best, and now everybody knows this. Let's not waste the chance to get the institutional overhaul we need.
Agree we need overhaul. Wonder how we might decide which RCT’s should roll forward then? If new drugs show potential vs. generics in early trials, then by what mechanism can they qualify for taxpayer funded FDA style testing? They need some skin in the game to prevent abuse of the system don’t they? How to prevent abuse by the revolving door “I approve your drug you hire me in 2years” type corruption? The very same issues we currently have with the FDA.
I say we remove the FDA’s right to prevent market access for any claim, then they are just another standard, competing with other standards like CE Mark for market share. Some buyers will determine CE Mark is good enough to buy the product and not require FDA approval, others may require FDA approval, the market decides. Market’s enforce discipline towards the customer or their profits will fall. If buyers of medical products had a choice of free market standards to require a given product live up to, FDA, CE Mark etc… then those standards would need to demonstrate their fairness and cost competitiveness in testing and present proper unbiased RCT designed study results. Fail to do so and your brand is hurt, succeed and show reduction in medical reversal over time, then your standard has demonstrated excellence and can charge a premium the market will support.
Free markets solve this problem well, just look at the USGBC LEED standard vs. the NAHB Green Build standard for successful free market competition between standards in the marketplace. Each satisfies a niche and allows for more green technology innovation and verification.
We would have an explosion of innovation in healthcare if the FDA had to compete with other standards like CE Mark of NGO standards that would emerge if the FDA did not have it’s monopoly on ‘violence’. Perhaps barriers to approvals for low risk Value Based preventative approaches would vanish?
Sadly the only delving into the flawed and harmful policies that were foisted on the American public may come down to legal actions and the Congressional hearings that just started into accountability for COVID decisions made in the last two years. They included two of the authors of the Great Barrington Declaration. Unfortunately, this will be twisted into a political quagmire like everything else nowadays and science will suffer some more. Keep on writing Vijay and eventually more of us will keep pushing for a return to , or a beginning to, real science and research. Thanks.
Profit-only-oriented economies and science are simply not compatible. We won't get anywhere until scientists unionize and go on labor strikes to demand basics like you elucidate here. We need to keep parasitic capitalism in check.
Brilliant once again Vinay! This one is a gem I will share with my epidemiologist friend, Ken ... with whom I've shared several other gems of yours. Thank you for continued and generous sharings!
Perhaps useful to ask why we have a NIH that seems populated by administrators and politicians who suppress any scientists who happen to work there? I see the MMWR documents and see great problems of analysis to seemingly support an already established conclusion. One thinks in a world of large data we could do better. And for the amount of money spent why the data management is so poor.
Comments were only locked on prior posts by accident. Sometimes I'm in too much of a hurry, as readers of this will have guessed
Vinay, I was one whining about locking previous threads -- even though you almost never read these comments, the banter among the commenters has always been interesting. Thanks for clarifying that.
Are you in a position to do the oft-referenced masking study? I expect I have funding if you are. So far I have not been able to get anyone to take it on, and my institution won't support it. Just curious.
All of this stupidity started with the masking NPI, then moved on to the cleaning NPI ,the barrier NPI, the antisocial distancing NPI and then the lockdown NPI. All known to most of us to be prima facie useless, but that did not stop anyone. A decent RCT for each of those would likely still be mostly ignored, but would make an excellent starting point for a better battle against the next round of idiocy.
Send me a PM please, thanks Dr K.
Dr Prasad, I am a 69 year old family doctor of 43 years of practice. I am retiring at the end of next month. Yours is the first substack subscription I have purchased because I have appreciated your videos and op eds on research and looking at the data with a critical eye to the methods used to obtain the data. Over the years I have tried to be courteous to drug detail people talking about new drugs and have not critically analyzed the research data supporting the use of any new drugs. Generally I would try to stay behind the curve in using new drugs until my specialist colleagues are using them. I wonder now how critically they would look at the research data supporting the use of new drugs.
Thank you for your critical approach to research and I look forward to following more in your substack.
Warren Julien MD
Leaving aside that vaccine mandates breach the Nuremberg Code and no-one should ever be forced to have a medical treatment (including ‘vaccines’ and masking) on ethical grounds, what I have never understood is the failure of mandate advocates to recognise the practical argument - ie if the vax protects you, why do I have to be vaxed and if the vax doesn’t protect you why do either of us have to be vaxed? Some argue that the vax could reduce the load on hospitals from unvaxed Covid patients but this is clearly rubbish when public health data show the majority of Covid patients are overwhelmingly vaxed and boosted. And again, on ethical grounds, do we discriminate against people who make poor lifestyle choices which lead to obesity, diabetes, drug and alcohol abuse, heart disease and cancer, who are the vast majority of all hospitalisations? No - because we live in a free society that respects the rights of individuals to live their lives as they choose - except when it comes to the forced jabbing of the entire population with an experimental product which doesn’t even prevent the disease it was designed for. Crazy.
Making pregnant mothers deliver IN MASKS with fully masked (smile less, expression less) medical staff. Versus unmasked —
I’d donate to fund that RCT.
FWIW Oakland, CA Public Libraries are still mask mandate zones. “In this house we believe in…”
Maybe if more of us patients asked "What was the outcome of the randomized trial on that?" It might trickle down to demanding such research. I will try to remember to ask that.
I think I am also going to be taking a statistics course.
Excellent point. Unfortunately, all these useless observational studies serve not only to provide gainful employment for scores of navel-gazing researchers, but also to generate countless media headlines, every week a striking new finding or a magical new solutions. Incentives are skewed. We need a more scientifically and ethically sound approach - scientific communities should do a better job at setting sounder standards along the simple lines you are suggesting. And coming from economics, where we rarely even have the luxury of a randomized trial, i am especially dismayed.
Good line from you about the Pfizer guy's pants pocket and any change in there. I share your dismay about crap "science" being done, especially the epidemic of faux epidemiology studies over past two decades. Thanks to personal computer technology, it is the case that damned near anybody can round up a bunch of data, hatch some null hypothesis, and proceed (as they say at the University of Minnesota) to "shoot a bunch of P-values". Somewhat depressing actually.
Please keep writing. For me, you are one of the more sane voices. In a hurry-up culture, you need not apologize. As an excellent writer of opinions, you excel. Hope you remain healthy.
We need to take the monopoly protection away from the drug companies. The expensive thing about inventing new drugs is the testing they have to do in trials, not coming up with the ideas of what to try in the first place. So now we have drug testing firms such as ICON whose customers are the pharmaceutical industries and who advertise that they have the expertise to hold trials which will produce results that will get your drugs approved ....
It takes freedom of information requests to find out what the trials actually produced in the way of results, because only the results that look good will be presented, and in a way that makes them look better than they are. Nobody gets the answers to the questions that actual doctors have about the new drugs.
Do they work better than the old things we already use, or is this just a shiny new way to make money because the patents on the old thing expired? Unless there is significant improvement, it is better to stick with the one we are familiar with, having used it for so many years. Do they work on the patients we want to give them to? Too many studies are on the young and healthy, when what we need to know is what happens when we give them to the seriously unhealthy.
It's not as if we don't know what we want to know about new drugs. And it is not as if we couldn't get clinical trials to find this stuff out -- if only the people working the trials worked for us, instead of the drug makers. So get rid of the monopolies, and instead fund testing trials out of taxes on successful drugs.
We are never going to get a better chance to do this, because it means the destruction of the pharmaceutical industry as we know it. We thought giving the drug companies a monopoly would
let them fund the expensive trials, and it would all work out for the best. This is not the best, and now everybody knows this. Let's not waste the chance to get the institutional overhaul we need.
Agree we need overhaul. Wonder how we might decide which RCT’s should roll forward then? If new drugs show potential vs. generics in early trials, then by what mechanism can they qualify for taxpayer funded FDA style testing? They need some skin in the game to prevent abuse of the system don’t they? How to prevent abuse by the revolving door “I approve your drug you hire me in 2years” type corruption? The very same issues we currently have with the FDA.
I say we remove the FDA’s right to prevent market access for any claim, then they are just another standard, competing with other standards like CE Mark for market share. Some buyers will determine CE Mark is good enough to buy the product and not require FDA approval, others may require FDA approval, the market decides. Market’s enforce discipline towards the customer or their profits will fall. If buyers of medical products had a choice of free market standards to require a given product live up to, FDA, CE Mark etc… then those standards would need to demonstrate their fairness and cost competitiveness in testing and present proper unbiased RCT designed study results. Fail to do so and your brand is hurt, succeed and show reduction in medical reversal over time, then your standard has demonstrated excellence and can charge a premium the market will support.
Free markets solve this problem well, just look at the USGBC LEED standard vs. the NAHB Green Build standard for successful free market competition between standards in the marketplace. Each satisfies a niche and allows for more green technology innovation and verification.
We would have an explosion of innovation in healthcare if the FDA had to compete with other standards like CE Mark of NGO standards that would emerge if the FDA did not have it’s monopoly on ‘violence’. Perhaps barriers to approvals for low risk Value Based preventative approaches would vanish?
Sadly the only delving into the flawed and harmful policies that were foisted on the American public may come down to legal actions and the Congressional hearings that just started into accountability for COVID decisions made in the last two years. They included two of the authors of the Great Barrington Declaration. Unfortunately, this will be twisted into a political quagmire like everything else nowadays and science will suffer some more. Keep on writing Vijay and eventually more of us will keep pushing for a return to , or a beginning to, real science and research. Thanks.
Profit-only-oriented economies and science are simply not compatible. We won't get anywhere until scientists unionize and go on labor strikes to demand basics like you elucidate here. We need to keep parasitic capitalism in check.
Brilliant once again Vinay! This one is a gem I will share with my epidemiologist friend, Ken ... with whom I've shared several other gems of yours. Thank you for continued and generous sharings!
Perhaps useful to ask why we have a NIH that seems populated by administrators and politicians who suppress any scientists who happen to work there? I see the MMWR documents and see great problems of analysis to seemingly support an already established conclusion. One thinks in a world of large data we could do better. And for the amount of money spent why the data management is so poor.