It was all totally wasted. The findings were wrong and the net contribution to scientific understanding was negative. Publish or perish, ultimately pushed by funders and institutions, is driving a toxic culture of scientific waste. We have to stop. 5/5

@First10EM nails it again . Promoting and adopting clinical decision rules without implementation studies should be as taboo as promoting and adopting new drugs without RCTs

@joshwangmd @First10EM These kind of 'physician prescribing preferences as instrumental variable' studies are often limited as physicians somewhat select their patients and do multiple interventions (so hard to isolate one) - but in the poison control context could work really well

@FerozeSidhwa, main author of the original NYTimes article, has since shared a corresponding CT scan ( which further corroborates the image. It would be good to hear if @nickmmark and @PulmCrit stand by their original accusation in light of this. 3/3

Of note, effect was smallest (and non-significant) in severe brain injury (GCS 3-5), similar to TXA in CRASH-3. Many of these patients likely too sick to benefit. 3/3

A devastating account of what Israel's war on Gaza has done to its healthcare workers, hospitals, and children

Superb takedown of andexanet-alfa by @emlitofnote . Turns out even the highly dubious primary outcome didn't favour andexa when you actually included all the patients enrolled in the trial Shameful conduct by AstraZeneca.

@DrToddLee Universities and PDs say "it's royal college, our hands are tied", but coordinated non participation across multiple universities would bring it to a very swift end.

@HandtevyMD @NEJM Strange claims to make when these subgroups were specifically looked at in the trial. No effect heterogeneity in malaria vs no malaria, and no difference by Hgb level (further detailed . How about 'battling the error' with your own RCT?

I'm not saying either of these are true, but based on the RCT publication and trial registry, it's hard to say. If anyone knows the study authors, please reach out. Sadly lead author not on Twitter, I got no reply to email, and I'm too late for letter to editor. 7/7