Yung Gonzaga
@YungGonzaga
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🔬Hematologist (INCA and Grupo Oncoclinicas - RJ) Reflexions on clinical practice with a bit of statistics. Cutaneous Lymphomas.
Joined August 2021
@MakisMD @ABDanielleSmith Just as not prescribing ivermectin for these "indications" is n times safer than prescribing it and just as effective = 0
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NEW ARTICLE Published (again) in Braveheart Journal of Medicine. Editor in Chief: Mel Gibson
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Article published in Braveheart Journal of Medicine. Editor in Chief: Mel Gibson
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Classic example: changing the venous catheter after x days to prevent bloodstream infection (a good practice measure in the ICU becoming the target). It improves the measure without impacting what really matters (besides increasing the risk of iatrogenesis)
GOODHART'S LAW: When a measure becomes a target, it ceases to be a good measure. Biomarkers are easily gamed by pharma treatments that change the # at the expense of hidden risks, e.g. Optimizing: HbA1c Hypertension Cholesterol Testosterone Schmokhstsakirfingintfin, etc.
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the old habit of attributing causality (repeatedly saying vitamin D reduced this and that) where it is not possible to do so. Love (in this case, for vitamin D) is blind
Vitamin D supplementation was associated with a 40% lower risk of dementia over a decade, a relatively recent study shows. After five years, 84% of supplement users were dementia-free compared to just 68% of non-users in a study of over 12,000 people. Vitamin D reduced dementia risk by 33% in adults with mild cognitive impairment or APOE e4, a key genetic risk factor for neurodegenerative diseases. And while vitamin D reduced dementia risk across the board, some groups benefitted more. Women, adults with normal cognition, APOE e4 non-carriers, and those without depression saw the greatest brain-protective effects from vitamin D supplementation. Vitamin D’s brain-protective effects may stem from its unique role as a steroid hormone, structurally akin to estrogen and cortisol. It regulates thousands of genes, many of which govern critical brain processes—an effect consistent with findings from randomized controlled trials showing improvements in cognitive function and IQ scores in older adults. PMID: 36874594
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Do you also scribble all over the book when you're reading, or do you see it as vandalism?
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@nntaleb To add clinical perspective, I weigh the NNT of any intervention against the outcome's relevance, side effects, and financial cost. Some oncology drugs for ex. cost a fortune to extend life by weeks, often at the expense of making patients' lives miserable.
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@AaronGoodman33 Article published in Braveheart Journal of Medicine. Editor in chief: Mel Gibson
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Article published in Braveheart Journal of Medicine. Editor in chief: Mel Gibson
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The definition of personalized medicine
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@Eduardoigbrasil Cuidado pra não confundir risco e dano. O risco de estrongiloidiase disseminada após um pulso pode ser baixo mas, se acontecer, é letal. A maioria das neutropenias febris, p ex. não são infecciosas e nem por isso vc vai deixar de começar ATB empírico.
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With a sample size in the millions, even small differences become statistically significant. I missed a discussion addressing the clinical relevance of the magnitude of the differences found, in contrast to their statistical significance.
Patients treated by female physicians have better outcomes than those treated by men- our work led by Kiyan Heybati and @propelresearch published today ➡️ Physician patient concordance associated with better outcomes particularly between female physicians and female patients
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Happy to have written the chapter on cutaneous lymphomas for this important work. Feliz de ter escrito o capitulo sobre linfomas cutaneos dessa importante obra
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