Sorry, Dr. Jha, but you shouldn't confuse medical care with the scientific enterprise. Although the 2 are commonly conflated, they are really distinct. 1/

The goal of science is to acquire knowledge. The goal of medicine is to help the sick. That's a fundamental distinction.

Also, scientists stand apart from their subject matter--as distantly as possible. Physicians, on the contrary, are in "a relationship" with patients. 2/
Of course, medical care should rely on scientific knowledge, but that means that science should be at the service of the patient-physician relationship, not the other way around! /3
Also, scientific knowledge can never be the ultimate arbiter of medical decisions.

First, scientific knowledge is often limited or provisional, especially with a new disease.

Second, for every patient there are myriad circumstances that influence a medical decision. /3
Third, even if excellent scientific knowledge is present, the physician must always judge how it applies to the patient, or whether it applies at all.

Fourth--and most pertinent here--one cannot narrowly limit the scientific knowledge to only RCTs as you do in your statement. /4
By now, it's almost a cliché that the enthusiasm for EBM and RCTs did not live to its promise.

I won't rehash all the arguments here (and there are many!) but I'm sure you're familiar with this piece by Dr. Frieden from only a couple of years ago https://t.co/f7jHvDujUZ /5
(Note: I don't agree with a lot of what it says, but it serves to make my point). /6
Why do you think that doctors who wish to use a combination of safe, available, and affordable agents (and you know that they are so) "threaten" to "derail" the scientific enterprise? That makes no sense. /7
There is always a tension between the need to acquire scientific knowledge and the practical demands of patients and physicians. But, from a moral standpoint, it is the latter who should have priority. /8
The scientists should patiently (!) make their case and ask for volunteer participation in their experiments. They should not impose their desire for scientific advancement over and above the needs of patients and of the physicians who serve them. /9
You admit in your piece that "patients continue to demand" access to early therapies. Why are you so intent on denying them such access? /10
And, by the way, the therapy is not just HCQ. As I'm sure you know, those who advocate for early outpatient therapy propose various combinations of agents to tackle the virus--another reason existing RCTs may be inadequate. /11
I don't want to pronounce on whether these various approaches would "prove themselves" in a RCT.

My point is that your attacks miss the point: Medical standards cannot be reduced to scientific ones. /12
There was a time when saying so wasn't the least bit controversial. But the medical profession--or at least its leadership--seems to have lost the compass on this. /13
The root of the problem is in medical education, by the way.

If you have an interest in the historical background for this, here are a couple of the pieces that I wrote on this topic a few years ago: /14
https://t.co/q5ECfaN47b
and /15 https://t.co/gaOt8roUBK

More from Science

Epic thread incoming:

I'm going to answer the question so many people have been asking this week:

WHAT IS PROJECT X???

Here's the definitive thread to tell you - and show you -precisely what Project X is

Grab a drink, sit down with me and let's #TalkLiberation

<3

1/?

"Project X" is actually called "PanQuake".

Pan means "all". Quake is the huge effect our voices can have when our communications are uncensored and when we have access to brand new functionality that *enhances* our social reach, rather than diminishes it

Here's our logo:

2/?


You can follow the fledgling official PanQuake Twitter account here: @pan_quake and see our super cool new website here:
https://t.co/F7wLSeM6aK

You can find our donation page here: https://t.co/VICFnsR0RX

Keep reading this thread to find out why we created it & what it is

3/?

SPOILER ALERT: Much of the content below this point is from my personal slides & speech notes from today's launch event. That stream got totally ruined by (big) tech problems, but I'm happy to report everything is turning out wonderfully


Here are some of our most high profile & dedicated public advocates for PanQuake - many of whom were scheduled to appear at our launch. All of whom stuck around for hours, to do a prerecord of the event, which is being edited, processed & uploaded for you as I write this.

5/?

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Great article from @AsheSchow. I lived thru the 'Satanic Panic' of the 1980's/early 1990's asking myself "Has eveyrbody lost their GODDAMN MINDS?!"


The 3 big things that made the 1980's/early 1990's surreal for me.

1) Satanic Panic - satanism in the day cares ahhhh!

2) "Repressed memory" syndrome

3) Facilitated Communication [FC]

All 3 led to massive abuse.

"Therapists" -and I use the term to describe these quacks loosely - would hypnotize people & convince they they were 'reliving' past memories of Mom & Dad killing babies in Satanic rituals in the basement while they were growing up.

Other 'therapists' would badger kids until they invented stories about watching alligators eat babies dropped into a lake from a hot air balloon. Kids would deny anything happened for hours until the therapist 'broke through' and 'found' the 'truth'.

FC was a movement that started with the claim severely handicapped individuals were able to 'type' legible sentences & communicate if a 'helper' guided their hands over a keyboard.
https://t.co/6cRR2B3jBE
Viruses and other pathogens are often studied as stand-alone entities, despite that, in nature, they mostly live in multispecies associations called biofilms—both externally and within the host.

https://t.co/FBfXhUrH5d


Microorganisms in biofilms are enclosed by an extracellular matrix that confers protection and improves survival. Previous studies have shown that viruses can secondarily colonize preexisting biofilms, and viral biofilms have also been described.


...we raise the perspective that CoVs can persistently infect bats due to their association with biofilm structures. This phenomenon potentially provides an optimal environment for nonpathogenic & well-adapted viruses to interact with the host, as well as for viral recombination.


Biofilms can also enhance virion viability in extracellular environments, such as on fomites and in aquatic sediments, allowing viral persistence and dissemination.