70 Comments

"Yet the use of this evidence can never be as algorithmic as guidelines or quality measures or news stories make it seem." That statement is the essence of your message! There are so many applications to your message - it could be at the very least a book.

We try to teach students, that guidelines and algorhithms are not mandates, but must be adapted to the needs of the patient, family, and individual situation. Government mandates are even worse! Doctors must have the freedom to make judgements in concert with the patient. There will never be one size fits all in medicine.

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Wonderful piece. I appreciated the examples from other areas of medicine as well.

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I really liked your conclusion. No patient is the same as the "normal" patient. The clinician's job is to translate results as it relates to your current patient. So many people, especially the government, believe that you can tell how the patient will react to a treatment just by what the computer tells you. This is not true. Every patient is different, and a robot should never replace a clinician in the analysis of your patient.

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interesting, thank you.

p.s. note extraneous word in; They were young (age 64), mostly male, non-obese, patients who **were** could tolerate medical therapy of heart failure.

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And yet our Government spent 1.6 billion on Paxlovid and still advocating its use.

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If we can disregard drug trials because different people might react differently, we might as well not do drug trials at all. Each person is uniquely different from all other people in many different ways . The only way we can be investigate whether a drug will work on a given individual is to do a trial with many people who are identical to the person we want to use the drug on. This is impossible. Drug trials with a large number of subjects, all different from one another, can only tell us if the drug works on a population of subjects. It has public health significance but not necessarily relevant to any single individual. If we can't accept this limitation, then we should. just abandon all drug trials rather than conduct them and later point out their obvious uncertain relevance to any given individual.

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I imagine there are distinctions related to population that matter. I suppose that is the real dilemma on genetic based drugs that are intended for a small fraction of individuals. We can see via VAERS that the mRNA vaccines affected some people adversely. Without a detailed investigation which I understand has not been done, we don't fully understand the parameters. It would useful to know in advance who might be at risk from the mRNA vaccine and why.

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There are too many parameters to to know if we really want to know about any individual.

Sure we can study all those who "identify as black" or who were born with blue eyes. That is a population study. Bur within that population no matter how narrowly defined, there still will be individuals and they all will differ from each other in many, many, .many ways, some ways that are inconceivable to us now but will be. discovered. in the future.

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"too many parameters". My hope has been with "big data" in developing an analysis framework. I would hope that the paid public health researchers would be involved in establishing suitable biomarkers that might give insight into immune system responses. Sadly, I don't see how we get to that "in the future" when we haven't bothered to start the analysis. But such work seems critical if we intend to continue technologies like mRNA that involve a complex dance inside a human.

But population studies for genetic drugs intended for a small subset of individuals seems impossible. I assume the authorities have alternate ways to determine effectiveness of proposed treatments for such subsets.

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What you have to do is treat each patient. with humility. knowing that. each person is different. Science. can never deal with. all the variables due to changing. external

circumstances

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While I can quite agree with individual attention and care, how does advocating a vaccine for all young children even arrive in the game? Much of the pandemic response has been one-size-all.

But I was expecting that analysts would be teasing out data from VAERS, from reported deaths, etc to see what factors can be postulated as common and start to collect data to understand the illness along with the "cure".

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Great article and discussion -thank you Dr. John.

I'm a tech nerd, with no medical/science training, but have a curious mind and a love for data.

Seems like comprehensive RCT's are almost impossible to do with the type of confidence we'd hope for.

Humans are unique in their DNA, their range of physical conditions, etc....but what strikes me as a tough thing to factor in is the consideration of the patient's current pharma and med treatments.

Again, I'm not a practitioner, but trying to understand the interaction(s) of various pharma combinations, in a wide range of human condition seems like a daunting task.

Accepting this, RCTs must be done, but their conclusiveness will not be as strong as we'd like. That's why I think intelligent patient + intelligent holistically oriented medical professional are required. Need both to provide the best assessment and treatment approach. Industrial medicine does not promote this.

Also, the COVID has made me aware that there are multiple dimensions to good medical practice. Patient treatments, public health, socioeconomics, cultural consideration all must be considered.

In COVID, extreme "locking down" might have saved some lives, but the knock-on negative impacts would have been worse (IMHO). We need a holistic approach when dealing with big issues like this.

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The nurses, doctors, OTs, PTs, and research scientists in my family (two who also have their MPH) appreciate those like yourself willing to opine and provoke critical thinking and debate regarding medical practice and public health policy/actions. We recognize the complexities and nuances of providing best practice medicine, but we try our best to “check” any arrogance and bias during our debates. We often disagree on EBM interpretations and extrapolations as well as public health decisions. We all agree that trust in public health institutions and regulatory agencies have plummeted and with good reason.

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Nefarious is always a little difficult to prove but quite often the enrollment criteria for a trial can indicate intention. For example did Pfizer not enroll vaccinated patients due to availability or were they concerned with performance in this population?

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I was part of one of the first BNP tests product launches in the US. We had very narrow and strict enrollment criteria which gave us a ROC curve of .90. When doing a meta analysis of all BNP tests years later you saw a average ROC curve of .83, still a good diagnostic test but below our original study. Enrollment criteria matters and can give a false impression. The VA study for hydroxy that caused it to loose the EUA was due to a bad enrollment criteria and this was absolutely nefarious in my opinion. They knew this would cause the drug to have little benefit. The drug was administered late and to mostly critically ill patients.

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This article is spot on. Look at the “troponin” develop in very specific set of patients and circumstances and now drawn on everyone. How many people has a false troponin lead to procedures and complications. The “d-dimer” how much damage has that done when released broadly. PFO……we see studies looking for that in 88 year old patients……so sad how things that may help a few folks, when released get generalized and weaponized against patients, providers i guess in mainly the fear of “not doing enough”

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Brilliant! Absolutely brilliant - the right tone and pitch to share with my family and friends to awaken curiosity. Thank you 😊🙏

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never stop learning, (now at the age of 77)

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Again underscores the importance of evidence based practice and practitioners.

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This article only continues to confirm my working theory that the widespread failure of paxlovid is entirely the result of interaction with vaccine-induced damage to the immune system (antigenic fixation and likely other injuries as well).

The phenomenon of "paxlovid rebound" is occurring all over the place because viral counts are brought low by paxlovid's enzyme inhibition, but there is little effective immune response during this time- there is no "knockout punch" during the window of opportunity the drug allegedly produces.

Furthermore, I suspect they knew this was likely by the time of the trials- vaccine failure was already visible to insiders if not to the public- and made sure a non-representative sample gave them the results they wanted.

I'm glad my unvaccinated ass hasn't had to experience any of this firsthand.

And it remains my deepest wish that the liars, frauds, and murderers in this worldwide crime spree pay and pay dearly for what they have done.

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I have an unvaxxed 70 yo friend who just experienced rebound from Paxlovid. She is however immunocompromised, suffering from systemic scleroderma. And I guess her age counts against her. Non obese though.

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Age and she's likely taking immunosuppressants for her scleroderma like you said. Hope she's doing okay.

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She's getting better, thanks! Isn't Paxlovid dangerous for immunocompromised people? In five days it knocks the virus back but the immune system may not be able to fight the uprising post treatment. Brian Mowrey's substack "Unglossed" proposed a mechanism for that.

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Paxlovid is not dangerous for immunocompromised patients. There's some discussion of longer courses of it for that subgroup, and there have been some ad hoc trials and case reports of 2nd rounds of Paxlovid in cases of rebound for older patients. No studies I've seen published (or on the preprint servers) have demonstrated an increased risk to immunocompromised patients.

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Aug 3, 2022
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I see the abstract which were 568 patients believed to be unvaccinated but where is the full paper with details? The current 150 inpatients with ~ 79% unvaccinated related to the 568?

I find the asides providing an assessment of motivations somewhat unsettling. Disagreements need not receive such an assessment IMHO.

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MD, MPH wrote, "We still, even now, have 150 inpatients admitted with Covid ..."

Q1- Does your hospital still administer the deadly drug Veklury (remdesivir) to some of these patients?

Q2- (If in the United States) Does your hospital still collect a 20% "new drug bonus" provided under "The Cares Act" for administering remdesivir in a hospital setting, to be calculated as 20% of the ENTIRE hospital bill? Find out from your hospital administrators ... they usually do not refuse money ... even blood money such as this.

BTW, the 20% "new drug bonus" for using remdesivir is in addition to $13,000 the hospital collects for each Covid positive admission, and in addition to the $39,000 the hospital collects for putting a Medicare patient on a ventilator.

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Aug 3, 2022
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Your avoidance of specifics and facts, as well as your dismissive tone, hurts YOUR credibility, and makes YOU look like you are not a serious person ... frankly your answer makes you seem more like you might really be a TROLL than an actual doctor.

Too many of you doctors (assuming for the moment that you are a doctor) went along with the institutionalized killing when you should have spoken up, and advocated for early and alternative treatments like the good doctors who did speak out ... Good doctors like Dr. Paul Marik, Dr. Zev Zelenko, Dr. Peter McCullough, and others ... The sheeple doctors just went along with hospital protocol as thousands of their patients kept dying on vents and from remdesivir -- patients who were denied even the right to try an alternative treatment ... Dr. Marik was fired from his job for trying to administer ivermectin.

May God have mercy on the souls of the many frightened sheeple doctors who cared more about keeping their hospital job than the lives of their patients!

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"frankly your answer makes you seem more like you might really be a TROLL than an actual doctor. "

My thought also. The "doctor's" responses were argumentative, belittling, and non-professional in tone and content. They differ markedly from those of the rest of the commenters in quality and substance.

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Aug 3, 2022
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Not sure whether to ask you how many beagles died this week, Tony? ... or what color silk scarf you'll be wearing at this week's presser, Deb?

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“We still, even now, have 150 inpatients admitted with Covid; 79% of them are unvaccinated” This is interesting, and seems to contradict what I’ve found in many states public breakthrough data, especially post omicron. Is this a change? How many of those attributed as unvaccinated could be those with status unknown?

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I've NEVER heard of one unvaxxed person to get rebound of covid. Do you have data to support your claim?

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I'm a resident. I've seen a few people hospitalized more than once for (not just with) COVID.

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On what would be called a rebound? Where they tested negative, then positive a few days later? That's different from what I've seen: people who didn't quite kick it then got worse.

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Asking this of MD, MPH? Gonna guess their answer is the medrxiv link above, which I at least have yet to, but will read.

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Don't forget, kids, unvaccinated also = <2 weeks last jab. Gotta protect those vaccine stats.

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I would love to have publicly available anonymized “patient event data” which by individual lists dates of injection(s) and infection(s).

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Aug 3, 2022
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Unless your testing and reporting are better than, well, just about anyone, your 1000/week is likely closer to 10,000 per week but a subset are getting sufficiently ill to seek care, or worse require hospitalization. This has been attributed to the plethora of BA.1 and BA.2 cases which are providing some immunity to BA.5... enough to moderate the symptoms and reduce the serious illness rate. Those with "up-to-date" vaccinations and prior BA.2 conversion are on the order of 100x less likely to require hospitalization than someone who was solely depending on immunity derived by natural infection.

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Would be very interested in your reference for this!

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I'm looking... in my archives.

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Aug 4, 2022
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Aug 4, 2022
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I've focused on COVID epidemiology since... 18 JAN 2020. Yes, that early. I was concerned after I took the time to read the reports I could access.

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Thanks for this — I have not looked at Florida data yet, and this is useful. It is a different picture than from Utah, which I have been watching: https://coronavirus-dashboard.utah.gov/risk.html Which interestingly also though may be starting to show a trend back toward higher severity in the unvaccinated category again.

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The progression has differed from region to region and state to state. I recall seeing that the West is picking up again. I've taken a bit of a holiday from analyzing all the stats on a daily basis. So, I'm not surprised you're seeing an uptick in Utah.

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>> Typical uninformed antivax verbiage.

We'll see who's still standing when this is all over. Being a true believer won't protect you from justice. Vaccine mandates have been a global war crime, and the truth will out.

Tell yourself whatever you need to in the meantime. I see no need to debate this further, as likely you do not either.

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Aug 3, 2022
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"Politically motivated," in this case, means trying to save humanity from what you are doing to it.

You will hang. Chances are, by your own hand, when you realize what you have done.

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Aug 3, 2022
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Yeah, these comment threads are disappointing. The Dunning-Krugger effect is strong around these parts. I'm a FM resident and don't agree with some of the COVID policies. Especially masking and vaccinating kids under 5. I don't think it's killing them, I just think the evidence of benefit isn't as robust as people think and that public health is hurting it's credibility even further for little gain. That doesn't mean I don't think some things are beneficial and we're done well. But a lot of people (especially those who will comment) are more towards either extreme viewpoint. Unfortunately it's hard to hold a nuanced view when you don't have the knowledge to do so. We haven't done a great job of teaching people either.

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If you were a doctor who embraced Covid vaccines when they came out in 2021, then you could, to some extent, be forgiven.

If you are a doctor who still pushes these vaccines today, you are complicit in mass democide. You maintain willful ignorance when patients trust you for life-or-death decisions. You were given education which allows you to evaluate evidence on your own, but you lack the intellectual spine to reach conclusions in stark opposition to your peers and the medical hierarchy. You close your eyes to evidence that short-term deaths, within weeks of these vaccines, are as high as 1:800. That the number of disabled Americans has grown by 3-4 million since January 2021, that birth rates have fallen 5-27% across states and countries, that hundreds of healthy children have died - and that this is likely only the beginning, and the greatest impact of these vaccines (cancers and mass deaths) is yet to come.

As a person like this, your future in the medical profession is short-lived.

By 2025, if you are able to forgive yourself (!!!), you will no longer be a doctor. You will be a shoemaker, or a gardener, or a plumber. But no one will ever again entrust you with their life.

And if you pushed injections on people, there's a substantial probability that you will have to relocate, cut all ties and adopt a new identity, or suffer the anger of the people that you have harmed.

Mark my words: this is one of the last years when you still get respect for being a doctor. It will become a curse word.

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This, to me, is not a good thing. It is partly why we have so much experimental polypharmacy. Doctors prescribe all of these meds I would suppose from studies that do not reflect the real world. Patients need the real world results, not profiteering theatrics. The research nurses and pharmacists should know about safety signals and contraindications within the trials. And doctors should get all of the data. The pfizer vaccine data dump at PHMPT.ORG is a perfect example of important data withheld from doctors, that should never be allowed. And yet here we are...

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like with the statins.

the chance of benefit is near to negligible, the risk of side effects is 100%.

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And yet- and YET- every GP/family doc I speak to speaks of statins as though they are as harmless as air, and should basically be handed to anyone who might even be standing near a book with the word "cholesterol" in it.

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if those doctors do not seem to know about the adverse effects of statins, statins being about the most prescribed drug there is, imagine what they know about the other more obscure drugs, or about ANYTHING for that matter...

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It isn't even the individual ignorance of "those doctors." This is a widespread sentiment.

Check this out:

https://pubmed.ncbi.nlm.nih.gov/22779765/

https://bigthink.com/health/statins-drinking-water-wonder-drugs/

https://www.medpagetoday.com/opinion/at-large/24259

This is very much a thing. Remember when you got the chance to vote on it?

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I'm healthy as a horse. One blood test I forgot to skip the cream in my coffee that morning and my HDL came in a bit higher than the "acceptable" range. Looking at my results through the portal I saw the boxed tip to the GP to "discuss statins" with patient.

My husband has bp that gets him lectured about beta blockers etc: 140/80. No sale: those drugs cause dementia over the long term My BP is 125/60, and now I'm reading that diastolic should be above 70 to avoid dementia from low blood flow. You either learn to kick the tires or you end up a lab rat.

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I have a nearly identical experience (and BP, for that matter!) Husband and I were both given prescriptions for statins. Both had abdominal pain. NEITHER of us presented with actual health issues- just "bad HDL numbers."

I'm happy to kick the tires and refuse to be a lab rat. Authoritarians, especially ones in white lab coats (some of which hang around here) would like to make sure I don't have a choice about any of it, and are happy to call me an uneducated, mind-addled fool for my crimes of heresy.

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Aug 3, 2022
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