Vinay Prasad MD MPH
Vinay Prasad MD MPH

@VPrasadMDMPH

4 Tweets Dec 18, 2022
Saw this today
There is a crisis in medical education where docs think they know the counterfactual for individuals
1. Many other drugs could have been used, inc. past drugs, which oft again have activity
2. impossible to know effect of B (beyond pd)
3. B failed in RCT
#ASH22
A cancer pt who gets treated with many lines of therapy by definition has more indolent biology than someone who unfortunately dies on 1st or 2nd line treatment
Resistant and se clones rise and fall with other drugs
As such re-treatment oft generates response again
But...
the most important point is that just as doctors are unable to accurately tell people "how long they have" they are also unable to accurately say "were it not for..." in fact the latter is even harder
We run randomized trials precisely because a doctor saying Bela-pom-dex saved my patient is not a reliable way to know which drugs actually let people live longer or better lives.
#ASH22

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