Showing posts with label TWIV. Show all posts
Showing posts with label TWIV. Show all posts

Monday, September 28, 2020

The Covid Drug Wars


The Covid Drug Wars that Pitted Doctor Against Doctor 

  • from The New York Times Magazine - August 8, 2020
  • You can also listen to it (like a podcast) if you prefer to multi task.
  • There's a Wisconsin tie-in with a doctor at UW-Madison, who later went to Aurora-Milwaukee
Every once in a while, I stumble across a podcast, article, or discussion that sticks with me, and haunts me enough to share it with you here on the WHSLA Blog in the hopes that it might generate some additional discussion. This is such an article.

I found out about this fascinating article by way of Daniel Griffin, MD, PhD, a NYC physician and instructor at The Columbia University Medical Center.  He works in the trenches of The Covid Pandemic and gives a regular Covid-19 clinical update on the This Week in Virology (TWiV) Podcast.  He talked about this article back on August 23, 2020. 

Click arrow to play


  • from August 23, 2020
  • Listen to the first 40 min. (or so) for Griffin's talk.  [Skip the first 5:30 min. of introductions.]
  • They also have a Microbe tv version where you can watch the Zoom mtg, if you prefer.

I think it's helpful to hear Griffin's talk about it because he was seeing some of the same things in real life.   As a Medical Librarian during Covid-19, I was distressed about the lack of best evidence and how people were making treatment decisions.  It just goes to show that physicians are people, too.  Human Beings.  When confronted with so much human suffering,  the emotional drive to do something/anything can override what might be best for the patient -- esp. when you don't really know what treatments work or not.   

It's a fascinating look at what happened, and what went wrong.
I'd love to know what you think ...

Monday, April 27, 2020

TWIV Podcast: Evidence-Based Science and Medicine for Covid-19: TWIV 606


TWIV 606: Evidence-Based Science and Covid-19 [Listen to the podcast; get more info and links mentioned in the episode.]




As a Medical Librarian living and working in the current time of Coronavirus,  I've been struggling with what to send people asking for research on Covid-19, when the best available "evidence" is only just emerging and appears on pre-print servers and hasn't had time to perk through all the usual peer review and filters of fully-formed evidence-based practice.  In other words, it's not what we're used to as gold-standard evidence.  What we are seeing is much lower on the evidence pyramid. 

On the one hand, it's an exciting time to see the research emerge and evolve, to witness so many people around the world working to solve this emerging and evolving pandemic-sized infectious disease. It's also more than a little alarming to see the state of the evidence ...

Researchers and physicians are willing to try something/anything if it might help solve some small part of the Covid-19 puzzle.  If they put together very small studies with no control to compare outcomes, what is that study really worth?   

I'm not the only one with these concerns, which is why I was glad to see the TWIV podcasters addressing this topic.   Give it a listen ...    at least the first 45 minutes where
Dr. Daniel Griffin gives a nice description of how physicians make decisions, running the gamut from the ultimate goal of evidence-based practice to all these other varieties we've seen since the onset of Covid-19: 

  • Experience-based medicine (including experience bias)
  • Vehemence-based medicine
  • Eloquence-based medicine (More spin than science.)
  • Diffidence-based medicine ("No good answers here.")
  • Defensive-based medicine
  • Careful observation and experience based medicine 
    • Did it help or hurt?  Stand there and think about it.  Did it work?
  • Evidence-based medicine
Always remember, Physicians are human.  They are subject to the same stress and overwhelm everyone else gets.  Early on in this pandemic, there was an emotional, anxious, desperate response to do something/anything to make a difference in outcomes for Covid patients.  Do everything and see what sticks ...   Now Dr Griffin's advice is to "Don't just DO something: Stand there ... and see if it worked."

What are you listening to to keep up with Covid-19 developments?