#OTD 1901, Queen Victoria's funeral took place. Here's a little medical history THREAD (1/9) about one of Britain's longest reigning monarchs. 👇

"Queen Victorian on her death bed" by Emil Fuchs.

A staple of anti-lockdown conspiracism in yoga/wellness is that public health measures are oppressive, authoritarian, and stifling what it means to be human. Masks suppress identity and speech. Vaccines assault the sovereign body. Influencers must rise up against tyranny! /1

Ironically, pandemic management in economies where yoga/wellness is lucrative has been a neoliberal, choose-your-own-adventure mess in which centre-right governments barter with public health to enact a patchwork of half-measures that punish the poor and marginalized. /2

The goal is not universal health rights, or protecting medical systems, or saving as many lives as possible. The goal is to return to business-as-usual, using public health as a pit stop on a productivity race off a cliff. The ice caps aren’t melting fast enough, I guess. /3

Right-leaning governments, like influencers, have assessed the COVID threat with the magical bias of limitless optimism. Then they work to normalize COVID casualties as a new cost of doing business. *This* is what alt-healthers and Qamoms call “socialist”, or “communist”. /4

Centre-right governments and wellness influencers share a goal: get back to the optimism of making productivity heroic and consumption virtuous, without any reflection on structural issues of injustice, or what universal health care funding and standards would look like. /5

Fun fact: the standard advice for if a dog, cat, or human bites your hand, is to feed the bite. Push your hand further into their mouth, forcing the jaw open.

Nurses, EMTs, veterinarians, etc are taught to respond this

The advice for a human biting you is to jam your hand or arm deeper into their mouth, and rub the spot under their nose back and forth.

If you attempt to remove your hand, or forearm, the teeth do what they're supposed to and gouge out a chunk.

This vicious wolf attack illustrates proper technique.

So: every EMT and nurse who gets bitten by a human, is trained to jam their hand or forearm deeper into the mouth, feeding the bite so the jaw widens enough to remove the limb

Also, every redneck learns this along with the advice of "never run from an angry dog"

Mistakes natural lifters make

THREAD ⬇️

1) Bro Splits

Let's start off with the big one.

A natural lifter needs the actual training session to trigger the increase in anabolism that a steroid user will get 24/7.

After a workout, anabolism/protein synthesis is elevated for roughly 30-36 hours.

So training a muscle once a week is sub optimal as you're getting 30-36 hours of enhanced growth out of a 168 hour week.

Whereas if you train a muscle 2-3x per week this goes up to 60-72 hours or even 90-108 hours of enhanced anabolism, leading to faster growth.

Obviously there will be some individual differences here, but as a natural, if you only train a muscle once per week, you're leaving a good chunk of gains on the table.

It's optimal to spread your total weekly volume out across the week by increasing your frequency.

2) Not getting strong

If you get strong on the basic lifts and their variations such as the squat, deadlift, presses, rows and chins, I guarantee your physique will show it.

Take your squat from 225lbs x 10 up to 315 x 10 your legs will be bigger.

Stop fucking around!

It's Monday AM post-@ASCO #GU21 & clinic starts in a couple of hours! Lots to process - I'll try to tackle optimal 1L tx for #kidneycancer. I'll make a case for cabo/nivo, leaning on the beautiful (& timely) tables below from @lalaniMD, @SoaresAndrey & @brian_rini (1/15)

What about IO/IO? We have long f/u w #CM214 data w nivo/ipi, no doubt (@AlbigesL et al in @myESMO Open). And treatment-free interval discussed by McDermott @BIDMChealth is no doubt impt. But we've known data not as impressive for favorable risk (2/15)

And furthermore, as @ERPlimackMD points out in another tweet, impt to look at primary PD rates (seen in @lalaniMD's table) - nivo/ipi at 19%!!! CR rate used to be something we highlighted w nivo/ipi, but now comparable across studies (3/15)

Okay now to the really tough stuff - comparing TKI/IO regimens. Something interesting I will add to @brian_rini @uromigos table above is the HR for PFS by INVESTIGATOR review. If the diff in HR for PFS by IND review caught your eye, this is even more striking (4/15)

I think INV-assessed PFS is impt, but if you're a skeptic, forget that argument. Turn instead to #QOL with axi/pembro. Kudos to @brian_rini @tompowles1 @ERPlimackMD et al for advocating for QOL in KN-426. @crisbergerot et al have taughts us the importance of these metrics. (5/15)