BC HEALTH
Saved by @CodyyyGardner

How did it come to this? A deeply misguided effort (@joyhataley) to silence @randyhillier, a MPP in the provincial legislature. This reflects poorly on the medical community. How could one do it differently in a thoughtful, educated manner. Lets consider. 1/

 First, Mr. Hillier and I don't share political perspective but we do share a respect for facts. Facts are the foundation of debate and for the development of sound policy. Ontario has no mechanism to robustly debate C19 facts as the legislature is basically shuttered. 2/
So Mr. Hillier has consequently decided to organize rallies and engage in civil disobedience. All rather normal behavior. He has an audience because leaders in the medical/political community haven't convinced the public that draconian actions are necessary. 3/
It may surprise many but the last time such draconian actions were taken were the middle ages. The plague killed half of europe. Lockdowns likely facilitated death, as after people panicked and killed their cats/dogs, rats florished and congregated indoors. 4/
Mr. Hillier tweets acknowledge the unprecedented draconian actions and expand upon concerns centered on civil liberties and the destruction of institutions that maintain the health and well being of Ontarians. Seems rather straightforward. 5/
Politicians have a rhetorical flourish but the smart ones ground themselves in facts. Mr. Hillary's tweets often highlight public health facts, such as hospitalization, death and all cause mortality. It isn't a pleasant discussion but it must be done to inform debate. 6/
Mr. Hillier displays reasonable understanding of those facts and is knowledgeable to question "cases" given the deeply flawed use of PCR. So then, let the debate begin. Question his interpretation and bring counter facts/data to the table. It isn't hard. 7/
Such a debate would be enlightening for all, especially those that support Mr. Hillier. A large number of his supporters are within the working class who have seen their livelihoods and communities dismantled over the last 10 months. 8/
Its important to present facts and context with previous years, as respiratory viruses have seasonal cycles. Data scientist do this routinely and many good examples can be found on twitter. 9/
I've provided an example from a data scientist who routinely works with these sorts of data sets. This Canada wide data is interesting as it highlights our early epidemic trend and also our questionable practices with the reporting of death. A debate for another time. 10/
Data, facts and debate are important and when placed within a common public health framework, it is highly informative. I have attached such a framework from Dr. Kulldorff, a Harvard epidemiologist. 11/

https://t.co/IJiFPL3FWX
He along with Sunetra Gupta (Oxford) and Jay Bhattacharya (Standford) authored the Great Barington Barington Declaration. Interesting read and it simply states that the ideas which guided public health prior to March 2020 should be used again. 12/

https://t.co/OHQc6gdldm
This scientifically grounded approach is what separates informative debate from propaganda. Propaganda is characterized by an absence of facts and is designed to exploit fear. It uses manipulative language/images to drive emotion and to destroy rationality. 13/
Many times, people can't visualize a propaganda campaign because they themselves are gripped by fear. As such, they actively contribute to it. This is an image from your own tweets presented without facts. 14/
It would be more appropriate to highlight the mountain of statistics surrounding the frail elderly. Respiratory virus are for many the last contributing element in a long chain of comorbities and events. It's an informative learning exercise. 15/
I encourage all to engage. As Dr. John Lee has stated from the beginning, C19 won't be remembered as a medical crisis, it will be remembered as a knowledge crisis. Excellent ground level clinicians who engage on this topic include @Origandclever and @JeanmarcBenoit. 16/
I think we can all appreciate that the Ontario gov't and our underperforming science table doesn't set a good example. Too often they engage in propaganda-like messaging. But perhaps, this is the time, the general public can set a better example. 17/
So go forth and debate with Mr. Hillier in a deep quantitative manner. He is an MPP, so he is used to it. It will be enlightening and engaging for all. End.

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In medicine, reckoning with racism includes reappraising the very syntax we use every day. Proud to add my voice w/ @J_Ikeme and @RWGrantMD in this @JAMAInternMed pub addressing:

Does race/ethnicity belong in the first line of the patient

Some background: I’ve struggled with this question since early in medical school

Medical syntax is designed to communicate information in a predictable sequence with key elements prioritized to facilitate efficient communication and formation of an assessment and plan

2/

From preclinical lectures to Qbank questions to clerkship rotations, race/ethnicity was often prioritized in the same sentence as age + gender.

I grew accustomed to reading/hearing: a 70-year-old Black man w/ history of x, a 50-year-old Hispanic woman presented w/ y.

3/

However, when it came time for me to use race/ethnicity, there was always tension. Race/ethnicity are self/socially-ascribed identities that in clinical practice are almost always assumed by providers based on appearance. I was also concerned about the potential for bias

4/

I wondered how my own care would be impacted or not impacted by my ethnicity (Hispanic) – I have light skin so I’m not sure if my doctors would even identify me as such – but how would my care be different if I was presented as a 30-year-old Hispanic male?

5/
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Ary Serpa Neto
Ary Serpa Neto
@a_serpaneto
The #RELAx trial has been published today in @JAMA. It was coordinated by Anna Algera. This thread is to explain the rationale, what we did, the findings and the meaning.
The rationale of #RELAx is based on the following

First, there is NO adequate evidence on the level of PEEP in non-ARDS patients. Most of the studies are old, conducted in post-surgical patients (short-term ventilation), and were not powered to detect differences in patient-centered

Second, despite the absence of evidence, the levels of PEEP used in non-ARDS patients increased over years, from 5 to 7/8 cmH2O, probably as a reflection of studies and practice in ARDS

Third, one IPDM showed that higher levels of PEEP could benefit more severe ARDS patients. However, opposite trends (higher mortality and longer ventilation) were found in mild ARDS with higher PEEP (despite not powered to be statistically

Fourth, most of the weaning protocols include PEEP ≤ 5 cmH2O as a criterion for readiness to wean. Theoretically, a standardized liberal strategy of higher PEEP could delay weaning in some
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Southern Anti-Racist | Abolition Now
Southern Anti-Racist |...
@antiracistsouth
While #Tulane school of medicine is rightfully being exposed for its contemporary racism towards faculty, staff, students (and patients) due to the racist firing of Dr. Princess Dennar, it’s important to call out the deeply anti-Black history of this school, specifically... 1/

The way #Tulane became a private institution (originally was a public university) at the end of Reconstruction to avoid having to desegregate. The school charter says it was founded for “white men” only... but there’s more (much more) to this story... 2/

cw: medical racism

Tulane’s school of medicine rose to national prominence for its collection of human “specimens” in their anatomy museum “rivaled only by Harvard”. How did it acquire these “specimens” you might ask?

The collection was “curated” by a Dr. Edward Souchon... 3/

Dr. Souchon was mentored by the late James Marion Sims, the “father of modern gynecology”, who himself had started collecting body parts, organs, and skeletal remains from enslaved Black people during slavery. Souchon continued “curating” his own collection in horrific ways. 4/

The Souchon Collection grew over several decades, eventually touring the state as a traveling “public health” exhibit- nearly all of the body parts stolen, harvested and illicitly acquired from formerly enslaved and poor Black people via Charity Hospital. 5/
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InspiredTeenTherapy
InspiredTeenTherapy
@SashaLPC
Thrd: Menstruation/Dysphoria

1/ Difficult periods are sometimes the first catalyst for young women becoming alienated from their bodies.

Some have given congratulatory speeches about the vague accomplishment of "becoming a woman."

2/ Others learned about periods through a mundane sex-ed lesson at school. Yet others knew very little about their periods except they are sometimes painful, can be embarrassing, and make activities they’d taken for granted,

3/ like swimming and outdoor play, all-of-a-sudden much more difficult.

When young women hate their periods, they might be told, in a matter-of-fact grumbling way, “well, nobody likes having a period, honey. It’s just a part of life.”

4/ On a personal note, till my early/mid 30s, I knew very little about the menstrual cycle. For me it had always been completely out of sight, out of mind. Once a month, I’d be reminded it exists and I’d have a kind of “oh crap!” moment.

5/ I’d complete the necessary hygiene and try to move on with my life. I was often plowing through various stages of this monthly cycle with little acknowledgement or understanding of how my entire mind, body, and mood was ebbing and flowing. Every month, for years on end.
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Dr. Joolz Denby\U0001f499
Dr. Joolz Denby💙...
@JoolzDenby
We’ve done menstruation, let’s talk about the menopause! Because only women however they present can have the menopause although men who have had treatments for prostate cancer can have symptoms mimicking the menopause. There’s nothing scary about

the menopause. It’s a perfectly natural function of the body but it’s tied up with a thousand stereotypes of women, ageism and ‘old women are frightening’. True, old women are often very frightening to young men because look! A woman who doesn’t give a rat’s

arse what you think of her now all her mating hormones have gone and with it your charm as a potential mate. Now you’re just another annoying lad. That’s gotta hurt. Menopause means Wisdom, like it or not and it’s not always nice or cosy. Old women

are encouraged to refer to themselves as ‘young at heart’ and ‘as young as you feel’ and other such crap and told to ‘never give in to age’ which is ludicrous. Cosmetic surgery is now a thing but I can tell you what the surgeons and marketing

men won’t - it does not make you look young. You’re just an old woman who looks like at best, she’s had a great holiday and at worst like she was was trapped in a wind tunnel. Old is good. Old is meritorious. Old is survival. Old means you didn’t die young
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My new theory: A lot of it is guilt.

2/It's true that in some circles - the media, universities, many big corporations - liberal norms *are* enforced to some degree, and the enforcement has probably gotten stronger in recent years.

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