Venk Murthy MD PhD
@venkmurthy
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#cardiometabolic #prevention ; Multimodality #cvimaging ; Posts may be my opinions & are not medical advice; RT≠endorse
Ann Arbor, MI
Joined March 2009
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Pinned Tweet
My tweets are not a news outlet (i.e. "All the News That's Fit to Print").
I tweet what I find interesting.
I don't tweet things that are stated frequently or better by others.
My goal is not to please all readers but simply to amuse myself.
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So glad that CDC is now agreeing that extended intervals between mRNA vax doses may be better, especially among young males.
We were called anti-vaxed and attacked for contemplating this months ago.
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I personally know 1 of the docs who spoke at press conference about President's status.
He is a brilliant & honorable person and I can't believe he would be part of a conspiracy to hide the current state of his patients health.
Quit the conspiracy mongering w/o evidence.
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Let me just say this, despite the inevitable hate that will spew for it.
The CDC got this wrong. In essentially no circumstances should a patient with myocarditis soon after 1st mRNA vax dose get a second dose, even if the heart recovers.
11. Here are the proposed
@CDCgov
recommendations for use of mRNA vaccines in adolescents & young adults. Note if myocarditis occurs after a first dose, the 2nd should be deferred until more information is know, though if the heart has recovered, dose 2 could proceed.
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Where is the evidence for this claim about the updated booster?
Did I miss it?
Being vaccinated and boosted reduces your risk of dying or getting critically ill and going to the hospital. The updated booster also increases your chances of being in attendance at upcoming gatherings with family and friends.
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Pre-COVID most docs/scientists would say things like
"It appears that..."
"Evidence is most consistent with..."
Etc.
This even w/ strong RCT evidence
Now w/ COVID, find confounded observational study w/ results the way one likes...
"This is the answer. Period."
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Its truly amazing how we were dismissed, attacked, and mocked for discussing vax myocarditis in dispassionate terms
Some of the perpetrators have now started talking about this issue in similar language
I won't wait for the apologies for the cruel treatment we got
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Very concerning if these days are borne out in a full report!
(Dr. Muller is a very accomplished investigator and biomarker expert though so I suspect it will)
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Let me get this right, we can implement infrastructure to mandate, track and verify vaccination for children in schools, restaurants, museums, etc, but it was unreasonably difficult to ask for good data showing high efficacy before doing so.
That about right?
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Repeat after me:
Peer review is not meant to find fraud.
Peer review is not meant to find fraud.
Peer review is not meant to find fraud.
Peer review is not meant to find fraud.
Peer review is not meant to find fraud.
Peer review is not meant to find fraud.
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Wow, this is a big deal. I have also seen statements that Denmark is doing something similar.
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The Big 10 report on COVID relies heavily on this paper which found rampant abnormalities among normal controls and had many statistic that make no sense.
Time to retract or correct this paper.
This is now the officially funniest thing on earth.
See in this tweet, the same image everyone has been tweeting, about the T2, T1, or whatever that is all funny or something, in the hearts of people who have had covid?
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"Kids are resilient"
Read that as:
* My kids are fine, why aren't yours?
* I'm privileged enough to work around any issues
* I care more about the majority than the disparities from the minority who are significantly affected
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Commotio cordis is a diagnosis of exclusion.
IMO it's premature to make or exclude this diagnosis.
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I am amazed by how many high profile twitter docs are now spewing hateful or demeaning language to those who disagree with them about COVID and other topics.
I'm guessing the wild west of Mastodon will fit them well.
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Excellent summary of the status of COVID heart & how it's mostly not a thing
Cardiologists who loudly hyped this should be explaining why they got it wrong & how they will do better
Here are a few tips in mini-thread 👇
Read excellent article first:
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I was greatly disappointed that so many docs immediately promoted implausible bad science saying COVID caused heart damage in ~70% of even mild cases.
I am even more disappointed some of the same docs are dismissing vax myocarditis as a minor lab test abnormality.
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No real downside... This is *not* science.
One could make the same claim about short courses of HCQ or IVM.
2/ We need to wait & see whether a THIRD dose is needed to provide enough protection in kids 2-5 years of age.
But in the meantime, there's no real downside to getting kids under 5 started on their first two COVID shots. They're safe.
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Anecdotes aside, I'm quite confident that screening healthy people with whole body MRI is a bad idea for almost everyone except the people who own the testing center.
I say this as someone who has studied medical imaging and risk assessment for a looooong time.
I think a lot about asymmetric risk, and that extends to my health.
There are certain conditions like aneurysms that have no symptoms but then kill you suddenly.
So, as a healthy 43 year old, I went in for a full body MRI.
What I learned amazed me…
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Excellent piece by Paul Offitt. *Must* read.
In plain terms, push to approve & roll out bivalent booster is *not* following the science.
Why are we seeing mandates for this? What legal/ethical/moral framework supports that w/o evidence of benefit?
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Yep. This is the issue.
❌ Bad science
❌ Bad precedent
❌ Bad policy
That piles of docs are not screaming in opposition is deeply disappointing to me.
Serious Q: If FDA authorizes 2-dose vaccine for under 5s and then the Pfizer trial is not successful, then what?
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Hot off the presses! 37% of highly-trained endurance athletes (mean age 36y) had late gadolinium enhancement (read: scar/fibrosis) on cardiac MRI *without* COVID.
Prevalence and pattern of cardiovascular magnetic resonance late gadolinium enhancement in highly trained endurance athletes
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What is the difference between misinformation and the science changed?
Too often the answer has been follower count, shrillness of message, and whether the speaker is a member of the select vs. out-group
After 2 yrs where at some point natural immunity, vax induced myocarditis, & the possibility vax'd people transmit virus were all considered misinformation
Seems reckless to think White House should have access to this info, and it will surely be misused
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No doubt
@VPrasadMDMPH
is brilliant to notice such things.
The flip side is why do so many experts keep missing this stuff?
If a 4th dose lowers all cause mortality the minute after its given, the study is confounded.
It can't work that fast. 🧠
We need RCTs not more garbage obs studies interpreted by biased twitter accounts, who would demand RCTs powered for death, if the politics were reversed
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For decades pediatricians have taught us not to treat little kids as small adults.
Now some docs want us to do exactly that for COVID vax.
Fascinating.
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Now that Pfizer will have to fund studies of vax myocarditis, I suspect a subset of academics will suddenly start to take it seriously or at least be more vocal about it.
$PFE
#Comirnaty
's FDA approval comes with 6 myocarditis post-marketing study requirements, as well as expected further pediatric study. Approval letter:
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Truly strange that critical vaccine evidence:
* Comes well after regulatory clearance
* Shared first with politicians and not scientific & medical community
This is not following usual scientific, medical regulatory practice!
New: Biden officials are getting long-awaited data today on the performance of Pfizer's updated Covid vaccine.
Will provide the clearest look yet at whether the bivalent boosters are significantly better than the original version
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If COVID PCR is negative in a high risk patient, don't believe it
There are a lot of false negatives due to poor sensitivity.
Repeat!
Patient admitted with dyspnea and abnormal CT scan. SARS CoV2 PCR negative on day
#1
and
#2
. Turned positive on day
#3
.
#COVID
ー19
#IDtwitter
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Anyone who credulously tweets a K-M curve like this should turn in their sciencing license.
Yet this man is called on repeatedly to comment on literally everything in medical science.
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For years, I raised concern treating AFib detected by watches may not avert stroke/save lives.
RCT out now shows anticoag after detection by implanted devices (more accurate & higher risk pop) leads to more bleeding without significant benefit.
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I self-censored because of how Twitter enforcers behaved. To be honest the bad behavior of academics on twitter pushed away folks who could have contributed.
Many eye opening behind the scenes stories to share when the time is right.
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So, Norway has decided not to engage in screening of asymptomatic people for COVID19.
They posted this figure to justify it.
Let's work through the math!
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Quizzed my intern this morning: what are the most common life-threatening complication of statins?
Her response: Choking on the pill.
Me: That's about right.
@ethanjweiss
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I never believed ivermectin was likely to work for COVID.
But condescending and mocking those who did is not the way to convince them. ("Horse dewormer")
Leaders of public health need to focus on honey and not vinegar.
In the least surprising but still helpful study
Ivermectin is great as a dewormer in horses
It does not work for COVID
We all wish it did
It doesn’t
But thankfully we have drugs that do. Like Paxlovid
So if you get COVID — skip the Ivermectin and get a medicine that works
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New paper out today in
@JAMACardio
that originated from a question
@RaviShah_MD
had several years ago:
what are the relative contributions of genetics, fitness and physical activity to the development of obesity?
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@VPrasadMDMPH
Has there ever been a case of a drug where the CDC recommended getting a second dose when there is minimal benefit to the patient and a serious adverse event with the first dose??
They even consider 2nd dose in kids with *myo*carditis with first dose!
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This is probably the best survival curve I have ever seen.
COVID vaccines are amazing!
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I was shadowbanned ostensibly for discussing COVID test characteristics
* MS in chemistry from MIT
* MD & PhD from Johns Hopkins
* Worldwide recognized expert in medical diagnostics
They didn't like the message I guess
They tried to bury it
#TwitterFiles
@bariweiss
@mtaibbi
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TBH I'm not a football guy so whether they put off a year doesn't really affect me, but the Big 10 is a majorly respected organization and many Americans get their news from
@espn
.
Unfortunately much of the messaging centers around a flawed paper.
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Govts now recommending a single dose of vax to populations at high risk of vax myocarditis:
* UK
* Sweden
* Norway
* Denmark
* Hong Kong
Will US update soon? Would love your thoughts!
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Which is harder to do?
A. Make 1st high volume electric car
B. Build reusable rocket to transport humans to space & back
C. Link computer to brain
D. Maintain micro-blogging social media network?
News media is saying someone who has led A-C is now out of his depth for D
Lolz
🚨Ben Collins, NBC News: “Twitter employees want to stress that the company is a nightmare right now and you cannot work there. And the website is built on sticks and it might fall apart. It’s a house of cards.” “Elon is deeply out of his depth.” “This could be really bad.”
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Professor: what a journey!
The days were long but the years short
Could measure the journey in papers/R01s but I would rather measure it by all I learned along the way & the colleagues who became friends
🙏 to all the friends/family whose support at every step made it possible
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Completely irresponsible to say you "have a cure for cancer" when what you have is an unproven whole body screening MRI with a little AI sprinkled on top
Need to show improved outcomes, which is super hard. Outcomes could easily be worse.
I believe we have a cure for cancer.
Early detection.
Here’s how
@ezrainc
plans to detect cancer early for everyone in the world (the secret Ezra master plan):
Step 1 (done):
Launch a 60-minute full-body MRI that screens for cancer and 500 other conditions in up to 14…
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I regret not speaking out more loudly during hype over risks to young folks from COVID myocarditis scare triggered by a crummy paper (that had nearly every number corrected and was still off by ~100x).
Shame on the so called leaders in cardiology that jumped on that train.
That said, I regret not speaking out even more loudly.
Too many sports seasons were cancelled.
This also contributed to prolonged closing of schools in Fall 2020 - an epic tragedy for so many children.
I wish I had spoken more strongly on this issue like
@MJAckermanMDPhD
did.
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I am hearing from primary care colleagues that parents are concerned their kids are playing competitive sports without EKG/echos.
More valuable than that would be to mandate no games/practice without AED + CPR trained coach, trainer, and/or official present.
Here is why 👇
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I was honored to get the jab early.
I recommend it to my pts.
I'm not ready to mandate it for children ibased on relatively small, short term studies.
Calling this anti-vaxism is unfair, unprofessional, and unscientific.
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Now at Costco!
(No, I didn't buy, but I was tempted).
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I'm tired of credentialism.
Many, many times I have pointed out that ordinary practicing docs, nurses, lab techs and others sometimes have insights that the highest experts lack.
I believe the culture of
#medtwitter
needs reform.
A little thread. 🧵👇
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This is a global tragedy which has erased decades of progress for many, many millions.
The implications will take generations to redress.
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The desire to retcon COVID shutdowns that happened in the US and western countries is certainly fascinating.
Could't buy housepaint because somehow selling paint would spread COVID.
Kids couldn't go into stores.
People were jailed for giving haircuts.
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Bad policy. Bad precedent. Not following science.
Just bad.
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I'm told that we shouldn't mistrust the media.
How can we trust them when they constantly go to Topol for quotes on seemingly never ending list of subjects while he misses glaring problems again and again and again?
Reporters, put in legwork to find new experts!
It appears
@EricTopol
is aware of the feedback that he is tweeting a flawed observational study of Paxlovid where the curves separate immediately & is generally a poor reader of medical literature & should not be quoted by newspapers
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Sigh. We hear this idea that the
#1
cause of obesity is genetics yet:
* Best polygenic risk scores only explain ~10-15% of BMI
* Marked differences in obesity b/w long-term immigrants & originating countries (e.g. East Asia)
Obesity is the second leading cause of preventable death in America after smoking. Lesley Stahl reports on a new medication that helps with weight loss but is wildly expensive and covered by very few insurance companies.
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Why is the recommendation of a European health authority getting flagged?
What am I missing?
Danish Health Authority updates COVID vaccination based on age-risk profile for Autumn
(Published currently on website)
People >40 benefit most from vaccination.
Children: Vaccine no longer for everyone. Only after medical (risk) assessment.
1/2
👇
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I was called "unethical" by med students for discussing the problems related to the COVID cardiac MRI studies and overdiagnosis of myocarditis.
Now rumor has it, myocarditis is rare in NCAA and the KOLs are claiming credit for knowing all along.
Are you seriously calling me unethical for tweeting about a paper that shows athletes can have LGE without COVID?
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This morning I pointed out a wasteful use of PPE on non-life saving invasive procedure.
Through the day, I was called cruel, insensitive, gaslighting even.
Hardly anyone stepped up to defend me even though most know I'm right.
Speak up. Save lives. Conserve PPE.
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It's a real scandal that many on
#medtwitter
&
#epitwitter
essentially conspired to call this fake news.
It's been confirmed over and over.
The FDA should act given we have alternatives: Moderna should not be used in younger males, as many other countries have decided.
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Turns out talking about RCTs is an effective way to figure out which individuals have more hate than sense.
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Will this end the discussion of rampant, serious cardiac involvement of COVID in athletes with no cardiac symptoms?
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I'm a cardiologist. Here is what I think about covid vaccination and myocarditis:
Case 1: Prior myocarditis unrelated to COVID ➡️ discuss with doctor. Probably 1 dose, depending on clinical factors and preferences.
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There is no replacement for RCTs.
None.
The two biggest failures in COVID19 policy were
1. Hubris to think humans were all powerful & could entirely change mother nature
2. Not subjecting our interventions to empirical testing, creating bitter tribal disputes, based on no credible data & never learning the answer 🧵🧵
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Generally trauma to the chest from person-person deposits only a small amount of energy into the heart compared to small hard objects like a baseball or motor vehicle collisions.
The amount of energy is proportional to the square of the velocity of the impact.
1/
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The leading voice in cardiology, reduced to hyping rare case reports of COVID myocarditis.
Time. to. end. this. nonsense.
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Should have been strategy of vax roll out from day 1
We messed up initial rollout by equating risk of 80 yo nursing home pts & 25 yo healthy teachers
We messed up booster by oversimplifying to 1 size fits all
We messed up bivalent vax by oversimplifying again
Same mistake x 3
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Does this mean no access to professional guidelines, journals, etc that came with that membership?
If so, this hurts patients which is not a good plan.
Doctors are sworn to help everyone, regardless of nationality, even in war.
Reverse this poorly thought out policy.
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If you are thinking "what harm could a little chloroquine do to my COVID pts?" or "worth a shot right?"
In vitro data favorable 4 chloroquine in Chikungunya too - see what happened.
Quote below from
@ScienceMagazine
. Link to primary paper in reply
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Testing low risk individuals with no symptoms is a Bayesian nightmare.
The CDC now advises that vaccinated people be tested for the coronavirus if they come into contact with someone with Covid-19, even if they have no symptoms. Previously, it only recommended vaccinated people get tested if they were experiencing symptoms.
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Ab titers are a surrogate endpoint that may not be so tightly linked to reduced infections or other important endpoints.
Titers may have been good enough earlier in pandemic, but at this stage we should seek more evidence of meaningful endpoints.
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Sigh. I guess
@Twitter
@TwitterSafety
purports to know more than actual cardiologists about myocarditis
COVID myocarditis is indeed uncommon
COVID-vax myocarditis is likely uncommon but could be concern for low risk population (akin to VITT). We need more data to know if it is.
How ironic that the largely fake COVID myocarditis is being supplanted by the likely real COVID-vaccine myocarditis.
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The irony is that the folks who labelled this misinformation are almost certainly less educated and less informed on this issue than
@rfsquared
.
What's sad is they also won't be accountable in the slightest for this and many similar errors.
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Myocarditis is an uncommon complication but it increasingly seems like repeated mRNA vax among otherwise healthy/low risk younger men and boys may not be wise.
Glad to see this piece laying out the case.
"Based on what we’ve learned, it indeed appears that Pfizer boosters likely offer more harm than benefit for males under 30 with respect to hospitalization."
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Did anyone else notice he is talking about fully body MRI while standing in from of a CT scanner?
🤔
Early detection is our best chance at beating cancer.
The
@ezrainc
Full Body MRI can help you screen for cancer in 13 organs.
The most frequent question I get when talking about what we do at Ezra, is how we handle false positives. Here’s what we do:
Incidental findings can…
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Norway has decided against asymptomatic community testing for COVID with PCR due to excessive rate of false positives.
Very nice illustration of how even a very high specificity test can fail in a very low prevalence environment!
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Perhaps one of the best lines ever written about medical guidelines from
@raj_mehta
&
@RichardLehman1
, by way of
@drjohnm
TWIC podcast.
👏👏
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Case 3: Prior myocarditis related to COVID vax ➡️ no further doses until we understand more.
Recurrent myocarditis is bad. Can be really bad.
Not responsible to rechallenge the body in this type of case.
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Our letter about the use of cardiac MRI in asymptomatic people post-COVID has now been published on
@cvctcardiobrief
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Atrial fibrillation is a metabolic disease!
RCT evidence of improved AF control with exercise intervention from
@PrashSanders
and colleagues
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PROMISE Diabetes Substudy Tweetorial...
I was planning a much funnier tweetorial will polls and illustrations and the like but due to competing deadlines and tons of clinical work today, this will have to do.
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Heard ad for
@Menards
on radio this AM. I used to like their clean, bright big box hardware stores
Then they banned children during COVID: "Menards encouraged shoppers with children to buy online and pick up at the store."
Never give them business again
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This is a *really* bad take.
I can’t believe I have to say this, but self-limited troponinemia is not as bad as post-multi-system inflammatory syndrome with reduced systolic ejection fraction.
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Letter regarding use of cardiac MRI in asymptomatic people recovered from COVID19 with many diverse signatories has been sent to leading medical societies.
Will be published soon.
Watch for it.
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Some folks equate any deviation or even discussion of deviation from CDC recommendations re: COVID as:
* Denial of how bad COVID is (nope)
* Supporting people who are anti-vax (nope)
These are done in an effort to distract & assign guilt by association.
Reject these arguments.
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My name is Venkatesh. It means lord of venkata hills (a Hindu deity), destroyer of sins, and remover of obstacles.
Almost *nobody* in America pronounces it correctly.
I don't care whether or how you (mis)pronounce it.
I do care deeply whether you at least listen to my ideas.
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Honestly, given the infectious field of viral particles in COVID19 is essentially a radiation field, it's all pretty much Time-Distance-Shielding
Time - minimize duration of contacts
Distance - physical distancing
Shielding - masks and barriers
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Apparently being an expert in cardiology, cardiac imaging, inflammatory heart disease, cardiac risk assessment, and preventive cardiology is insufficient.
Gatekeeping and credentialism knows no bounds apparently.
@theangr20074523
@JHowardBrainMD
@genevievefri
@VPrasadMDMPH
@rfsquared
@WesPegden
@venkmurthy
@DrAmyBeck
@medpagetoday
None of the authors are experts in pediatric vaccine policy. They are Twitter contrarians that like to make a social media splash by publishing controversial blog posts criticizing mainstream experts. I trust ACIP and the data they presented.
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Ooof! *sigh*
My grandma was among only a few women in her community who had 8th grade literacy.
Her primary lesson to us and platform as local village board member was EDUCATION above all else.
She lived through famines, wars, epidemics, cholera, TB, smallpox, etc.
Genuine q for ppl more concerned about schools being closed than covid: are you aware mandatory schooling is barely a century old in this country?
Maybe ur all grandparents had highschool, but what about ur great-grandparents?
Yes, education is important. But it’s a pandemic!
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FDA advisory committee rejects boosters for all those age 16+ in major rebuke to White House.
Follow the science.
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Too often what was medical misinformation yesterday turns out to be scientific consensus today.
Thought provoking piece from
@drjohnm
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I probably shouldn't have left even a crack in that door.
TBH I can't think of any reason to ever consider 2nd dose in a person who had myocarditis with first dose, but I'm not sure there isn't something I didn't think of or something that could arise/change in the future.
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LOVE that more people are speaking out about low quality of COVID CMR data now that OSU data turn out to have questionable images & no controls.
Some of us stuck out necks out to speak about this for weeks.
Thank us by reevaluating all those KOLs who hyped this uncritically.
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Very thought provoking and provocative piece on risk reduction for young adults by
@VPrasadMDMPH
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Science is often open for debate because:
* Rarely have perfect experiments - flaws, limitations, etc almost always present
* Even w/ strong scientific evidence, often important follow-up ?s raised
* Implementation often requires value, economic, and/or political judgements
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Watched Wonder Woman 1984
My wish is to get back my 151 minutes
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@chadinabhan
There are reporters & twitter peeps who are literally accusing entire team of docs & RNs that stood there & gave a reasonably detailed status report of lying based on unnamed sources & rumors.
These are academic docs & military service people.
They deserve a little respect.
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Given the below facts, would it be that hard to do a trial of COVID boosters powered for death + hospitalization?
1) ~3/4 million cases/day
2) ~2k deaths/day
3) ~150k hospitalization
4) ~1/2 of vaccinated are boosted (~120 million in US)
5) $PFE $MRNA combined profit >$10bn
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@SahilBloom
@XavierHelgesen
This isn't a great idea. It is not based on science and ends up selling misery to many people and helping very few.
Anecdotes aside, I'm quite confident that screening healthy people with whole body MRI is a bad idea for almost everyone except the people who own the testing center.
I say this as someone who has studied medical imaging and risk assessment for a looooong time.
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Mind blowing article about life in academic medicine by Joseph Simone. Wish I understood these when I started this journey. H/t
@thebyrdlab
"Understanding Academic Medical Centers: Simone’s Maxims"
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Anyone notice not long ago
@NateSilver538
was flamed by epi/pub health community for questioning COVID vax rollout plans & now senior public health leaders are declaring a botched rollout.
Was that just credentialism?
Or does the Overton window swing about wildly these days?
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I was told that in the COVID era anecdotes have substantial value.
What I didn't realize was that it would take 50+ authors to convey them.
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Enormous tragedy.
ENORMOUS.
If rich countries do not redistribute surplus vaccine this year, between 1m and 2.8m lives could be lost, according to new analysis by Airfinity, a life-sciences data firm
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WHO seriously considering airborne precautions rather than droplet for COVID after important new NEJM study (NEJM link next tweet):
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