Excellent piece. It's shocking that this is even debatable. It's not like this is the first time in medicine we ran into the perils of overdiagnosis. You cite Moynihan from 20 years ago, but that's not even some outlier idea. Sackett, Cochrane, Gigerenzer, Gray, Greenberg - all very prominent voices have been talking about this for decades. When Sackett coined the "Half of what you'll learn in med school will be wrong in 5 years" aphorism, clearly, we knew the harms of over testing were NOT going to be in the "wrong half".
After mammograms, after South Korea Thyroid PSA screening... how could we get this again? What could happen to convince us that over testing was a good idea?!?
When I was a surgical resident at UCSF Dr Larry Way, one of my professors, would say "don't order a test unless the test will change the treatment." Back then, 1989, we were testing too much and without thought. We are there again and as Dr Sebastian Gonzalez-Dambrauskas clearly states over testing can have consequences. I have seen perfectly reasonable people descend into perpetual fear during this pandemic. They are now serial testers. They are asymptomatic and they test because they went somewhere, or someone they know got sick. They frantically hunt for tests if they think they came in contact with omicron. They cue up on the website in order to get the 4 free at home antigen tests offered by the President. While I am all for empowering people during this pandemic at home testing has created a new madness and it is, in some cases, creating a new neurosis. The worried omicron well.
I have tried to council friends, family and patients to use antigen tests wisely and test only if symptoms start. We know antigen tests lag behind PCR tests by 3 days in diagnosing CV19. So don't test right after exposure, its a wasted test. Test 5 days after exposure if at all. My advise falls on deaf ears.
Test-o-rama may make the anxious feel less anxious but overall will it make a difference in the pandemic? I doubt it but we shall see. One thing is certain: it is benefiting Abbott and other manufacturers.
Not only that, there are tons of people clearly with omicron who are testing negative. It’s insane. My nanny for sure has Covid. Very sick even with all the early treatment. Doctor is treating her for Covid. Still testing negative.
My doctor said this is so common.
Me my husband and toddler had a day of nausea/ GI stuff, a headache and some fatigue. That was it. Same exposure.
I personally went from almost weekly testing to maybe once every few months. When I got covid in december via lat-flow I intentionally went and got a pcr so that I would have a formal proof of "recovery" (Europe)
Testing is a large economic enterprise now, controlled by relatively few players. The US for example, on Jan 11 reported ~2.5mn tests. The UK 1.6mn. France 1.8mn. This is a lot of money being spent! I'm not being flippant when I say the Covid-Industrial-Complex is a real thing now.
I can't think of a single thing being done, anywhere, which is in the realm of "covid mitigation" which is actually not doing a significant net harm.
Your post is timed well for Melbourne, Australia. Today, government announced twice weekly rapid antigen tests for all schools (students & teachers). School here starts in a week. And they are calling in retired teachers to assist with expected teacher shortage. With the steep age gradient harm associated with the COVID19, it all doesn't make much sense?
Vinay, I just watched your podcast rebutting Robert Malone. (seems like you agree with him a lot).
I think you may have mischaracterized Malone's position about possible cancers, etc, due to vaccine. I don't think he has claimed these are proven. But they ARE possibilities that haven't been ruled out. I believe that informed consent for a novel therapy requires everybody knows the possible future outcomes.
Also, you mentioned PRISM and Vacsafe... and you suggest these are tools that can detect vaccine safety signals. Would you be interested in doing a podcast or writing a blog post about how these systems work and what they currently show about vaccine safety?
Also, at the end of your podcast you said maybe you should bring in guests. Why not bring in... Robert Malone! you can rebut him in real time and maybe correct or moderate some of his assumptions (like that Ivermectin was the cause of Uttar Pradesh beating covid).
Great piece! I say this all the time in a very practical way to anyone I know who is thinking of getting tested when they are either asymptomatic with a sick family member in their house....or someone who has a sniffle, etc. Why test? What will knowing the result do for a healthy adult or child....change behavior? Change treatment protocol at home? Change outcome? Likely no to all of the above. Don't waste time in line for tests, stay home & away from others, treat accordingly like you would any other resp. virus!
I know a lot of people feel this way. I don’t personally feel like we’re quite there yet. Too many people are still dying. If our government ever gets it’s act together re: treatments, then we’ll be there.
Partly this is selfish; I’m pregnant and Covid is the top cause of maternal mortality. I hate vaccine and mask mandates, particularly for kids in both cases. High cost, low value. But testing and staying home when you actually *have* Covid seems like high value for cost. Natural immunity is real, so it’s not going to happen to any individual very often. And we could help the HCW shortage by ditching the vaccine mandates! (I can dream.) But I don’t want to go for a routine check-up and get infected by an asymptomatic HCW, especially right now when I have zero chance of getting any treatment.
Great comments!! RE: Your last sentence, literally the punchline of the piece -- ITS is a pronoun, just like HIS, HERS, THEIRS, etc. and no apostrophe is involved. IT'S is a contraction of "it is". There is no such thing in English grammar as the term ITS' -- no. such. term. Having cleared the air with that comment (which some will say is pedantic but they would be wrong) let me congratulate the author sincerely on a neatly delivered message. I recently heard a terrific wisecrack from a respected virologist who was interviewing a famous immunologist about the COVID disaster -- the virologist's comment was, "The human immune system did not evolve to prevent the development of positive PCR test results". This should lead us to ponder a closely related issue: I wonder if the author of the present piece (or Vinay) might elaborate on the huge communcation problems that have ensued secondary to conflation of, and ignorance about, the often heard terms, "infected", "ill", "case", "contagious", etc. It is a fact that in some state health department jursidictions, for example, a patient with a positive PCR test result is called a "Case" regardless of the presence or absence of any symptom or sign of COVID. Even the CDC cannot speak clearly in this context -- e.g. in the MMWR issue of Jan. 28th we see the terms "infected" and "case" used with absolutely no clarification of what was meant by either. One of the blowbacks of this chaos (which is totally preventable) is made obvious repeatedly when we hear people on news shows, and their "expert guests", say things like, "Vaccination has been proven to prevent infection" -- Well, look at the defintiion of "Case" in the Pfizer RCT -- in that huge study a "case" was a person having BOTH a positive PCR test result AND at least one or more signs or symptoms that were listed. So what say you? Are we going to recognize the reality (for example) that not every person with a positive PCR test result will become symptomatic and thus technically "ill" ? Or deal with the issue that any asymptomatic person with a positive PCR test result today might become symptomatic and sicker than hell one week from now?
Vinay- here is an example of having many specialists/ experts all together- sharing views that were not dictated by NIH / CDC- I hope you watch/ listen...there are only 1 or 2 who sounded quaky to me. BUT- we should always try to put biases aside if we are truly interested in truth and making our world a better place.
This took place today- 1/24/2022 in a Senate conference room.
Excellent piece. It's shocking that this is even debatable. It's not like this is the first time in medicine we ran into the perils of overdiagnosis. You cite Moynihan from 20 years ago, but that's not even some outlier idea. Sackett, Cochrane, Gigerenzer, Gray, Greenberg - all very prominent voices have been talking about this for decades. When Sackett coined the "Half of what you'll learn in med school will be wrong in 5 years" aphorism, clearly, we knew the harms of over testing were NOT going to be in the "wrong half".
After mammograms, after South Korea Thyroid PSA screening... how could we get this again? What could happen to convince us that over testing was a good idea?!?
Oh... wait... https://www.huffpost.com/entry/trump-no-covid-19-tests-no-covid-19_n_5ee7cc27c5b69e917f1d3b2b
When I was a surgical resident at UCSF Dr Larry Way, one of my professors, would say "don't order a test unless the test will change the treatment." Back then, 1989, we were testing too much and without thought. We are there again and as Dr Sebastian Gonzalez-Dambrauskas clearly states over testing can have consequences. I have seen perfectly reasonable people descend into perpetual fear during this pandemic. They are now serial testers. They are asymptomatic and they test because they went somewhere, or someone they know got sick. They frantically hunt for tests if they think they came in contact with omicron. They cue up on the website in order to get the 4 free at home antigen tests offered by the President. While I am all for empowering people during this pandemic at home testing has created a new madness and it is, in some cases, creating a new neurosis. The worried omicron well.
I have tried to council friends, family and patients to use antigen tests wisely and test only if symptoms start. We know antigen tests lag behind PCR tests by 3 days in diagnosing CV19. So don't test right after exposure, its a wasted test. Test 5 days after exposure if at all. My advise falls on deaf ears.
Test-o-rama may make the anxious feel less anxious but overall will it make a difference in the pandemic? I doubt it but we shall see. One thing is certain: it is benefiting Abbott and other manufacturers.
Not only that, there are tons of people clearly with omicron who are testing negative. It’s insane. My nanny for sure has Covid. Very sick even with all the early treatment. Doctor is treating her for Covid. Still testing negative.
My doctor said this is so common.
Me my husband and toddler had a day of nausea/ GI stuff, a headache and some fatigue. That was it. Same exposure.
None of us are vaccinated.
Just wildly bizarre.
I personally went from almost weekly testing to maybe once every few months. When I got covid in december via lat-flow I intentionally went and got a pcr so that I would have a formal proof of "recovery" (Europe)
Testing is a large economic enterprise now, controlled by relatively few players. The US for example, on Jan 11 reported ~2.5mn tests. The UK 1.6mn. France 1.8mn. This is a lot of money being spent! I'm not being flippant when I say the Covid-Industrial-Complex is a real thing now.
I can't think of a single thing being done, anywhere, which is in the realm of "covid mitigation" which is actually not doing a significant net harm.
Your post is timed well for Melbourne, Australia. Today, government announced twice weekly rapid antigen tests for all schools (students & teachers). School here starts in a week. And they are calling in retired teachers to assist with expected teacher shortage. With the steep age gradient harm associated with the COVID19, it all doesn't make much sense?
Vinay, I just watched your podcast rebutting Robert Malone. (seems like you agree with him a lot).
I think you may have mischaracterized Malone's position about possible cancers, etc, due to vaccine. I don't think he has claimed these are proven. But they ARE possibilities that haven't been ruled out. I believe that informed consent for a novel therapy requires everybody knows the possible future outcomes.
Also, you mentioned PRISM and Vacsafe... and you suggest these are tools that can detect vaccine safety signals. Would you be interested in doing a podcast or writing a blog post about how these systems work and what they currently show about vaccine safety?
Also, at the end of your podcast you said maybe you should bring in guests. Why not bring in... Robert Malone! you can rebut him in real time and maybe correct or moderate some of his assumptions (like that Ivermectin was the cause of Uttar Pradesh beating covid).
Great piece! I say this all the time in a very practical way to anyone I know who is thinking of getting tested when they are either asymptomatic with a sick family member in their house....or someone who has a sniffle, etc. Why test? What will knowing the result do for a healthy adult or child....change behavior? Change treatment protocol at home? Change outcome? Likely no to all of the above. Don't waste time in line for tests, stay home & away from others, treat accordingly like you would any other resp. virus!
I know a lot of people feel this way. I don’t personally feel like we’re quite there yet. Too many people are still dying. If our government ever gets it’s act together re: treatments, then we’ll be there.
Partly this is selfish; I’m pregnant and Covid is the top cause of maternal mortality. I hate vaccine and mask mandates, particularly for kids in both cases. High cost, low value. But testing and staying home when you actually *have* Covid seems like high value for cost. Natural immunity is real, so it’s not going to happen to any individual very often. And we could help the HCW shortage by ditching the vaccine mandates! (I can dream.) But I don’t want to go for a routine check-up and get infected by an asymptomatic HCW, especially right now when I have zero chance of getting any treatment.
Great comments!! RE: Your last sentence, literally the punchline of the piece -- ITS is a pronoun, just like HIS, HERS, THEIRS, etc. and no apostrophe is involved. IT'S is a contraction of "it is". There is no such thing in English grammar as the term ITS' -- no. such. term. Having cleared the air with that comment (which some will say is pedantic but they would be wrong) let me congratulate the author sincerely on a neatly delivered message. I recently heard a terrific wisecrack from a respected virologist who was interviewing a famous immunologist about the COVID disaster -- the virologist's comment was, "The human immune system did not evolve to prevent the development of positive PCR test results". This should lead us to ponder a closely related issue: I wonder if the author of the present piece (or Vinay) might elaborate on the huge communcation problems that have ensued secondary to conflation of, and ignorance about, the often heard terms, "infected", "ill", "case", "contagious", etc. It is a fact that in some state health department jursidictions, for example, a patient with a positive PCR test result is called a "Case" regardless of the presence or absence of any symptom or sign of COVID. Even the CDC cannot speak clearly in this context -- e.g. in the MMWR issue of Jan. 28th we see the terms "infected" and "case" used with absolutely no clarification of what was meant by either. One of the blowbacks of this chaos (which is totally preventable) is made obvious repeatedly when we hear people on news shows, and their "expert guests", say things like, "Vaccination has been proven to prevent infection" -- Well, look at the defintiion of "Case" in the Pfizer RCT -- in that huge study a "case" was a person having BOTH a positive PCR test result AND at least one or more signs or symptoms that were listed. So what say you? Are we going to recognize the reality (for example) that not every person with a positive PCR test result will become symptomatic and thus technically "ill" ? Or deal with the issue that any asymptomatic person with a positive PCR test result today might become symptomatic and sicker than hell one week from now?
Vinay- here is an example of having many specialists/ experts all together- sharing views that were not dictated by NIH / CDC- I hope you watch/ listen...there are only 1 or 2 who sounded quaky to me. BUT- we should always try to put biases aside if we are truly interested in truth and making our world a better place.
This took place today- 1/24/2022 in a Senate conference room.
https://rumble.com/vt62y6-covid-19-a-second-opinion.html
Thank you! 🙏🏻👏🏻