From ignore the code, the most sensible explanation of the Monty Hall problem I have yet seen. Yes, changing your mind once more information is available is a good idea. The devil is in establishing what constitutes new information. For better or worse, life is not a game show.

Cool resource alert: Improving Your Statistical Inferences by Daniël Lakens has the best introduction to p values I’ve seen on the free web. Frank Harrel’s Biostatistics for Biomedical Research has been available for a while, but only suitable for advanced readers.

I have always admired prolific writers like Matthew Yglesias and Scott Alexander — both now on Substack, and not by accident — for their ability to produce tens of thousands of words daily, ⊕ My admiration being tampered somewhat by ChatGPT and other LLMs, which are about as intellectually and factually rigorous as Alexander, and slightly less so than Yglesias; some sacrifices do have to be made in the name of productivity. on top of the random bite-sized thoughts posted on social media. There are only so many words I can read and write in a day, and for the better part of the last year, my language IO has been preoccupied by helping clean, analyze, interpret, and write up the results of a single clinical trial, which are now finally out in The Lancet Neurology. ⊕ Yes, my highest impact factor paper to date is in a neurology journal. Go figure.

The paper is about our clinical trial which used the body’s own immune system to treat autoimmune disease — and a particular one at that, myasthenia gravis — via technology that up until now has only been used against cancer (CAR T cells). It has made a decent impact since it came out less than two days ago. It got a write-up in The Economist, for one. Endpoints News as well. Evaluate Vantage got the best quote — it is at the very end of the article. And there is a whole bunch of press releases: from National Institutes of Health, University of North Carolina, Oregon Health and Sciences University, and of course Cartesian Therapeutics.

What went on yesterday reminded me that Twitter is not going anywhere any time soon: all of the above releases were to be found only there, not on a Mastodon instance, the journal’s own media metrics do not — and can not, at least not easily — trawl the Fediverse for hits, and I can’t just type in “Descartes–08”, “myasthenia gravis CAR-T”, or “Cartesian” into a Mastodon search box and get anything of relevance. ⊕ One could, of course, argue that you wouldn’t get anything of relevance on Twitter either, most of the discussion consisting of people who have barely read the tweet, let alone the article. And one would be correct. And while most of the non-Web3/crypto tech world has moved out, it looks like people in most other fields, from medicine to biotechnology to the NBA commentariat, are maintaining substantial Twitter presence.

This will, of course, have no impact on my commitment to staying out of the conversation to the extent possible while maintaining a semi-regular schedule of 500-character posts, which may now, IO bandwidth having opened up, become a tiny bit longer. Thank you for reading!

After seeing a friend and collaborator yet again plant foot firmly in mouth, I begin to see a pattern. A course on ergodicity should be a requirement for a public health degree, since the masters of public health keep getting it wrong (see also: the screening colonoscopy debate).

Any text about building a better NIH will have my interest, and the Brookings Institute came up with not one such text but eight! To my bemusement, zero of the nine authors responsible have any background in biomedical science. Could that be why some of them were so good?

There is a strong belief among scientists and lay people alike that:

1. more information is always better (it isnn’t)
2. hard numbers are the only valid form of information (they aren’t)

Combine the two fallacies and you get to today’s level of misinformation and self-deception.

It will be 13 years this June since I have left a job teaching histology at the University of Belgrade to start internal medicine residency in Baltimore. And lo and behold, I am back teaching, sort of.

UMBC — University of Maryland Baltimore County to friends — is starting a graduate course on clinical trials. I will be helping out Wilson Bryan, the recently retired Director of FDA’s OTAT (aka “head of cell and gene therapy”), to design and run it. Maybe even do a lecture or two. The two of us talked briefly about the new course on a UMBC podcast, ⊕ This is also where I learned what my title would be. Graduate instructor, apparently. The amount of paperwork required was not commensurate with the title. Oh my, all that docusigning… which is out today.

The course will be an in-person/on-line hybrid, so even those not in the area — and it will be held at UMBC’s Shady Grove campus — may join this coming September. From what I understand, giving people who are not physicians the opportunity to learn about designing, running, and interpreting clinical trials is a rarity, so it will be interesting to see who shows up and where the discussion leads us.

So, 13 years… Different university, different subject matter, but how much could things have changed since then anyway?

A one-two punch today for the journal Science, which while not at the very top of my to-read publications is still the “S” in CNS and therefore, I guess, important.

Punch one: trying to be more woke than the Pope; punch two: actually being — and this should come as no surprise — quite bigotted in practice. Want to submit a paper from your gmail address, you foreigner? Off with yer head.

NB: I do think small-s-science has a noise problem and have written as much. But has playing whack-a-mole ever been a good solution for anything? Or should we change incentives by removing publication count as requirement for promotion in academia and — even more importantly — clinical medicine?

And in some positive news — can you imagine those still exist? — the US Food and Drug Agency has issued their draft guidance on decentralized trials (PDF download). America is playing catch-up with the UK in this regard, but better late than never!

Exploring the link between Sickle Cell, α-Thalassemia, P Falciparum Malaria and Burkitt Lymphoma in Africa

• Speakers: Sam Mbulaiteye, MBChB, M.Phil., M.Med.; Swee Lay Thein, B.S., F.R.C.P., F.R.C.Path., D.Sc., FMedSci
• Wednesday, May 10 2023, 12pm EDT
• Watch here

Diabetes Mellitus: Great Progress; Diabetes: The Marathon of Life

• Speakers: Douglas Melton, PhD; Courtney Duckworth, MD
• Tuesday, May 16 2023, 4pm EDT
• Watch here

Is Cerebrovascular Disease Ever Really Silent? Stroke, Small Vessel Disease, and Cognition

• Speaker: Rebecca F. Gottesman, MD PhD
• Wednesday, May 31, 2023 12pm EDT
• Watch here