The Diagnostic Detective attempts to explain why study design is the biggest enemy of RCTs of diagnostic tests open.substack.com/pub/thediagn...

Ever notices that RCTs of 'transformative' diagnostic tests almost never show benefit to patients. In Part 1 of 2, the Diagnostic Detective makes this case. In Part 2, I will attempt to explain why. open.substack.com/pub/thediagn...

A great failure of PEPFAR (among many successes) was not insisting on an RCT of switching vs not switching to DTG in a large cohort of African patients. Now we are stuck with observational evidence on the side-effects of INSTIs www.thelancet.com/journals/lan...

The commonest cause of sepsis in adults with advanced HIV disease in Africa didn't even get a mention! @thelancet.com #tuberculosis Sepsis - The Lancet www.thelancet.com/journals/lan...

We're pleased to announce our 2026 guideline update to induction treatment for cryptococcal meningitis! sahivsoc.org/Files/SAHCS%... @neleshg.bsky.social @tomboylesid.bsky.social #HIV #CryptococcalMeningitis

There is something seductive about single blood tests for multiple diseases. The diagnostic detective looks at the Galleri test and the Bayesian effect of the NHS-Galleri trial. #grail thediagnosticdetective.substack.com/p/the-seduct...

DO NOT be tempted to extrapolate these finding to low resource settings. Many aspects of this trial (eg incentives) are not achievable for us. Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges | New England Journal of Medicine www.nejm.org/doi/full/10....

The Diagnostic Detective looks at Apple Watch hypertension alerts. Spoiler- they are poorly studied and likely add little #Applewatch open.substack.com/pub/thediagn...

The one where I argue that Smartwatches in healthcare should be seen as screening tests and held to the same standard of evidence open.substack.com/pub/thediagn...

PSA testing for individuals vs populations. The medical equivalent of general relativity meets quantum mechanics. It all depends on your perspective. open.substack.com/pub/thediagn...

Vaginal microbiome testing- is it useful in the absence of symptoms? The Diagnostic Detective investigates open.substack.com/pub/thediagn...

Should healthy people test their gut microbiome? Or is it just an expensive mirror of what we already know? The Diagnostic Detective investigates. open.substack.com/pub/thediagn...

In South Africa, where lenacapavir introduction is anticipated in early 2026, the Wits RHI study will provide the Department of Health with the evidence they need to adapt quickly and in real time as they integrate lenacapavir into existing HIV prevention programs unitaid.org/news-blog/le...

Why don't we lose weight the way we expect when exercising- The Diagnostic Detective investigates open.substack.com/pub/thediagn...

Do Continuous Glucose Monitors make healthy people even more healthy. Or is it another fad? The Diagnostic Detective investigates open.substack.com/pub/thediagn...

Publication of our protocol to test the safety of valganciclovir in patients with advanced HIV, CMV viraemia and no end organ disease. First Patient First Visit is imminent. pmc.ncbi.nlm.nih.gov/articles/PMC...

Does it help healthy people to take Vitamin D supplements? The Diagnostic Detective takes a look. open.substack.com/pub/thediagn...

@jaynesutherlandtb.bsky.social Nice study but... I'd rather you chose a threshold with NPV of 99% and say X% had TB effectively ruled out. This would help me as a clinician. An NPV of 95% doesn't help, I am going to investigate with sputum etc. #blueintheface academic.oup.com/cid/article/...

"World's first potential trillionaire has killed 600,000 people, including 400,000 children" is the only headline that anyone should ever read about Elon Musk

Do you need to drink 2 litres of water a day to stay healthy- or are you being duped? The Diagnostic Detective investigates open.substack.com/pub/thediagn...

The Diagnostic Detective asks if the latest liquid biopsy for cancer is all that its cracked up to be. #GRAIL open.substack.com/pub/thediagn...

#Tuberculosis AI stethoscopes unimpressive in symptomatic patients. If they are ever useful (which I doubt), IMO it would be as a replacement for dCXR in active case finding. Is anyone doing that study? pmc.ncbi.nlm.nih.gov/articles/PMC...

Of course paracetamol doesn't cause autism but can the media stop saying 'not treating fever in pregnancy will lead to harm to the baby' without any EVIDENCE to back this up. It's conceivable that treating fever actually causes harm (this is a hypothesis not a statement of fact). #thenewsagents

The Diagnostic Detective asks- should you take paracetamol (acetaminophen) for a fever? Will it help, will it hinder? thediagnosticdetective.substack.com/p/does-parac...

This is why indiscriminate use of CAB/RIL in Africa will be a disaster. INSTI resistance emerged in approximately 40%–70% of individuals experiencing VF. VF is rare in clinical trials (per diems), it will be much higher in standard of care settings in Africa. academic.oup.com/cid/article/...

I will be delighted to present a case from South Africa at this meeting

Today the Diagnostic Detective asks- are cramps caused by dehydration and salt loss? Can you guess the answer? thediagnosticdetective.substack.com/p/is-cramp-c...

Another failed shortening study in patients with extensive disease (mostly). I am reminded of Einstein's definition of insanity. Shortening studies need to focus on patients with minimal disease. #tuberculosis - The Lancet Infectious Diseases www.thelancet.com/journals/lan...

The Diagnostic Detective asks 'Can your body become resistant to antibiotics?' open.substack.com/pub/thediagn...

Can you prevent colds and 'flu with vitamin C. The Diagnostic Detective takes a look. open.substack.com/pub/thediagn...

Should you finish a course of antibiotics even if you feel better? The Diagnostic Detective takes a look, including the Special Case that is #Tuberculosis open.substack.com/pub/thediagn...

Free access to our article on the inclusion of LMICs in platform trials of bloodstream infections. SNAP in Johannesburg. @steventong.bsky.social @gurujosh.bsky.social authors.elsevier.com/a/1lVzy,RGPg...

The Diagnostic Detective looks at the evidence behind probiotics to restore gut health after a course of antibiotics. the results might surprise you. open.substack.com/pub/thediagn...

Today the Diagnostic Detective moves to Medical Myths. Does running really ruin your knees? Or are knees like hearts; use them or lose them?https://thediagnosticdetective.substack.com/p/does-running-on-roads-ruin-your-knees

Conclusion says 'no significant difference' but it was a small study with 11%[95% CI –0·9 to 22·5] ARR. Surely a Bayesian approach would be more informative? I would use steroids in these patients - The Lancet Respiratory Medicine ‪@lancetrespirmed.bsky.social‬ www.thelancet.com/journals/lan...

“Now is the time to build – not dismantle.” IAS’s Anna Grimsrud 🇿🇦 discussing the future of differentiated service delivery models, scale-up and PrEP integration. #IAS2025

SNAP trial update ➡️ The DSMC provided a recommendation to close the ADJUNCTIVE domain (Clindamycin), due to a statistical trigger for futility being met. #IDsky

Can't believe the EMPIRICAL study showing reduced MORTALITY in kids with pneumonia given valganciclovir didn't get an oral! Come on #IAS2025. This is a VERY important finding.

The upcoming NIRVANA study will randomise these folk to valganciclovir or placebo to test safety, with a view to a phase 3 trial powered for mortality.

I hope all attendees at #IAS2025 ask themselves an important question. In these times of austerity, can I put my hand on my heart and say that the resources used to send me here could not be have been better used elsewhere? If yes, happy days enjoy. If no, please reconsider future 'academic' travel.

Fabulous idea. So many people who would make great doctors have traditionally missed out. Well done Edinburgh www.bbc.com/news/article...

“We are at risk of missing out on a generation of scientists — because people will leave" Devastating impact of Trump cuts on South African scientists www.nytimes.com/2025/06/17/h... via @stephanienolen.bsky.social

Kathryn Maitland really does do the best studies. Bravo. Intravenous Rehydration for Severe Acute Malnutrition with Gastroenteritis | New England Journal of Medicine www.nejm.org/doi/full/10....

This represents an important advancement in our understanding of phenotype based TB regimens. The time is right for a definitive trial. #tuberculosis

Can we just accept the maxim that in people with virological suppression, ANY 2 drugs from different classes will be non-inferior to ANY standard regimen? Or can we at least publish these studies in very low impact journals and move on. #HIV #LancetHIV www.thelancet.com/journals/lan...

‪A plane from DRC landed 2 days ago with an extended family who recently attended a funeral and had close physical contact with the body. They have now dispersed all over America. The body is confirmed to be Ebola positive. We have an effective vaccine. What would you say in your initial address?

Out with vaccines In with bleach?? WTAF!? www.wired.com/story/chlori...

"Brooke Nichols, an associate professor of global health at Boston University, has estimated that these cuts have already resulted in about 300,000 deaths, most of them of children, and will most likely lead to significantly more by the end of the year."

it boggles the mind that the same people who are absolutely sure that SARS-CoV-2 is a bioweapon are working destroy our ability to perform the exact research that would maximize our preparedness to counter such a bioweapon

I'm sceptical about a wide-spread roll out of Cabotegravir/rilpivirine LA in Africa due to high risk of resistance. However, the look of delight on a 24 yr old vertically transmitted HIV patient when I told her of its existence was quite something to behold. #idsky