Inocencio Perez Alejandro retweeted
The Philippines has climbed out of the bottom 10 in the PISA 2025, posting its best score since its third time joining the global assessment in 2018.
🇵🇭 now ranks 72nd in reading (out of 91 countries) and is hailed by the OECD for being the fastest riser globally @philstarnews
Inocencio Perez Alejandro retweeted
高齢者のスタチン、心血管疾患を起こさないリスクはわずかに増えるかもしれないが(相対利益1.025)、健康寿命が延びるわけでもなく、非心血管疾患で死亡する人もスタチン投与と無関係に多く、筋肉痛や糖尿病リスクといった生活の質を下げる副作用を抱え込む可能性が高くなるというRCT。これを水道水に入れてルーチン服用など狂気の沙汰?という解釈もできるね。
Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults | New England Journal of Medicine nejm.org/doi/10.1056/NEJMoa2…
Inocencio Perez Alejandro retweeted
Just published paper: shifts #EBM teaching from tedious primary study critical appraisal to pragmatic, patient-centered application, emphasizing interpreting effect sizes, understanding evidence certainty, and applying data in shared decision-making.
pubmed.ncbi.nlm.nih.gov/4234…
Inocencio Perez Alejandro retweeted
After the Nuremberg Trials, one of the most unsettling conclusions did not come from the courtroom, but from the psychiatrist tasked with evaluating the defendants.
Dr. Douglas Kelley, the U.S. Army psychiatrist assigned to assess many of the senior Nazi officials, expected to find monsters people fundamentally different from the rest of humanity. He did not.
What disturbed him most was how ordinary they were.
They were not raving madmen. They were not obvious sociopaths. They were intelligent, educated, and often convinced they were simply doing their duty, following orders, or serving a higher cause. Kelley warned that this was the real danger: evil does not always look abnormal. It often presents itself as competence, obedience, and institutional loyalty.
His central warning was deeply uncomfortable there are people with morally vacant or destructive tendencies everywhere. In every society. In every era. What determines the outcome is whether systems elevate those people, shield them from accountability, and normalize their behavior, and whether ordinary citizens are willing to question authority when it matters most.
Modern bureaucracies and institutions are powerful precisely because they diffuse responsibility. Decisions are broken into policies, protocols, committees, and “best practices.” Harm is rarely framed as harm; it is reframed as necessity, risk management, or compliance. Individuals are encouraged not to think morally, but procedurally.
This is how ordinary people become capable of extraordinary wrongdoing by outsourcing conscience to institutions and convincing themselves that accountability lies somewhere else.
The lesson of Nuremberg is not that “those people were different.” It is that they were not.
That is why vigilance matters. That is why blind trust in authority is dangerous. And that is why a healthy society must protect dissent, accountability, and moral courage especially when it is inconvenient.
History does not repeat itself because people forget facts. It repeats itself when people convince themselves, “It could never happen here.”
Inocencio Perez Alejandro retweeted
FREE ACR Rheumatology Virtual Grand Rounds! Bring high-quality #rheum education straight to your residency program.
📚 27 recorded didactic sessions with synced slides + embedded assessments
🎓 Free, open access for residency programs
🩺 No rheumatologist on staff? No problem. Get expert explanations & ready-to-use content.
Explore both adult & pediatric #rheum modules today! 🔎
Adult: acr.tw/4oEwNsH
Pediatric: acr.tw/4a7i5qM
Inocencio Perez Alejandro retweeted
“That is why this task force continues to say: nothing is better than methotrexate and glucocorticoids to start”
- Josef Smolen, on RA treatment
#EULAR2025 @RheumNow
A welcome push towards generalist model of care for hospitalized patients. #pcp2025
Inocencio Perez Alejandro retweeted
This has been needed for a long time!
Redefining obesity
A new report of @TheLancetEndo commission that overrides current BMI categories and better defines features and pathophysiologic consequences of pre-clinical and clinical obesity
thelancet.com/journals/landi… open-access
(such as an athlete with no fat excess is not obese, but is according to current BMI based definition)
Inocencio Perez Alejandro retweeted
Medicine is difficult! Standing over my 46 years of clinical practice, I couldn't agree more...
doi:10.1136/bmj.q2163 @Drlipid @DrMarthaGulati @PamTaubMD @biljana_parapid @AmarPut @AndrewJSauer @ErinMichos @SABOURETCardio @ctinocomesquita @OtavioBerwanger @JohnKastelein 👇🏽👇🏽 – at Rio de Janeiro, Brazil
Inocencio Perez Alejandro retweeted
Replying to @DrNeilStone
I think a much better way of putting this is
“Doctors should follow most guidelines most of the time.
When they don’t they should have a well reasoned explanation for deviating and should at least think twice before doing so or even seek a second opinion”
The problem with the previous phrasing is it promotes the image of anarchic hero doctor and conflates being a good doctor within not following guidelines. It puts the doctor at the centre of the argument and argues for exceptionalism for the doctor not the patient.
Inocencio Perez Alejandro retweeted
Thank you @Erman_Akkus for ur reply it is a good learning opportunity for #ESMO24
In 15 tweets, I will summarize the trial, my criticism, and why this reply contains 3 common errors that oncologists make because our training doesn't teach these ideas.
First, the trial...
Inocencio Perez Alejandro retweeted
✅ Main mechanisms for low therapeutic adherence in the context of #Lupus @LupusAcademy 2024
➡️ Primary vs secondary
➡️ Intentional vs non-intentional
➡️ Adherence vs Compliance vs Persistence
Inocencio Perez Alejandro retweeted
Sleeping in on the weekend may be protective for your cardiovascular health
Here’s what you need to know 1/10 🧵
Inocencio Perez Alejandro retweeted
Replying to @jeremykauffman
You'd probably find the book, "When Doctors Don't Listen" by Leana Wen (yes, lock 'em down Wen).
She argues doctors are not incentivized to find a correct diagnosis so much as they are to rule out serious ones.
Math skills (or lack thereof) aside, I suspect this plays a role.
Inocencio Perez Alejandro retweeted
Unleashing frailty from the laboratory into the real world: A critical step toward frailty-guided clinical care of older adults. #geriatrics agsjournals.onlinelibrary.wi…
Inocencio Perez Alejandro retweeted
Blood culture stewardship
Clinical Situations Where Blood Cultures are Low Yield and Generally Not Recommended in the Absence of Severe Sepsis/Septic Shock
doi.org/10.1093/ofid/ofae479





































