iiinova — where your digital self keeps evolving

Michael Marks @drmichaelmarks.bsky.social · 02/10/2026

Thanks @benvyle.bsky.social for hosting us @thelovetankcic.bsky.social to discuss community co-creation, participation, engagement and qualitative research as part of out collaborative projects focused on the control of syphilis in the UK.

A photo of a group of people in a line. In the centre they are holding up postcards about syphilis.

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Gabriele Pollara @gpollara.bsky.social · 21/09/2026

🚨 NEW RESEARCH TECHNICIAN POST 🚨 👉 Interested in understanding the biology of recurrent UTI? 👉 Keen to work in my own and @jennyrohn.bsky.social research groups at UCL? Then please do take a look at new position available 👇. Informal enquiries encouraged. #UTISky www.ucl.ac.uk/work-at-ucl/...

ucl.ac.uk

UCL – University College London

UCL is consistently ranked as one of the top ten universities in the world (QS World University Rankings 2010-2022) and is No.2 in the UK for research power (Research Excellence Framework 2021).

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Michael Marks @drmichaelmarks.bsky.social · 21/09/2026

Congratulations. Richly deserved. Hope we can setup new collaborations as you move to the new post!

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Brennan Kahan @brennankahan.bsky.social · 15/09/2026

***JOB ALERT*** We are seeking to appoint 3 Statistical Methodologists to work on methods related to the statistical analysis of clinical trials, or innovative design methodology. The posts will be based within the UCL Institute of Clinical Trials and Methodology. www.ucl.ac.uk/work-at-ucl/...

ucl.ac.uk

UCL – University College London

UCL is consistently ranked as one of the top ten universities in the world (QS World University Rankings 2010-2022) and is No.2 in the UK for research power (Research Excellence Framework 2021).

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Antonia Ho @drtoniho.bsky.social · 15/09/2026

See details of 2 #PhD posts based at CVR & 12 other projects based in Finland, Denmark, Netherlandsx Spain & England through the DETECTIVE MSCA Doctoral Network 🦠🕵️‍♂️ 👇

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Michael Marks @drmichaelmarks.bsky.social · 15/09/2026

In October we are hosting an open-evening on academic infectious diseases training in London. ACF posts open to people who have/will completed IMT. ACL posts for those who completed a PhD & in general already hold NTN in Infectious Diseases. If interested in attending sign-up using the link.

docs.google.com

Infectious Diseases ACF/ACL evening

We will be hosting an evening on the Pan-London Infectious Diseases NIHR ACF/ACL schemes where you will be able to understand more about the schemes in London and hear from current fellows. The meeti...

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Michael Marks @drmichaelmarks.bsky.social · 14/09/2026

Care was close to the community so we were treating cases early & outcomes were good. Nested acceptability & health economic evaluations coming soon. Work led by a great team of Ethiopian colleagues from the Armauer Hansen Research Institute & @lshtm.bsky.social. Funding from @nihr.bsky.social

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Michael Marks @drmichaelmarks.bsky.social · 14/09/2026

We deployed CO2 cryotherapy at a health centre and trained the staff to make a parasitological diagnosis of CL and deliver CO2 cryotherapy. We found ~2/3 individuals with CL could be treated at the local health facility using this model. Most people received 4-6 rounds of cryotherapy.

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

Still 1 week to apply. Looking for a great mathematical modeller to come and do a post-doc @lshtm.bsky.social focused on STI modelling in the UK.

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Michael Marks @drmichaelmarks.bsky.social · 12/09/2026

There are some beta lactamases such as some TEMs as well as efflux pump mediated resistance mechanisms too I believe where isolate can be Co-Amox Res but Pip-Taz sens so these represent a clear non Pseud indication too.

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

Very well deserved & especially good news in challenging times for research funding.

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Nicole Lieberman, PhD @nicolelieberman.bsky.social · 10/09/2026

Absolutely thrilled to share that my NIAID Director’s New Innovator Award (DP2) has been funded. I’ll be using functional genomics, biochemistry, and immunological techniques to understand the mechanisms and drivers of immune evasion by Treponema pallidum, the bacterium that causes syphilis.

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

They will do just that. You can separately pay for a before or after or both consultation but they will happily just scan you.

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

Still 1 week to apply. Looking for a great mathematical modeller to come and do a post-doc @lshtm.bsky.social focused on STI modelling in the UK.

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

It is. And I doubt data linkage will happen as its $$$.

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

In theory I guess data linkage would allow 12-24 month relapse rates (at least as coded in GP data) to be calculated by randomised duration.

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

Evidence based for duration pretty poor. We didnt recruit cystitis (primary care only) but was based on clinical diagnosis. I think data suggests moderate % cystitis cure without antibiotics so I won't be surprised if 2/7 works for some (without necessarily being correct 'empiric' duration).

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Michael Marks @drmichaelmarks.bsky.social · 10/09/2026

It's a MAMS-ROCI design. You randomise across a range of potential durations and then fit a spline if I recall correctly to identify the optimal duration.

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Michael Marks @drmichaelmarks.bsky.social · 09/09/2026

Congratulations to team at Malawi Liverpool Wellcome @liverpooluni.bsky.social. Recruited 1st participant into our trial of treatment for congenital syphilis. Study led by Bridget Freyne @ucddublin.bsky.social & now running in South Africa, Malawi and Indonesia. Hoping results by end of 2027.

clinicaltrials.gov

ClinicalTrials.gov

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Michael Marks @drmichaelmarks.bsky.social · 09/09/2026

UTI was Nitro and Pivmecillinam I believe with the same MAMS-ROCI design for identifying optimal duration.

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Michael Marks @drmichaelmarks.bsky.social · 09/09/2026

DURATIONS is also (has also) randomised UTI in primary care. in UK to between 2-5 days I believe. So we should get UK data on both lower and upper UTIs from the trial in the next 12 months or so.

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Michael Marks @drmichaelmarks.bsky.social · 08/09/2026

Our 3rd International Syphilis Symposium Webinar coming up on 23rd Sept. With talks on scaling up Dual HIV-Syphilis testing in Liberia & developing surveillance for congenital syphilis in Asia-Pacific. Register online as well as catching recordings of previous webinars from earlier in year.

internationalsyphilissymposium.com

ISS Webinar Series — International Syphilis Symposium

A quarterly webinar series bringing together clinicians, academics, and public health organisations focused on global syphilis control.

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Michael Marks @drmichaelmarks.bsky.social · 07/09/2026

Agree. I think best interpretation is maybe you can stop earlier if not tolerating and recognise that there is a slightly higher risk of recurrence (esp ?for enterococcus) but probably overall if tolerating then going to the end is worth it. If this truly varies by bug would be worth knowing.

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Josie Bryant @josiebryant.bsky.social · 07/09/2026

Apply to do a PhD at @sangerinstitute.bsky.social with me on global genomics of Mycobacterium abscessus bbsrcdtp.lifesci.cam.ac.uk/project-refe... About the scheme: bbsrcdtp.lifesci.cam.ac.uk/application-...

bbsrcdtp.lifesci.cam.ac.uk

Project Reference: TRG27-SAN-JB1 | Cambridge Biosciences DTP PhD Programme

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Michael Marks @drmichaelmarks.bsky.social · 05/09/2026

Very excited to see the launch of the joint @lshtm.bsky.social & Birkbeck BSc in Public Health A first for @lshtm.bsky.social to be offering Undergraduate courses & great to see this in partnership with Birkbeck given their very strong focus on widening participation.

bbk.ac.uk

Public Health - Birkbeck, University of London

Birkbeck’s BSc Public Health is run jointly with the London School of Hygiene & Tropical Medicine. Gain work-relevant skills to support your career development.

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Michael Marks @drmichaelmarks.bsky.social · 27/08/2026

Agree I suspect this result is confounded and we need proper trial data. At this point I am not sure more EHR data can move the dial on this.

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Prof Tom Solomon CBE @runningmadprof.bsky.social · 20/08/2026

As a medical student in Mozambique, studying hypoglycaemia in children with malaria, I saw first-hand how research can lead to discoveries with real-world impact. But the UK’s clinical research workforce is declining just as patient need is rising. Read - sciencedirect.com/science/arti...

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Michael Marks @drmichaelmarks.bsky.social · 20/08/2026

When I lived in Pacific we did an investigation on unexplained fever. Found was Scrub typhus. Surprised 1st time proven in country. In discussion w local MOH someone said 'did similar investigation years ago with samples to Marseille, heard they found typhus but never shared raw data with us so...'

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Philip Bejon @philipbejon.bsky.social · 18/08/2026

Kilifi is a coastal County in Kenya, where @kemriwellcome.bsky.social has undertaken 35 years sentinel surveillance of malaria. Dramatic changes that I think aren't widely appreciated. Work led by @alice-kamau.bsky.social Highlights and link to paper:

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Michael Marks @drmichaelmarks.bsky.social · 13/08/2026

Excited to now able to say funded @nihr.bsky.social for Streptococcal Adaptive Platform Trial (STRAP!) Evaluating 1) Optimal backbone anitibiotics 2) Benefit adjunctive anti-toxin antibiotics 3) Benefit IVIG Collab with Australia (hope also NZ & Canada) building off SNAP. Aim open in UK in 2027

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Michael Marks @drmichaelmarks.bsky.social · 10/08/2026

Four clinical academic jobs @lshtm.bsky.social for people in UK training - Closing this week on Friday

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

Or could spend money on understanding how to better deliver interventions that actually do work but are under utilised? IPT, cash-transfers, nutritional support?? If someone sent me a trial proposal for this Q now I dont think I could in good conscience fund it given the opportunity cost.

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

Doesnt really make sense to just directly use Tanzania data as a prior as they have very different absolute effect sizes. But if you take the relative effect from Tanzania as the basis for a beta-binomial prior the net is still similar - there is about a 50% chance that the NNT is 1000 or less.

A graph showing the posterior distribution of a bayesian analysis showing the probability that Vitamin D decreases the absolute risk of TB by at least 0.1% in absolute terms.

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

I believe Vitamin D is cheap and very unlikely to be harmful. But I believe that if there is an effect it is tiny - even at a public health level. I also believe that we have pursued this question at the expense of other interventions & this represents a huge opportunity cost.

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

Here is the Mongolia data quickly re-analysed with a Bayesian model and a beta-binomial prior centred on null. Plotted probability there is a 0.1%, 0.2%, 0.3% absolute risk reduction in TB disease (NNT 1000, 500, 333). <50% chance NNT is 1000 & only a 8.7% chance that is as low as 333.

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

So neither demonstrated an effect and both are consistent with some effect or no effect. What size trial would you want before you agreed to stop pursuing this question?

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

I understand why people want it to be effective and the rationale that a small effect of a cheap intervention is worth pursuing. But at some point you have to admit defeat. If you do a trial with 8000 people in it & get an effect estimate of RR 1.1 (0.87-1.38) then I think time to call it a day.

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

If there is an effect I wait to see anything convincing. South Africa children (800/arm): pubmed.ncbi.nlm.nih.gov/37211272/ Mongolian children (4000/arm): www.nejm.org/doi/full/10.1056/NEJMoa1915176 PLWHIV in Tanzania (2000/arm) pubmed.ncbi.nlm.nih.gov/32621874/ All negative trials.

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Michael Marks @drmichaelmarks.bsky.social · 08/08/2026

Excited 2nd site open in our trial to improve treatment for congenital syphilis. CARES-1 led Bridget Freyne @ucddublin.bsky.social evaluates alternatives to prolonged courses of IV penicillin. Congratulations to team in Indonesia for recruiting their 1st participant into the study this week!

clinicaltrials.gov

ClinicalTrials.gov

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Michael Marks @drmichaelmarks.bsky.social · 06/08/2026

Closing in a week - 4 academic clinical training jobs @lshtm.bsky.social

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Michael Marks @drmichaelmarks.bsky.social · 04/08/2026

No I submit it periodically as a response to trials as they come out. NEJM for example rejected it. I guess I could go again with this most recent trial.

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Michael Marks @drmichaelmarks.bsky.social · 04/08/2026

I attach a copy of the letter I have on several occasions sent to journals when they publish yet another of these trials.

The image shows a letter discussing the failure of Vitamin D to improve health outcomes in a large number of trials. It concludes:

Outside of the trial setting, a wide range of observational studies have reported Vitamin D to have strong associations with a wide range of clinical outcomes. This has been accompanied by basic science studies which have demonstrated pleiotropic effects, in particular on immune responses, which provide plausible mechanisms by which Vitamin D might ultimately influence clinical outcomes.

Despite this observational and basic science data, the consistent message of randomised controlled trials is that vitamin D based interventions have little if any discernible health impact. What can explain this disconnect between basic science, observational studies and the results repeatedly observed in trials? Potentially, the association of Vitamin D and poor outcomes is true but our interventions do not sufficiently impact on VItamin D and it's downstream mediators to have a health impact. Secondly, we are targeting only a single molecule amongst a complex milieu of other important mediators. Just like trying to 'stop sepsis' by targeting activated protein C we may well be merely playing around the edges of a larger system and unable to impact the ultimate clinical outcome.

Or perhaps Vitamin D's association are simply not causal. Given the diverse range of diseases targeted by Vitamin D in trials, and the consistently negative findings of these studies, this option appears to warrant consideration. Whatever the reason, the research community has now committed several millions of dollars repeatedly testing the hypothesis that vitamin D modification will have significant health impact. The repeated failure of this strategy does not reflect well on science funding. We should take time to reflect and consider how we ended up here.

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