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Adam W Gaffney Profile picture
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6 Oct, 4 tweets, 1 min read
Odd thing about reporting about this study, which sheds light on immune mechanisms that cause chillblain lesions, is the almost entirely negative evidence for prior/current SARS-CoV-2 infection in those with "COVID toes."
They tested 50 patients with chillblain-like lesions (CLL) in April 2020 w/ 3 different different serological tests twice, & found that they "were all negative in the CLL group, except for four positive and four doubtful IgA ELISA anti- SARS-CoV-2 tests at the first visit" !
By way of contrast, 100% of serological samples from a comparator group who had documented previous mild COVID-19 were positive ...
This would seriously seem to undercut an assertion of etiological causality between SARS-CoV-2 infection (but not necessarily other viral infections) and chillblain like lesions, which importantly occurred before COVID-19 as well.

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More from @awgaffney

Adam W Gaffney Profile picture
8 Oct
Many diseases are defined along a spectrum, by continuous variable(s).

While the presence (or absence) of such diseases may be obvious at either extreme of that spectrum, there is no "true" objective threshold at which no disease becomes disease.

jamanetwork.com/journals/jamai…
Instead, the line is drawn by human beings, and the decision of *where* to draw the line often hinges on pragmatic (utilitarian) considerations, namely:

At what threshold do the benefits from diagnosis/treatment outweigh its harms? Cochrane said something like this long ago.
That is how, to some extent anyway, we seem to have decided where to draw the line between high blood pressure and normal BP:

At what blood pressure do the gains of blood pressure lowering exceed its harms? (Anyway that's how it should be defined, in my opinion).
Read 11 tweets
Adam W Gaffney Profile picture
17 Sep
We have more ICU beds per capita than almost any other nation (some would even argue too many).

The real problem is twofold:

1) We often don’t have healthcare infrastructure where we need it, because supply follows profit, not community medical need. vox.com/coronavirus-co…
2) As @dylanlscott makes clear in this article, US healthcare is uniquely uncoordinated and fragmented. There is no regional much less national coordination of patient flow & transfers & and bed capacity. Doctors are just picking up phones and calling & calling & calling.
I want to return to this in an academic venue sometime soon, but I wrote about it very briefly for @DissentMag last year - the case for bringing back health planning

dissentmagazine.org/article/bring-…
Read 4 tweets
Adam W Gaffney Profile picture
31 Aug
New study in NEJM provide further support for more aggressive blood pressure control. The prevention of stroke would be enough for me.

There are few recent advances in medicine that delivers such big population health gains as blood pressure treatment.

nejm.org/doi/full/10.10…
Julian Tudor Hart famously emphasized the critical importance of blood pressure control on the population level, noting the "rule of threes" - a third didn't know they had high blood pressure, a third knew but wasn't treated, and a third was treated but not controlled.
He personally measured the blood pressure of every person in the Welsh community he was responsible for, and his control of BP may have contributed different mortality trajectories in his vs. neighboring communities.

pubmed.ncbi.nlm.nih.gov/4193685/
Read 4 tweets
Adam W Gaffney Profile picture
24 Aug
It first seemed like ivermectin was one more low-evidence-based drug, albeit with a curious degree of politicized enthusiasm. It is far worse. Its evangelists appeared to have convinced some, perhaps many, that it is a substitute for vaccination.

washingtonpost.com/nation/2021/08… Image
Pierre Kory, the most prominent physician backer and head of the ivermectin enthusiast group FLCCC, has been cagey about this at times, but here he is posting a slide "Pfizer v. Ivermectin" suggesting superiority of ivermectin vs. vaccine in Covid prevention. Image
However, even worse is that the FLCCC Alliances' COVID-19 "prevention" protocol includes ivermectin (as well as vitamins, mouthwash, etc.) but ... no mention of vaccination. Maybe it was just an innocent oversight? Hmmm...

covid19criticalcare.com/wp-content/upl… Image
Read 7 tweets
Adam W Gaffney Profile picture
23 Aug
Our new study just up @JAMAPediatrics: the number of inadequately insured children in the US rose to 24.4 million in 2019, based on our analysis of the National Survey of Children’s Health

jamanetwork.com/journals/jamap…
We used the definition of under-insurance of Kogan et. al (and others), who found 14 million underinsured in 2007 (we classified children as “inadequately insured” if they underinsured or uninsured within the last year”)

nejm.org/doi/full/10.10…
We found that the number of underinsured children rose from 16.2 to 18.1 million from 2016 to 2019; in addition, there was a rise in the number of uninsured children (the latter finding was also seen in analyses of the American Community Survey).
Read 4 tweets
Adam W Gaffney Profile picture
21 Aug
Great article detailing the sabotage of a highly successful program that repopulated the endangered Red Wolf population, which has now erased all progress. Count me “Team Red Wolf” on this one. thenation.com/article/enviro…
Meanwhile, however, Biden is allowing Trump’s decision to lift protections for Gray Wolves to go forward. I’m also Team Gray Wolf.

npr.org/2021/08/20/102…
I frankly don’t understand anti-wolfism, which is apparently a thing.
Read 6 tweets

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