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Adam W Gaffney Profile picture
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23 Oct, 6 tweets, 2 min read
"Treatable Mortality" -- i.e. deaths potentially preventable via medical care -- is much higher in the US than 4 "peer" nations. Moreover, we've stopped making progress in the past 10 years, widening the divide.
Meanwhile, blood pressure control — a big way modern medicine saves lives — has been deteriorating over this same period for the general US population.
Similarly, among adults with diabetes, both glycemic control and blood pressure control are worsening.
Meanwhile, while a feared and predicted 2020 surge in uninsurance did not come to fruition (for a number of reasons, including aggressive policy), the number of insured has gradually risen since 2016 according to three benchmark federal surveys:
Uninsurance and underinsurance among children rose from 2016-2019:
To be clear, I'm emphasizing the worsening trends in blood pressure and glycemic control as a failure of the healthcare system — we're doing something wrong.

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More from @awgaffney

Adam W Gaffney Profile picture
23 Oct
A new paper examining how the ACA's Medicaid Expansion affected provision of visits to Medicaid patients versus other patients supports our more descriptive analysis on the same issue — & our broader argument about utilization impacts of coverage expansion
sciencedirect.com/science/articl…
The new paper finds that Medicaid expansion was associated with more visits provided to Medicaid patients, as you'd expect. Yet this was offset by a very small decline in visits among privately insured patients, w/ no impact on Medicare pts.

In aggregate, no change in visits.
This mirrors our more descriptive analysis, which found increases in visits among lower income individuals and small falls among those not targeted by the ACA.
Read 7 tweets
Adam W Gaffney Profile picture
23 Oct
What an utterly horrifying tragedy.

Although what went wrong is unclear, I don’t see how the use of guns with live (albeit bullet-less) cartridges can be justified on sets.

google.com/amp/s/amp.cnn.…
A “blank” — a cartridge without a bullet — still has the explosive power of a cartridge with a bullet. If something gets lodged in the barrel, a potentially deadly projectile can be fired, which is what happened to Brandon Lee (a bullet was stuck in the barrel from previous use)
It doesn’t seem that surprising that having people - without particular training in firearms - pointing and shooting blanks on crowded sets might produce rare yet horrible tragedies, particularly given the inevitability of human error.
Read 4 tweets
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
6 Oct
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 ...
Read 4 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

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