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Adam W Gaffney Profile picture
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2 Nov, 5 tweets, 2 min read
For everyone wedded to the notion that group differences in lung function stem from genetic difference, this new & massively important study should shake you up: there was a *huge* secular shift in lung function over the past century+ in Europe. 1/2

thelancet.com/journals/lanre…
We should *not* assume that racial differences in lung function are “innate”, whatever that means, considered in conjunction w/ our recent study confirming that Black-White differences in lung function are associated w/ worse mortality among Black people

ncbi.nlm.nih.gov/pmc/articles/P…
At the end of the day, those of us in the pulmonary community need to acknowledge that oppression, for lack of a better word, compresses the lungs.
More precisely, in light of these (and other) studies, I believe that Black individuals’ lower average lung function compared to whites is most likely due to a complex array of socioeconomic / environmental factors that can be best summed up with the term “oppression”.
This is a matter of considerable clinical importance: today, in the US, lung function algorithms are racially-based. Should they be? What are the clinical ramifications and alternatives? There is surprising little discussion, & very little incorporating a radical critique.

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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
"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.
Read 6 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

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