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Adam W Gaffney Profile picture
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7 Nov, 8 tweets, 2 min read
To the extent that healthcare access mattered for vaccination uptake (I believe it did substantially, although obviously many other factors at work), it will matter much more for a drug that requires, at a minimum, access to expedient testing with rapid results, and likely an Rx
If we had a universal primary-care-based health service, with geographically defined catchment areas where each of us was some clinicians'/practices' concern, and much greater public health — medical care integration, I would be much more optimistic.
Everyone of us should have a primary care clinician who spends at least some time each year thinking (and sometimes worrying) about us — and sometimes bugging us — even if we go year(s) without coming in for a visit.
Although the truth is worse than that. It's not merely that some people remain totally outside the healthcare system, with nobody devoting time to their health or concerns. It's that even among those with some contact, the *distribution* of physicians' attention is so disparate—
In this respect, however, I suspect the maldistribution is far worse among specialists than primary care doctors.
Somewhat tangentially, I want to bring up one of the silliest health policy concerns of the last decade: that some people see a doctor annually even if they are healthy and young, and that this is a waste of money or something.

nytimes.com/2015/01/09/opi…
Frankly, not sure I've ever met the person with perfect psychological and physical health that this cost-saving measure was theoretically designed for, but either way its all smoke and mirrors. Proponents conflated "useless rote exams, lab tests or xrays" with "annual visit"...
...And in so doing gave a progression sheen to a regressive policy concept.

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More from @awgaffney

Adam W Gaffney Profile picture
8 Nov
A new study at @JAMAInternalMed finds that protracted symptoms are not independently associated with evidence of prior SARS-CoV-2 infection ascertained serologically (except loss of sense of smell), but is associated with belief in having had COVID.

jamanetwork.com/journals/jamai…
Although that is the top line finding, as important to my mind was the finding that among those who believed they had COVID, there was no correlation between antibody positivity and any protracted symptom (except for loss of sense of smell).
In August, I wrote:
"The lack of difference in symptom prevalence between those with and without serological evidence of a prior SARS-CoV-2 infection in such studies suggests that for some, 'long COVID symptoms' could arise from processes other than a prior SARS-CoV-2 infection"
Read 4 tweets
Adam W Gaffney Profile picture
7 Nov
The mainstreaming of dubious quackery about Lyme is many years in the making, but it is seems to be reaching something of an apogee with Ross Douthat’s recent work, which I fear could lead many a suffering person to useless, even harmful treatments. nytimes.com/2021/11/06/opi…
How much does this matter? Arguably not much. Although, the nearly universal “deference to narrative” shown to his (and similar work) in recent years by nearly all commentators is not so innocuous. On social media you will find innumerable heartfelt stories of individuals…
… who believe they (or loved ones) have suffered any number of terrible maladies from COVID vaccination (linkages not based, to be clear, on medical knowledge about these vaccines). Should the etiological claims in such narratives receive the same deference as those of Douthat?
Read 4 tweets
Adam W Gaffney Profile picture
7 Nov
Clinically, one of the great unresolved questions of treating critically ill COVID patients is how long to push off intubation. Some deny the controversy, but it is real, & it is quandary. A question uniquely difficult, if not impossible, to address with randomized trials.
One of the first things for the critical care community to do is to acknowledge that it is a serious quandary, and to not pretend that our pre-existing orientation to the proper timing of intubation/MV in acute hypoxemic respiratory failure was right.
And I would add, that for such an important question, there has been a surprising paucity of observational studies — or even commentaries, editorials, debates — in CCM journals.
Read 6 tweets
Adam W Gaffney Profile picture
2 Nov
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.
Read 5 tweets
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

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