Harlan Krumholz Profile picture
Jan 25 6 tweets 5 min read
Our new piece: #Racism as a Leading Cause of Death in the US. "To address racism, understand its impact on health, & identify remedies, a national set of metrics is needed to galvanise action & promote accountability." bmj.com/content/376/bm… @bmj_latest #HealthEquity @YaleMed Image
@bmj_latest @YaleMed "Black people in the US are more likely to die young—not because there is some intrinsic biological risk, but because of racism… For many racial & ethnic minority groups, particularly for descendants of enslaved Africans, equality in health and longevity remain beyond reach."
@bmj_latest @YaleMed "The excess deaths associated with race can be understood as a toll that is in large part a result of racism in the United States. There is no biological reason, independent of social context, that Black people should die younger than White people."
@bmj_latest @YaleMed "In sheer numbers, the excess deaths associated with Black race, that is the cumulative excess across each cause of death, are higher than the reported leading causes of death among Black men and women under age 65.” In a sense, it is the leading cause of death in its own right.
@bmj_latest @YaleMed The elimination the death differential by race should be a national priority and will take multifaceted efforts. But we suggest that the excess death rates associated with being a Black person ought to be a health equity metric that is consistently reported and compels action.
@bmj_latest @YaleMed Thanks to @DaisySMassey, @KarenSheares for their partnership on this piece. And to many others at Center for Outcomes Research and Evaluation, who contributed w/suggestions & supporrt. Equity measures will not be sufficient to combat adverse health effects of racism, but a step.

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More from @hmkyale

Jan 22
Your data, packaged and sold by @IBM. 'Business analysts said the data dump instantly makes Francisco Partners a significant player in the multibillion-dollar business of buying and selling sensitive information about the care of patients.’ @statnews @caseymross
@IBM @statnews @caseymross How did IBM get all your sensitive health data to sell? They bought other companies that acquired your sensitive health data. And how did they get it? Mostly from 3rd parties who obtained it from health systems, insurers, & others you trust with your data. #privacy #digitalhealth
@IBM @statnews @caseymross And what is being done w/your sensitive data as billion dollar companies buy and sell it? [well, something that makes it valuable to people who want to buy it] And can you reclaim it or get access to it? [no] And is there consequences to orgs that share your sensitive data [no]
Read 9 tweets
Jan 21
Was watching #Dopesick, and I started reflecting on when I first learned IMS (now IQVIA) tracked every prescription by every doc &sold it to pharma so the doctors could be targeted for drug sales… and how inappropriate that seemed to me. And yet I didn’t do anything.
I was on a plane and a drug representative was sitting beside me going through the prescriptions written by doctors he covered - and there was so much detail. Data-drive marketing…& we docs had no idea the companies were tracking us in this way… & IMS was making billions on it.
It felt like an invasion of privacy… & I was puzzled that it could be legal…we were saying at the time that pharma should not be giving gifts…but we didn’t talk about tracking of individual MD's prescribing patterns by the sales teams - and how they acted on that information.
Read 21 tweets
Nov 29, 2021
So many questions still about med device regulation. In our @JAMAInternalMed article we take the Class I recall of Penumbra JET7 Reperfusion Catheter to explore oversight of med devices in the US. Led by star med student @ktkadakia jamanetwork.com/journals/jamai… @jsross119 @AdamLBeckman
@JAMAInternalMed @ktkadakia @jsross119 @AdamLBeckman "JET 7 device was subjected to class I recall following more than 200 adverse event reports, 14 of which involved patient deaths.” We explore the evidence at authorization that the catheter was safe and effective. The findings were disappointing. @YaleMed @YaleCardiology @US_FDA
@JAMAInternalMed @ktkadakia @jsross119 @AdamLBeckman @YaleMed @YaleCardiology @US_FDA "Regulatory analysis indicated that each of the Penumbra reperfusion catheters was cleared under the 510(k) pathway (which allows devices to be authorized with limited to no clinical evidence), with limited submission of either new clinical or animal data.” So this is an issue.
Read 4 tweets
Nov 22, 2021
Since I drink a lot of tea I really liked this @uk_biobank paper… I am usually skeptical of these types of studies, but this is a good one. “...drinking coffee and tea separately or in combination were associated with lower risk of stroke and dementia.” journals.plos.org/plosmedicine/a… Image
@uk_biobank I was just a little uncertain why people at the top end of coffee and tea consumption tended to have a higher risk… looked a bit like a j-curve. Image
@uk_biobank In the table the authors side-stepped it by considering the group with 4 or more cups a day as high coffee and tea consumption and lumped everyone together. For stroke, more dose response for tea than coffee with this approach, and ischemic stroke. Lots of comparisons... Image
Read 5 tweets
Nov 22, 2021
Glad to be part of an in-depth analysis of aortic valve replacement in US elderly, led by remarkable @mori_md & @aakriti_15 w/interdisciplinary team of cardiologists & cardiac surgeons. Findings highlight key trends in the TAVR era. jacc.org/doi/10.1016/j.… @JACCJournals @YaleMed Image
@mori_md @aakriti_15 @JACCJournals @YaleMed First, the Medicare beneficiaries receiving a new aortic value increased 60% from 2012, with increasing TAVR (percutaneous procedure) and decreasing SAVR (aortic valve surgery). TAVR up 680%; SAVR down 40%. Marked practice change. @YaleCardiology @ArnarGeirssonMD @ajaykirtane Image
@mori_md @aakriti_15 @JACCJournals @YaleMed @YaleCardiology @ArnarGeirssonMD @ajaykirtane This study took an approach to investigate total aortic valve replacement; often we are looking at the two procedures and comparing them, but missing overall growth of the total procedures and trends in outcomes. More people getting them…and mortality and readmission dropping.
Read 5 tweets
Nov 18, 2021
Lots of discussion about science journals…here’s the thing, they do not make it easy on authors. Each journal has their own format, they do not accept each others peer reviewers, they often ask authors to pay for privilege of publishing, and ask authors to donate time to review.
There are so many ways to make this easier… be flexible on format until you decide you want the paper… then you can ask authors to format according to your particular preferences.
Come to agreement about peer reviewers; with each journal starting over with peer reviewers it creates so much more work and delays. There are ways to share among the journals if author so elects.
Read 6 tweets

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