Here's my list of 12 papers in 2021 at the intersection of health care, medicine, economics and policy that surprised me, made me think, or were just damn clever.
I'm just going to focus on non-COVID-19 papers - we have enough of that other stuff in our feeds.
Off we go!
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Before we dive in - this is
A) definitely not comprehensive
B) definitely not in order of awesomeness
I’m also focusing on papers written by folks outside my direct circle of collaborators (w/ a couple of non-Harvard exceptions I can’t resist).
@NEJM@McGarryBE@ashdgandhi@DavidCGrabowski From June-Aug 2021, we compared resident and staff infection + mortality rates between 12,000 homes with the lowest staff vaccination rates (~30%) vs. highest (~80%).
In the least vaccinated homes:
+132% COVID cases in residents
+58% staff cases
+195% resident mortality
yikes
@NEJM@McGarryBE@ashdgandhi@DavidCGrabowski Over an 8 week period, if all nursing homes were magically raised to the highest staff vaccination levels nationally (~80%), we would have:
4,775 fewer resident cases
7,501 fewer staff cases
703 fewer resident deaths (nearly 50% of all deaths)
@JAMAInternalMed The authors took a cross sectional cohort of >26,000 French survey respondents and compared their reports of persistent symptoms in early 2021 with:
@NEJM There's no consensus on how to diagnose diabetes in pregnancy, which is VERY common and, if treated, can reduce risk of infant + maternal complications.
So the authors compared the more sensitive, single visit "one step" approach to a "two step" approach that can take 2 visits.
@NEJM There was a HUGE difference in diabetes diagnosis between the two groups:
One-step: 16.5% of women diagnosed with diabetes
Two-step: 8.5% diagnosed
This diagnosis comes with a lot of emotional and clinical baggage!!
It's 2021. We have developed an effective vaccine for a novel virus in months and we can land a probe on a comet.
There is major cognitive dissonance with our potential as a society vs. the every day struggle to provide basic care for common conditions
Let me give a few examples.
Take hypertension. 1 in 3 Americans has it. It causes millions of years of life lost.
What is the process to diagnose and treat it? I have to beg my patient to buy a $40 cuff at a pharmacy, measure their BP, then call or send the numbers to me.
Alternative is coming to the office to get their BP measured. What a waste of resources. There are no cheap BP cuffs that can upload measurements to our EHR. Insurance doesn't cover them.
Without data I can't just randomly prescribe and titrate a BP med and hope for the best.