Don Goldmann, MD

@sacjai Value-based care instead of values-based care

Perhaps my (current) least favorite bit of healthcare jargon: “Whole-person care.” What’s yours?

@halletecco Very important. Remembering a child who was being given a ‘supplement’ that turned out to be key in diagnosing her serious condition requiring hospitalization.

Got bivalent mRNA vaccine at branch of major pharmacy chain. Impression, confirmed by friends & colleagues: Even with limited COVID vaccine uptake, pharmacists are overwhelmed by increasing reliance on them for immunizations. Distracted, multi-tasking, feeling unheard. Unsafe.

@sacjai @Forbes As an NHS caregiver who was waiting in line for a breakfast BAP said to me: "Why do you focus on value in the US? I'm more interested in valueS." Equity is required for values based care, as are PROMs & co-design/shared decisions. Shaving 0.2 days from LOS is not the answer.

Attend any healthcare conference and everyone is proclaiming their passion for “value-based care.” The expression has become ubiquitous and its virtuousness goes unchallenged. But should this be the case? I explore this question in @Forbes. forbes.com/sites/sachinja…

@Laurie_Garrett @NYPD We need to be careful in naming the ‘culprit,’ who is still a ‘person of interest’. The existing evidence seems convincing, but…. Richard Jewell is a history lesson on this point.

If @NYPD has identified the culprit in this morning's subway terror, he is from Wisconsin & Pennsylvania -- two states where it's a lot easier to obtain firearms than in NYC. Other reports describe him muttering to himself on the N train, and leaving his Glock & keys there.

@halletecco Aside from the alleged corruption, the epidemiology supporting some of the cliamed associations was quite weak. A common issue in microbiome research - now better recognized. Good call not to have invested at that point.

@davetp @mlipsitch @jfeldman_epi @michaelmina_lab Deleted for reasons stated in my thread.

@DAGoldmann @mlipsitch @jfeldman_epi Dr. Goldmann I would encourage you to take the tweet down. It is clearly incorrect, and more importantly can be used to discredit the important work @michaelmina_lab is doing.

I’m just going to say it… Private insurers should not be on the hook for tests used for public health When the primary beneficiary of the test is not the test user but their neighbors, it should be Govnt $ Private health insurance should be for medical use of rapid tests

@michaelmina_lab @mlipsitch @jfeldman_epi I clearly miss-stated while trying to make a general point about the need for transparency regarding expertise & COI when commenting publicly. You are a key leading expert on rapid testing & clearly have expertise in epi & immunology. No insult intended. Clumsy tweet. I apologize

@DAGoldmann @mlipsitch @jfeldman_epi Your insinuation above was entirely directed at me. It was complete fabrication - a total lie about a very recent colleague. Why? Retaliation bc I chose to leave your department? Ignorance of my research and expertise? Either way, shameful. And far below what should be Ok

@mlipsitch @jfeldman_epi For the record, I was talking generally about how some of the best COVID communicators have to speak about issues beyond their expertise. Mina is key expert on testing, leveraging his clear expertise in epi & immunology. No disrespect intended. Main point was need to disclose now

@DAGoldmann @jfeldman_epi Who has done some of the most original science in some time in immunoepidemiology and on this and many other relevant questions knows of what he speaks and tweets.

@LouisPostel @JamesFallows A good local first step would be to ban 2-cycle gas leaf blowers in Lexington. Polluting, noisy, needless.

Gas-Powered Leaf Blowers: the End is Nigh, by @JamesFallows fallows.substack.com/p/gas-powered-…

@EricTopol Anything special about the few people who had modest, if any, boost?

The striking booster (3rd dose) effect of mRNA vaccines on neutralizing antibodies vs Delta, and in people with prior Covid who were vaccinated medrxiv.org/content/10.110…

@michaelmina_lab @nytimes Please direct the national audience to an honest, clear, accurate source that people not versed in stats can understand, especially if they haven’t achieved the level of health literacy of Twitter experts. Seriously. In general NYT graphics have been clear, creative & informative

I agree. This is another incomplete and skewed @nytimes effort regarding COVID recently. The graphics are nice, but, c'mon, NYTimes is one of the most influential publications in the world and has a responsibility to include or account for the gamut of studies

More good sense before germ theory: Fracastoro's "seminaria" - infectious "seeds" spread by direct contact, indirect contact by "fomes" (fomites), and airborne by "strong" seeds that could prosper in the victim and spread to others - 1546. De contagione et contagiosis morbis

Good sense before germ theory: Marcilio Facino, 1481, on Bubonic Plague: Avoid conversations...and when you converse stay at least two braccia (6 feet) away from your companion, and be in an open space...And make sure the wind is not blowing towards you.

Roger Bacon, 13th cent. empricist: 4 causes of ignorance/error: The example of unreliable and unsuited authorities, the long duration of habit, the opinion of the ignorant masses, and the propensity of humans for disguising ignorance by the display of psuedo-wisdom. So relevant!

@Robotbeat @ashishkjha It's "sad" because it's inequitable & makes official FDA and CDC approval a joke. When a 75 year-old friend asked if she should take advantage of CVS's lack of scrutiny, knowing what I know about the data and risk, I said yes. But I don't feel good about the system and "fudging"

@DAGoldmann @ashishkjha Why is that sad?? We have so many vaccines they’re going bad!

CDC advisory committee voted for boosters for anyone over 65 and those over 18 with underlying conditions (including obesity, smoking) But NOT for healthcare workers or teachers. Huh But a majority of American adults who want a booster will get one based on these criteria

@DrLeanaWen @CDCDirector With daughter counciling in underserved school in red city, boosting SEEMS logical. But how to connect dots to benefit with existing data? It's ?problematic to say "follow the science" & "guided by data" & then say it's obvious to boost. Always need to state logic behind opinion.

And... I spoke too soon. Now this is a mistake from CDC ACIP. Really, we are not allowing healthcare workers, many of whom got vaccinated in back in December, to get a booster? What about teachers in cramped classrooms where masks aren’t required? @CDCDirector needs to overrule.

Theater Pharmacy my small town anchor for 90 yrs. I'm loyal so fill my antenol (tier 1 generic) there. This time $56! Told that's PBM price, but discounted to $15. $0 at CVS, Anthem's "preferred" pharmacy along with other chains. Local pharmacy doomed. Ugly face of "integration."

@halletecco Serious question from someone who strongly believes female entrepreneurs have a harder hill to climb. Do U think gender bias played a role in prosecuting E Holmes? Her lack of expertise, naive Board, & unwarranted hype are deplorable, but I can't ignore possible gender bias.