There are some of us that don't have the pleasure of being able to consume milk products like we wish because when we do, it is accompanied by diarrhea, abdominal pains and bloating.

Sorry my dear friend, you're lactose intolerant. Let's talk about lactose intolerance today.

In medicine, reckoning with racism includes reappraising the very syntax we use every day. Proud to add my voice w/ @J_Ikeme and @RWGrantMD in this @JAMAInternMed pub addressing:

Does race/ethnicity belong in the first line of the patient

Some background: I’ve struggled with this question since early in medical school

Medical syntax is designed to communicate information in a predictable sequence with key elements prioritized to facilitate efficient communication and formation of an assessment and plan

2/

From preclinical lectures to Qbank questions to clerkship rotations, race/ethnicity was often prioritized in the same sentence as age + gender.

I grew accustomed to reading/hearing: a 70-year-old Black man w/ history of x, a 50-year-old Hispanic woman presented w/ y.

3/

However, when it came time for me to use race/ethnicity, there was always tension. Race/ethnicity are self/socially-ascribed identities that in clinical practice are almost always assumed by providers based on appearance. I was also concerned about the potential for bias

4/

I wondered how my own care would be impacted or not impacted by my ethnicity (Hispanic) – I have light skin so I’m not sure if my doctors would even identify me as such – but how would my care be different if I was presented as a 30-year-old Hispanic male?

5/

ADHD, a thread (1)
If you have #ADHD & are struggling please know you’re not alone. This week on @Overview, we're talking about living w/ ADHD & Anxiety during the pandemic & many the stigmas & misconceptions that making things worse.

I was diagnosed w/ ADHD when I was 7. And in so many ways it’s been a blessing. I love my energy, the hyper-focus, the calm I feel in chaos, the ability to & feel emotions so intensely. It’s allowed me to to see the world differently be in a constant state of wonder.(2)

But realizing all that has been a long, difficult journey so figured I’d share some of my own struggles as well as the resources from @HowtoADHD because Jessica's channel has been a game-changer for me.(3)

First off, #ADHD Attention Deficit Hyperactivity Disorder is a dumb description. It implies a deficit in attention & always hyper people. ADHD is a spectrum, & what we all have in common isn’t that we can’t pay attention. It’s that we have trouble controlling our attention.(4)

There are amazing analogies out there, like trying to watch 6 TV’s at once when someone else controls the remote. Or like driving a race car on city streets and spinning out whenever you try to turn.

A staple of anti-lockdown conspiracism in yoga/wellness is that public health measures are oppressive, authoritarian, and stifling what it means to be human. Masks suppress identity and speech. Vaccines assault the sovereign body. Influencers must rise up against tyranny! /1

Ironically, pandemic management in economies where yoga/wellness is lucrative has been a neoliberal, choose-your-own-adventure mess in which centre-right governments barter with public health to enact a patchwork of half-measures that punish the poor and marginalized. /2

The goal is not universal health rights, or protecting medical systems, or saving as many lives as possible. The goal is to return to business-as-usual, using public health as a pit stop on a productivity race off a cliff. The ice caps aren’t melting fast enough, I guess. /3

Right-leaning governments, like influencers, have assessed the COVID threat with the magical bias of limitless optimism. Then they work to normalize COVID casualties as a new cost of doing business. *This* is what alt-healthers and Qamoms call “socialist”, or “communist”. /4

Centre-right governments and wellness influencers share a goal: get back to the optimism of making productivity heroic and consumption virtuous, without any reflection on structural issues of injustice, or what universal health care funding and standards would look like. /5

Here is a tweetorial from our latest publication in @Annals_Oncology about longitudinal tracking of esophageal adenocarcinoma. #OesophagealCancer #EsophagealCancer https://t.co/QWvrzBXmK7 1/8

We sequenced 245 plasma samples from 97 patients with oesophageal adenocarcinoma using a 77 gene pan-cancer ctDNA panel. 2/8

Variants derived from previously characterised driver oesophageal adenocarcinoma genes had a significantly higher VAF than variants from other genes, indicating selection. 3/8

Peripheral blood cell samples were also sequenced for 78/97 patients. CHIP mutations were identified in 23% of cases, longitudinal tracking of CHIP variants suggested these variants were dynamic over time. 4/8

We found patients that were ctDNA positive post-surgery had a significantly poorer survival than ctDNA negative patients, and the elimination of CHIP variants improved the positive predictive value. 5/8