Twitter | Search | |
Jason N. Doctor
Norman Topping Chair in Medicine & Public Policy, USC, Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy & Economics
6,341
Tweets
995
Following
1,246
Followers
Tweets
Jason N. Doctor 8h
Replying to @gertner_alex
No. This is because a virtual 'coin flip' assigns patients to doctors (events leading to ED visits occur at random times). There will be equal rates of patient who demand or shy from demanding opioids in each physician . quartile.
Reply Retweet Like
Jason N. Doctor 9h
Replying to @jasndoc
This isn't a historical problem it is a current problem with how we approve drugs and the (lack of) separation of industry from the process.
Reply Retweet Like
Jason N. Doctor 9h
Inequality, low wages, immobility, job loss all contributed to the opioids crisis. But so did an absurd idea: pain was safely and easily treated with opioids. FDA & Pharma ties made this possible. Non-triplicate states reduced sludge and invited marketing.
Reply Retweet Like
Jason N. Doctor 10h
The Alan Parsons Project
Reply Retweet Like
Jason N. Doctor 10h
Replying to @ryanaboyd
Did they find this screenplay in the vault next to the Big Chill and Kramer vs. Kramer?
Reply Retweet Like
Jason N. Doctor 11h
Replying to @adfoxMD @asacarny and 2 others
Alpert et al. show TX, ID, NY, CA, IL made it a hassle to Rx. Only those who really needed opioids got them. avoided marketing in those states. Demand never shifted to the right, so consumption capital stayed low despite SDOH deaths. Illicit market never flourished.
Reply Retweet Like
Jason N. Doctor retweeted
Matthew Herper Dec 7
Really great thread.
Reply Retweet Like
Jason N. Doctor 11h
Yes. Their design is underappreciated.
Reply Retweet Like
Jason N. Doctor 12h
Replying to @gertner_alex @adfoxMD
The point I would like to get across is that SDOH and other causes of addiction may co-exist. And that it is too restrictive (and thus less plausible) to dismiss one view for the other.
Reply Retweet Like
Jason N. Doctor 12h
Replying to @gertner_alex @adfoxMD
That is one example, Alpert paper is another (Suicides & EtOH deaths independent of non-triplicate/marketing deaths). To be clear, believing preferences do not change with increased consumption is a very restrictive assumption. Less restrictive to allow preferences to change.
Reply Retweet Like
Jason N. Doctor 12h
Replying to @gertner_alex @adfoxMD
Regarding 'compartmental'. It is fine to bin people into categories and rule-outs if they come in with a swollen foot, for example. But, this strategy is bound to run into problems when ppl have competing reasons for drug use and changing preferences for drugs as use continues.
Reply Retweet Like
Jason N. Doctor 12h
Replying to @gertner_alex @adfoxMD
To address endogeneity Barnett et al. looked at high and low-intensity opioid Rx ED physicians. Haphazard assignment to a high-intensity ED doc led to greater chance of long-term opioid use. So consumption alone predicts outcome.
Reply Retweet Like
Jason N. Doctor 13h
Replying to @adfoxMD @gertner_alex
It is not contradictory to believe that ppl experience trauma and want to numb themselves while others live a well-adjusted life, yet theyfind their preferences for opioids changing the longer they consume them.
Reply Retweet Like
Jason N. Doctor 13h
Replying to @adfoxMD @gertner_alex
That’s a compartimental view. The best risk prediction tools are awful. Consumption capital explains most of the variance in studies.
Reply Retweet Like
Jason N. Doctor 14h
Replying to @adfoxMD @gertner_alex
There is no protection conferred by a legitimate Rx. We have a fragmented system. I doubt we should think of this as protective.
Reply Retweet Like
Jason N. Doctor 14h
Replying to @adfoxMD @gertner_alex
I wish it were as simple as a couple of bad actors in Appalachia. Then it would be easy to deal with. But it is a national problem. Rx deaths still leading cause in many Western states. Fragmented healthcare system, poor pain training, industry influence all play a role.
Reply Retweet Like
Jason N. Doctor 16h
Replying to @DavidJuurlink
Bayesian:When you hear hoofs beating think buffalo not moose.
Reply Retweet Like
Jason N. Doctor 17h
Replying to @causalinf
Pure efficiency
Reply Retweet Like
Jason N. Doctor 17h
Replying to @gertner_alex
I am talking about full agonist Rx, basic idea is that someone (not you) just blatantly wronged another (by exposing them to opioid addiction) and, when confronted tries to convince people that it was a good thing they are on the drugs because a crackdown will bring withdrawal.
Reply Retweet Like
Jason N. Doctor 17h
Replying to @gertner_alex
Yes but very important that we not view the healthcare system as a salve for these problems it was a catalyst that accelerated and can accelerate deaths.
Reply Retweet Like