More seriously, if following a grammatical rule causes confusion you can choose to ignore the rule (or, as would be the sane choice in the Buffalo situation, evade the rule by rewriting to avoid the issue).
General rule: don’t use the comma. If the sentence is ambiguous to the reader in a specific case, then either: add a comma, or rewrite your sentence to be less confusing.
For example, “Apples, oranges and pears” the “and” has the about the same count as the pause after “Apples”; pausing before the “and” feels like a stutter.
"We're having hot dogs, hamburgers, and peanut butter and jelly.
Especially in a medical setting where the aesthetics of a sentence are not close to as important as clarity.
Style guides that don’t use the Oxford comma will suggest either: adding the comma where necessary to avoid confusion, or rewriting your sentence to be less ambiguous.
What is the benefit to not having the oxford comma? Is there a tradeoff I'm missing here, or are people advocating to avoid it simply on the basis of "I don't like it"?
Humans are quite decent at parsing ambiguous text, you'll find.
If this sentence was describing places you shouldn’t visit as an example, a bullet point list would probably be more appropriate. So in a more context-appropriate example this would probably be rephrased as
This disease is found in the following areas:
* Jamaica
* Antigua and Barbuda
* Turks and Caicos
Now I’m not arguing if this particular style guide is a good idea or not - but I can see why you might want to avoid the original statement which was quite hard to parse with confidence.
All confusion could be removed by a few commas, I don't see why you wouldn't add those.
If we were guaranteed that Oxford commas would always be used then there would be no confusion.
Some people are against the Oxford comma being mandatory, like me.
I would punctuate your phrase exactly as you did. And at the same time I wouldn't use it in situations where there's no benefit. You, just like all other grammatical devices
We visited:
- Jamaica
- Antigua and Barbuda
- Turks and Caicos
I can't read that sentence no matter where you put the commas, I thought there were 4 entries until I spelled it out to make this comment and wondered why my list was short.