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Tyler Black, MD Profile picture
@tylerblack32
Jun 18, 2021 • 6 tweets • 2 min read • Read on X
Scrolly
I love my #dslr camera - though phones are amazingly convenient and that means a lot in photography, nothing beats physics and light-gathering.

Quick comparison.

I was standing, looking at this building. There is a window washer 150m away.

.../
/2

There he is. Here, I'm using my phone camera's natural "5x zoom" lens
/3

Lets use the Samsung-marketed "superzoom!" I can.. well... I can see him.

The phone is doing what it can with its tiny sensor and algorithms. But see that bucket? let's pull out my DSLR.
/4

i can read the bucket from 150m away! (Cropped to hide identity)
/5

extreme zoom:

WARNING! Children can fall into bucket and drown.

(important safety information btw).
Photography is such a great hobby, and if using a phone and its capabilities is what gets you into it, great! There are things you can do with phones that are incredible.

But in photography, photons and sensor size matter!

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More from @tylerblack32

Tyler Black, MD Profile picture
May 13
OK @joannamoncrieff ,lets do this.

POINT BY POINT
🔽🔽

/2 Image
Point 1: "Disease-targeting" is an invented criterion

1a. You demand drugs show "disease-targeting effects" or be presumed harmful. This is never necessary. The actual claim: reliable symptom change across replicated RCTs.

/2
Point 1: "Disease-targeting" is an invented criterion

1b. Cardiology doesn't know the molecular lesion driving most post-MI mortality benefit from beta-blockers. We use them anyway because they work. "No known mechanism, therefore presume harm" would gut most of medicine.

/3
Read 14 tweets
Tyler Black, MD Profile picture
May 5
RFK is no better at psychiatric medications than he is about vaccines.

RFK's "overmedicalization crisis" thread is a master class in using true-ish numbers to imply a false conclusion. Let's go through it. 🧵

/1
The core trick: he treats prescription prevalence as self-evidently bad. But high rates only signal a problem if the meds don't work, are given to people who don't need them, or cause net harm. He establishes none of this. He just gestures at numbers.

/2
The same rhetorical structure would indict insulin prescribing, or asthma inhalers. Prevalence is not pathology. The question is whether treatment matches need — and whether the alternative (untreated illness) is better or worse.

/3
Read 20 tweets
Tyler Black, MD Profile picture
May 4
Disabled people should not live in poverty.

It makes no sense the way we treat our people with disabilities in Canada. Canada has the full apparatus to implement adjusted payments, yet we typically support disabled people WELL under the poverty line.

/1 Image
Canada has an official poverty line: the Market Basket Measure. It's regionally calibrated, methodologically sound, and updated by StatCan.



A single person on BC PWD receives ~$18.4k/year. The Vancouver MBM is ~$29k.

/2www150.statcan.gc.ca/t1/tbl1/en/tv.…
That's not a rounding error. It's a structural choice.

PWD recipients in Vancouver sit at roughly 47% of the poverty line and below the Deep Income Poverty threshold (75% of MBM), which is the level StatCan uses to flag the worst material deprivation in the country.

/3
Read 10 tweets
Tyler Black, MD Profile picture
May 2
Quick thread: "How do SSRI's work" 🧵

I've had a few patients ask me how SSRI's work.

To be clear, my first answer is "well we know they are supposed to block serotonin reuptake, but it's not that simple and we don't really know."

But, if you want the best 2026 science...

/1Image
For a few particularly science-interested patients, I walk them through what we currently have for the 'best evidence' even though we're still not sure.

This is the "best story" I can tell about SSRI's right now.

(nb, this is NOT locked in, this is MY best synthesis)

/2
1) SSRIs BLOCK the Serotonin Transporter
The protein that pulls serotonin back into the neuron after its released is blocked. Serotonin lingers longer in the synapse, the gap where neurons signal each other.

This is very well established, & how SSRIs were designed.

/3Image
Read 15 tweets
Tyler Black, MD Profile picture
May 2
The Ihben story is making the rounds. "Judge forced 18 vaccines, child got autism." It's being treated as a smoking gun. It is not a smoking gun. It is barely a story.

/1
Sourcing: one father, one advocacy org (CHD), one GiveSendGo. Records sealed. No filings. No named physicians. Every outlet repeating it cites the same Defender article. This is a closed loop, not corroboration.

/2
"18 vaccines in one day" is not a thing. That number counts antigens as doses to make the headline scream. Real catch-up schedules don't work this way and you can verify that in five minutes on the CDC site.

/3
Read 10 tweets
Tyler Black, MD Profile picture
Apr 30
🧵Borderline Personality Disorder (BPD) 🧵

Ask any person who has been even suggested to have BPD; they will uniformly tell you that they have been told to try DBT (Dialectical Behavioural Therapy). Reflexively recommended. "Gold standard."

This is not science-supported.

/1Image
Quick history: Marsha Linehan developed DBT in the late 1980s, published the foundational manual in 1993. She drew on CBT, Zen Buddhism, and dialectical philosophy. Brilliant clinician, brilliant marketer. Her institute has trained tens of thousands of therapists worldwide.

/2 Image
That marketing machine is the reason DBT is "the BPD treatment." It is not the reason DBT works better than alternatives, because it does not.

The faint superiority signals in older trials evaporate once you adjust for allegiance bias (DBT researchers studying DBT).

/3
Read 16 tweets

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