Tyler Black, MD Profile picture
Dec 3, 2021 11 tweets 4 min read Read on X
Suicidology during the Pandemic (US)
=-=-=-=-=-=-=-=-=-=-=-=-=-==-=
(and a quick lesson in visualization)

Suicide rates decreased significantly when the pandemic started, and remained lower than 2019 for the remainder of the year. This is the monthly breakdown.

#COVID19 /1
This is the best way to visualize yearly changes, and media types/communication types, please take note. This graph contains all of the necessary information to put a yearly change into context.

This graph is my invention, called the "GETH"

Why is it the best, you ask? /2
FIRST: it standardizes each month and year to "per 100,000 per year". Populations change over time and months have 28-31 days. This variation matters and without controlling, introduces error. /3
SECOND: it shows the historical context. the years prior to the previous year are in grey, and the most recent year is more prominent and highlighted in blue. /4
THIRD: it shows error bars for the "target year" (2020). Error bars are not necessary for the fact, but they ARE necessary to determine whether or not a change is outside of expectations. See how clearly April and May are lower than previous years? /5
By combining all these things together, you can get a sense of year-on-year change, as well as the historical context, as well as the variation one would expect. /6
The GETH is also useful for subgroups.

Here we can see the 2020 changes for Men in the United States. April was significantly lower, and every month following was either lower than or the same as 2019. /7
Women fared even better, with many of the months being lower (and 5 significantly so) than previous years. /8
Unless you're a real estate board trying to pump your industry, you should always include:

1) population & time adjustment
(not just "# of deaths")

2) historical information for context
(not just year-over-year change)

3) uncertainty measure (i use 95% CI for proportion) /9
The GETH does all of that, and in one graph, you can convey all of the information necessary to understand the larger picture.

Be a good science communicator! Follow these principles. /10
(and yes, by the way, GETH is inspired by @masseffect, because I am a geek. To make the acronym work, it's short for "Graphical Envisioning of Temporal Happenstances", because it can be used for any time frame and any occurrence, not just suicide)

with <3 to @bioware /11

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More from @tylerblack32

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
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
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
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
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
Apr 30
The McCullough Foundation's @NicHulscher — who posts garbage medical misinformation — styles himself an "independent epidemiologist."

His entire career has been spent publishing with, and working for, McCullough. Image
No academic post, no health agency, no clinical role, no pre-Foundation experience. Hired straight out of his 2024 MPH by the senior author on nearly every paper bearing his name.

/2
He publishes almost exclusively with McCullough, overwhelmingly in predatory or fringe journals, and has already been retracted twice — plus an Expression of Concern — in a career that's barely two years old.

/3
Read 7 tweets

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