Tyler Black, MD Profile picture
Dec 31, 2021 12 tweets 5 min read Read on X
The editorial process at @FrontiersIn makes a blunder. A study looking at "Developmental delays in children born during the pandemic" claims that fine motor delay and communication delay were seen comparing 2015-2019 & 2020.

This is very misleading. I see this mistake a lot.

/1
In fact, it is true that comparing 2020 to 2015-19 shows high anomalies in these two delays. But, if i compare 2016 to (2015, 2017-20) I would get the SAME significance testing. 2016 is worse than 2020 for fine motor and on par for communication.

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This is a case of a fallacy "cherry-picking."

The authors compared 2015-19 to 2020 but NOT:

2015 to 2016-20
2016 to 2015,2017-20
2017 to 2015-16, 2018-20
2018 to 2015-17, 2019-20
2019 to 2015-2018, 2020

And intentionally so, due to the cherrypicked "pandemic" situation.

/3
Had they done proper statistical tests, it would be completely obvious that 2016 and 2020 had similar rates of both delays.

Instead, cherry picking + selection bias leads to an erroneous association.

/4
The authors suggest they *controlled* this by pooling 2015-2019, but in fact they committed another fallacy!!

This is called statistical underfitting. The average is simply an inappropriate comparator.
You can clearly see the underfit here. By averaging 2015-2019, they created an average line that is supposed to represent all years "on average". But it's clearly underfit, and 2016 sticks out like a middle finger to statistical decency!

/5
Fortunately, the careful critical reader can see just how variable these numbers are, in the **FIRST FIGURE**. The peer reviewers failed the editorial process by not pointing out how this figure elevates a "possible limitation" to a "statistical failure."

Noisy numbers!

/6
The communication number is even more shaky.

While the issue isn't underfit of the average, the main issue is that 2020 would NOT be significantly different when compared to: 2016-2019, 2015-2018, 2018-2019, or ANY combination that *excluded* 2017, which seems low.

/7
In fact, very obviously, the KEY to 2020 being "statistically increased" is not 2020's elevation, but rather 2017's small stature. A simple eyeball test shows this, and yet the reviewers missed it.

/8
If we look at other measures of delay that didn't test significantly, we can see how fluctuations played such an important role.

Sorry for the scratchy comments, but it's late when I'm composing this and its irritating how obvious this is.
This type of error is *critical* during a pandemic, and undoubtedly adds fuel to the type of misattributed "cause" that drives so much covid-denialism activism.

It's not challenging statistics either, and this is what peer review is supposed to correct.

/fin
the paper in question, which *should* have concluded, if either of the two reviewers considered the obvious statistical issue, that "delay rates were within normal year-to-year fluctuation."

frontiersin.org/articles/10.33…

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More from @tylerblack32

Jan 31
Talking to kids when they're struggling🧵
For parents (or anyone who cares for kids!)

It can be really scary to notice something in your kid & be worried suicidality/self-harm.

How do you approach kids?

I've had this conversation >10000 times so I have some tips!

Be CALM

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CALM is a memory-trick to remember the key concepts of communicating to a struggling kid but also to remind you to be in control of your own emotions. If you are prepared, you will defeat your initial instinct, which will be to FREAK THE BLEEP OUT!

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First, COOPERATE!

You & your kid are a team, and you have a common goal: their present & future wellbeing. Don't set yourself up as the security guard, jailor, punisher, or antagonist. Don't push. Don't pull. Be alongside them, tell them you're willing to walk with them.

/3Image
Read 17 tweets
Jan 30
Suicidology
Predicting Suicide Death

A recent study looking at >2M Americans presenting to ERs with MH concern shows the difficulty of "predicting suicide" - we can't predict suicide to help guide important clinical decisions.

The problem: Sensitivity vs PPV

/1Image
They used machine learning EMR-coded variables (outpatient visits, medications, previous appointments, age, etc etc) - you can see the entire dictionary used to "predict" here (word doc):

They had 2,069,170 ER visits and 899 suicides within 90 days.

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After running the model and letting machine learning do its thing, the best fit had the following predictive properties at the 95% percentile cutoff of risk:

Sensitivity: 34.8% (deaths/positive predictions)

Is this helpful?

/3
Read 18 tweets
Jan 20
Debunking Antivaxxer Tropes:
"Antivaxxer is a slur" 🧵

Many many many accuse me of using a "slur" when I say "antivaxxer". It is a twitter shorthand for sure, but it is not a "slur", and I use it without regret or remorse.

/1


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I certainly believe that if one is an "anti-vaxxer", they are not using science, reason, or reality to understand vaccines.

& I note a distrubing trend in antivax and some concerning other beliefs.

That being said, when I say antivax, I only mean "antivaccine belief holder"

/2


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Check out my "antivax misinfo" threads. Someday take a look at the "hidden replies" & note that the antivax profiles are quite.. well.. recognizable.

Note: Do not assume every "Antivaxxer" is, I just notice the trend. As do many of my colleagues here space fighting misinfo.

/3
Read 10 tweets
Jan 19
Debunking Antivaxxer Myths
"🇪🇺 Vaxxed Countries have higher mortality"
No, they don't.

This is COMPLEX:

a) countries had different PRE-VACCINE infection (offers more dangerous protection than vax but indeed protection). Obv, vaccination NOT correlated with pre-vax death.

/1 Image
b) The FIRST VACCINATION SERIES against OG COVID was phenomenally effective at preventing infection, transmission, illness, hospitalization, and death (VE >80-90% in all).

This is clearly evident by one of the most striking correlations you'll see!

COVID deaths vs Vax:

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And because COVID was the primary driver of excess mortality in 2021, excess ALL CAUSE mortality was almost identical to COVID MORTALITY.

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Read 17 tweets
Jan 18
Edward Dowd is popular with antivaxxers.

He presents data to scare people into believing that vaccines have caused harm, & he continuously is on the bandwagon that C19 vaccines cause cancer. This is contrary to the damage.

Here, he's using a report using 1998-2019 data.

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In fact, there was such a DROP in incidence (assumed to be due to lack of access to health care) in 2020, that they had to amputate the model at 1998-2019 so that it wouldn't project a decrease! (a reasonable thing to do!)

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In their report, they clearly show that their trending is based off of models that ONLY end at 2019. ZERO PERCENT of this report is suggesting, implying, or reporting that vaccines have led to an increase in cancers.

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Read 19 tweets
Jan 17
Jordan Peterson is not being "silenced."

He will have a huge platform & can say what ever he wants as long as there is right wing grift.

He is a licensed professional being held standard.

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It is against his license to publicly suggest to die by suicide.

It is against his license to publicly & intentionally call physicians 'criminals,' people "not beautiful" or "appalling self-righteous moralizing things."

His license prohibits misgender people intentionally.

/2


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The standards of his college are publicly available; including social media. By being licensed, he represents his college and the profession, and that college/profession gets to have a say in how they are represented.



/3cpo.on.ca/members/profes…
Read 8 tweets

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