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Tyler Black, MD Profile picture
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Feb 9 • 8 tweets • 3 min read
even the surgeon general @vivek_murthy ..

abcnews.go.com/Politics/surge…

Though expression of concern is always OK, let us not be swept up by one-sided and biased narratives of what the evidence is showing.

/1
We have significant evidence emerging that many of the dire outcomes decreased, and there are nuanced changes (not devastatingly huge) both positive and negative. An excellent review of the evidence and its problems here.

ncbi.nlm.nih.gov/pmc/articles/P…
add in this incredibly detailed data from Ontario (canada's largest nation; generally strict school closure measures) shows some changes up and down (-50% to 28%) in various measures.

/3
jamanetwork.com/journals/jamap…
That is to say, to proclaim today that the pandemic has had a "devastating impact" on youth mental health is pure hyperbole. we can't say that, and the most devastating outcomes (suicide, suicide attempts, hospitalizations) looking lower to average to to (Eating DO) higher.

/4
It is important for public health officials to rely on mental health experts, and especially be cautious to not succumb to moral panic or groupthink when things like this are discussed. Missing is discussion of orphanhood or fear of sickness.

/5
I'd encourage Dr. Murthy, and any public health physician, to seek out evidence *counter* to the well-established moral panic, because it's there.
On the positive note, Dr. Murthy had excellent advocacy for the importance of not simply going back to "business as usual" and correcting the severe deficits in pediatric mental health going back decades.

This stat DEFINITELY pre-pandemic (and maybe a bit hyperbolic?!?)
haha thanks to @LtUhura2017 , i'm now aware that i have elevated Ontario to national status, much like they do every day ;)

oops.

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More from @tylerblack32

Tyler Black, MD Profile picture
Feb 11
Bizarre new trend: painting fears about the virus (thousands of deaths daily, approaching 1M us deaths, no current end in sight, vaccine effectiveness but waning over time) as "unreasonable" and "unsustainable."

What a weird form of gaslighting.
I totally agree with tamping down the 🚨alert🚨 style messaging, but it's not "fearmongering" to acknowledge the real thing to be fearful of.
As far as I know, a virus killing thousands per day, mutating, and creating problems for our vaccines while much of the world still not vaccinated is kinda fearful.

Isn't it smarter to acknowledge the fear about the real thing and do realistic things to impede that thing?
Read 4 tweets
Tyler Black, MD Profile picture
Feb 10
Thrilled to announce that with @QdQwerty and colleagues, we have published very timely description of pre-pandemic mental health. Congratulations to Dr. Alison Lee for the hard work on the publication, and proud to be a part of it.

Let's take a look!

academic.oup.com/pch/advance-ar…

/1 Image
In this study, we took a look at the types of mental health presentations for kids over a 3y period. We used the HEARTSMAP, a reliable tool for helping emergency departments document psychosocial assessments and help with treatment planning.

jpeds.com/article/S0022-…

/2
In total, we looked at the HEARTSMAP data for 1,530 kids.

Broken down by the HEARTSMAP domains:

PSYCHIATRIC: 40% with severe concerns
SOCIAL: 27% moderate/severe concerns
YOUTH HEALTH: 22% moderate/severe concerns

/3 Image
Read 8 tweets
Tyler Black, MD Profile picture
Feb 10
I've offended some with comments on mental health expertise; and I should clarify. I do not mean to rob clinicians of *experience* (for example, many ER docs or pediatricians will see mental health concerns). And maybe even hundreds of cases per year!

/1
However, expertise is different than experience. Most of physicians would (if they could??) refer to experts when they need expert care for those problems. In the same way, despite seeing many kids with heart problems, most pediatricians are not experts in cardiology

/2
The problem is that experiences are shaded by our biases externally and internally, and expertise typically involves a foundation of theory, specific knowledge, and enough experience to balance complicated sets of information and render an expert opinion.

/3
Read 10 tweets
Tyler Black, MD Profile picture
Feb 10
A long time in the making, and the legal and critical importance for dealing with the pandemic as we enter year three.

So proud of my province. As of March 24, 2022, ALL regulated health professionals MUST be vaccinated.

#bcpoli

/1
This is so important to protect universal access to all Canadians, including those who must be protected through OUR vaccination.

As they say in trucker, honk honk.

/2
The order applies to:

acupuncturists

audiologists

chiropractic doctors (chiropractors) (78% voted against in a non-binding resolution, so a huge win)

certified dental assistants

dental hygienists

dentists

dental technicians

dental therapists

denturists

dietitians

/3
Read 6 tweets
Tyler Black, MD Profile picture
Feb 9
A well balanced, expert review of quality of evidence limitations, the mixed nature of results we're seeing, and the implications of all of this as it pertains to "Covid-19 impacts on youth mental health."

/1
"Longitudinal findings paint a more nuanced picture than some cross-sectional studies from the early stages of the pandemic, though there is reason to believe that there could be long-term impacts on youth mental health, especially in more vulnerable youth."

/2
Compared to some very one-sided evidence reviews from the Canadian Paediatric Society and the Royal Society of Canada, and the awful #urgencyofnormal document, this review highlights the complexities and nuances.

/3
Read 6 tweets
Tyler Black, MD Profile picture
Feb 9
Update for @politico

A group of non-mental-health credentialed doctors makes statements about mental health that are not supported by the bulk of our evidence.
For example, in Massachusetts out in @JAMA_current , new referrals for child mental health issues decreased sharply early on, and increased (about the same) later on, but this would not be by anyone's stretch a "dramatic increase."
You can certainly see how selectively grabbing March 2021, for example, might allow that statement, but not the bulk of the evidence, including Mar-Jun 2020 and Jan-Jun 2021 combined.

(note: Mar-Jun 2021 every jurisdiction in MA open school)
Read 4 tweets

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