Tyler Black, MD Profile picture
Feb 15, 2022 11 tweets 3 min read Read on X
USA Suicidology Update, 2020-2021
********
I can now create a 2021 provisional estimate, with error, for the suicide rates for 2021. My method will be described at the end of the thread.

Contrary to the #moralpanic 2020-2021 suicide rates did NOT increase.

/1
The rate for both males and females in the United States will likely be within the expected fluctuation of the previous years, and still less than the "peak" of 2018 pre-pandemic.

/2
For Adults 61-84, likely a slight uptick for men but within 2019 levels, and for women no overall change.

/3
For adults 41-60, the significant drop seen in 2020 will likely continue for both men and women.

/4
For adults 25-40, no changes are significant but there seems to be a continuing and increase of about 2.5% per year in the male rate since 2009.

/5
For YOUNG ADULTS (18-24), **please note that neither change is outside of the error prediction so this is best described as** no significant differences. If the point estimates hold, they will both be highs. However, neither increase unprecedented or "A TSUNAMI" if they hold.

/6
For PEDIATRIC POPULATION (0-17), **please note that neither change is outside of the error prediction so this is best described as** no significant differences. Even if the point estimates hold, none of these increases unprecedented or "A TSUNAMI".

/7
All-in-all, its looking like 2021 will be a mundane year for final suicide numbers. In the coming days I will do my best to take a peek at the racial divides.

/8
"2021 ERROR SIZE"
I ran a model in which all the previous "Jan thru June" rates were compared to that year's final rate, to get the most conservative (largest) error in this prediction.

For the second year in a row, the "TSUNAMI OF SUICIDE" moral panic will not test true.

/9
"2021 Provisional Rate"

The 2021 rate is then displayed as the Jan-June rate (adjusted to to increase by 2.6% when provisional to final, based off of previous CDC Wonder updates), with the error bars above.

/10
Source: @CDCgov WONDER

/done

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More from @tylerblack32

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
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

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