Plenary at #SER2022 with @zeynep re aspects of human behavior that were not adequately incorporated into pandemic response. This is a very dense talk w/o slides so livetweet is a bit bumpy... but talk was super interesting so I did my best.
For example, because of stigma, it doesn't make sense/isn't possible to have effective rules that only sick people wear masks.
Idea that masking or testing would make people 'reckless' just didn't make any sense and inconsistent w/ prior research.
Informing people is always better. Efforts to 'guide' people's behavior by withholding information or withholding resources decay trust and undermine public health efforts overall.
Argues that apparently child vaccine approval has been delayed in order not to 'undermine confidence' or 'confuse' people - nothing could be more confusing or undermine confidence more than failing to prioritize getting vax to kids.
Why did we ban outdoor activities? People need to get together at some point - need to give people accurate info about safer vs riskier activities- instead of expecting people not to do any activities.
Response to incomplete vaccination rates by lumping all unvaxed people as 'anti-vax' instead of recognizing major barriers in trust and access to accurate information also has delayed vaccine takeup.
Instead we got a social media environment that feeds caricatures (and you can always find an example that matches the caricature) instead of trying to understand where is the public health approach here?
Of everything we screwed up in the pandemic, very little comes back to not having the right tools. We technically had good tools pretty early, e.g., vax, rapid tests. Problems come from not taking into account the sociology of the situation.
Prior research actually suggests authorities in times of crisis often fall back on Hobbesian attitudes not trusting the public and implementing rules that backfire.
[I've lost the thread here re aerosols and airborne transmission]
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Plenary from @michaelmina_lab at #SER2022.
Testing is not just a medical tool! Most of the discussion of testing is focused on medical diagnostics but testing is a public health tool. We need to start thinking/evaluating testing as a population health tool.
Applications of tests for public health? test to isolate; test to exit isolation; test to enter/stay; test to go; contact tracing. Medical testing is for patient; testing for public health is for others.
Conflating what are medical vs public health tools is a major problem. Priority for medical tests (FDA's priority): high sensitivity. Secondary considerations: cost and speed. For public health, we need to prioritize fast, frequent, accessibility, affordability over sensitivity.
Outline: 1. why we've failed to find cures for AD. 2. Establishing a pipeline for id'ing drug targets w/ systems biology (APOE-signature, PREVENT AD based on candidate drugs in mouse models, and the DREAM study, real world analyses of pharmacotherapies)
Reminder is that it's been more than 100 years since Alzheimer described the key pathologic features. Year on year publications on AD have grown - now>1000 pubs/month! Yet shockingly little to offer patients.
Capstone of @UCSF_Epibiostat Sampling Knowledge Hub series with @EpidByDesign talking about generalizability and transportability in research.
Two issues in interpreting an intent-to-treat estimate as a public health. 1. Internal vs external validity (difference between the study sample and people in general) and 2. Exposures vs population interventions (not everyone in real world will take up intervention).
Thread about @manlyepic & my @jamaneuro commentary re one especially shameful aspect of the FDA approval of #aduhelm. Before working w/ @manlyepic on this, I knew it was bad, but I didn’t know how bad. doi:10.1001/jamaneurol.2021.3404 1/27
In @Biogen’s FDA filing, only 0.6% (ie 19 people) of 3285 trial participants identified as Black, 3% as Hispanic, 0.03% (1 person) American Indian or Alaska Native, and 0.03% as Native Hawaiian or Pacific Islander. Of 9% identified as Asian, 94% were recruited in Asia. 2/n
But it gets even worse: of those 19 Black participants, most were randomly assigned to control or low-dose treatment arms. FDA approved a medication with known increases in risk for brain bleeding after only 6 Black people had received the approve dose. How is that okay? 3/n
This guy's incredible. Silicon valley background- made software to help people safely document human rights violations. Started in 1991, when a grad student at @UMich soc and demography. Struggled after seeing what was happening in Guatemala and El Salvador- many crimes.
Adopted as personal motivation defense of human rights. In El Salvador, began non-violent accompaniment: accompany someone who is under threat of violence, eg a religious leader. You are 'noisy' & use privilege to try to protect, w/ camera, passport, & home country network
Rohit Vashish from @UCSF_BCHSIt presenting at @UCSF_Epibiostat department meeting about using electronic health record (EHR) data to emulate target trials to understand treatment effects for chronic disease management, example with type II diabetes
Beautiful explanation of the data gap: there is just no way to have good head-to-head RCTs of all the important medication decisions for all of the important potential outcomes (retinopathy, acute CVD event, etc). We must use "real world data", e.g. EHR data.