This is a fascinating response from Dr. Miller, from whose work I've learned much over the years!

Some thoughts:

1/
I agree with Dr. Miller that the utility of ethicists in the #RoomWhereItHappens for public health emergency policy response ought not be assumed. That said, I strongly believe that an appropriately-trained ethicist can be helpful, at least in the following ways:

2/
(1) Trained ethicists often have facilitation skills, specifically as regards to complex normative and ethical problems unfolding in urgent or emergent contexts. Applied ethicists in practice almost never dictate or pronounce conclusion -- if they are practicing well IMO.

3/
Rather, ethicists can help facilitate and sometimes even mediate conversations & disagreements in ways that can help teams & communities identify key assumptions and value conflicts (2). This work is useful from a #ProceduralJustice perspective even if consensus is impossible

4/
Of course, there are lots of ways ethicists can detract from policy conversations during a public health emergency, but it's not clear to me why this would be a universal concern for almost any professional bkgrd (eg don't get me started on doctors w/o public health training)

5/
In the final paragraph of his blog post @hastingscenter, Dr. Miller poses some questions that perhaps shape his skepticism on the utility of ethicists in these contexts:

6/ If, all things considered, ethicists should be at the table,
Now on this point I completely agree with Dr. Miller. The vast majority of practicing bioethicists in the West are simply NOT public health ethicists. They typically lack much of a background in public and population health, let alone policy work associated w/ public health.

7/
Here, the solution is obvious: We should train more public health ethicists! And specifically policy and advocacy training in context of #PHEPR (public health emergency preparedness & response) ought to be a core part of this training ...

Thoughts?

8/

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More from @prof_goldberg

Oct 31
I respect Hiroko Tabuchi but once again, we have a NYT story on #COIs btw #academia and industry focused on the wrong points. Far too much time is spent on compliance w/ disclosure requirements, when disclosure FAILS as a remedy for #MotivatedBias.

nytimes.com/2022/10/31/cli…

1/
More discussion is had on the notion that the sponsor has "no influence" on the work of the center at issue when we know beyond a shadow of a doubt that it is the depth of the relationship btw the sponsor and the center that leads to behavior of partiality.

2/
I will never cease to be amazed at the willful ignorance that prevails in conversations about #COIs and #MotivatedBias. The #DecisionSciences lit is rich but is roundly ignored in almost all of the reporting on these subjects (incl. by the principals involved).

3/
Read 4 tweets
Sep 30
As anyone who works on #COIs and #MotivatedBias can tell you, this arrangement is ethically unacceptable from an #OccupationalHealth perspective. HCPs paid directly by the league are in NO conceivable sense "independent."

nytimes.com/2022/09/30/spo…

1/ Under the league’s concussi...
And giving team physicians the "ultimate say" is absolutely the last thing you would do if you truly understood COIs as exposures and #MotivatedBias as a population health harm. It is literally inconceivable that this arrangement continues apace.

2/
Remember a week or so back when I talked about the deep connections between the #railroadindustry and contemporary public health policy? This is one of them. The RR industry pioneered the model of having company physicians care for injured workers.

3/
Read 6 tweets
Sep 20
For those following at home, the advice on the Intarwebz explicitly warns against any kind of preheating an empty enameled cast-iron vessel in a cold oven (even if you begin the preheat with the vessel in the oven). To wit:

1/ NEVER Preheat An Empty Dutch Oven Preheating an empty Dutch
Note that this warning is not identical to warning against placing a cold empty vessel in a preheated oven. That too is inadvisable but is not the same warning as above.

2/

bigtimekitchen.com/preheat-enamel… NEVER Drastically Change the Temperature of a Dutch Oven If Never preheat an empty, enameled Dutch oven. You can use but
This is just one website but the same advice is easily found on countless others. Picking up on this problem, @kingarthurflour had a long post comparing bread baked in a "cold" Dutch oven vs. a preheated and found little appreciable difference:

kingarthurbaking.com/blog/2017/07/0…

3/
Read 5 tweets
Sep 19
Look, I just do not understand how to use cloches or bread bakers. I have a nice one which was a gift, but my breads are almost always better when I just bake on a sheet.

I get the idea, I think. When you preheat the vessel and load the dough in

1/
The escaping moisture creates steam (can also be added via various techniques I use). The lid keeps the steam in which helps with a beautiful rise and makes an awesome crust. I get this. But the reality is much more complex for me.

2/
First, I have an enameled cast-iron and a stoneware cloche, neither of which can be preheated empty. So when I load the proofed dough in the vessel into the oven, the vessel itself takes awhile to build up heat.

3/
Read 6 tweets
Sep 16
As someone who knows more than a little about the history of the railway industry and occupational and public health (both US and UK, actually), I'm rendered almost speechless by what is happening with the possible strikes in the U.S.

1/
I firmly believe that it is difficult to understand contemporary problems in public health policy and even health care policy in the US w/o really integrating the histories of the railway industry and railway medicine. The connections are LEGION.

2/
They include:

- basic reasons why private health care is provided by third parties rather than directly from corporations and employers;

- the origins of the #ManufactureOfDoubt in regulated industries;

- accusations of #malingering and feigned illness in social policy;

3/
Read 9 tweets
Aug 22
There's a lot in this thread, but one pt I'd like to extract is connected to something I've been arguing for years and #onhere quite a bit recently:

#MethodologicalIndividualism in public health occurs where we position the individual as the unit of change.

1/
This is in comparison to structural interventions, which often alter upstream factors and institutions. My favorite example of the latter is laws and policies, but can also include infrastructure and built environmental changes, etc.

2/
But leading public health officials in the US have completely followed the #MethodologicalIndividualism that has dominated public health policy and priorities for much of the 20th c. until now. See:

pubmed.ncbi.nlm.nih.gov/19965565/

3/
Read 13 tweets

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