Daniel S. Goldberg Profile picture
Apr 4 8 tweets 6 min read Twitter logo Read on Twitter
In my work I offer some reasons why we hang on to micro-level interventions even when the evidence is clear that they exert only modest, transient effects.

For one, macro- and meso- level work is challenging and often requires destabilizations of power.

Yet, as I often argue, for our anti-stigma work we actually DO need micro-level interventions like educations and trainings. They DO have some effects and are easier to implement.

The only problem is when micro-level interventions come to dominate the entire field of our anti-stigma work, which the evidence suggests happens, especially in public health spaces.

Instead, my teams and I advance a tripartite anti-stigma approach.

We need macro-, meso-, and micro- level interventions for stigma and discrimination, all at the same time. They all have strengths and weaknesses. Macro- can be extraordinarily powerful, but have long time horizons and often short and unpredictable policy windows.

4/ screenshot of slide entitled "Using Legal Epidemiology
We need to lessen stigma today, not just wait for big social and legal changes at national and global levels.

Micro- is relatively fast and easy to implement, but much less powerful and enduring.

But what about meso-level interventions? There's very little work on this space; it's where my research teams and I are most active and most interested.

We discuss this some in our @Health_Affairs Policy Brief on structural addiction stigma and law:


But we are working on a lot more about this, including some exciting examples of meso-level-driven antistigma work in law and policy unfolding in real time in my home state of Colorado.



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More from @prof_goldberg

Nov 1, 2022
This is a fascinating response from Dr. Miller, from whose work I've learned much over the years!

Some thoughts:

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:

(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.

Read 9 tweets
Oct 31, 2022
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.


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.

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).

Read 4 tweets
Sep 30, 2022
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."


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.

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.

Read 6 tweets
Sep 20, 2022
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.


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:


Read 5 tweets
Sep 19, 2022
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

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.

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.

Read 6 tweets
Sep 16, 2022
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.

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.

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;

Read 9 tweets

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