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Tyler Black, MD Profile picture
@tylerblack32
Aug 1, 2023 • 16 tweets • 5 min read • Read on X
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Big Book of Mortality
America, 2020-2022

We now have reliable mortality data for 3 years of the pandemic, 2020-2022. COVID as the underlying cause of death was the #3 killer of Americans.

On this graph, every cause of death causing >0.1/100k per year is graphed.

/1 For each of these graphs, we have multiple-layered line graphs. Y axis: logarithmic scale, rate of death per 100,000 X axis: ages 1-85+ plotted: each cause of death for the top 17 causes. This list is (all americans): #17 - Assault (75,329) #16 - Parkinsons (118,607) #15 - Septicemia (123,371) #14 - Hypertensive disease (127,888) #13 - Influenza/Pneumonia (142,144) #12 - Suicide (143,506) #11 - Transport accidents (144,058) #10 - Chronic liver disease (162,907) #9 - Kidney diseases (164,654) #8 - Diabetes mellitus (306,498) #7 - Alzheimer's (373,598) #6 - COPD/Chronic lung disease (442,14...
This is a cleaner version of the chart, where only the top 17 causes are graphed.

We can see that there are two causes that erupt after 50 (Parkinson's and Alzhiemer's).

External causes (Accidents, Suicides, Homicides) erupt early and stick around.

/2 same graph as previous
People under 30 die much less frequently, but COVID-19 cracked the top ten coming in at #9. COVID WAS A TOP TEN CAUSE OF DEATH UNDER 30.

External causes of mortality loom large in this group.

/3 #18 - HIV (626) #17 - Legal Intervention (632) #16 - Septicemia (1,283) #15 - Pregnancy or Postnatal (1,397) #14 - Chronic Liver Disease (1,480) #13 - COPD/Chronic Lung Disease (1,500) #12 - Cerebrovascular Accident (1,796) #11 - Influenza (1,895) #10 - Diabetes (2,461) #9 - COVID-19 (6,602) #8 - Heart Disease (8,307) #7 - Cancers (11,291) #6 - Congenital/Chromosomal Abnormalities (16,202) #5 - Complications of Delivery/Childbirth (29,205) #4 - Suicide (32,992) #3 - Assault (33,726) #2 - Transport Accidents (39,845) #1 - Non-transport Accidents (62,756)
This is why the "but kids rarely die from COVID" argument by covid denialists and the Urgency of Normal Ghouls is particularly awful - because young people rarely die of ANY diseases but of course we care very much about pediatric cancers and diabetes and other things.

/4
Looking at women, COVID is a top ten cause of death <12, gets to about 7th by 30, and ends up being the third leading cause of death amongst all American women.

External causes of mortality peak in female youth but overall are much less common than with men.

/5 #18 - Pneumonitis due to solids and liquids (J69) (33,994) #17 - Hypertensive disease (59,434) #16 - Assault (60,934) #15 - Septicemia (60,986) #14 - Parkinson's (72,491) #13 - Influenza/Pneumonia (74,030) #12 - Kidney Disease (85,957) #11 - Chronic liver disease (102,524) #10 - Transport Accidents (104,674) #9 - Suicides (114,098) #8 - Alzheimer's (115,644) #7 - Diabetes (173,616) #6 - COPD/Chronic Lung Disease (209,362) #5 - Cerebrovascular aciednts (212,226) #4 - Nontransport Accidents (328,987) #3 - COVID-19 (531,710) #2 - Cancers (955,534) #1 - Heart Disease (1,153,970)
Looking at men, external causes rank higher generally. At no age is COVID less than a top ten cause of death and it again ends up at #3 overall.

/6 same graph as previous but on linear scale
Data notes:

The rates (Y axis) per 100,000/year. They are plotted logarithmically as the elderly deaths would make it impossible to see younger deaths.

EG: this is the graph for men on a linear scale. Helpful for sorting out causes of death 75+, useless for most ages.

/7 #18 - Pneumonitis due to solids and liquids (J69) (33,994) #17 - Hypertensive disease (59,434) #16 - Assault (60,934) #15 - Septicemia (60,986) #14 - Parkinson's (72,491) #13 - Influenza/Pneumonia (74,030) #12 - Kidney Disease (85,957) #11 - Chronic liver disease (102,524) #10 - Transport Accidents (104,674) #9 - Suicides (114,098) #8 - Alzheimer's (115,644) #7 - Diabetes (173,616) #6 - COPD/Chronic Lung Disease (209,362) #5 - Cerebrovascular aciednts (212,226) #4 - Nontransport Accidents (328,987) #3 - COVID-19 (531,710) #2 - Cancers (955,534) #1 - Heart Disease (1,153,970)
In short & in conclusion, COVID IS A VERY IMPORTANT CAUSE OF DEATH AT EVERY AGE.

If you were a child, Top 10
if you were a young adult, Top 7
If you are middle aged, Top 3

/8
Covid minimizers, denialists, ghouls, and antivaxxers have abused the concept of infection fatality rate or age stratification to the point of uselessness: COVID-19 IS A ONCE IN A LIFETIME PANDEMIC THAT KILLED 1 MILLION AMERICANS, important at EVERY age.

/fin
also note to minimizers: - flu very much still a top 15 cause of death.
A shareable little graph, COVID was AT LEAST a top 12 cause of death at every age 1-85 Image
and finally, in the truest transparency, here is the entire dataset that created the graph:



feel free to check my work!docs.google.com/spreadsheets/d…
@RMHayes5 @PeterHotez Error non-transport accidents
@dccarbene @PeterHotez btw here's 'firearm deaths'. totally doable!

cdc wonder is an amazing database Image
@samjlord It was also largely on par with heart diseases, so it feels a lot to me like you cherrypicked your argument there.
hey, ghouls! no, COVID-19 deaths were not overcounted. in fact, almost all of the evidence we have tells us that COVID-19 deaths are undercounted

see:



and

https://t.co/wXcD7w8dPXbu.edu/sph/news/artic…
who.int/news/item/05-0…

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More from @tylerblack32

Tyler Black, MD Profile picture
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
Tyler Black, MD Profile picture
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
Tyler Black, MD Profile picture
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
Tyler Black, MD Profile picture
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
Tyler Black, MD Profile picture
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
Tyler Black, MD Profile picture
Apr 30
The McCullough Foundation's @NicHulscher — who posts garbage medical misinformation — styles himself an "independent epidemiologist."

His entire career has been spent publishing with, and working for, McCullough. Image
No academic post, no health agency, no clinical role, no pre-Foundation experience. Hired straight out of his 2024 MPH by the senior author on nearly every paper bearing his name.

/2
He publishes almost exclusively with McCullough, overwhelmingly in predatory or fringe journals, and has already been retracted twice — plus an Expression of Concern — in a career that's barely two years old.

/3
Read 7 tweets

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