Tyler Black, MD Profile picture
Suicidologist, emergency psychiatrist and pharmacologist. Data geek, ok, lots of other geek. Views expressed are my own and not my employers'. he/him/his
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Jan 31 17 tweets 6 min read
Talking to kids when they're struggling🧵
For parents (or anyone who cares for kids!)

It can be really scary to notice something in your kid & be worried suicidality/self-harm.

How do you approach kids?

I've had this conversation >10000 times so I have some tips!

Be CALM

/1Image CALM is a memory-trick to remember the key concepts of communicating to a struggling kid but also to remind you to be in control of your own emotions. If you are prepared, you will defeat your initial instinct, which will be to FREAK THE BLEEP OUT!

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Jan 30 18 tweets 5 min read
Suicidology
Predicting Suicide Death

A recent study looking at >2M Americans presenting to ERs with MH concern shows the difficulty of "predicting suicide" - we can't predict suicide to help guide important clinical decisions.

The problem: Sensitivity vs PPV

/1Image They used machine learning EMR-coded variables (outpatient visits, medications, previous appointments, age, etc etc) - you can see the entire dictionary used to "predict" here (word doc):

They had 2,069,170 ER visits and 899 suicides within 90 days.

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Jan 20 10 tweets 6 min read
Debunking Antivaxxer Tropes:
"Antivaxxer is a slur" 🧵

Many many many accuse me of using a "slur" when I say "antivaxxer". It is a twitter shorthand for sure, but it is not a "slur", and I use it without regret or remorse.

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I certainly believe that if one is an "anti-vaxxer", they are not using science, reason, or reality to understand vaccines.

& I note a distrubing trend in antivax and some concerning other beliefs.

That being said, when I say antivax, I only mean "antivaccine belief holder"

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Jan 19 17 tweets 5 min read
Debunking Antivaxxer Myths
"🇪🇺 Vaxxed Countries have higher mortality"
No, they don't.

This is COMPLEX:

a) countries had different PRE-VACCINE infection (offers more dangerous protection than vax but indeed protection). Obv, vaccination NOT correlated with pre-vax death.

/1 Image b) The FIRST VACCINATION SERIES against OG COVID was phenomenally effective at preventing infection, transmission, illness, hospitalization, and death (VE >80-90% in all).

This is clearly evident by one of the most striking correlations you'll see!

COVID deaths vs Vax:

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Jan 18 19 tweets 8 min read
Edward Dowd is popular with antivaxxers.

He presents data to scare people into believing that vaccines have caused harm, & he continuously is on the bandwagon that C19 vaccines cause cancer. This is contrary to the damage.

Here, he's using a report using 1998-2019 data.

/1 Image In fact, there was such a DROP in incidence (assumed to be due to lack of access to health care) in 2020, that they had to amputate the model at 1998-2019 so that it wouldn't project a decrease! (a reasonable thing to do!)

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Jan 17 8 tweets 4 min read
Jordan Peterson is not being "silenced."

He will have a huge platform & can say what ever he wants as long as there is right wing grift.

He is a licensed professional being held standard.

/1 Image It is against his license to publicly suggest to die by suicide.

It is against his license to publicly & intentionally call physicians 'criminals,' people "not beautiful" or "appalling self-righteous moralizing things."

His license prohibits misgender people intentionally.

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Jan 17 23 tweets 8 min read
Mythbusting in the pandemic
Mortality in Canada

Data of ALL 🇨🇦 mortality 2000-2022 to test this myth, so lets run through the proposed causes of the antivaxxer "#diedsuddenly", & other mortality issues.

First up: ❤️
Ages 20-39 (86% vaccinated!)
no excess heart deaths!

/1 Image OK but what about ischemic heart disease (heart attacks).

Still no, in this 86% vaccinated group.

And antivaxxers who "See something" in 2021, do you also "See something" in 2014, 2006, and 2002? thats why we use comparator error bars.

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Jan 14 7 tweets 2 min read
Awful, stigmatizing people like this nonclinical psychologist who claims to be an expert in trauma, really do discount the experiences of SO MANY who get very unwell and do not have a history of trauma. Believing trauma causes everything actually causes severe harm to many.

/1 Image There are many causes of mental illness that ARE KNOWN that have nothing to do with trauma, and many that ARE NOT KNOWN that have nothing to do with trauma, and it's even possible to have a history of trauma and have it NOT contribute to an illness, or it might be crucial.

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Jan 12 5 tweets 3 min read
Mythbusting about COVID:
"Vaccines didn't benefit kids"

FACT: At every age, children benefit greatly from vaccination.

Infants <6mo (via maternal vaccination)

* 52% less likely to be hospitalized (80% during Delta, 38% during Omicron)
* 70% less likely to be in the ICU

/1 stock photo of an infant in hospitalized state (adobe licensed) In kids 6mo to 5y:

43-80% less likely to go to the ER
40-60% less likely to get COVID

/2 stock photo of a child in a hospitalized state (adobe license)
Jan 11 20 tweets 6 min read
Mortality Update 2024
🇺🇸United States🇺🇸

We have data to June 2023.

For DISEASES (including COVID), we can see a strong effect of the pandemic, with unsurprising COVID peaks.

Overall, an EXCESS of 1.16M Americans have died of diseases since the pandemic.

/1 Image Note! 2023 has seen a return to expected mortality, with there being a *slight* decrease in disease-cause mortality that is probably best seen as 'average pre-pandemic trend disease mortality'.

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Jan 4 5 tweets 2 min read
Cognitive Dissonance

For the past few days, I've been posting a lot of stats showing that pediatric suicides have NOT INCREASED but likely DECREASED (🇦🇺🇨🇦🇺🇸) during the pandemic. Many of the contrary replies are people who are saying some version of "nuh-uh."

/1 These minds are having what we call cognitive dissonance: the distress caused by two contradictory ideas (in this case: facts vs belief) .
Our brains don't like that.

Typically, we have reactions to it:
- denial ("nuh-uh")
- frustration/anger ("how dare you minimize?!?")
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Jan 2 9 tweets 3 min read
Kids & Suicide - US Update
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School-aged children (5-17 years) had a robust reduction in suicide rates during the pandemic.

The headline result is robust: 544 fewer children (-9%) died of suicide during the pandemic than modelling would predict.

/1 Pediatric (5-17) suicide rate over time, 2010-2023 June  plotted x axis: date by year (monthly data fills in) plotted y axis: rate of suicide per 100,000 per year  the plot has a model built off of the 2010-2019 years, and shows the time starting the pandemic (2020 march) onwards highlighted, and a gradual decline compared to expected levels is seen. We now have 4 COMPLETE school years during the pandemic. I have a lot to say about this, but take the time to digest this graph. Overall, there has been no "tsunami of suicide" in schoolkids due to the pandemic, lockdowns, or otherwise.

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Jan 1 23 tweets 6 min read
"The Unethical Conspiracist", part two:

I didn't expect my lengthy thread on this disinformation spreader to go viral, but I am pleasantly surprised. I'm really glad it resonated, and I hope the word continues to get out.

Let's go a bit deeper.

/1 Image Just today (Happy New Years), he posts this very lengthy "retort" to @Truth_in_Number's excellent criticisms of his awful use of data. I will now (yay Brandolini's principle) spend a lot of my time to go through & show how much BS he put into 1 slide.

Lets take his first 5!

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Jan 1 19 tweets 6 min read
"The Unethical Conspiracist"

There is an account frequently cited to me that apparently shows vaccine-caused death. Named "ethical skeptic" but not a skeptic nor ethical.

I'm going to take an incredible amount of work (yay Brandolini's principle) to show you what I mean.

/1 Image All this account ever does - and I mean ever - is cook models to create narratives that support his crank, consipracist ideas:

* CDC is hiding vaccine-caused cancers
* Cancer deaths are rising due to vaccines, etc.

So lets take this random graph of his.

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Dec 27, 2023 11 tweets 3 min read
The biggest problem for Anti-vaxxers and their theories that vaccinated people are dying at high rates:

Excess mortality has generally followed infection (COVID+flu+RSV) waves, and there is no tremendous effect of vaccine period.

Even if we look at SIX models in the US!

/1 Image In this graph, we have two types of "future modeling" (what we use to calculate excess mortality), ARIMA and Winter's Additive Method. For each, we have 3 sets of data used to feed the model (5, 10, 21 years).

Models generally agree (5-year ARIMA unsurprisingly variant)

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Dec 23, 2023 7 tweets 3 min read
So far, the most-read article the latest issue of @tandfonline's Human Vaccines & Immunotherapeutics - our letter outlining the data and method errors in an erroneous meta-analysis that claims to show cardiac mortality of COVID-19 vaccines.



/1 tandfonline.com/doi/full/10.10…
Image Serious errors in the article undermine its conclusion - the report that constitutes >90% of the meta-analysis was the awful, edited report by anti-vax surgeon general Joseph Ladapo.

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Dec 12, 2023 27 tweets 8 min read
Do NPIs like lockdowns, masks, infection control measures, & limiting visits work?

A hypothesis testing mini-Twitter-paper (🧵):
(TWITTER PREPRINT!)

It's a nuanced question (what do we mean by "work"?), but lets use data and approach it from one angle.

/1 Image INTRODUCTION:
Prior to the pandemic, infectious like RSV, Pneumonia, GI Viruses, etc, killed about 60 Canadian children per year, with variability due to strains and season (high 72, low 44). This is a high-ranking cause of death under the age of 5, at about 3.3 per 100k.

/2 note: stock photo from Adobe, licensed to author
Dec 10, 2023 23 tweets 8 min read
🧵 BUSTING ANTIVAXXER MISINFO 🇨🇦

Antivax myth : vax caused young people to die of cardiac/vessel disease.

REALITY: NOPE, these deaths during vax period within trend.

But let's REALLY test the "vaccines caused circulatory harm" claim! Systematically, like a scientist may.

/1 Image To quickly orient you, this dynamically generated graph can analyse the overall trend, the most recent 5 year trend, and then use that trend to "predict" expected deaths during 2020-2022.

Obviously, cardiac deaths right on trend, with a slight blip (within error) in 2020.

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Dec 5, 2023 16 tweets 5 min read
🧵Suicidology (🇨🇦)
Suicide Since the Pandemic

We have a new @StatCan_eng data release, and can now report on suicides to 2022.

Suicides are MASSIVELY down during the pandemic, and from 2020-2022 we had ~2,759 fewer suicides than expected.

Let's look at age breakdowns.

/1 Image In the VERY YOUNG age group (0-14), we see a very significant deviation from expectations in Canadian girls (-35.7%, p=0.004), whereas young boys in Canada continued on expected rates.

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Dec 1, 2023 13 tweets 4 min read
A quick primer on "Q-T prolongation" for those whoprescribe psych meds.

If you do, you MUST know 10 key points:

Point 1: The QT is the time (in s or ms) between the Q wave and the end of the T wave, approximating the time from ventricular contraction to full relaxation.

/1 Image Point 2: The QT interval is important. A short QT (often genetic causes) and a long QT (often medication caused-over 100 medications are associated with prolonging QT, but it can be due to electrolytes, genetics, & other factors) is linked to cardiac symptoms including death!

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Oct 21, 2023 10 tweets 3 min read
The myth of "FIRST DO NO HARM"

Imagine the scene:

Beep... Beep...
Dr. Jones takes the scalpel, ready to make the first incision. Without surgery, the internal bleeding not stop.

Suddenly, the nurse grabs her hand. "Stop the surgery! Remember, doctor 'First do no harm?'"

/1 Image Of course, this scenario doesn't happen, and in surgical suites across the world, surgeons regularly cut into patients, inflicting harm.

Other harmful things done on a daily basis? X-rays, blood tests, medications, exercise tests, injections, stitches to name a few.

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