Notes toward a history of drug epidemiology 31dec2016

Artificial silk

The beginnings of the Carbon Disulfide (CS2) story.

The Code Switch and Drug Use

JSTOR: Benoit et al., 2003

A recommended reading for anyone interested in ethnicity and ethnic self-identification, or the colloquial meanings of "race" differences.

We need to abandon that term in scientific discourse. Leave it to others. Ask them "Exactly what do you mean by 'race' when you use that term?"

Another word choice issue for scientists: I cannot recommend this article's vocabulary of "hard drugs" ( versus "soft drugs" ) in that it places too much stress on the "demon drug."

A drug is an agent in the agent-host-environment triad. Are some infective agents "hard agents" and others "soft agents"? Tell that to anyone who lost a loved one to "the common flu" or to those who were infected with Ebola virus and survived.

A misplacement of explanatory power.
Represents confused pharmacological thinking.

But read the article and judge for yourselves. Some potentially great ethnographic material in this article, and the term "code switch" is worth learning. Applicable in immigration and cross-cultural studies generally.

Discussion of optimal heroin price, and miscellaneous notes on heroin

Neri F. (1996) working paper. Must read for heroin epidemiology master's.

A "popular culture" perspective from 1981 (might need a JSTOR account to read this one):
"Heroin Boys"

What an ethnographer learns by applying ethnographic approaches to law enforcement wiretapped conversations. What a truly great study! Natarajan, 2006

Unusual syndromes deserve attention

The Alice in Wonderland Syndrome
https://www.ncbi.nlm.nih.gov/pubmed/25841113



LSD flashbacks
https://www.ncbi.nlm.nih.gov/pubmed/25841230

Expect these syndromes to become more prominent with appearance of new synthetic compounds, not only cannabinoids, but other molecules.

As for tools needed to study them, think of the charity luncheon foodborne disease outbreak challenge and think through the possibilities for latent variable analyses.

In the following version of the charity luncheon case study, the attack rates vary by the different ways to combine potential signs and potential symptoms into a syndromic case definition. This case study version eliminates that part, but imagine what you might try to do if you had attack rates specific to each food and to each combination of foods eaten and not eaten.

See Lesson 1.

Peer Recovery Coach Tactics on the Frontlines of Drug Outbreaks

Must one be in recovery to be an effective peer recovery coach?

This is not a question intended to be dismissive about efforts of " in recovery" coaches, who deserve nothing but accolades.

But it is a pertinent question in two contexts:

(1) How to make most efficient and effective use of scarce resources, counting the indirect benefits of employing " in recovery" coaches?

and (2) What is the analogue to a peer recovery coach when a community faces an outbreak and struggles more to constrain occurrence rates for newly incident users before the community has accumulated enough cases required to mobilize treatment services?

npr story on peer recovery coaches

Popular culture expressions (Levy collection at JHU)

Popular culture expressions of mental, behavioral, and social disturbances, as well as early memes (drug user mischief). A good source of images for your presentations, and the Levy collection includes sheet music for the music literati.

Family strife related to alcohol intoxication.

URL for Levy collection search tool

Related collections link

Search results from Visual Hunt public domain "heroin"

Anything of interest to our program, family studies, etc.: please post a comment and we'll assemble a collection we can share. It appears that all images in the Levy collection from before 1923 are in the public domain, except as noted by the collections' archivists, but check it out yourselves:
http://levysheetmusic.mse.jhu.edu/copyright

"Image courtesy of the Lester S. Levy Collection of Sheet Music, The Sheridan Libraries, The Johns Hopkins University"

Time to get back to that overdue chapter after a little quasi-recreational distraction.

Until you're dead, don't bet against neuronal plasticity.

Until you're dead, don't bet against neuronal plasticity.

Brain plastic people: Whoa baby now,....

Too early to evaluate effects of cannabis policy change?

Consider two time series: (1) the rate of suicide deaths, and (2) the unemployment rate.

Does the unemployment rate influence the suicide rate?

I maintain that research on this question remains non-definitive until we can specify the plausible distribution of  the analogue to an infective agent's incubation interval or a drug's induction interval.

One alternative to specifying a plausible distribution is to assert that any such epidemiological effect can be estimated almost immediately after a shift upward or downward -- i.e.  an almost immediate effect within a span of 1-48 months. In the unemployment-suicide context, this assertion ignores commonsense ideas about buffering against adversity that is connected to individual wealth (e.g., size of an employee's retirement savings account) or social capital (e.g., a Dutch uncle or aunt).

Another alternative is to try many different lag values, which converts the activity to a fishing expedition, with a false discovery penalty to be paid as a consequence of being undisciplined in these matters.

(A hidden fact is that the first assertion essentially can become a slippery slope in the direction of the fishing expedition, unless the research team finds evidence of an immediate effect. Why? One can look into the discussion section of a failed 'time series experiment' and see why. One limitation is almost guaranteed to show up there -- i.e., "It is possible that we did not specify the lag time correctly.")

To this point, the kind reader may see where I am going with this line of reasoning:

(1) Any attempt to specify an analysis approach for problems of this type must begin with Bayesian thinking about plausible distributions for the incubation or induction interval or its "lag time" analogue.

(2) We should be skeptical when we see published evidence based on an incautious assertion of a short lag time with no evidence of advance thinking about plausible alternatives.

So what are we to make about the series of articles being published on effects of changing cannabis policy environments in these United States of America?

* When they assert a short lag time, but consider no alternatives to the just-mentioned slippery slope?

* When they try out many different alternatives willy-nilly?

See Pacula & Sevigny, 2014

Then, for some technical details to help in advance specification of Bayesian distributions :

Pacula & Lundberg, 2014

Estimation of drug policy impact is not a simple matter.

"Smokin' Reefer" with Cab Calloway

I stumbled across the Levy Sheet Music Collection web page and this 1932 "Smokin' Reefer" song in the Alan M. Chesney historical collection, but it would not show lyrics. My search for lyrics took me to these recordings.

Cab Calloway tunes

#cannabis
#marijuana

History of Medicine Resources 12/20/2016

Introduction to the History of Medicine

Ancient Medicine

Healing Spaces

Getting the most from Pubmed

How a sociologist became the pigeon guy...

A pig story in our future?

Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015

CDC MMWR report through 2015

Nootropics in the news

"Cosmetic neurology"

Hacking your brain with micro doses of street psychedelics

The next big thing?
Or yesterday's news?


postscript 12/26/2016:

Intellerall: Green Coffee Magic?

Theobald Smith: A Beginning

We already have seen that in a less UK-oriented era, Fredrik Holst of Norway might now be regarded as European Father of Epidemiology by virtue of his well-designed population surveys of specific categories of mental disorders. These surveys are described in Anthony and Van Etten (1998) and in Tambs (2015; https://www.ntnu.no/ojs/index.php/norepid/article/viewFile/1893/1892).

Across the Atlantic, Theobald Smith is an American candidate. This is an excerpt from one of the obituary descriptions of his life, and more should follow. Search for Theobald Smith to find the later entries. Here, pay attention to the metaphor of a chain. We will return to that metaphor later on.

 

 

Lee N. Robin's - 12/12/2016 Retrospective Entry

AJPH article on drug use, 1967

Let's ignore the idea that it ever is important to be "the first" to do anything in psychiatric epidemiology (or any other science). By itself, that claim is empty. Some things don't matter, and it isn't important to be first to do something that doesn't matter.

I will leave it to the reader to judge whether this research is important because it was "the first" of its type. It is important work even if it is not the first study of its type.

In a later post, I'll suggest some prior work on this topic, but in the meantime, read the article, learn from it, and see the beginnings of Professor Robins' brilliant career in psychiatric epidemiology.

We miss her.

Nan Laird Interview

I have been trying to track down interviews with luminaries in the field, and to encourage our current trainees and early career stage investigators to go meet with people and contribute their own interviews. My search has been for interviews with Lee Robins, Jane Murphy, and others I have mentioned in prior blog posts, but along the way, I found an excellent interview with Harvard Professor Nan Laird and want to share it with you. Another superb biostatistican, Louise Ryan, was the interviewer and did an excllent job of eliciting pertinent autobiographical details from NL, including her key work on the EM algorithm, how contributions to longitudinal modeling played out, and creation of the NIMH joint Epidemiology-Biostatistics T32 program. Read the interview and you will learn about 'thinking algorithmically,' among other things.

I hope you enjoy reading it and will volunteer to find other useful interviews I can post on our whatnot shelf for psychiatric epidemiology.

Link to PDF:
Nan Laird interviewed by Louise Ryan: Downloadable PDF

Photo of Nan Laird from within the PDF:

Authorship customs and citation counts

I promised some blog posts on some of the many distinguished women who have made classic contributions in psychiatric epidemiology, and I decided to start by reviewing work of several whose work I read when I was a postdoc, but never had the pleasure of a familiar acquaintance or a personal contact of any lasting duration.

For other reasons, Rema Lapouse came to the top of my queue this month, and I discovered a very clearly articulated description of some problems to be solved in psychiatric epidemiology, written by her in 1957, roughly 10 years after her studies at Johns Hopkins School of Hygiene and Public Health.

Lapouse, AJPH, 1957.

She died too young, in 1971, and I never met her, but her papers were recommended to me by Mort Kramer and Ernie Gruenberg when they were introducing me to this field.

I did meet Barbara Snell Dohrenwend in the late 1970s, and I believe it was when the American Psychopathological Association still was meeting in a small low ceiling mini-hall in the lower floors, possibly the basement of the old St. Moritz Hotel opposite the Pond in NYC Central Park. But this was no more than a passing acquaintance, and she died too young as well, in 1982.

To start with the end, here is BSN's obituary in the NYT:

BSN obituary


Here is a link to her collected archives at Columbia University: archives

I wanted to re-read her books with Bruce Dohrenwend so I started to track them down. The search led me to this article by Bruce, which provoked me to write a note about changing authorship customs, and the impact on science citation counts, etc.

Take a look below to see a 1970 handling of collaborators in a major field survey of the time, all of whom apparently did heavy lifting to produce the evidence reported here, but whose names do not appear in the authorship list. Instead, they appear in the acknowledgments. As such, their names would not be attached to the citation count for this article.

Contrast the modern custom of including the name of an author who has proofread the paper and done little else, or consulted on a statistical approach, or some minor assist of that type, but did not read the manuscript before it was submitted for publication.

I leave you to judge whether the modern custom is an improvement, but when I see colleagues on authorship lists for more than about 12 published papers per year, 1 per month, I always wonder whether there has been a full reading and thorough critique of each manuscript before (or after) submission, or whether there is some kind of courtesy authorship custom in motion. (Or whether they have no administrative and instructional or mentoring duties. Mentoring of new faculty members, especially, requires a senior author to help others to get their work polished up for publication, but deserves nothing more than the type of acknowledgment that Professor Dohrenwend models for us in his acknowledgements section. Even when an authorship position might be contemplated on the basis of many red pencil marks on the manuscript page, or even when help has been conveyed during the design or conduct phases of the work, the inclusion of the mentor in the authorship list can actually harm the early career colleague's reputation as an independently creative scientist. Mentors should be allowed to bask in reflected glory on many occasions, with the spotlight shining directly on the future of the field, and sometimes one should write solo author papers, even when many others contributed to the effort, with gracious acknowledgments as exemplified below, written by still-active Bruce Dohrenwend when he was some 46 years younger than he is now.)

Bruce Dohrenwend 1970

What is a 'Symptom'?

When I studied psychopathology at Hopkins, I was taught that a symptom is an observable manifestation of an underlying pathological (disease) process, and could be distinguished from a 'sign' of the process as in the distinction between 'the patient says he feels hot' versus 'I measured the temperature and it is one degree above normal' or as something akin to what might be answered when the patient is asked "So what is bothering you and brings you to see me today?" versus what the MD discerns that the patient might not know about. The answer to that question might or might not be a symptom. For example, the patient might say "I came to you because I need a script for Adderall." And that would not be a symptom. Or, if you have started to down-regulate the dose of an opioid analgesic, the patient might say "I'm not getting the same pain relief when I take the drug," and it would not be 'tolerance' but rather your own down-regulation of the dose that makes the difference.

So, when we look at the natural history of drug involvement, what are we to make of a cannabis user who says "I have to take more of the drug to get the same effect." Presumably, if the user is getting the drug from an official MM vendor, dosage is more or less held constant. Or is it? And if the user is getting it on the street, the dosage is even more unknown. So, is that report a substantiation of a 'symptom' of a drug dependence process? To hard to tell.

For this reason, we use the term 'clinical feature' when we are uncertain about whether the user report is a symptom or whether it's something else (an 'experience'?).

Tolerance is a clinical feature of the neuroadaptational facet of drug dependence, and we ask about tolerance in our assessments of drug dependence, but the answer to that single question doesn't make it into a 'symptom' or 'symptom report'. It is a report on a drug experience, that in context we think of as a hypothesized clinical feature of what might be an underlying syndrome.

But suppose the user reports this 'tolerance experience' but nothing else remarkable is going on? Then is it a symptom? For sure not ! But is it still a 'clinical feature' for drug dependence. Yes, it is, but not 'of drug dependence as observed in that user'.

We have some papers on the profile of symptoms observed in users who qualify for the drug dependence syndrome case definition. In that context, when the user clearly qualifies as a case of drug dependence, we are well within standard psychopathology scientific practice to say that we are studying the profile of symptoms in a set of users found to qualify as cases of the drug dependence syndrome.

But when we are studying emergence of clinical features, one by one, in a set of newly incident users, irrespective of whether they have become cases of drug dependence, then we are not studying the symptoms of drug dependence in those patients. Hence, we shift to the term 'clinical features'.

Many years ago, we used the vocabulary terms 'experiences' and 'problem experiences' and even 'problems' in order to avoid what then was called 'over-medicalization' of illness experience. (See Austrian philosopher Ivan Illich.) About the time of the NIMH ECA studies, we were allowed to speak of symptoms and clinical features even when talking about drug experiences.

[What's the problem with 'problem'? Well, consider when you ask an LSD user whether the drug has caused them to have hallucinations or illusions, and they enthusiastically say they have had that happen, and then you ask "Was that a problem for you?" The response often is a puzzling look, shift of eyebrows, etc. (That's why they were taking the LSD in the first place. It wasn't a problem for them. It was what they were seeking in the LSD experience.) Not a problem. Just an experience.]

Until the pendulum swings again, I urge you to think carefully about whether you are studying 'symptoms' as can be seen in suspected or confirmed cases, but more of the time, you can save yourself trouble with reviewers by speaking of these experiences as 'clinical features' of the syndrome or as 'clinical features associated with' the syndrome. That is, the object of study is anchored as something that is found in the context of a syndrome and helps to define the syndrome via its 'running together' with other clinical features. And then the methods of study, if limited, become interpretable as a mixture of signal and noise, where the signal would be an experience that truly is a 'symptom' of an underlying pathological process.

But for the most part, reviewers tend to go along with 'clinical features' (and many would accept, without thinking, the use of the term 'symptom' if they never have studied psychopathology seriously). But you can be disciplined about your use of the term 'symptom' and show that you are a serious student of psychopathology.

Unless our trainees are studying known cases for whom the pathological process is well-characterized, I ask them to use the term 'clinical feature' or 'experience' in lieu of 'symptom' and that seems to satisfy even the most serious students of psychopathology one encounters in the peer review community. 

Even once in a while, a reviewer will insist on use of the term 'symptom' and I find that a note to the editor of the journal is sufficient to address that kind of reviewer misbehavior. [Proper reviewing behavior would be to raise a minor word choice issue and suggest an alternative, but not to insist on one's preferred word choice as a condition of accepting a manuscript for publication. But proper reviewing behavior is another topic. I won't post a blog on that topic unless the reading audience files comments to ask for it. I'm enough of a pontificator as it is, but you'll have to encourage me to pontificate on that subject, which is not really about neuropsychiatric epidemiology.]

About the experience of taking a medicine

Medication = the process of administering, including self-administration.

Medicine = what is administered

Medicine NOT the same as medication.

For a great museum display on what people say after they have been medicated or have engaged in self-medication:


Medication-Artifact Museum

RDoC and your future (if NIMH funding is something you seek)

RDoC Resources, including webinars

FEAD: Film Exchange on Alcohol and Drugs and a question for Blog correspondents

FEAD: Film Exchange on Alcohol and Drugs


I found this web resource when looking up whether Virginia Berridge's also might be from South Africa. (No autobiography or biographical details on Professor Berridge's found yet.)

Is there any similar audiovisual web resource for neuropsychiatric epidemiology?

Also, heavily UK oriented?

Should CPDD do something more international?

ACNP has a useful video archive as well as transcripts from our history project.

[It was now-deceased Vanderbilt Professor of Pharmacology Oakley S. Ray, with whom I had corresponded since 1972, who hooked me into the ACNP History Committee, and I came up through its ranks to become the chair of that committee about the time ACNP was celebrating its 50th anniversary. As events would unfold, in a cost-cutting move and perhaps in fallout from our invitations to have Cathy DeAngelis and David Healey give committee-sponsored lectures that were deemed controversial by some members, ACNP Council de-commissioned the History Committee about that time. Perhaps I'll go down in ACNP history  as the last chair. (Putting it that way, I guess I'm a captain who did not go down with the ship.)]

C. DeAngelis Web Site after she returned to Hopkins from JAMA.

Catherine DeAngelis ACNP lecture (History of Women in ACNP)

David Healy ACNP lecture

Women in psychiatric epidemiology

As I look over my prior posts, I see almost exclusive coverage of work by men, generally white of European descent.

I shall try to add some diversity now and in the future. If I understand correctly, Joy Mott helps in two ways, including her South Africa heritage.

Perhaps blog-correspondents can suggest others I might neglect otherwise

Recent re-reading is from and about Joy Mott, Rema Lapouse, and Mary Monk, and a new find is Virginia Berridge at the London School:

Joy Mott

Rema Lapouse and Mary Monk, et al.

Virginia Berridge: Start here.

More of V. Berridge's work in this field.

Interviews with V. Berridge

Youtube contributions from a link on V. Berridge's web site:
https://m.youtube.com/watch?v=bLhHcoVq1Ew

More planned to follow on  Ruth Fairbanks, Lee Robins, Barbara Dohrenwend, Jane Murphy, Charlotte Silverman, Anita Bahn, Zena Stein (who panned our first NIMH R01 proposal during a site visit to Hopkins with Eugene B. Brody of UMaryland, in what probably was a lifelong favor to me), Myrna Weissman, Glorisa Canino, Judy Brooks, and Linda Cottler, to mention just a few who deserve mention.

On tools in psychiatric epidemiology (and the value of long distance networking)

Study the most influential contributors in your chosen field: Tools you can use

Available via MSU and other e-resources, if not direct from Wiley Online.

You can interview those who are most expert in your own specialization area.

I was lucky to be paid by DEA to travel around the US and to interview many luminaries in preparation for my dissertation research.

Often, in those days (early 1970s), it just required writing in advance and getting reply to request (all snail mail until Group 2 telefax machines made fax fast and cheap in late 1970s), and then flying to a meeting, either a scientific or professional meeting where the expert was willing to meet, or to the office. The interviews fed directly into the conceptual model I had to build, but also gave me valuable career advice.

(DEA was generous. I flew all over the place and made wonderful contacts with field leaders, some of whom ended up writing letters of recommendation for my promotion and tenure at Hopkins, for my election to scientific organizations, etc. -- because they knew me since I was 23-25 years old, and could see what I was doing over the years.)

[In 1972-75, each page of a fax took as many as 7-8 minutes to send, over a standard telephone line. In 1972, when I was writing the research proposal to DEA, most offices did not have a fax machine; it all was snail mail for this type of correspondence unless you got someone who would take a blind call on the long distance phone (still pretty much a telephone monopoly and priced accordingly).]

You can't believe how happy we were when the Group 2 fax standard came out in ~1978 and most offices could afford a fax machine and to pay for the outgoing call, but within about five years (1982-83) ARPA BITNET came online for academia, and made it possible for me to forge a trans-Pacific proposal for Alzheimer's disease research in Australia, where Scott Henderson and Tony Brie were based. Then, eventually, by 1985, they had cobbled together funds from the Australian MRC and our Fulbright Commission so I could fly the family to Sydney-Canberra for three months in 1986 to finalize design and conduct of the first community-based case-control study of Alzheimer's type dementia. In the process, I was able to convert my early use of the Mini-Mental State Examination for ECA sampling of community dementia cases, and put it to work in a general practice surveillance for dementia among seniors living in a Sydneyside catchment area. In this work, we picked up a signal of potential protection from OTC analgesic and anti-inflammatory drug compounds like aspirin, as we had hoped to see based on prior pre-clinical studies:

https://www.ncbi.nlm.nih.gov/pubmed/1615110

Concurrent with set-up and completion of that work in Australia, John Breitner and I had been trying (unsuccessfully) to get funds for epidemiological research on AD in the US, and with Marshal Folstein's help, I had been working out details for putting the McHugh-Folstein Mini-Mental to work as a first stage large sample assessment tool in a sequenced multi-stage sampling (SMSS) for probability gradient sampling of cases and non-cases for intensive diagnostic workup, and assessments of suspected causal influences. Perhaps coincidentally, the NIMH ECA leadership decided they needed a standardized assessment of cognitive functioning for the five-site epidemiological catchment area surveys; they chose the Mini-Mental, allowing us to take the community design John and I had written into our first (unsuccessful) NIMH R01 proposal, and put it into play with an NINCDS supplement to the NIMH ECA collaborative agreement. The SMSS design can be seen in #1 in pilot form for general medical ward research, and in #2 in community survey form:

Mini-Mental MMSE Epidemiology Early Days

While in Australia with Scott and Tony, I continued working with John Breitner on his insights into the use of co-twin studies of our hypothesized protective associations, but that's another story that unfolded into the era that included widespread global communication and resource-sharing via the post-BITNET internet tools for our research collaborations:

Some neuropsychiatric epidemiology history on using aspirin and other anti-inflammatories to prptect against Alzheimer's type dementias

Methods and tools pay a central role in the discovery processes of psychiatric epidemiology.

* See Holst Norwegian surveys of 1825-35, Rosanoff Nassau County survey from 1916-17, Gruenberg survey of civil commitment-eligible community elders, and Lemkau-Stampar survey of schizophrenia in NE Yugoslavia for where I got the idea to harness MMSE in large sample epidemiological studies of the dementias, with second stage diagnostic workup. Scott Henderson's panel survey of stressors and psychiatric morbidity in the mid-1970s provided key references to the quality control work of Eugene Deming, and I think Scott said he worked those out with the help of Paul Duncan-Jones, a great thinker who died too young. I covered Holst, etc., in prior blog posts. I'll try to add on on the Henderson panel survey before too long.

p.s. Let me know if these embedded links are not working. I set them up, possibly incorrectly.

NSDUH R-DAS resurrected as less useful somewhat clunkier PDAS

Details here, but do some exploration:

http://pdas.samhsa.gov/#/?_k=6dmm20

I can see no STATE nor REC nor ELG nor other useful constructed variables that formerly were in R-DAS (e.g., ungrouped age in years).

It looks as if PDAS draws on the same dataset as one would use for online SDA analyses, based on a couple of checking runs I did.

For example, here is the unweighted count and weighted count for age and sex of adults in SDA for 2013 and in PDAS for 2013. I am not seeing much difference.
SDA:
https://drive.google.com/open?id=0B9Ud1oy4LsimeVNsZE5leEdIUXM
PDAS:
https://drive.google.com/open?id=0B9Ud1oy4LsimRC1wOFoxU3VGVG8



Here is pair of SDA and PDAS runs on crack flag and cocfyu, also with minor variations that suggest use of same datafile.
SDA:
https://drive.google.com/open?id=0B9Ud1oy4LsimS0Z5U1ZwNXNTYm8

PDAS:
https://drive.google.com/open?id=0B9Ud1oy4LsimeUp0cWVMZGdWTkk

It would appear that PDAS functionality has been reduced in the shift of the subcontract from ICPSR to RTI, sadly.

I tried and was able to achieve a "Network Request Failed" error message as shown here in an attempt to get an age-specific estimate of the probability of starting to drink in 2011 and continuing to drink in the month prior to assessment in 2013. (Always pays to push the system to its limits, sooner rather than later.) I am not sure whether there is a "confidentiality" rule at play, or something akin to a CPU limit being set. Someone should push it and then ask the help desk with a concrete example.

https://drive.google.com/open?id=0B9Ud1oy4LsimNWxTSml5clFfczg

To end on a positive note, it now is possible to export a PDAS table to CSV format file, and that is a plus. (Look on PDAS output down at the bottom of the resulting PDAS table for a link to create the CSV file, near the documentation of the date of your run and the dataset used.)

We'll have to see whether we can get our friends at SAMHSA to restore functionality and utility of PDAS to the level of the former R-DAS, but the lesson for today is that the restricted data portal has become more central to anyone wishing to harvest new evidence from this important public health research resource. Given a choice between PDAS as presently constituted versus offline SDA dataset analyses, I'd always choose the latter, unless someone can show me PDAS variables not in SDA version of that dataset, or someone comes up with a good reason to favor PDAS. At present, not sure why it was commissioned. Seems redundant with online analyses via the ICPSR portal. 

[No sign of a batch option. Clunky point and click, and I could not find a way to type in known variable names, nor to recode a variable. Alas. A backdoor for recoding might be found by using a CONTROL variable as in my network failure example, but with taking advantage of informatively combined variables. For example, there is a variable for cannabis CF conditioned on (gated by) use in the year prior to assessment. Put the CF variable in the Row position, put the age of first cannabis use in the Column position, and put the AGE2 variable in the Control position. In this way, you might be able to estimate the fine-grained age-specific occurrence of the CF for newly incident users who started two calendar years before the assessment year, versus the occurrence of CF for newly incident users who started in the calendar year before the year of assessment, unless network failure is encountered. Here, the trick would be to take the analysis-weighted-age-specific numerators for each CF from PDAS, age by age. Repeat for MJFLAG to get weighted number of ever users as of each age in that year, with approximations when AGE2 is binned.  Then get the age-specific population count from the US Census, subtract the ever users from the age-specific census count, add back in the weighted number of newly incident users so that the "at risk" count grows properly, and form the ratio of the weighted number of newly incident users with CF, age by age, in each numerator and the size of the "at risk" population, age by age in the denominator. The PDAS would give you this for 12-21-year olds, and you could check your derived (concocted?) estimates against those values, but it would give you a way to study the age-specific cannabis CF incidence for age by age subgroups older than 21 years. Come to think of it, you can do this in SDA more readily, so why do it with PDAS until PDAS gets more variables not in SDA.]

Oh well.

Statistical Power in Evaluations That Investigate Effects on Multiple Outcomes

http://www.mdrc.org/sites/default/files/EC%20Methods%20Paper_2016.pdf

Interesting guide for researchers.
Discuss with others.

Treatment selection

NPR Unbroken Brain from July 2016


Alas, there is more heterogeneity than one case report signals.

For some people, the tough approach is needed.

This is can be approached as a treatment selection problem for which there are quantitative approaches:

This article by Manski is a useful starting point for some, but you may wish to start with more elementary problem set-ups as in the Wooldridge text or in this short summer course:

http://econ.msu.edu/estimate/

http://econ.msu.edu/estimate/registration.php

Wooldridge: Sixth edition: 

Introductory Econometrics: A Modern Approach

Serious Emotional Disturbance in Children

National Academies Press, 2016, Workshop Report

See recommendations. What they cover, what they don't.

https://www.nap.edu/read/21865/chapter/1

1980 views on drug use

https://www.nap.edu/read/18827/chapter/1

Note word choices such as "redemption" of the overuser.

Is this word choice appropriate for science or for a science-based public health or psychiatry?

A worthwhile contribution from friend William Eaton

Big picture issues for our field:


http://www.jhsph.edu/departments/mental-health/about-us/origins-of-mental-health.html

WPA Section (Epidemiology and...)

Our Section counts the Aberdeen meeting as its first event.

It is fortunate that Nuffield Trust posted this volume and has made it available.

http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/psychiatric_epidemiology_1970.pdf

Take my advice and download your own copy, and study it.

Trace the themes forward.

Mechanic puts in print what we all know.
In epidemiology, the size of the prevalence estimate can be made as large or as small as you like (or as is liked by the funding agency).

Worked Example: See the original NIMH ECA estimates from 1984-85, and the downward re-visitation of those estimates created by introducing a novel "clinical significance" criterion.

I will try to insert the citations later on, or someone can post a comment with them.

I am thinking of Jerry Myers et al. ECA-paper from 1984 (maybe 1985?) and the paper in which Bill Narrow and Darrel Regier introduced their novel criterion to bring down the ECA estimates, perhaps 1989-2000.

(We put this sort of criterion to good use in our World Mental Health Surveys work on alcohol and other drug dependence.)

Great Oral History resource

Oral History Online is available via library electronic resources:

LOCAL LINK (requires log in)

Click on this link to external resource for Oxford Oral History books to purchase. 

Studying epidemiology, you can use your reading of oral histories to enrich your understanding of the epidemiological phenomenon you choose to study, in addition to patient, client, and community member encounters you must structure as part of your educational process and career development plans. Without building beyond family and personal experience, and beyond what you can read, you will have a narrow view of the phenomena -- typically not enough for transformative science.

The oral histories you read in preparation for these experiences can help you know what questions to ask, to create mental structures for recall of what you cannot transcribe or record on the spot, and to recall that our discipline's search for variation within pre-specified population boundaries is complemented by anthropology's disciplined search for the beginnings and endings of those boundaries (i.e., via deliberate anthropological search for sameness, lack of variation, and the edges of group membership and identification that are signaled by appearance of variation where the prior inquiry showed sameness). Recall the analogy from ecology: each flock of birds settles in the branches of old forest trees, ignorant of the county line. Possibly the 14th way of looking at a blackbird. 😉

Learn from the oral history tradition how to conduct your own interviews, en route to formal education and workshops on interviewing for ethnography.

I use such methods when I travel by myself, go to bus stops, sit, and wait for people to come ask me what I am doing there. I tell them, and we start sharing connections. They often take me home to visit with their families and share a meal after we stop at the market so I can bring something.

[Do not try this until/unless you are savvy about personal safety. I also have some robbery and extortion stories to tell.]

It's how I have learned about life in many places, including remote villages of Samoa, where to find their magic mushrooms (growing on 'cow pies' out in not-too-remote farm fields near Apia), etc.

Enjoy!

Photos by J.C. Anthony, all rights reserved:

Savai'i, ferry	Apia, rural family compound

Sometimes I get lucky, traveling to a place where a former research fellow looks after me. That was true for my study visit to Kerala State, India, a wonderful place.
The late Dr. V.S. Mani hosted my visit, took me up into the Southern Western Ghat mountains to meet local villagers, and for a cruise out of Alapuzha, and also taught me about Aryuvedic medicine, the Kalari fighters, and many temples in both Kerala and Tamil Nadu (e.g., . Here is a memorial web site for Mani, who completed but died too soon to publish his community survey of psychoses in Kerala:  http://www.thrani.com/mani1.htm

Here are (1) photos of three brothers in a mountain village we visited en route during an overnight trip to a temple in Tamil Nadu, near Vikramasingapuram (with waterfalls and monkeys), as well as (2) snaps taken in his lovely home, where his family hosted a dinner and sat for a portrait:

Non-thematic Halloween treats

Halloween treats:

Click HERE to see an animated Halloween treat.

http://66.media.tumblr.com/5b7bd9c128e2f05c3bbd5f58a5448f64/tumblr_mld3gugWzc1r9jbwno1_r1_500.gif

From Balzer's vintage collection. Print in color and trim to 12" to 16" diameter circle for your turntable, and spin it! Or, go to his online collection
 ( dickbalzer.tumblr.com ) and see a great set of animated gifs.

Seen in rural Shenandoah Valley of Virginia last weekend: