Thursday, December 29, 2016

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.

Tuesday, December 27, 2016

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

Friday, December 23, 2016

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.




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.

Thursday, December 22, 2016

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.


Friday, December 16, 2016

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.

 

 


Monday, December 12, 2016

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.

Friday, December 9, 2016

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: