Thursday, April 27, 2017

Some dance to remember; some dance to forget... or drink in this case?


Interesting article 

I am fascinated by the finding that low parenting predicts LESS alcohol use in the second group of adolescent girls (p=0.057, almost). Are they self-disciplined precocious occasional drinkers? Is low parenting an indicator for something else for this group? Also noticed the correlation between alcohol use and low parenting is negative at baseline for the second group. They are definitely a special group.

I think the authors raised an important point. We often look at the average assuming cases and effect estimates are homogeneous, but more often they are not. 

My thoughts about Jim's question on whether it is worth the while to publish cross-sectional evidence on parenting-alcohol relationship: it would come down to the assumptions. If it is safe to assume the relationship is a positive feedback loop, then yes. If it is a one-way positive or negative relationship, then yes. Would provide initial estimates for future longitudinal studies. If it is a two-way negative relationship or a mixture of positive and negative relationship, then probably no, because it becomes complicated very quickly depending on when kids are assessed in a cross-sectional survey. 

But again, that is population average. Does it apply to everyone? Maybe not. In addition, there may be unobserved heterogeneity in the background. Parental drinking, peer affiliation, number of kids in the household, neighborhood environment... 


Comments from Jim:
Chicken and egg problem: What if drug use causes parents to relax their supervision and monitoring?There is a quite rational decision in epidemiology to start with relatively inexpensive and logistically feasible study designs, such as case-control research, before moving on to the more expensive prospective two-wave or longitudinal multi-wave designs that can throw more light on issues such as uncertain temporal sequencing. (Here, some epidemiologists would turn to the within-field jargon term of 'reverse causality,' but let me again warn that communication across disciplinary boundaries is far more important than any display of group membership as represented by use of within-field jargon terms. 'Uncertainty about temporal sequencing' is apt to serve well in a public forum or research article, whereas epidemiology 'bull sessions' might be appropriate venues for the within-field jargon of 'reverse causation' and the like.)

This new contribution is a very interesting longitudinal multi-wave study that deserves attention because it has a capacity, within the limits of its assumptions, to estimate the degree to which drinking might cause parents to back off and relax their supervision and monitoring behaviors. The assumptions, both conceptual and methodological, should be studied with care, and after you consider the evidence, ask yourself whether it was a mistake for journals to publish the early articles with no more than cross-sectional or two-wave study data on the monitoring hypothesis.


If interesting comments are provoked, I will leave a later comment to tell you what I  think.

Saturday, April 22, 2017

Opioids epidemic: points to ponder

Article can be read quickly  here.

But watch for a bit of sophistry in there.

On the legalize side: Which legalization model? EOH model? Nicotine model? State monopoly model?

On the prohibition side: State pays minimum of $36K/year for non-productive and life chances-damaging incarceration? 

State actively discourages pharmaceutical R&D via market constraint (won't allow marketing except when the product meets FDA criteria for each medicine to be used in practice of medicine)?

What if the only intended use is 'to get high' under controlled conditions of 'recreational use' as might be set by the state regulatory agency for laser tag or paintball game establishments.

At present, the pharma R&D cannot innovate in this domain due to the federal government's creation of a monopoly for 'unethical innovators' such that 'ethical Pharma' could never make a profit on a drug developed with non-medicinal 'getting high' in mind.

Analogy in auto industry:

You cannot build a car 'for speed' unless its only use is on a non-public track.
Plus, we don't allow anyone to create a non-public track.

Consider a flight around the moon.
Govt says you cannot build a space travel device unless its only use is for military-industrial-scientific purposes.
Plus, you cannot launch it without govt permission.

So, at present, it's easier to raise capital (and find willing consumers) and to develop commercial space travel than it is to develop safe alternatives to our ancient plant-origin drugs with inherent toxicities: EOH, nicotine, cannabis, cocaine, psilocybin.....


Please, each of you, sign up, and monitor situation.

NSDUH restricted data portal and some issues of inferential statistics in large sample context.

Sign up here to be notified: 
sign up

See B.7 of this report for issues faced when comparing state estimates, plus useful information about covariances (sometimes ignorable).

Tuesday, April 18, 2017

On risk factor, and its essential meaninglessness

Perhaps the title should be: Its essential over-abundant meaningfulness, because it refers to so many different things, and thereby has little communication value outside the tribe of epidemiologists (JCA : 28 April 2017).

Words lose their value when you must define them clearly each time you use them. As with 'addict' or 'addiction' or 'going crazy,' here we have a term that, by itself, carries little or no information value.

December 2016, BMJ: A 'taboo' against using 'risk factor' in research reports, 
 

See Section 1.12.3.4 in this book chapter from 1998:


Thanks to friend, David Vlahov, for bringing the BMJ article to my attention!

Monday, April 10, 2017

Friday, April 7, 2017

Xanax human interest story

Human interest story: Xanax (alprazolam, anti-anxiety benzodiazepine)