Discover and read the best of Twitter Threads about #PHEthx
Most recents (11)
In my work I offer some reasons why we hang on to micro-level interventions even when the evidence is clear that they exert only modest, transient effects.
For one, macro- and meso- level work is challenging and often requires destabilizations of power.
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For one, macro- and meso- level work is challenging and often requires destabilizations of power.
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Yet, as I often argue, for our anti-stigma work we actually DO need micro-level interventions like educations and trainings. They DO have some effects and are easier to implement.
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The only problem is when micro-level interventions come to dominate the entire field of our anti-stigma work, which the evidence suggests happens, especially in public health spaces.
Instead, my teams and I advance a tripartite anti-stigma approach.
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Instead, my teams and I advance a tripartite anti-stigma approach.
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This is a fascinating response from Dr. Miller, from whose work I've learned much over the years!
Some thoughts:
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Some thoughts:
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I agree with Dr. Miller that the utility of ethicists in the #RoomWhereItHappens for public health emergency policy response ought not be assumed. That said, I strongly believe that an appropriately-trained ethicist can be helpful, at least in the following ways:
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(1) Trained ethicists often have facilitation skills, specifically as regards to complex normative and ethical problems unfolding in urgent or emergent contexts. Applied ethicists in practice almost never dictate or pronounce conclusion -- if they are practicing well IMO.
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As anyone who works on #COIs and #MotivatedBias can tell you, this arrangement is ethically unacceptable from an #OccupationalHealth perspective. HCPs paid directly by the league are in NO conceivable sense "independent."
nytimes.com/2022/09/30/spo…
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nytimes.com/2022/09/30/spo…
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And giving team physicians the "ultimate say" is absolutely the last thing you would do if you truly understood COIs as exposures and #MotivatedBias as a population health harm. It is literally inconceivable that this arrangement continues apace.
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Remember a week or so back when I talked about the deep connections between the #railroadindustry and contemporary public health policy? This is one of them. The RR industry pioneered the model of having company physicians care for injured workers.
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As someone who knows more than a little about the history of the railway industry and occupational and public health (both US and UK, actually), I'm rendered almost speechless by what is happening with the possible strikes in the U.S.
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I firmly believe that it is difficult to understand contemporary problems in public health policy and even health care policy in the US w/o really integrating the histories of the railway industry and railway medicine. The connections are LEGION.
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They include:
- basic reasons why private health care is provided by third parties rather than directly from corporations and employers;
- the origins of the #ManufactureOfDoubt in regulated industries;
- accusations of #malingering and feigned illness in social policy;
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- basic reasons why private health care is provided by third parties rather than directly from corporations and employers;
- the origins of the #ManufactureOfDoubt in regulated industries;
- accusations of #malingering and feigned illness in social policy;
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There's a lot in this thread, but one pt I'd like to extract is connected to something I've been arguing for years and #onhere quite a bit recently:
#MethodologicalIndividualism in public health occurs where we position the individual as the unit of change.
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#MethodologicalIndividualism in public health occurs where we position the individual as the unit of change.
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This is in comparison to structural interventions, which often alter upstream factors and institutions. My favorite example of the latter is laws and policies, but can also include infrastructure and built environmental changes, etc.
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But leading public health officials in the US have completely followed the #MethodologicalIndividualism that has dominated public health policy and priorities for much of the 20th c. until now. See:
pubmed.ncbi.nlm.nih.gov/19965565/
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pubmed.ncbi.nlm.nih.gov/19965565/
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Honestly, the complete takeover of population health policy and approaches by a #medicalized notion of #MethodologicalIndividualism sort of fills me with despair -- not just now, but for the future of public health.
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npr.org/sections/healt…
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npr.org/sections/healt…
Of all the missteps CDC has made, the doubling-down on approaches that position the individual as the unit of change (#MethodologicalIndividualism and b/c of the source) essentially sanctions it as the dominant mode for public health practice is arguably rock bottom.
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It's in the scientific guidance as well. Look at this sentence:
This is of course NOT a Whole Population Approach or even a structural approach to health equity which would require action from those with the power and agency to redress the effects of #StructuralViolence and
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This is of course NOT a Whole Population Approach or even a structural approach to health equity which would require action from those with the power and agency to redress the effects of #StructuralViolence and
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I am super happy to announce that I have been awarded a US$5000 grant from @StraussLibrary to develop an OER ("Open Educational Resource") Casebook of Public Health Ethics Teaching Cases.
Other than the wonderful CDC Casebook, teaching cases in #PHEthx are scarce.
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Other than the wonderful CDC Casebook, teaching cases in #PHEthx are scarce.
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I should know, since I have been scraping the Internet for a decade trying to find them. One of the first-day axioms in #PHEthx is that in important ways it is simply different from health care/clinical ethics. Good teaching cases must reflect these differences.
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But some of the early casebooks are frankly dated, and other than the remarkable CDC Casebook ⬇️ there simply are not any good collections of cases really focused on public health ethics & law/policy (let alone open-source ones, either).
ncbi.nlm.nih.gov/books/NBK43577…
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ncbi.nlm.nih.gov/books/NBK43577…
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I've found it profitable to trade on a distinction between what I've termed "operational" vs. "structural" #PHLaw #PublicHealthLaw
One task public health lawyers can perform is helping public health officials understand the full scope of their legal authority.
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One task public health lawyers can perform is helping public health officials understand the full scope of their legal authority.
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This task is critically important to functional public health governance, esp. b/c the scope of this authority has changed rather dramatically in the US since the Palpatine began.
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We might term this work "operational public health law," since it is focused on operative provisions of public health law that govern the scope of (at least) state action. It can illuminate what interventions public health officials can "operationalize."
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I see that we are still slavishly worshipping at the idol of RCTs in epidemiologic science as the evidentiary warrant for public health action. I have written LOTS on the foolishness of this, its disastrous ethical & policy implications, & it's role in #ManufactureOfDoubt.
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It's almost as if people have never heard of the #PrecautionaryPrinciple. If we demanded evidence of exposure-harm or intervention-benefit that flowed from RCTs to warrant public health interventions, we would have essentially NO public health action AT ALL.
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More on this, from my 2016 paper on importance of maintaining epistemically reasonable standards for proof of harm (& benefit!) as warrant for public health action:
(The subject of the paper is COIs and lays out my arg for regarding them as ordinary epidemiologic exposures)
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(The subject of the paper is COIs and lays out my arg for regarding them as ordinary epidemiologic exposures)
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I've been studying chronic pain for going on 15 years now. I have some thoughts on this, many of which I've articulated elsewhere and for some time now:
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The Quiet Scientific Revolution That May Solve Chronic Pain nytimes.com/2021/11/09/wel…
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The Quiet Scientific Revolution That May Solve Chronic Pain nytimes.com/2021/11/09/wel…
The headline and the article fundamentally misconstrues the primary causes of the devastating and highly inequitable undertreatment of pain in the US (and globally, but that's another conversation).
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The primary causes for our failures in treating people in pain humanely and effectively are not connected to lack of technical, clinical, or scientific knowledge.
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Speaking as someone who studies anxieties about malingering and their connections to health, disability, & social policy, the framing of this NYT article is enormously problematic.
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The Man Who Filed More Than 180 Disability Lawsuits nytimes.com/2021/07/21/mag…
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The Man Who Filed More Than 180 Disability Lawsuits nytimes.com/2021/07/21/mag…
The article is well-written, but it leaves out an enormous amount of context. Most importantly, ADA and disability law violations are de rigeur. They are common, frequent, every day occurrences. Ask people w/ mobility impairments how airlines handle their wheelchairs.
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Ask hearing-impaired or Deaf people about the availability of SL-fluent interpreters in public accommodations. And on and on and on. It's endless.
As w/ most forms of civil rights and antidiscrimination laws in the US, the rules are observed in the breach.
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As w/ most forms of civil rights and antidiscrimination laws in the US, the rules are observed in the breach.
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