Sean X. Luo Profile Banner
Sean X. Luo Profile
Sean X. Luo

@seanluomdphd

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#Addiction psychiatrist and researcher working at the interface of #neuroscience , #mentalhealth , #statistics and #AI .

New York, NY
Joined December 2013
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@seanluomdphd
Sean X. Luo
10 months
When a patient arrives for treatment for #opioid use disorder, is it possible for clinicians to predict whether they might return to use at the end of the treatment period? Does this relate to what kind of treatment they might have received? 🧵
@JAMAPsych
JAMA Psychiatry
10 months
The individual-level prediction tool described in this study may be a universal risk measure for return to opioid use by treatment week 3. Interventions to prevent return to regular use should focus on this critical early treatment period.
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@seanluomdphd
Sean X. Luo
2 years
@sebatlab Well, this argument makes no sense because fresh PhDs get paid 150k routinely in industry. What you are really describing is that the academic budget is too low to pay PhD (and PIs) a higher salary.
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@seanluomdphd
Sean X. Luo
2 years
@sebatlab I read the thread and I write budgets know how postdocs get paid. You and I both know postdoc salaries are not adjusted by their skills relevance. It’s determined by market supply and demand. Extensive experience in a niche field does not translate to a higher salary.
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@seanluomdphd
Sean X. Luo
2 years
@sebatlab I’m not lecturing you and the reason you pay your staff higher salary is that they’d be otherwise scooped by industry (ie supply demand). The phenomenon is also not specifically an academic. Highly trained specialists in skills that are no longer in demand will get paid less.
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@seanluomdphd
Sean X. Luo
2 months
@lexbyanyname There's no scientific evidence that it will take "months" of "radical rest" (how is that even defined).
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@seanluomdphd
Sean X. Luo
5 years
The biggest thing I learned in PhD is how to work effectively with people you may not “like” as a person (at least initially). Additionally, graduate students are often bad at figuring out whether someone is a good advisor except in hindsight. #phdchat @AcademicChatter
@marinadsouza22
Marina D
5 years
Does it make sense to join a specific lab for a PhD program from the advisor rather than the project? It's not that you dislike the project, but you're not incredibly excited about it. However you really like the kind of person the advisor is. #phdchat @AcademicChatter
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@seanluomdphd
Sean X. Luo
2 months
@MarkLRuffalo I dispute the utility of this distinction. You might say that the fact that having a contaminated water main is a "psychosocial etiology", but it's largely irrelevant to providing biological treatment to people with cholera.
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@seanluomdphd
Sean X. Luo
10 months
@markhoro I see patients like this all the time. Bipolar. Late life with cognitive decline. Withdrawal. I think all this says is that clinical psychologists and psychiatrists have different caseloads, and a clinical psychologists may have no exposure of some cases in an entire career.
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@seanluomdphd
Sean X. Luo
1 month
@urcervix_ Or what, you'll give them a bad review? LOL most med students don't care about their OB rotation.
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@seanluomdphd
Sean X. Luo
2 months
This is an interesting study. Basically it says escitalopram with nothing else is equivalent to meditating 2.5 hrs weekly (cc: @PeterDKramer ). Pragmatic design, screened outpatients. I think this kind of data speak well for antidepressants, actually.
@StanleyWongMD
Stanley K.L. Wong
3 months
Mindfulness-based stress reduction (MBSR) is well tolerated and found to be noninferior to Escitalopram (an antidepressant) for people with an anxiety disorder. 🧵 1/8
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@seanluomdphd
Sean X. Luo
1 year
@jbcarmody I'm not sure how to solve this problem. The standard practice now is you write your draft letter and the faculty signs it and put it on a letterhead. I think LORs should be eliminated. They are mostly pure paperwork at this point.
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@seanluomdphd
Sean X. Luo
1 month
@cremieuxrecueil I thought this study was notably negative, actually. Effect sizes of of UBI experiments are *decreasing* in time. Perhaps partly due to inflation. I reviewed this topic a number of years ago and at the time the effect sizes were larger.
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@seanluomdphd
Sean X. Luo
5 years
@nkolakowski @Ferguson_Writes Actually the yard is being filled rapidly by random professional service firms. I think there are deals on groupons of commercial real estate...
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@seanluomdphd
Sean X. Luo
2 years
@MJSerraPhD @jayvanbavel There is a “hidden curriculum” that increases your chance of success if you parents had experience. In this case, I suspect if you do a sophisticated causal inference you’ll find this factor is causally related.
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@seanluomdphd
Sean X. Luo
6 months
@justin_garson @DrAnnieHickox Not really. You should do a rotation and shadow an inpatient unit. Delusions are not that easy to differentiate from reality and typically require collaterals from multiple sources in rendering a clinical decision.
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@seanluomdphd
Sean X. Luo
3 years
@dromanber As someone who works in the field: you are wrong re: opioid pills. They are getting way harder to access not easier.
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@seanluomdphd
Sean X. Luo
9 months
@geoffreyhinton @andywalters Except nobody is willing to put a stamp to take the responsibility of a read. Will you? This is the problem with mission critical AI. They may be able to do the work but they aren’t authorized to make decisions.
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@seanluomdphd
Sean X. Luo
4 months
@MarkLRuffalo This well known literature was never replicated. It was predicated on small effect size. I wouldn't read too much into it. There was much hoopla to develop oxytocin and derivatives into NDAs for various psychiatric indications in the mid-2010s. All phase 2s failed.
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@seanluomdphd
Sean X. Luo
1 month
@rlmcelreath What's more curious is that you'd think Huberman, a Stanford-tenured neuroscience professor, would know better. This shows that people who don't work with humans generally don't know how to properly interpret human subject's data (read: is this study any good?) in context.
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@seanluomdphd
Sean X. Luo
3 months
@ChrisPalmerMD The more important question is how to avoid therapeutic nihilism in a case like this. Clearly it’s neurodevelopmental, but somehow we feel less defeated with, say, severe autism. The expectation level is different for someone without intrinsic intellectual disability.
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@seanluomdphd
Sean X. Luo
11 months
@emollick Causality causality causality. Firms that can afford to pay might have better representation. I read the paper. Tables 1-4 not adjusted for size/profitability: curious as one would expect methodologically a paper like this should've been better. Let's hope reviewers catch it.
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@seanluomdphd
Sean X. Luo
4 months
@MarkLRuffalo It's problematic to draw mechanistic theories from small inconsistent signals from a small sample of a handful of research groups that cannot be considered independent. All it says is that sometimes this sometimes that and we should try for a larger study.
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@seanluomdphd
Sean X. Luo
5 years
@InertialObservr @j_bertolotti Thankfully you can prove that you don’t need to shuffle too many times to make something “well shuffled”.
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@seanluomdphd
Sean X. Luo
24 days
@PaulMinotMD This is not it. Large RCTs are as close to hard science as you can get, IMO. It's vastly more "hard" than the actual physiological studies that are done in animal models. I know I've done both. The problem with "thoughtful critics" is they criticize without offering solutions.
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@seanluomdphd
Sean X. Luo
1 year
@NYCComptroller @NPR This is a distortion. The two cohorts are not directly comparable. People who are going to jail cannot go to a typical Housing First facility without substantial additional support. There is actual health economics study on this and the results are mixed.
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@seanluomdphd
Sean X. Luo
5 years
@Farzad_MD I don’t know why these papers always plot a ROC curve: oh look I have a pretty way to show you a number of a particular simulation (with no variance). It’s a peeve of @f2harrell which I endorse 1000%. #MachineLearning #DeepLearning
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@seanluomdphd
Sean X. Luo
6 years
@tyrell_turing I think the controversy isn’t whether the brain can do what a computer can do, but that whether that’s ALL it can do. Saying the brain is by definition Turning complete is like saying a refrigerator that contains an ice maker is by definition an ice maker.
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@seanluomdphd
Sean X. Luo
2 months
@MarkLRuffalo Maybe. Maybe not. But this statement is philosophical and has no clinical implication. To cite a simplistic example, my manic patient X tells me he is falling in love with Y. I gave him Depakote, he says he was in error. Is this explainable by neuroscience? Who cares?
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@seanluomdphd
Sean X. Luo
3 months
@tkaiser_science I think publication bias also plays a big role. It’s beyond clinical lore now that large effect sizes in early psychedelic trials cannot be replicated in large randomized studies.
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@seanluomdphd
Sean X. Luo
2 years
@nkolakowski @mangiotto Wow. This tweet really brought back memories of earlier childhood when people had two VCRs...
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@seanluomdphd
Sean X. Luo
11 days
@MeganTStevenson No. The effect is very small either way. The study shows a substantially expensive UBI yields an essentially null result.
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@seanluomdphd
Sean X. Luo
14 days
@Jendaffin Strawman. Never ever in the history of antidepressant has anyone ever claimed that antidepressants can cure depression.
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@seanluomdphd
Sean X. Luo
5 years
@nkolakowski @Ferguson_Writes Oh man. The comment section in the nytimes article is uniformly negative lol. I think you are right they will continue to hire in NYC (like FB and GOOL). Just nk incentive and no real estate.
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@seanluomdphd
Sean X. Luo
2 years
@KordingLab I always find it interesting when people try to predict a diagnosis using bio markers that you can ascertain by asking a few questions and the gold standard criteria are based on clinical judgement.
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@seanluomdphd
Sean X. Luo
25 days
@ElementoLab The conclusion in the abstract is insane. This just says that insulin-dependent DM is a different entity than non-insulin-dependent DM. Where were the reviewers?!?
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@seanluomdphd
Sean X. Luo
2 months
@MarkLRuffalo BPD (and other PDs) is practically the only example of this. I am actually shocked that (simplistic delivery of) Lexapro is as effective as a running program for depression. This is saying that if you take a pill, you don't get cholera even if you keep drinking cholera water.
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@seanluomdphd
Sean X. Luo
3 months
@KordingLab What makes you think that high-risk projects are what "truly matters"? It seems that a lot of high-risk projects are docked at study sections for "lack of significance". I don't think thinking about your career as "only worth doing if..." is a good idea.
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@seanluomdphd
Sean X. Luo
3 months
@Keirwales @MarkLRuffalo For a lay person, you would be right. If you are a clinician delivering a structured treatment for BPD, the essence of treatment is to NOT treat them differently WHEN they are manipulative attention-seeking, etc.
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@seanluomdphd
Sean X. Luo
1 month
@knityarn No. it's one in 5 doctors *who had long COVID* can no longer work. Please stop spreading fake news.
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@seanluomdphd
Sean X. Luo
10 months
@DrDimitrios That's not the point of the partisans. The point is mainly that since it's "situational" (as opposed to "genetic" or even the vaguer term "biological/chemical"), you would want to avoid writing meds for it. This isn't typically how medicine works, but never mind that.
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@seanluomdphd
Sean X. Luo
3 years
@wesyang The most interesting in that whole thing: 45k a year.
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@seanluomdphd
Sean X. Luo
7 months
@MarkLRuffalo Yes. But science is science. It’s not in service of what you think is boring or not. Clozapine works for some people and it doesn’t really matter if this fact renders the foundation of their pathology more or less “rich” based on some aesthetic judgement.
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@seanluomdphd
Sean X. Luo
1 year
@AAC0519 @RezaC1 Not necessarily. It depends on the development. Apartment buildings on Fifth Avenue are all multifamilies. The land underneath is more expensive than Roslyn Heights.
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@seanluomdphd
Sean X. Luo
3 months
@StanleyWongMD I read this study very differently. This study showed that ADHD meds are NOT associated with heart failure or arrhythmia. The HTN/arterial disease association may very well be due to people with ADHD having worse preventative care.
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@seanluomdphd
Sean X. Luo
6 years
@rburdine1 Why is this an issue? I wouldn’t even bother talking to the PO. 1) Replication is valuable. 2) collaboration with other groups in a multi site for renewal.
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@seanluomdphd
Sean X. Luo
3 months
@Keirwales @MarkLRuffalo I don't think exposure to trauma specifically necessarily elicits sympathy. People can't handle BPD patients because they are challenging clinically and taking care of them requires specific training and lots of experience.
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@seanluomdphd
Sean X. Luo
5 years
@doctorid @shrinkrapdinah ^^ This is a pernicious falsehood that should be dispelled both on and off Twitter each and every time it's said out loud. #Antidepressants are very different from placebo and are much more effective than placebo for individuals with moderate to severe symptoms of #depression .
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@seanluomdphd
Sean X. Luo
4 months
@ChrisPalmerMD According to Gunderson's studies, the average recovery cycle for something like BPD and other severe personality disorders is *5-10 years*. I don't find the ways with which these people are treated as scientifically informed at all.
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@seanluomdphd
Sean X. Luo
6 months
@justin_garson @DrAnnieHickox I'm not invalidating you. I'm saying that if you were on the other side, you'd see how things are done. You've eaten a sausage and you say I don't like the way it tastes. I'm inviting you to step into the kitchen.
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@seanluomdphd
Sean X. Luo
5 months
@AllenFrancesMD I would correct you and say high rates of "pseudoaddiction". True primary benzo addiction is very rare.
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@seanluomdphd
Sean X. Luo
5 years
@KellyMDoran @NEJM I find it curious that they didn’t do a gender/ethnicity breakdown of that 1.5%. Bet those numbers would look even worse.
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@seanluomdphd
Sean X. Luo
2 years
@GregSimonKPWHRI Actually neither surprising nor particularly disappointing. Very important finding and consistent with clinical observation that low intensity “suicide talk” from clinicians can often trigger self harm/suicidal ideation. Cc: @PeterDKramer
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@seanluomdphd
Sean X. Luo
5 months
@catano_chris Do you want an honest answer? It's because the field has "lower impact" (narrowly defined by IF, etc) and therefore it needs to actively draw a more general audience to get cited. I live in a "lower impact" field and tailor my papers to high-impact journals knowing that.
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@seanluomdphd
Sean X. Luo
1 year
@MarkLRuffalo I love Yalom as much as anyone else, but this statement seems to be one of those "yes, but it really depends..." situations...
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@seanluomdphd
Sean X. Luo
5 years
@GallaherCaren @doctormromeo Presumably. Not unusual in a city hospital ER?
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@seanluomdphd
Sean X. Luo
4 months
@DuchessVonD @filth_filler @MarchandSurgery @HRTFRG @CISFAKER @Drug_Researcher @ADrugResearcher @TheRealJMysl @transkatgirl @knucklemonk @Kensinghenge The largest target of Abilify is not schizophrenia patients. This medication is prescribed much more frequently for depression and off label. I agree that the utility of this modification is dubious I think they *did* patient based focus groups prior to development.
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@seanluomdphd
Sean X. Luo
5 years
@cecilejanssens @michelnivard If they didn’t they might get a null result in particular relating to a smaller sample size. This would guarantee a rejection from Science.
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@seanluomdphd
Sean X. Luo
1 month
@dtmorgan18 You basically just revealed that you make quite a bit of money. If your income is low your premium would be also low. Sometimes much much lower. Would you prefer to consider it as a form of taxation instead?
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@seanluomdphd
Sean X. Luo
3 months
@KordingLab I tell "mentees" to avoid backing yourself into a corner. Sometimes you have to do a boring project to get the team paid. It's okay. Not every single project needs to be constantly exciting or high-risk. Flexibility = better mental health = better science
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@seanluomdphd
Sean X. Luo
2 months
Wow, I'm surprised by how negative the advisory panel is on this one. 9 to 2?! I mean I am not a huge fan of #MDMA but feels like there's groupthink there @Drug_Researcher @PeterDKramer @MarkLRuffalo
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@seanluomdphd
Sean X. Luo
3 years
@drugmonkeyblog Still ultimately a funding rate issue. In the olden days, funding rate was 35%+, you'd be less concerned about the arbitrariness of the reviews: throw darts enough times something will stick. Now you see constantly twitters of 10 years of effort to get 1 grant.
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@seanluomdphd
Sean X. Luo
2 years
@emollick Except the effect size between the Big Five and any predictable clinical outcome is not large enough for practical applications…
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@seanluomdphd
Sean X. Luo
4 months
@Dr_Perreault I don’t think it’s necessarily anyone’s “problem” or anyone “failed”. I worked at a Nobel prize winning lab and often students and postdocs don’t publish for 5+ years and yet has some of the highest academic placement rates.
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@seanluomdphd
Sean X. Luo
1 month
@otis_reid There are strange threshold numbers in number theory all over the place, mostly because of the nature of primes... Similar things exist in other branches of math, like why are there odd finite simple groups ("sporadic").
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@seanluomdphd
Sean X. Luo
2 months
@vsbuffalo Typically this is modeled with a regression line, which is wrong. In reality, it's better modeled as a 2-D skewed distribution. There's a relationship, it's just very noisy.
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@seanluomdphd
Sean X. Luo
24 days
@MicrobiomDigest I've noticed this happens more in a European audience than an American audience. The main reason is that American universities have been superior in the last 10 years in placing women in senior/leadership roles. It's difficult to devalue when one is in charge of funding, etc.
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@seanluomdphd
Sean X. Luo
1 year
@RezaC1 I don't think this is the issue at stake. Homeowners won't object (air and light issues excepted) if private developers valued the land properly and developed profitable products. The real issues stem from restrictions of the type of development that can happen.
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@seanluomdphd
Sean X. Luo
2 months
@BipolarBattle Sometimes you do have to "force" meds. As an extreme example, if someone's in the ICU and vented, they still receive antipsychotics. The question of force has to do with the judgment of consent and capacity, which is dynamic and can not be answered in a blanket way.
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@seanluomdphd
Sean X. Luo
5 years
@joshuy @amitabhchandra2 Other than vaccines, can you think of a single [medical] primary prevention strategy that had withstood the rigor of empirical testing? If you are talking about behavioral interventions, as someone who works in this field, none of them have worked.
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@seanluomdphd
Sean X. Luo
4 months
@BudoffMd But what IS the risk of taking a low dose statin with zero CAC which maybe a false negative in younger patients? It seems that the amount of absolute risk reduction, small as it is, is worth it.
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@seanluomdphd
Sean X. Luo
4 months
@NickTaber Yes, but that's too vague to be helpful. A car can be incredibly destructive. It's just a tautology.
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@seanluomdphd
Sean X. Luo
10 months
@markhoro Not sure what exactly this proves. Increased caloric intake carries the same degree of risk correlation for obesity but GLP-1 meds are there. When you get shot by a gun you still need surgery and blood plasma. Your arguments are conceptually confused.
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@seanluomdphd
Sean X. Luo
2 months
@rhonederrico @MarkLRuffalo Btw, there's another paper that said Zoloft works as well in the aggregate as a 2.5 hour a week meditation program for anxiety, which is equally shocking to me. These kinds of results indicate to me that no way these pills are placebos.
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@seanluomdphd
Sean X. Luo
10 months
@ProfRobHoward I am convinced that this person says these things to get hits as a marketing strategy.
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@seanluomdphd
Sean X. Luo
2 months
@nickmmark They have and will write it up. It'll be in a secondary journal. Maybe even JAMA Internal Medicine, if the team is "well connected". It's called a minimum publishable unit.
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@seanluomdphd
Sean X. Luo
2 months
@MarkLRuffalo A running program addresses multiple cholera-like psychosocial "causes" of depression (i.e. social isolation, lack of exercise, poor circadian rhythm, etc etc etc). It's actually quite remarkable that we somehow hit a pill that gives you EXACTLY the same effect.
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@seanluomdphd
Sean X. Luo
10 months
@sanilrege Here’s what I think is interesting: most SSRIs are written my PMDs. So the argument really boils down to PMDs should write less SSRIs and ask more about sexual side effects and refer more for therapy, none of which I disagree with. But this ends up narrowing their angle a LOT.
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@seanluomdphd
Sean X. Luo
10 months
@AllenFrancesMD I think it’s hard to learn these things through didactics. Sometimes therapy feels like brainstorm sessions if we are talking about strategy to savoring “good minutes everyday”
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@seanluomdphd
Sean X. Luo
2 months
@MarkLRuffalo @JonathanShedler @dr_alexharris Because that is the "subconscious drive", the "id" of the discussion. You are afraid that if everything is "the brain", something "bad" will happen to the field of psychotherapy. Psychiatrists never attack therapy, but therapists generally attack meds.
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@seanluomdphd
Sean X. Luo
7 months
@GeorgeKirov1 Yes but “rare variants” might just be due to genealogy. Very difficult to show the actual mechanistic causality.
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@seanluomdphd
Sean X. Luo
2 years
@joshdubnau It’s a bit cavalier to confuse academic “trainees” with “the working poor”. Most of academias issues can be solved by: 1. Cut phd flow. 2. Match system for both academia and industry jobs. 3. Shorter grants and restrictions on # submitted.
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@seanluomdphd
Sean X. Luo
2 months
@LauraGMitchell No. It's not even about race. Because if it's about race Asians who live in Long Island would advocate for denser zones and turn Great Neck into Sunset Park.
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@seanluomdphd
Sean X. Luo
9 months
@DrAnnieHickox They make a causal interpretation of a reverse causal association. People who get treated for diabetes also have a worse outcome. Doesn’t mean treatment itself is harmful.
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@seanluomdphd
Sean X. Luo
25 days
@nikillinit Expanding residency slots, especially in primary care, is actually much more expensive than getting rid of student loans. That's why. There are estimates that large systems lose 1M a year on a new primary care.
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@seanluomdphd
Sean X. Luo
3 months
@YouGoChi @AcademicChatter If you are a single person it's a bit easier. It's reasonable to survive on a postdoc salary level indefinitely even with student loans. The main issue is affording a family on a single postdoc income. This is only possible with extreme constraints.
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@seanluomdphd
Sean X. Luo
2 years
@neuroecology For most people, it's actually fairly hard to get banned because nobody really cares about you.
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@seanluomdphd
Sean X. Luo
2 months
@StatisticUrban This is a bizarre point. 99% of people who got paid 60k for 10 years as a postdoc don't win the Nobel prize. Most are H1B holders (as was she, for a time). You are making a normative statement based on a n=1 observation.
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@seanluomdphd
Sean X. Luo
3 years
Yip: Roos et al 2019: low frequency cocaine use has similar outcomes to abstained controls #CPDD21
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@seanluomdphd
Sean X. Luo
2 years
@dr_alexharris I have a different interpretation. The measures pulled out in the meta-analysis don't measure anything about the change of serotonin concentration at the synaptic cleft, except PET 5HT1A receptor binding assays, but we all know how...noisy and small N those are...
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@seanluomdphd
Sean X. Luo
1 month
@KemtrupTweets If this is correct, children who are less coddled should have lower depression prevalence on an individual level. This seems false. In general depression is associated with MORE adverse childhood events on an individual level.
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@seanluomdphd
Sean X. Luo
10 months
@sanilrege I’m always confused when people say X (psychiatric disorder) “isn’t real”. And then when you press on them as to what they mean exactly of this, the answer is also confusing… so I think in general this debate isn’t a productive one.
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@seanluomdphd
Sean X. Luo
10 months
@psychgeist52 There are plenty of diagnoses in medicine that do not have biomarkers and are clinical. Believe it or not, HEART FAILURE (see NYHA staging) is a clinical diagnosis. So I think your "objection" is basically a philological one that has no practical consequence.
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@seanluomdphd
Sean X. Luo
1 month
@DrNadolsky So you’d think. I actually think it’s going to be MORE expensive and exclusive to get a human voice as a final verdict. People will pour in from all over the world when they don’t feel like they can trust the computer.
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@seanluomdphd
Sean X. Luo
2 years
@AdrianoAguzzi 3 benefits from high-impact papers, which are not always CNS (i.e. where is NEJM in here?). 1 is actually not necessary. Many prominent PIs relate to me that they never had a single supportive mentor sometimes even as a matter of pride.
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@seanluomdphd
Sean X. Luo
1 month
@morallawwithin This is not as much an argument for veganism as you might think. 1. milking a cow is not torture ==> hence you can eat cheese. 2. collecting eggs is not torture ==> hence you can eat eggs. 3. don't think invertebrates can be "tortured" ==> you can eat calamari. etc etc
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@seanluomdphd
Sean X. Luo
9 months
@fermatslibrary Yes but do you want to try to add that Higgs mechanism because then you’ll be look at a whole filled page.
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@seanluomdphd
Sean X. Luo
5 years
@trizzlor @jw_lockhart @sillyolyou @josephvitti The main methodological concern IS the phenotype controversy. I find it hilarious that geneticists can argue for a decade on how to analyze variants when the definition of a complex behavioral outcome is much harder.
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@seanluomdphd
Sean X. Luo
11 months
@rlmcelreath Isn’t this very problematic? This suggests that if you try parametric fitting of your joints it’s very sensitive to data. Seems to be a good argument to always use well behaving nonparametric Bayes.
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@seanluomdphd
Sean X. Luo
3 years
@naylorbmd There is really one reason for rejection for pilot projects: significance. Every other reason is window-dressing. You kinda have to read between the lines a little. Criticizing significance is often even harder for reviewers. It’s so hard it has to be subconscious.
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