Mr Epidemiology

No, I'm not a skin doctor


Mr Epidemiology

Why are middle-aged white Americans dying faster than others?

The best findings in science aren’t the ones that make you go “cool!”, they’re the ones that make you go “huh?”

A study in the Proceedings of the National Academy of Sciences reported a strange and unexpected finding. By looking at data from the CDC, researchers were able to evaluate mortality rates per 100,000 individuals, and compare this between ethnic groups. While there’s generally been a decrease in all-cause mortality, they found an increase in the mortality of middle-aged white non-Hispanic men and women in the US between 1999 and 2013 (solid red line below). This finding was unique to middle-aged White Americans – data from other countries also reported a drop in death rates.

So what makes White, middle-aged, non-Hispanic Whites unique?

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Hot time summer in the city (Legionnaires Disease)

1976 was a busy year in Philadelphia. They were holding the Bicentennial celebration, commemorating the two-hundredth anniversary of the Declaration of Independence. As part of the year-long festivities, the city had become a hub for events, hosting the championship game of the NCAA Final Four, as well as the all-star games for baseball, basketball and hockey. On the 4th of July, around 2 million people descended on the city for the celebrations, which featured a five hour parade with over 40,000 marchers and floats from every state. But it was to be a small, 2000 person event that would go down in history.

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Image courtesy Flickr user DaveZ

If you play with scorpions, don’t be surprised when you get stung

When I was 6 or 7, my uncle gave me a book of Aesop’s Fables. I liked their imagery, and the idea of talking animals with anthropomorphized human traits appealed to my child sensibilities. Recent news about Turing Pharmaceuticals raising the price of Duraprim, a potentially life-saving drug, from a paltry $13.50 to an astonishing $750 brought one of these fables vividly back to mind: the story of the Scorpion and the Frog.

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The impact of Obamacare, one year on

I used to bike to work every day in grad school. I lived around 2km away from the hospital I was based at (~ 1.24 miles), so biking was just the most efficient way to get to work every morning. One sunny July morning though, it all came crashing down. I was biking in, following the same route I’d taken literally hundreds of time before. And a pedestrian (with headphones in, oblivious to the world) walked out in front of me. I swerved to avoid them, hit the curb and then flew off my bike.

I don’t remember the next 15 seconds or so. I remember avoiding the pedestrian, losing control, and then the next thing I remember is being flat on my back. I then sat up and remember thinking that my left arm felt funny. I reached over and pulled it onto my lap, and then realized I was in trouble. The fact it was bent in ways it should never be bent in was one indication, the other was the shard of bone sticking out. A bystander yelled “Hey! Are you okay?” to which I replied “CALL AN AMBULANCE! MY INSIDES ARE OUTSIDE!!” (I’m quite proud of broken me for saying that)

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Advice for those considering and those in a PhD

Readers of the blog will know that I successfully defended my PhD in March. Today, I want to share some thoughts I have on the process for those considering a PhD and for those in the PhD.

Deciding if you want to do PhD is an important decision, and not one that should be taken lightly. I get a lot of people asking me whether they should do a PhD, and whether my thoughts have changed since I started. After four and a bit years, I have lots of thoughts. However, if I was to group them, they’d fall into two major categories: those considering a PhD, and those in the PhD.

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Level up! Mr Epid is now Dr Epid!

My old lab got me a cake to celebrate!
My old lab got me a cake to celebrate!

I’m back! I took an extended hiatus from the blog while I finished up my PhD, but, at the end of March, I successfully defended my PhD, and after making the changes suggested by the examining committee I submitted in the middle of April and started working. Those of you following along on Twitter will recognize the change in my Twitter handle from @MrEpid to @DrEpid; those of you who know me in real life will have heard me go on about it for the last few months as I prepare. For those wondering, I will eventually change the URL of my blog as well so they all match :)

For those unaware of the process, the PhD defence is an oral exam. At Queen’s (the process may differ at other universities), you submit your thesis, and then have to wait (a minimum) of 25 business days for the exam. The exam consists of 4 examiners; an examiner external to your university, one external to your department, one from your department, and the final examiner is your department head (or a department head delegate). You also have a chair from another department from your institution, as well as your supervisors there. After you give a 15-20 minute presentation, the examiners ask their questions. Typically, there are two rounds of questions, after which you leave, and the examiners deliberate. You’re then called back in, and they let you know their decision, and any changes you have to make before submitting your final thesis. My examiners were amazing, and while the questions were tough, they were fair. I actually really enjoyed the discussion I had with my examiners during my defence, and they ranged from the details of my analysis, to the concept of “ethnic identity” and what it actually means in terms of my research.

I want to thank everyone for their support over the past 4 and a bit years. As per prior precedents (Janiszewski, 2010; Saunders, 2013), I will be copy-pasting the acknowledgements section from my thesis below. I’d also like to thank the PLOS Blogs network, especially Victoria Costello for giving me the opportunity to join the network, and Travis and Peter for their support and encouragement when I started blogging. In addition, thank you to my co-authors Beth and Lindsay here who picked up the slack when I took a hiatus this year to focus on finishing up.

Finally, a special thank you to all the readers of the blog. It’s been a privilege to write for you, and it means a lot when you tell me how much you enjoy my work. Thank you, and I’m looking forward to getting back into writing more regularly.


I would like to start by thanking my supervisors, Dr. Will Pickett and Dr. Ian Janssen. I am grateful to have had the opportunity to learn from you both, and appreciate your support through my PhD journey. Your honesty, integrity, and willingness to always provide me feedback and support was always appreciated. Will, I look forward to our teams meeting in the playoffs again (hopefully with better results for me this time!)

I would also like to thank those in the Department of Community Health and Epidemiology/Public Health Sciences and the Clinical Research Centre for their support, with a special thank you to Lee Watkins and Deb Emerton for their help. Thank you also to the Clinical Research Centre Student Group. Your antics, customized t-shirts, snack breaks, and random dance parties always kept me entertained, and it’s been a pleasure working with all of you. The Thought Tub is richer for having you.

This work would not have been possible without the financial support of Queen’s University, the Ministry of Colleges, Training and Universities Ontario Graduate Scholarship, and the Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.

I would also like to thank my friends and colleagues, especially Anne, Kim, Raymond, Sarah, Alison, Hidé and Marion who have been unwavering in their support over the years. I also owe a special debt of gratitude to Rim, Lydia, Liam, Hoefel, Brian and the Gong Show/Danger Zone family for ensuring that I always get some physical activity, and that yes, I do even lift.

Finally, thank you to my family. Your love, support, guidance, and willingness to listen to me at all times of the day have allowed me to complete this project. Thank you.

“Oh no! What happened?” “W220.2XD: Walked into lamppost, subsequent encounter.”

Last week, I ran across this very entertaining piece over in Healthcare Dive about the new ICD-10 codes. The International Classification of Diseases (ICD) is an incredibly useful tool in public health that basically can reduce an injury to a series of numbers. As you can imagine, this is very powerful when it comes to determining if something is on the rise. Researchers can easily count the number of times something occurs, and if it’s up from previous years, there might be something there.

Part of the beauty of the ICD-10 codes is how specific they are. The previous system, ICD-9 (creative, I know) wasn’t nearly as specific as they only had 13,000 codes compared to the 68,000 in ICD10. With the advent of ICD-10, The Powers That Be have gone into painstaking detail breaking down injuries, diseases and other maladies into incredible precise codes that can be used by researchers and public health professionals.

Today, we’re going to go through my favourite ones.

Do you know what code it is if you get hit by a Macaw? Because one exists. | Photo via National Geographic
Do you know what code it is if you get hit by a Macaw? Because one exists. | Photo via National Geographic

W55.89XA: Other contact with other mammals
There are many codes for contact with mammals. Raccoons, cows, pigs and cats are all represented. However, the mighty seal is not covered, which made Buster Bluth very sad. He would have suffered from W55.89XA.


W61.12XA: Struck by macaw, initial encounter. ​

Look like our patient
*puts on sunglasses*
Is a little Macaw-struck

(The other option here was for an AC/DC reference…)

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Book Review: An Astronaut’s Guide to Life on Earth

Commander Chris Hadfield captured the world’s imagination last year, when, from 13 March to 13 May 2013, he was the first Canadian Commander of the International Space Station. While aboard the ISS, Commander Hadfield did a series of “experiments,” both for scientists, but, perhaps most importantly, for youth. This included genuinely interesting questions like “How do you cry in space? (video above)” and “How do you cut your nails?” and the always important “How do you go to the bathroom?” His amicable nature and genuinely infectious enthusiasm brought science to the masses, and helped inspire thousands of youth.

Commander Hadfield performed at the 2013 Canada Day celebrations in Ottawa, ON | Picture courtesy David Johnson, click for more info
Commander Hadfield performed at the 2013 Canada Day celebrations in Ottawa, ON | Picture courtesy David Johnson, click for more info

Recently, Chris Hadfield released his book – “An Astronaut’s Guide to Life on Earth.” My sister waited in line for 3 hours at our local Costco to get me a signed copy for my birthday, and I finally got around to reading it for this review. The book follows the life of Chris Hadfield as he becomes the commander of Expedition 35, detailing his attitude and the path he took to become the first Canadian Commander of the ISS. The book is split into three broad sections leading up to Expedition 35 titled “Pre-Launch,” “Liftoff” and “Coming Down to Earth,” with several chapters within each section.

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Bullet Points: This article has no waiting period

In December of 2012, I was asked my thoughts on the Sandy Hook shooting on Twitter, and if I was going to write about it through a public health lens. I said no – I didn’t want to weigh in so soon, and I didn’t really know where to start. Sandy Hook capped off a year where 130,437 people were shot by firearms. Of these, 31,672 people died, with almost 60% listed as suicides. Since that exchange, there have been several more mass shootings (defined as 4 or more fatalities in one instance – not including the shooter), and I kept surfing the internet to explore the arguments on both sides of the gun control debate. As pointed out by Kathleen Bachynski over on The 2×2 Project’s series on gun violence, aptly titled “Fully Loaded“, if “measles or mumps killed 31,672 people a year, we would undoubtedly consider the situation to be a public health emergency.”

The Smith & Wesson Model 29 became a classic after the Dirty Harry movies starring Clint Eastwood were released

The issue is, I’m not inherently against owning firearms. Sure, I don’t understand it, and it makes little to no sense to me how owning a gun makes you feel safer given how every other country in the Western world doesn’t and they seem to be getting along just fine, but that’s not the point. Many gun owners own firearms for self-defence, but use them mainly for fun and recreation – shooting targets and hunting are two of the major uses. More importantly though, Americans don’t want to give up their firearms, and that attitude isn’t going away any time soon: Anyone who thinks advocating for a universal ban on firearms in the US is wasting their time.

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What to do in Kingston this summer…. Part 4

I’m now in the midst of my sixth Kingston summer. Between the Masters and PhD, I’ve been here for a few years, and every year I find myself looking forward to the same things every time the campus clears out and the summer starts up (I’m a creature of habit, what can I say). But Kingston still surprises every year, and new things show up every year that keep things interesting. Amanda, Sharday and Rachel have all weighed in, and now it’s my turn! :)


The chocolate raspberry smoothie from Sipps is crazy delicious.
The chocolate raspberry smoothie from Sipps is crazy delicious.

1) Best summer eats

This is a toughie. Rule 1: Everything is better on a patio. Woodenheads, Atomica, The Toucan, their food is just better when you’re sitting outside enjoying it. I’m a big fan of the Pomegranate Italian Soda at Atomica, but this year I “discovered” the raspberry chocolate smoothie at Sipps. It was delicious, and I highly recommend it.

I’ll also add in the Kingston Olive Oil Company. It’s got lots of gourmet olive oils and vinaigrettes available, and is a great way to spice up a meal with some fancy olive oils accompanied by fresh bread from Pan Chancho. I recommend the fig vinaigrette and garlic olive oil, but you can try them all out in the store and see if one strikes your fancy!

2) Best ice cream place

Ice cream!! Is there a more summery meal? I think not. My favourite place by a mile is White Mountain – mainly because you can get ice cream, then wander down to Confederation Basin and watch the boats come in. It’s a great way to spend an evening. As Rachel pointed out though, they only accept cash, so come prepared!

3) Best spot for drinks

I’m a big fan of the patio at the Brew Pub – it’s got a nice, secret garden-esque vibe going on. Plus the food there is delicious! Try the salted pretzels with a beverage of your choice. It’s a great post-work-pre-dinner snack (thanks to Kim for showing me the light on that!)

4) Best summer locations

I love Confederation Basin. Sitting out, watching the water and the boats, and chatting with friends is one of my favourite ways to spend lazy summer days. People are milling around, some have blankets out, there are families walking their dogs and children playing. It’s just a really nice atmosphere. And it’s super close to the aforementioned ice cream.

5) Best summer festivals

Two of my favourite events are Movies In the Square and the Kingston Buskers Festival (July 10 – 13). The former is a great outdoor experience (bring your own chair though!) and they show the classics. This year, they’re showing Jurassic Park, Princess Bride and Space Jam (among others)!

The Buskers Festival is another fun one to watch – especially the fire show. The Buskers are incredibly skilled and really entertaining for the whole family, and they really bring the city to life. It culminates with a final show at Confederation Basin with the best Buskers pulling out all the stops to really blow you away. I highly recommend it!


This marks my final post on Gradifying, and so I’d like to thank all my co-authors – Sharday, Megan, Rachel, Amanda – for their input and support, as well as Colette Steer for her guidance with this position. I’m looking forward to seeing what you guys do next!

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