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As part of my interest in expanding the evidence base on various contraceptive options, I am currently collaborating on a systematic review of the effectiveness of various fertility awareness-based methods (FABMs) of contraception (note: this is not the same as the rhythm method, more on that another day). Working in this area has led to a number of fascinating connections and dialogues. Most recently, a Fertility Awareness Educator named Sarah Bly asked if I'd be willing to give a lecture on scientific literacy to her new class of students. This seemed like a nice science communication opportunity, a fun chance to present on much broader topics than I usually do, and a good way connect with new (to me) folks working directly with women on issues in contraception.
A few weeks before my presentation, Sarah shared with me that through years of using alternative medical approaches in her personal and family life, her ways of understanding health and healing are rooted in primarily in personal experience, and secondarily in science. I appreciated her sharing this with me for a few reasons. First, considering the different approaches by which people obtain and interpret medical information helped me be more explicit in my presentation about the specific elements that make me place great trust in science (while still trying to acknowledge/articulate areas for improvements). Second, I applaud people who invite constructive interaction and exchange with folks who have potentially divergent perspectives. So, I'm grateful to Sarah for the invitation, and to the students for the great discussions afterward - it was lots of fun!
The 50-minute talk was presented online, and the recording is linked below. A few brilliant folks on Twitter (shout out to Dr. Liz Allen & others!) suggested it might also be useful to provide links to shorter thematic clips - that's below, as well. As a talk geared primarily towards an audience with limited familiarity on certain scientific concepts - I'd welcome feedback from scientists and non-scientists alike on what could be improved for next time!
The 50-minute talk was presented online, and the recording is linked below. A few brilliant folks on Twitter (shout out to Dr. Liz Allen & others!) suggested it might also be useful to provide links to shorter thematic clips - that's below, as well. As a talk geared primarily towards an audience with limited familiarity on certain scientific concepts - I'd welcome feedback from scientists and non-scientists alike on what could be improved for next time!
- Link to full 50 minute version, starts with Section 1: My public health background & philosophy on FABMs (0:00-7:05)
- Link to version starting with Section 2: Scientific literacy and public trust in science (7:06-21:21)
- Link to version starting with Section 3: Common pitfalls in understanding medical studies (21:22-42:51)
- Link to version starting with Section 4: Finding trustworthy information (42:52-46:45)
- Link to version starting with Section 5: Useful adjuncts to scientific literacy and closing thoughts (46:45-50:40).
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I am enormously grateful to Georgewilliam Kalibbala, Scott Fabricant, and Dr. Ronald Gray for nominating me to the 120 under 40 campaign!
My profile was posted today, along profiles of many other nominees, including Patrick Segawa - who I blogged about just yesterday. Kudos, Patrick!
It's inspiring to read about young folks around the world doing all kinds of important work. I hope everybody interested in building the next generation of leaders in reproductive health will consider making a nomination today!
My profile was posted today, along profiles of many other nominees, including Patrick Segawa - who I blogged about just yesterday. Kudos, Patrick!
It's inspiring to read about young folks around the world doing all kinds of important work. I hope everybody interested in building the next generation of leaders in reproductive health will consider making a nomination today!
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Tomorrow, I leave for Indonesia to attend the International Conference on Family Planning! This incredible conference began in Uganda in 2009, was in Senegal in 2011, then Ethiopia in 2013, and will be in Bali this year. I've been incredibly fortunate to be able to participate at each one! It always re-energizes me to be surrounded by everyday heroes doing work in international reproductive health!
This year, I had an opportunity to volunteer to be a mentor to a youth attendee. As luck would have it, I was matched with a young Ugandan man who I've been linked with for some time on social media - the incredibly dynamic Patrick Segawa. Patrick's organization, PHAU (Public Health Ambassadors of Uganda), focuses on "edutainment" to raise awareness for sexual and reproductive health and rights in Uganda. Among other incredible activities, PHAU organizes dancing flash mobs in Uganda - please check out their website for more information about this great organization! Patrick was also recently nominated in the 120 under 40 campaign, which highlights young leaders in reproductive health from around the world. He is a rising star in our field, and I am very much looking forward to finally meeting him in person.
This year, I had an opportunity to volunteer to be a mentor to a youth attendee. As luck would have it, I was matched with a young Ugandan man who I've been linked with for some time on social media - the incredibly dynamic Patrick Segawa. Patrick's organization, PHAU (Public Health Ambassadors of Uganda), focuses on "edutainment" to raise awareness for sexual and reproductive health and rights in Uganda. Among other incredible activities, PHAU organizes dancing flash mobs in Uganda - please check out their website for more information about this great organization! Patrick was also recently nominated in the 120 under 40 campaign, which highlights young leaders in reproductive health from around the world. He is a rising star in our field, and I am very much looking forward to finally meeting him in person.
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This evening, the ever-fabulous Alice Dreger brought an important ongoing Twitter conversation to my attention. Several folks, including Amanda Michelle and others, had sounded the alarm about a company, Use to Believe, that was making misleading, scientifically-unsupported claims about products being sold on their website.
For example, the website claims that their lubricant, ProLube, can protect against HIV and other sexually transmitted infections.
For example, the website claims that their lubricant, ProLube, can protect against HIV and other sexually transmitted infections.
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This summer, Georgetown University hosted a meeting, organized by Vicki Thorn, founder of the National Office for Post Abortion Reconciliation and Healing, entitled Contraceptive Conundrum: A Symposium of Scientific Research.
But slapping the word "scientific" on the event title does not ensure a balanced, accurate discussion of data.
But slapping the word "scientific" on the event title does not ensure a balanced, accurate discussion of data.
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On March 30, 2015, Governor Doug Ducey of Arizona signed into law Senate Bill 1318, which requires doctors to tell women* getting an abortion that "it may be possible to reverse the effects of a medication abortion if the woman changes her mind, but that time is of the essence", and that "information on and assistance with reversing the effects of a medication abortion is available on the Department of Health Services' website".
In the US, medication abortion is typically a two-step procedure, first involving taking mifepristone, and within two days or so, taking misoprostol. On its face, SB 1318 seems intended to inform people that if they change their mind during that window between the two medications, an evidence-based medical procedure is available to help "reverse" the effects of the mifepristone (spoiler: the bill doesn't actually accomplish this goal).
People should have evidence-based information about all of their reproductive options, so they can make the best choice for their own individual circumstances. Even though the proportion of women who wish to terminate a pregnancy and then change their mind after taking mifepristone is likely to be small, any such person should absolutely be made aware of any scientifically proven intervention that can help them safely achieve their reproductive goals. So, is there scientific evidence for abortion reversal?
In the US, medication abortion is typically a two-step procedure, first involving taking mifepristone, and within two days or so, taking misoprostol. On its face, SB 1318 seems intended to inform people that if they change their mind during that window between the two medications, an evidence-based medical procedure is available to help "reverse" the effects of the mifepristone (spoiler: the bill doesn't actually accomplish this goal).
People should have evidence-based information about all of their reproductive options, so they can make the best choice for their own individual circumstances. Even though the proportion of women who wish to terminate a pregnancy and then change their mind after taking mifepristone is likely to be small, any such person should absolutely be made aware of any scientifically proven intervention that can help them safely achieve their reproductive goals. So, is there scientific evidence for abortion reversal?
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What is #365papers?
I already have a few New Year's resolutions (hello, my old friend Gym), but recently came across a science-related resolution that I really like and want to share.
#365papers is a challenge to read one peer-reviewed, scientific paper a day and to share something about it on Twitter. It was started by two professors in ecology and evolution, Meghan Duffy and Jacquelyn Gill.
#365papers is a challenge to read one peer-reviewed, scientific paper a day and to share something about it on Twitter. It was started by two professors in ecology and evolution, Meghan Duffy and Jacquelyn Gill.
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There are many things I love about working in international public health. Among them are opportunities to work with inspiring scientists from around the world (such as my brilliant colleagues at the Rakai Health Sciences Program in Kalisizo, Uganda), and to meet vibrant young people of many different cultures, especially those excited to discuss science or public health.
This young crew helped me improve my Malagasy language skills. Madagascar, 2000.
Walking down the road one day in Kalisizo, I met a young man named Georgewilliam. He struck up a conversation, asking what I was doing in Uganda. When I mentioned being a public health scientist, his eyes lit up! He talked about his love for science, and was eager to discuss his studies in biology and chemistry. He was applying for a program in medical laboratory technology, and wanted advice on the application/interview process. I visited him the next day after work to talk about it, and we became fast friends.
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This blog was written in conjunction with Kavita Nanda of FHI 360 and originally posted here on the K4Health website. It is republished here with permission. Disclaimer: Dr. Nanda and I were both directly involved in work on the 2014 WHO HC-HIV guidance and the USAID/PEPFAR briefer on hormonal contraception and antiretroviral medications.
Extraordinary gains have been made in the last decade towards increasing access to antiretroviral therapy (ART) for HIV. With an eye towards ending the AIDS epidemic by 2030, UNAIDS recently released bold targets related to HIV diagnosis and treatment. By the year 2020, their aim is to have 90% of all people living with HIV aware of their status, 90% of people diagnosed with HIV receiving sustained ART, and 90% of people on ART achieving viral suppression. As we move closer to these laudable public health goals, we must also consider how expansion of ART may affect and be affected by other health issues, such as prevention of unintended pregnancy among women living with HIV.
Among all people living with HIV in low- and middle-income countries, 52% are women (57% in sub-Saharan Africa). Most are of reproductive age, and many may wish to use a hormonal contraceptive method to prevent unintended pregnancy, such as oral contraceptive pills, injectables, implants, or hormonal intrauterine devices (IUDs). Access to highly effective contraception has other health benefits as well; it reduces maternal and infant morbidity and mortality, and is a necessary component in ending mother-to-child HIV transmission.
Therefore, an increasingly important issue is whether certain ART regimens are expected to have drug interactions when used with certain hormonal contraceptive methods.
Among all people living with HIV in low- and middle-income countries, 52% are women (57% in sub-Saharan Africa). Most are of reproductive age, and many may wish to use a hormonal contraceptive method to prevent unintended pregnancy, such as oral contraceptive pills, injectables, implants, or hormonal intrauterine devices (IUDs). Access to highly effective contraception has other health benefits as well; it reduces maternal and infant morbidity and mortality, and is a necessary component in ending mother-to-child HIV transmission.
Therefore, an increasingly important issue is whether certain ART regimens are expected to have drug interactions when used with certain hormonal contraceptive methods.
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* The views in this post are mine alone, and may not reflect the views of my previous or current employers, co-authors, or other colleagues *
As a young(ish) reproductive health epidemiologist whose scientific career will depend in part on publications, it is pretty scary to challenge a Goliath like Lancet journals. I respect these journals deeply. They bring important science to the forefront, they help us to improve health, medicine, and policy. Lancet journals, in particular, also engage admirably on social media and encourage researchers to do the same - better bringing science to the public.
But I experienced a terrible situation when publishing my work at Lancet Infectious Diseases, and it is important to challenge people, even our heroes, to do better. So, it's time to share my story. My intention is that this post contribute to efforts to protect other scientists and journals from experiencing the frustrating situation that I did, perhaps by stimulating more nuanced discussion on how to better prevent and address misconduct by peer reviewers (a topic which receives less attention than misconduct by authors). This issue may also be applicable to discussions on the pros and cons of open peer review. Please do share your thoughts in the comments section.
As a young(ish) reproductive health epidemiologist whose scientific career will depend in part on publications, it is pretty scary to challenge a Goliath like Lancet journals. I respect these journals deeply. They bring important science to the forefront, they help us to improve health, medicine, and policy. Lancet journals, in particular, also engage admirably on social media and encourage researchers to do the same - better bringing science to the public.
But I experienced a terrible situation when publishing my work at Lancet Infectious Diseases, and it is important to challenge people, even our heroes, to do better. So, it's time to share my story. My intention is that this post contribute to efforts to protect other scientists and journals from experiencing the frustrating situation that I did, perhaps by stimulating more nuanced discussion on how to better prevent and address misconduct by peer reviewers (a topic which receives less attention than misconduct by authors). This issue may also be applicable to discussions on the pros and cons of open peer review. Please do share your thoughts in the comments section.