Details, details...

File under Major Blindspots - this article describes a study that finds the IUD the most effective method of emergency contraception, with a failure rate of 1 in 1000.  Great, but for emergency contraception (post-facto-ooops birth control)  the morning after pill does just fine for my money with a low 1 to 3% failure rate. The article states, despite the IUD's efficacy and safety, it is rarely recommended by clinicians for emergency contraception.  The reasons cited - it is not covered by insurance and it is not readily available.  Frankly, I'd add invasive to the list of why it's not a great option as a back-up option.  You have to get an IUD inserted through the vagina into the uterus.  A great long-term contraceptive method, but not super-appealing morning after plan B.

Didn't we just go through this in Virginia?

Please consider a donation to Planned Parenthood.

Sounding the TAMPON ALARM!

For several months now, I've been wondering where the hell are the o.b. tampons? At first I thought it was my local CVS stock-out....then the CVS near work ran out...I found some at Safeway a month or so later, so assumed there must not be a real problem....then, I dipped into a back-up supply so I was good for another little while....I was able to buy some Lil'ets on my trip to London, so saved for another month. Then, as my reserves dwindled, I systematically began to seek my dear o.b.'s out. None at three CVS stores, none at Safeway, none at Giant, nor Rite Aid. Something was clearly up.

I began to hatch conspiracy theories.  Maybe it's that younger women don't use them, and I'm just a dinosaur set in my old o.b. ways.  Maybe it's some anti-feminist thing (my sis calls o.b.'s "radical tampons" because your actually have to touch yourself to insert the applicator-free tampon).  Maybe the U.S. is getting more and more bizarre in it's "American-way" ways because o.b.'s applicator-free-type tampon is way more prevalent than in Europe.   Maybe Kotex pushed them out in its latest re-branding (have you seen those sleek new black boxes?).   And I recently began to freak out- I wasn't out of tampons yet,  but I really didn't want to buy those plastic-y things or those stiff cardboard ones.

Well, I'm not the only one, and I'm not out of my mind.  Through a quick Google search I learned that women all over the U.S are desperate to get their hands on o.b's - even bidding them up on Ebay $76 for three packs!  

Here are some real-life articles on the Tampon Emergency with headlines worthy of the National Enquirer.... and a total hoot! Women in Dismay Over o.b. Tampon Shortage, (CBS News); O.B. Tampon Brand Missing From NYC Stores, (Huffington Post); Women searching far and wide for o.b. tampons after they mysteriously disappear from store shelves (NY Daily News); The Case of the Missing o.b. Tampons, (NY Times). These articles quote o.b. distributor Johnson&Johnson as saying somewhat cryptically, there was a "supply interruption."

But there is hope. As of early February, the Jezebel blog reports "O.B. tampons Return to shelves" (There are 367 comments on that particular post!). And official o.b. tampon website reports:

February 3, 2011: To our valued customers: We are pleased to confirm that o.b.® tampons are increasingly in-stock at more stores nation-wide as well as through on-line retailers such as:Amazon.com, drugstore.com, soap.com.

Supply may continue to vary in your area, however retailers who have received product include:

Acme, Albertsons, CVS, Cub, Duane Reade, Fred Meyer, Giant Eagle, Giant Food Stores, HE Butt, Jewel-Osco, Kroger, Lucky, Meijer, Publix, Rite Aid, Safeway, Sav-a-Lot, Shaw's/Star Markets, Shoppers, Shoprite, Inc., Stop & Shop, Target, Walgreens, Wal-Mart, Wegman's and other regional retailers. 

Well, this may be so, but the shelf was bare at my Safeway tonight. I'm still not desperate yet. I've got until early March to find some before I totally panic.

Smoking is absolutely filthy!

The U.S. Food and Drug Administration is proposing new large-print, highly graphic warnings on cigarette packs, such as the one to the left.  There are 36 more being proposed, and nine will be chosen.  These warning will comprise 50% of the front and rear panels of each cigarette packet, and 20% of any cigarette ad.  The images are appropriately disgusting  and jarring.

I think smoking is revolting.  It smells bad. It looks bad.  It makes people sick - fatally so.  It irritates non-smoking bystanders.  The foul smell sticks to clothes, hair, furniture, carpets, window shades, and tableware.  It turns teeth yellow and brown.  Kissing a smoker feels like kissing an ashtray. Sooner or later the young , hipster smoker turns into a hacking, addicted, aged-beyond-their-true-age, old, sick person smoking in the rainy, cold under an awning.

If my own personal horror does not make it clear enough, here are some hard facts from the NYTimes article on the new FDA warnings:

Public health officials are hoping that the new labels will re-energize the nation’s anti-smoking efforts, which have stalled in recent years. About 20.6 percent of the nation’s adults, or 46.6 million people, and about 19.5 percent of high school students, or 3.4 million teenagers, are smokers. Every day, roughly 1,000 teenagers and children become regular smokers, and 4,000 try smoking for the first time. About 400,000 people die every year from smoking-related health problems, and the cost to treat such problems exceeds $96 billion a year.

Smoking is increasingly stigmatized these days - if I have friends or colleagues that do smoke they would likely not be "out" in their habit.  In all honestly, I have less respect for smokers. I was devastated when I learned that Obama is a smoker, albeit a reticent and humbled addict. I'd even go as far to say that I find them disgusting themselves.  But I can't go that far because in all honesty, I feel sorry for them and their addiction and our shared human frailty.

I hope my daughter never starts.  Admittedly, I have smoked cigarettes at various times in my life.  I tried my first cigarette at about 12 years old...

A few of my favorite things: design, food, public health

Today's NYTImes Op-Ed includes a graphic, Lunch Line Redesign,  that illustrates how some simple design tweaks lead to better, healthier choices in the school cafeteria.  Design tweaks like fruit in a large fruit bowl, rather than a flat metal pan, increased sales.  An ice cream freezer with a closed opaque top reduced ice cream sales.  And an express line for healthy lunches (no chips or dessert) doubled sales for healthy sandwiches.

All of this is indeed very cool, as the US faces an obesity epidemic, and healthy fresh food options must find their way into our behavioral choices.  If these design fixes can help subtly influence these choices - not just our nutritional knowledge alone - then all the better.

Recently, I've found myself in two sandwich chains - Au Bon Pain and Panera Bread Company - which post calorie counts on the billboard menus from which I ordered.  On each occasion, I subconsciously considered the 2 or 3 most appealing selections, and then steered toward the lowest calorie option of those.  I made some assumptions in these choices - for example, that the calories were relatively equal in nutritional value - protein, fiber, Vitamin A or iron content, etc.  I also assumed that the calorie counts were wrong (having been tested in some food lab somewhere, and likely varied slightly, and likely for the worse, by food preparer).  Still, I assumed the relative calorie counts among the various choices still held true.  All this, in the flash of a few milliseconds of decision-making in the mind of a relatively well-informed, health conscious person.

Lots of disciplines melded here - and I appreciate the interdisciplinary application of design, public health, behavioral psychology, and economics.  I wonder how all this plays out in other choices we make - spending decisions, condom use, working out, etc.  I also wonder if school lunches are any less gross than they used to be.    

Ground-breaking gamechanger for women's health

At the International AIDS Conference in Vienna promising results were shared from a clinical trial of a microbicide to be used by women for HIV prevention.  This is great news indeed.  Since the beginning of the epidemic, one of the frustrating things has been that a woman has no way to protect herself from HIV infection without depending on her partner in some way.  All three methods of HIV prevention require some degree of cooperation from her guy:

• condom use - ultimately it's his call; 
• mutual monogamy between two HIV-negative partners  - again, she can be as monogamous as she wants, but it won't necessarily protect her if he is not - and vice versa, of course, though sadly the monogamy deck is stacked against her in many cultures and countries where there is high HIV prevalence; and 
• abstinence  - well, we all know how that goes! - not only is it exceedingly challenging between two people with any sort of chemistry and hormones, it's really a non-starter for many woman (and of course, in the case of rape, coerced and otherwise involuntary sex).  In places like Africa, where HIV prevalence is high, partner communication is low, and pressure for married couples to make babies is strong, the notion of refusing sex or insisting on condom use, even if she perhaps suspects he may be infected or at risk, in a marriage setting just won't fly

So where does that leave a woman in Johannesburg where HIV infection is 18% (or anywhere else for that matter)?  Up the creek without a paddle in terms of taking control of her health and life, with any sort of viable option to protect herself from HIV infection.  An effective microbicide could change that.

Clinical trials for microbicides (vaginal gels that can be applied to neutralize the virus and protect from infection) have been going on for years have had mixed results, at best. The news of this study is ground-breaking and could change the HIV prevention landscape.   In this particular clinical trial in South Africa, prevention of transmission os not 100% failsafe, only significantly reduced.  Researchers want to improve the efficacy, continue with additional trials, and if viable, get this thing to market ASAP.

Fabulous news! (Sometimes I miss practicing public health).

Magnetic Poetry Set for the UN

I've been in Vienna for one of those big international meetings.  In this case, it's the International AIDS Conference that takes place every 2 years (next one in DC in 2012).  To be more precise, I've been at a pre-conference symposium of about 450 people, as well as some smaller meetings.  The global conference has about 20,000 people and starts today - which is why I'm skipping town and heading home.  I enjoy my work on most days, and I used to do even more of this global hob-nobbing, but I grew weary and had other interests in life besides moving the gears of international bureaucracy, so I've moved in a slightly different direction.  Still when I'm back in the game, I get jazzed to be among my people talking about our stuff.  Increasingly though, I'm a little glazed and slightly dazed at these things. As an outsider, I find myself slightly bemused in our meetings, where we speak alot and say nothing, so I've decided to develop a magnetic poetry set for attending global meetings.  String together any of the below words and phrases, and you can participate, too!

inclusion     participation     participatory    comprehensive    inform    disseminate    society    community    community-based    healthcare systems     access     quality services      reduction    elimination    virtual elimination   eradicate    alleviate    women and children    safety and security    society    reach     researchers and practitioners     create     develop    support     strengthen    most vulnerable     affirm    re-affirm    commit    re-commit    progress    adequate progress   appropriate     process     measure    civil society     contribute    empower   reach    bringing together    chronicle and document   joint-efforts    gatekeepers    entry points   advance   rigor   robust evidence    knowledge gap    action   efforts   initiative     challenges and opportunities     stakeholders    partnerships   public-private partnerships    outcomes    results     resources   goals   2012   2015   programmes    
                    

Design for the Other 90%

This exhibit at the National Geographic Hall in DC sounds fabulous (and free!).

Of the world’s 6.5 billion people, 5.8 billion, or ninety percent, often lack the means to purchase even the most basic goods. Design for the Other 90% explores a growing movement to design low-cost solutions for those not traditionally served by professional designers. Entrepreneurs, engineers, students, professors, and architects from around the globe are devising cost-effective ways to improve access to water, food, energy, education, healthcare, revenue-generating activities, and affordable transportation. This exhibition demonstrates how design can be a dynamic force in saving and transforming lives, at home and around the world.

I find this design space very fascinating.  Design for the hip and wealthy is cool and fun, but what about functional, low-cost, low-tech, appropriate design that can improve the lives of the world's poor?

I've always been a fan of Path, a global health organization in Seattle for their global health programs and technology around this principle (PATH once stood for Program for Appropriate Technology in Health, but they've long abandoned the root of their acronym, and simply are known as Path these days).  Path has developed the Uniject, which allows low-skilled, "lightly trained" health workers to give vaccinations with single-use, pre-filled injection needles (reducing user-error and disease transmission through re-usable syringes). They've also developed a sticker that indicator if vaccines have spoiled from temperature extremes or rough rides in its arduous journey from pharma-plant to rural village.  And they are looking at the food industry to learn lessons about improving the thermo-stability of vaccines so that the delicate cold chain requirements of vaccine transport can be overcome.  Path has other cool health design projects for the other 90%.  One of my favorites is the ground-breaking work Path is doing on developing a microbicide to give a women the ability to protect herself from HIV- (and other STD-) transmission without depending on her partner to use condoms or be monogamous (two dicey propositions in the reality of many women's lives).

There are other neat industrial design innovations for the other 90% - the handcrank radio, the $100 laptop, the insecticide-treated bednet, among others.  And mobile phone technology is being used for everything from banking to refugee family reunification.  Mobile phones have become low-cost and widely accessible to the poor, making this technology potentially limitless in connecting the poor not only in their family and social networks, but also for education and economic participation.  Amazing!