UPDATE 9/9/19: The company that manufactures Daysy is now the subject of a legal investigation. More information is available here: http://www.khuranapc.com/daysy-investigation. If you purchased a Daysy, please be sure to read about the investigation and determine if you would like to speak with these lawyers to share your experience. (NOTE: as of 9/20/19 that link is no longer functional. I will share additional updates as they become available.)


In May 2019, 404 days after I submitted a commentary detailing egregious flaws in data collection and analysis of a study purporting to estimate contraceptive effectiveness of the Daysy thermometer -- that study was retracted from the journal Reproductive Health. The retraction note says: “Independent post-publication peer review has confirmed that there are fundamental flaws in the methodology which mean that the conclusions are unreliable due to selection bias and the retrospective self-reporting of whether pregnancies were intentional.”
 
Science reporter Stephanie Lee covered the retraction story in Buzzfeed. Prior writings had investigated Daysy and detailed unethical behaviors by Valley Electronics (Daysy’s manufacturer) – including that the company kicked people out of online forums for asking questions, and used manipulative language in their marketing materials. In a comment on PubPeer, I also detailed unethical behaviors by Valley Electronics.
 
I’m glad to have helped to remove junk science from the literature. Hopefully, fewer people will be made vulnerable to unintended pregnancy via misleading, unsupported claims. While the retraction was very important, it does not fully solve the problem. Elsewhere, I’ve described the concerning asymmetry between the rapid spread of misinformation on social media and the long, slow process of addressing misinformation in the scientific literature, and how this mismatch can ultimately impact public health.
 
So, I have more to say.

A few years ago, the Department of Population, Family, and Reproductive Health at Johns Hopkins Bloomberg School of Public Health asked me to give an "Amazing Alumni" lecture, as part of their 100th anniversary celebrations. I was beyond honored to be one of six alumni chosen to give a talk! I was asked to reflect on my career trajectory. Since most talks I do focus on research findings - it was a challenge (an intimidating one!) to put together a talk that was more personal. It was even more intimidating to deliver it to a room full of the people who taught me much of what I know about global public health!

I've worked on some controversial issues in sexual and reproductive health, so decided to make 'controversy' the theme. In retrospect, I'm annoyed I didn't sneak this Prince song in to the talk, but...live and learn.

It was a fun opportunity to reflect on some lessons learned so far in my career. The audio recording of my talk is posted here (a few minutes seem to be skipped near the end), and slides can be downloaded below.

I've admired the FPVoices project by K4Health and FP2020 for so long, and was very honored when they asked to interview me at the International Conference on Family Planning in Rwanda in November 2018.

In an audio interview posted on Soundcloud, we chat about what got me interested in reproductive health, who inspires me, working on controversial issues, doing systematic reviews, and subjects like hormonal contraception and HIV, fertility awareness based methods, multipurpose prevention technologies, reproductive justice, infertility, and more.

To see other #FPVoices, check out their wonderful page: http://fpvoices.tumblr.com/. I feel very grateful to be part of this community!

What if I told you that a fancy thermometer was "similar in effectiveness" as an IUD at preventing pregnancy, and only required you to take your temperature once a day?
 
Well, if I told you that, I’d be misleading you and putting you at risk of an unintended pregnancy.
 
But, that’s what a company called Valley Electronics AG has been telling consumers, in hopes of selling their $330 device called Daysy.

Over the last several years, I've been collaborating on a project on measuring infertility in low resource settings with an amazing group of friends/colleagues: Dr. Carie Cox, Dr. Ozge Tuncalp, Dr. Alex McLain, and Dr. Marie Thoma. The journal Human Reproduction recently published our manuscript, called: Estimating infertility prevalence in low- to middle-income countries: an application of a current duration approach to Demographic and Health Survey data.

The letter below was sent to Judge Sam Benningfield, in response to this news story. Access to contraception is critical to ensure reproductive health, and inmates who desire it should be provided with access to it. However, any form of reproductive coercion is unacceptable, and enticing inmates to use contraception in exchange for reduced jail time is coercive.

For many years, scientists have tried to answer several questions about whether various hormonal contraceptive methods (i.e., pills, injectables, implants, hormone-releasing IUDs, patches, and vaginal rings) impact various HIV-related risks. Key questions on this subject include:

1. Are HIV-negative women who use specific methods of hormonal contraception more likely to acquire HIV?
2. Are women living with HIV who use specific methods of hormonal contraception more likely to transmit their infection to a male sexual partner?
3. Are women living with HIV and using specific methods of hormonal contraception likely to experience faster clinical disease progression?
4. If a woman living with HIV is using antiretroviral therapy (i.e., medications to treat HIV), will using any specific method of hormonal contraception result in drug interactions. In other words, could using both medications at the same time make either medication less effective, or more likely to result in side effects?

The first question is the most controversial, and is a critically important question for women's health - particularly for those living in high HIV prevalence countries, including many in Eastern and Southern Africa. However, for a number of methodological reasons (many of which are detailed in this paper), it is extremely complex to design studies that will provide definitive answers.

In January 2016, I attended the fourth International Conference on Family Planning. I've been very fortunate to be able to attend all four of these incredible gatherings: in Uganda in 2009, in Senegal in 2011, in Ethiopia in 2013, and in Indonesia in 2016.

At these conferences, I'm always reminded what it feels like to be surrounded by everyday heroes working in reproductive health, and I inevitably come home more inspired and reinvigorated. This year was particularly energized because of the large youth delegation that brought incredible spirit and talents to the conference!

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.

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!

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 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.

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. 

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?

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.

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.

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.

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. 

* 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.

This past weekend, Dr. Alice Roberts published an article on the combined oral contraceptive pill in The Guardian. I was excited to see a media article on contraception by a scientist and a Professor of Public Engagement, assuming it'd be evidence-based and teach me more on writing about science for lay audiences.

The article implies a link between premenstrual dysphoric disorder (PMDD) and oral contraceptive pills, based in part on the opinion of Peter Greenhouse, a consultant in sexual health who sat next to Roberts at a conference dinner. Roberts writes:

A strong assertion!  Intrigued, I kept reading, eager for a discussion of the epidemiological evidence behind this statement (which contradicts information in resources like the evidence-based, frequently-updated book, Contraceptive Technology).

​When reporting on new scientific research, journalists sometimes seem to sacrifice accurate representation of scientific data for an eyeball-catching headline/story. The scarier the news, the more compelling the headline.  

To my understanding, journalists don't always get to write their own headlines, but they do have control over the balance of reporting within the story.  When reporting on issues related to contraception, some stories seem to focus exclusively on risks (or present risks out of context), without reporting the benefits of a given contraceptive method. 

Women deserve to know both the risks and the benefits (and any lingering scientific uncertainties!) related to any contraceptive method they may consider using.

Thanks for visiting! I intend to start blogging here soon, but I'm also very interested in what you have to say! Please strike up a dialogue. I know some of the subjects I work on evoke strong emotions, so let's keep it respectful, and wherever possible, evidence-based. 

I look forward to connecting and learning from you!