first: i’ve discovered that the content of the internet can be described as an ever-decreasing fractal. it goes something like this:

• most of the content of the internet is porn.
• of the portion of the internet content that is not porn, a proportion equal to (porn)/(total content) is taken up by questionable online vendors.
• of the portion of the internet content that is neither porn nor questionable online vendors, a proportion equal to (porn)/(total content) is stupid emo shit.
• of the portion that is not porn, questionable online vendors, or stupid emo shit, a proportion equal to (porn)/(total content) is devoted to anthropomorphizing cute animals.
• of the portion that is not porn, questionable online vendors, stupid emo shit, or cute animals, a proportion equal to (porn)/(total content) is absorbed by religious and/or political zealotry.

and so on, and so forth.¹ if i could find my notes from my undergrad 4th dimensional math class (primary text: flatland), i could probably even graph it out in something other than an ever-narrowing pie chart.

2. nothing gets my goat like a badly-written survey instrument. if you’re going to ask about sexual behavior and accept the fact that non-monogamy exists, you might want to ensure that your followup questions aren’t written with a monogamy bias so strong that it’s impossible for a multi-partnered person to answer them in a way that won’t give you crap data. yes, i’m looking at you, university of indiana PhD candidate research.²

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¹ these categories are not exhaustive, nor are they necessarily in the right order. i’m open to suggestions.
² honestly, if that’s the type of instrument design that gets approved, i’m glad i never went further in public health academia than an MPH. it seems there’s more rigorous design and pre-testing in the commercial world, where millions of dollars of marketing and r&d money are assigned on the basis of research findings.

in the next few months, i am going to have a crash course in the work done by reproductive endocrinologists.

funny, i never thought that this would be my life. but miscarriage #3 seems to be concluded, so we’ll see what happens. i may or may not blog about this, or anything else much. the urge to stick my virtual head in the virtual sand is strong.

(and it just struck me that when i created the category “women’s reproductive health” i never thought i’d be talking about me…)

i love me some medicoliterary geek humor.

i suppose, since i have the post editor open and all, that i should take this moment to apologize for the dearth of posts in recent months. i know i’m letting my loyal reading audience of 3 down, and i’m sorry. it’s just a bit difficult to tread water and type at the same time.

i had signed up for NaBloPoMo with the best of intentions. a post a day for a month? i could handle that. even with some light holiday travel, i could post from my phone. i’m not working right now, so what better way to exercise my photography and writing muscles?

who was i kidding. this is 2009. if there’s been a consistent theme this year, it’s been this: make a plan, have it fucked with. it’s amazing we even got to mexico (the asshattery of acapulco notwithstanding), all things considered.

so what happened to my plans this month? well, i learned two new medical terms, of course. (i hate learning new medical terms. “fetal bradycardia” was the first one of the year, and it’s been a constant suck since then.) these are the new two:

giant cell tumor of the tendon sheath; and
pigmented villonodular synovitis

there’s a school of thought that they’re really the same thing, just in different sites. from a treatment point of view, it doesn’t matter which one it is. neither is malignant; they’re both benign aggressive soft tissue tumors.

and i have one or the other in my right foot. it’s about the size of a golf ball. it wasn’t always so big, and only recently has it begun to cause any pain. by now, though, it has enveloped the two peroneus tendons and eaten up part of the cuboid bone (the x-ray and MRI look amazingly like a mouse has been at it). because of this, it needs to be removed before it causes major permanent structural damage. it needs to be removed NOW, because i’m still trying to get knocked up, and i’m not about to undergo general anaesthesia while newly preggers – again (we saw how well that worked out back in april). or, for that matter, hugely preggers (i know i’m getting ahead of myself, but i’m still hopeful). and since it’s an aggressive tumor, if it’s not removed, it’s going to keep growing, getting more painful, and doing more damage to my dainty (okay, size 9 – but it’s long and elegant at the moment) foot. even with the tumor removed, there’s a 45% chance it will grow back. grmpf. the upshot is that the week after thanksgiving (and two days before my birthday, no less – those plans certainly got screwed too), i’m going back under the knife.

that’s right. i’m headed for four surgeries in oh-nine. one for each quarter. yay me.

so i’ve been too grumpy to blog daily, and for the last week i’ve been gimpy due to pain and swelling following an exuberant core biopsy that angrified the tumor and the foot, which cut in on photography, and my plans to start working out again, and my plans to look for a job.

and there you go. the universe is mocking me. doing a damn good job of it, too.

the straight porn industry has managed to fool itself into believing that regular HIV testing by an industry-funded clinic – rather than mandatory condom use – is good enough to keep its performers protected from disease.

as they recently found out, it might be better than no testing at all, but it doesn’t hold a candle to condoms. the companies are blaming the condom-optional policy on the performers.

a much better rundown of the situation – and the stupidity that led to it – is over at sugarbank.

in related news, i see that lifestyles is now marketing a polyisoprene condom. there’s a review (6 months old) over at the condomunity.

the fourth circuit court of appeals has upheld virginia’s (previously overturned) “Partial Birth Infanticide Act,” which apparently criminalized a specific abortion method.

although it isn’t clear to the layperson (read: me) which procedure was banned, the wp describes this:

Although the Virginia law permits women to choose various abortion procedures, it specifically makes it a crime for doctors to perform a rare midterm abortion that involves partially delivering the fetus before crushing its skull to ease removal.

i haven’t yet had a chance to read the opinion myself, but the post’s coverage indicates that the majority’s opinion essentially reasoned that doctors’ criminal liability for performing this type of procedure is so unlikely that the fact of the criminal liability isn’t enough to invalidate the law.

the entire purpose of the law is to criminalize that abortion procedure. if it’s exceedingly unlikely to fulfill its purpose, the law is unnecessary legal accretion and has no reason to be cluttering up the books. taking the majority’s assertion (as interpreted by the post; as i mentioned, i haven’t yet read the opinion) at face value, if doctors are unlikely to actually face criminal prosecution for performing the procedure, and yet there’s substantial pressure to retain the law, there must be some other reason driving the decision.

hmmm. i wonder what it could be.

abortion opponents are apparently very willing to criminalize doctors’ therapeutic decisions. they seem to ignore the fact that if the doctor is committing a crime, then the woman is an accessory to the crime, and guilty of conspiracy as well. abortion opponents should be honest about their intent, and attempt to hold the woman criminally responsible as well. let’s see how far legislative efforts would go then.

hey, judy, wherever you are – the president signed the FDA tobacco bill. i think you’d be pleased with most of it.

miss you.

i always feel some embarrassment when former professors or other people i’m familiar with are publicly called out for wrongdoing, justifiably or not. such is the case with tee guidotti, former department chair at GWU SPHHS. a review panel found that “inattention to detail,” rather than interference from DC’s water utility, led him to the central conclusion in a published article that

there had been no identifiable health impact from the unprecedented concentrations of lead in [DC's] water from 2001 to 2004

subverting research for money, i can understand (but abhor). sloppy research? from a professor? inexcusable.

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the draft of kennedy’s HELP bill currently circulating (his answer to health care reform) prohibits health insurers from excluding pre-existing conditions from coverage. it also limits what characteristics insurers may consider when setting premiums, to “family structure” (although i wonder if that means they could charge higher rates for same-sex couples), community rating area (minimum size set by HHS), actuarial value of the benefit, and age (with limitations).

because insurers are also prohibited from excluding potential enrollees or placing annual or lifetime limits on benefits, (“each health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies for such coverage”) this could force a greater pooling of risk – causing some premiums to rise, and others to fall – although i suspect the actual outcome would be that insurers would simply offer a wider variety of clinical coverage options, and charge more for more comprehensive plans.

the bill does set out minimum coverage requirements for all plans, which must include preventive services rated “A” or “B” by the US preventative services task force (such as regular mammograms for women age 40 or over, cervical cancer screening for sexually active women, cholesterol & blood pressure screening, and certain disease screening for pregnant women. all other OB-GYN screening guidelines are interestingly currently under revision.), immunizations, and non-adult preventive care and screenings in guidelines promulgated by HRSA.

(at page 40 of 615 they started talking about health insurance gateways, and lost me completely.)

and of course, it goes on and on, and is currently being marked up in committee. best quote so far, by barbara mikulski (paraphrased): “some call this bill a combination of rube goldberg and karl marx. well, the current system is a combination of adam smith, darth vader, and invasion of the body snatchers.”

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update OH! and i totally forgot – my favorite public health news story of the week – yesterday’s news that a smoking ban is being rolled out in virginia’s prisons. in unsurprising republican fashion,

“I don’t have any problem with prisoners being denied the right to smoke,” said House Majority Leader H. Morgan Griffith (R-Salem). “The only question I have is what effect it would have on control.”

go figure.

earlier this month, maryland authorities issued a warning against consuming rockfish and bluefish caught in coastal atlantic waters (according to their chart, this doesn’t extend to rockfish caught in the chesapeake, but the chart hasn’t been updated since may ‘07).

the warning says that

pregnant women, women of childbearing age, nursing women and children under 6 should not eat rockfish or bluefish caught in the Atlantic by amateur fishermen. People not in those groups may eat one meal of rockfish, also called striped bass, from the Atlantic every month, and one meal of bluefish every other month.

note that it only applies to fish caught by amateur fishermen. not to commercially-caught rockfish or blues from the same area. why? well, it’s not because commercially-caught fish are safer. it’s because commercially-caught fish fall under federal jurisdiction.

when i have a spare moment, i’m going to check the feds to see if they’re also warning against eating those fish. it’s not like PCBs discriminate by type of fisherman.

update: a quick search on the fish & wildlife service website yields nothing; the FDA is equally useless. USDA?

i was browsing through the google analytics, curious about what search parameters bring people to this blog, and i came across this question buried in the list. it struck me that i’ve never really thought about it.

first, there are the definitional questions. what did the searcher mean by “worth it”? and – don’t laugh – what did he or she mean by “be”? is this a cost-benefit analysis? a worldview question? is my existence defined by my advanced academic degrees? (the short answer to that one is a resounding “no,” by the way.)

i grew up in a public health household, and the most fulfilling work i’ve ever done has been in that field. i decided to earn an mph for entirely economic reasons, though – the added income from the degree. there was very little offered in the coursework that i either hadn’t already studied, or hadn’t learned at the dinner table or in the field. (obviously this wouldn’t be the case for most people, but i remember looking at maps of central american countries with my father when i was in 7th grade, as he determined the catchment areas of rural health posts. the broad street pump was practically a bedtime story. in fifth grade, i made a presentation to my class on contraceptive methods, much to my language arts teacher’s dismay. imagine explaining vaginal suppositories to your teacher when you’re ten years old…)

the mph was “worth it” in the sense that i completed my coursework while working full time, and saw a satisfying bump in my income. but it didn’t do much to change the way i looked at the world, or analyzed problems. it was really just academic and professional recognition of something i already knew.

the jd on the other hand – now that is a completely different story.

i went to law school – several years after earning my mph – simply because i could. i scored well on the LSATs; international trade law and health law issues were directly pertinent to my work, and unlike public health, it was not something i could learn from my parents or on the job. i never had any interest in practicing law in the courtroom or for a firm. i just wanted the additional analytical tools. and from that perspective, earning the jd was definitely “worth it.” i loved law school. i didn’t have much exposure to the socratic method, but it was thrilling in the classes where the professor used it. hypos were essentially big puzzles to which case law, statutes, and regulations could be applied – fitting the pieces together to determine possible answers. i learned more about the u.s. government than i had before (growing up overseas and having a narrow academic interest in college can stunt one’s civics education), and my appreciation and respect for the rights and responsibilities of individuals grew enormously, challenging my generally-unquestioned collectivist public health mindset. my public health positions have been somewhat altered by my legal education, both reinforcing some beliefs and leading me to question and reject others. i think these are all good things.

i “am” an mph jd in the sense that those letters come after my name on my business cards. i currently work for an organization whose primary focus is the law, and in an issue area that happens to be health (but not public health as its usually construed). when i read the newspaper, i naturally gravitate toward health and law reporting in areas that interest me, and i think i’m more likely to question assumptions i come across than i was before my degrees. but the mph/jd doesn’t define all of me. a quick search through this blog gives a much better picture of who i “am” than five letters on cardstock, or the diplomas gathering dust at the back of my closet.

i’ve found many benefits to having an mph/jd, and given the opportunity, i would likely do it again. one drawback, though, is that i’ve educated myself out of the type of jobs (and beyond the expected income level) that i like – at least for the moment. i’m an analyst at heart. show me a forest, and i’ll start cataloguing the trees and wildlife, and developing theories about pretty much anything i’m asked about. the big picture – the policy decisions, the strategic planning, the long-term outlook – these are things in which i have no particular interest. if i agree with them, i’ll happily work to support them, but i’d rather leave the development to someone else.

so there you go. a more introspective post than i’ve written in some time. and it probably won’t help the person who originally posed the question one bit. because what “worth it” and “be” mean to me may be entirely different than what they mean to him or her.