About Mark Evans

I am a 2nd-year med student at the University of Pittsburgh. I have an MSPH in Global Disease Epidemiology and Control at the Johns Hopkins Bloomberg School of Public Health. I spent last summer doing epidemiology research on maternal & child health in India. Now I'm just trying to make it through 2nd year and Step 1 while enjoying myself along the way.

Rape Whistle 2.0

Rape whistle 2.0; uses smartphone to call for help. I wonder if it’ll turn out to be effective.

Uterine fibroid morcellation

Interesting short summary article about uterine fibroid removal. Had no idea there were an estimated 600k hysterectomies per year in the US.

Article summary:
There’s growing concern that minimally invasive surgery to remove fibroids by cutting up tissue into small pieces (morcellation) may lead to dissemination of undetected malignancies. A study of >1000 instances of uterine morcellation at 1 institution found 9 of 14 patients, or 64.3%, with benign and malignant uterine tumors experienced dissemination! The problem is that symptoms and imaging findings associated with uterine sarcoma vs. benign fibroids are often identical. Plus, endometrial sampling for uterine sarcoma only has a sensitivity of 38% to 62%. One proposed solution to the dissemination risk involves grasping fibroids through a minilaparotomy incision or the vagina and then shelling the fibroids inside a bag before morcellating them.

Female Voter Suppression

I probably shouldn’t have been as surprised by this as I was, especially in a state that has been one of the most active in recent months in anti-choice politics.

Starting this November, Texans must show a photo ID with their up-to-date legal name instead of IDs like a birth certificate. That’s not a problem for single or married men — but it leaves a third of Texas women scrambling in a state with just 81 DMVs in its 254 counties. 

(occupydemocrats.com via watchdog.net)

No Woman, No Drive

A friend sent me this great video about women driving in Saudi Arabia.

I wonder if we might expect other feminist memes/snowclones like this one?
No woman, no buy (financial independence, or shopaholic/profligacy stereotypes)
No woman, no eye (hijab covering eyes)
No woman, no thigh (fat shaming)
No woman, no pi (discouraging women from pursuing STEM careers)
No woman, no fly (women in Air Force or requests for sex-segregation on airline flights)
No woman, no pie (also fat shaming)
No woman, no bi (anti-bisexual, or also anti-lesbian)
No woman, no guy (virginity, virginity tests)

Most of these are a bit of a stretch, but I still think it’d be cool to see them.

Women to protest driving ban in Saudi Arabia tomorrow, October 26


Tomorrow, October 26, 2013, Saudi Arabian women are set to stage a massive protest against the ban on women driving. It is currently the only country in the world in which women are not allowed to drive.

FMI, follow Eman Al Nafjan, @Saudiwoman, and Madeha Al Ajroush, @madehaAlajrous on Twitter. Al Nafjan’s YouTube channel has lots of videos posted recently of women defying the ban. One of the videos even shows other cars giving the driver thumbs-ups as they pass by, beginning at about 40s.

Dr. Madeha Al Ajroush, who took part in the country’s first protest in 1990, posted a video of herself driving a couple of weeks ago.

A transcript of the English subtitles in the video reads:

It is now time for Saudi women to drive.
I’m ready.
My daughter is ready.
And also society is ready.
For how much longer can we live in an oppressive society that prevents us from our full rights.
I drove in 1990 to demand my right and now, twenty three years later, we still have not gotten our rights.
How much longer?

The website www.oct26driving.com has been widely reported to be a petition that gathered over 15,000 signatures before it was blocked by Saudi authorities.

NPR ran a story this morning in which Deborah Amos interviews Dr. Madeha Al Ajroush from Riyadh. Al Ajroush describes the feeling of the first protest as “exhilirating. It was great”. However, she has lost her job twice, after defying the ban in 1990 and again in 2011. The 47 women who took part in the 1990 protest were denounced by name in the newspaper, lost their jobs, and suffered a government travel ban. She was ordered to stop work as a photographer and officials confiscated and burned 15 years of photographs and documents, but the punishment wasn’t as bad as she feared, since she wasn’t jailed. In the story, Deborah Amos explains that there is no law against women driving, that it is an unofficial ban that is supported by conservative clerics. Al Ajroush describes what the ban is like for women:

It’s like a person being cut off–they’re legs are cut off and the wheelchair has been taken away from them and you are completely dependent on one gender.

Women have to be driven by male relatives or hired drivers, who are “part of an army of imported labor” in Saudi Arabia.

Every time I’m in the car with a stranger that hears all my phone conversation, that knows every single detail of my life. He knows what I like. He knows if I had a fight with my husband. He knows everything. It’s worse than the CIA in United States. [laughter] He knows everything about me.

Al Ajroush’s also describes how she will react when women finally get the right to drive:

I would be relieved and crying and the tears will be about the dedication and the years, and the losses, for such a simple thing–the right to drive.

Dr. Madeha Al Ajroush’s name sounds like “Madeeha Allagoosh” or “Madeeha Allagroosh”, and might be easily misspelled as Madiha, Medeeha, or Mediha and Allaghoush, Al Agoosh, Alla Goosh, Allagoush, etc.

The secret to a perfect marriage: just submit to your abusive husband

A star from the feminist reality TV show Real Housewives of New Jersey”, Melissa Gorga, has written a book about the secrets she’s learned to make her marriage work.

Tracie Egan Morrissey at Jezebel says it better than I ever could (especially since I haven’t read the book), but here’s my take on it. Her article’s title says that the New Book Advocates Marital Rape. I was expecting a run-of-the-mill account of rape culture through a single anecdote about how to please your man in bed. Instead we get an insiders view of an abusive relationship. As Morrissey put it:

The amount of sexism, gender essentialism, and caveman logic within its pages is so appalling that it’s difficult to believe that her book is anything but a cry for help.

It’s so bad in fact that her husband interjects his opinions throughout the book, including his rape advocacy/rationalization [emphasis mine]:

Men, I know you think your woman isn’t the type who wants to be taken. But trust me, she is. Every girl wants to get her hair pulled once in a while. If your wife says “no,” turn her around, and rip her clothes off. She wants to be dominated.

Women don’t realize how easy men are. Just give us what we want.

We are regaled with stories of how she uses sex to stave off his wrath and prevent him from cheating. How he as taught her and corrected her from the earliest days of her marriage exactly how he envisions her behaving. How he gets angry (justified as “he doesn’t feel respected”) if she’s not home and dinner’s not on the table when he arrives home from work. How they raise their boys with their own separate entrances to the house, but their daughter is going to be coddled and controlled until she’s safely married*. How he controls her dress and her weight. How she doesn’t even defecate if he’s in the house, lest he be reminded that women are human beings with bodily functions, too (one can only imagine the lengths she has to go to when she’s menstruating).

And of course there’s the sinister knife metaphor:

Joe always says, “You got to teach someone to walk straight on the knife. If you slip, you’re going to get cut.”

Top it all off with a healthy dose of domestic violence**:

If he gets one ounce of flack from me, he flips a switch and goes off.

…and you’ve got yourself the perfect marriage.

What has the world come to that books like this are sold as relationship advice?

* Married to her second boyfriend. Of course. Who else could it be? Not boyfriend number 3. You know what they say– 2’s company, 3’s a slut. And certainly not a woman, either. Can someone call social services for Antonia?

** It seems that in the book, her husband’s (physical) violence is limited to breaking things like highchairs, but that a friend has said in an interview that he has “smacked her on the face”.


Landmark report on drug-resistant infections in the US

The CDC just released a report, Antibiotic resistance threats in the United States, 2013, that “gives a first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs having the most impact on human health.”

The press release links to the nice infographics included in the report of national summary data. There’s also a video briefing by Dr. Tom Frieden, director of the CDC, and a digital press kit where you can download individual infographics.

img43Here are some simple infographics about three bacteria the CDC describes as “Threat-level Urgent”:

C. diff InfographicCRE InfographicDRNG Infographic

There’s also a couple of infographics explaining how antibiotic resistance develops and how it spreads.


I like this one because it is so simple while clearly illustrating 3 important principles:

  1. Antibiotics generally don’t cause resistance per se; rather, they select for organisms that already have resistance.
  2. Killing the “good bacteria” in our bodies allows resistant pathogenic ones to take over.
  3. Bacteria can transfer their resistance to other bacteria.

National Summary Data, Antibiotic Resistance

I like that this one illustrates the role of livestock in the development of resistance. I wish they’d made this one gender-neutral, but at least they have a mixture of men and women and of different race/ethnicities.


Rape in Asia

IRIN describes a UN report today with the results of a survey in Asia on rape and GBV.* The study was also published in The Lancet. The survey interviewed 10,168 men in 6 countries from Jan. 2011-Dec. 2012: Bangladesh, Cambodia, China, Indonesia, Sri Lanka, and Papua New Guinea. The study found the country with the highest prevalence of men who have raped women was Papua New Guinea:

“with 62 percent of the men interviewed there indicating they had raped a woman.” (IRIN)

The study probably found higher rates of rape than previous surveys in part because it never used the word “rape” in the questionnaire, asking instead (about non-partner rape) about having “forced a woman who was not your wife or girlfriend at the time to have sex” or having “had sex with a woman who was too drunk or drugged to indicate whether she wanted it”. Novel concept, that (that rapists might not think of the rapes they committed as rapes or that they’d show social desirability bias if the word “rape” were used).

It also found that:

“The most common motivation perpetrators gave for rape was a sense of sexual entitlement – the belief that men have a right to sex with women regardless of consent (73 percent of respondents). More than half said it was for entertainment (53 percent), while alcohol, often assumed to be a common trigger for violence, was the least common response.” (IRIN)

It’s interesting, though not surprising, that entitlement is the top motivation. Entitlement and entertainment. I just watched the first half of “Half the Sky” today and the focus seemed more on shaming rape victims and extending that shame to family members, who then turn on the victim. It’s just depressing how far there is to go, how difficult it is, and how easy it is to regress in encouraging cultural change that empowers women and teaches men to treat women as equals and not as objects they are entitled to use for their sexual gratification.

I wonder what the reasons could be for alcohol being the least common response. Would that be evidence in favor of or against the oft-cited adage that “alcohol doesn’t make you do anything you wouldn’t want to do when you were sober–it just gives you the ‘courage’ to actually do it (i.e. it disinhibits you)”? While I was in India this summer, I got into a bit of an argument with some friends about the statewide ban on alcohol instituted under Chief Minister of Gujarat, Narendra Modi. They seemed convinced that such a policy had all-but-eliminated domestic violence in the state. Needless to say, I am not convinced. I’m not even convinced that, individual liberties aside, the policy is actually a net benefit for the people of Gujarat. Alcohol deserves its bad reputation as possibly the first or second most harmful drug on earth, but I wonder if anti-alcohol-abuse campaigns that focus on DV aren’t obstacles to DV prevention in the long term.

*The IRIN site crashed and was giving 503 errors at the time of writing this article. The website for Partners For Prevention (who conducted the study) was down, too, according to NPR. Paranoid me wonders if it wasn’t sexist hackers angry about the study. Let’s hope I’m wrong.

Cochrane Collaboration joins AllTrials

That’s right, earlier today, the Cochrane Collaboration announced that it has “formalized its commitment to the AllTrials: All Trials Registered | All Results Reported initiative.”

This is great news, but I’m honestly a bit surprised that it took them so long. The Cochrane Collaboration is currently celebrating its 20th anniversary as a leader in the movement for evidence-based medicine. It was started as an answer to Archie Cochrane’s (a British epidemiologist) calls to maintain up-to-date, systematic reviews of randomized controlled trials (RCTs) of medical interventions. Cochrane Reviews, as they are called, are the gold standard in systematic reviews in the medical literature. This is because they use rigorous, standardized methods, published in the Cochrane Handbook, to ensure that the reviews are consistent, transparent, comprehensive, and as objective as possible. They are also accessible for free in over 100 low and middle-income countries (LMICs) (too bad they’re not open access).

When I first heard of Cochrane a few years ago, I couldn’t believe that something like them wasn’t already standard practice across the board. Come to think of it, I felt the same way when I first heard of “evidence-based medicine” for the first time. Wait, you mean huge portions of medical practice (even if you don’t count so-called “alternative” “medical” woo like homeopathy) are not based on evidence? Yes, it’s unfortunately true, or at least it was true before evidence-based medicine began to gather steam in the last two decades. Take, for example, the Cochrane logo:


The logo is what is called a forest plot[1] and this one is a tragic reminder of the danger of not using systematic reviews. Each horizontal line shows the results of one study. The vertical line is the point where the treatment does not help people, but it doesn’t hurt them either. The left side of the vertical line means that the treatment is good and the right side means that it’s bad. The length of the line shows how precise the results are (the shorter the line, the more precise it is). If a line touches the vertical line, that means the treatment didn’t make a clear difference. The diamond at the bottom is what you get when you combine all the studies. In this case, it’s for giving hormones called corticosteroids to pregnant women who are going to give birth too early in order to prevent their babies from dying. The study at the top was done in 1972.[2] Ten years later, it should have been clear that the corticosteroids worked (we now know they reduce the odds of babies dying by 30% to 50%). But, a systematic review was not published until 1989, so many doctors did not know how good corticosteroids were. Because of that, tens of thousands of babies probably died.

 It’s not an exact science, and it takes a lot of hard work to develop systematic reviews, but they really do save lives and prevent needless suffering. However, even though Cochrane has the world’s largest database of clinical trials, it is still vulnerable to the effects of not reporting the results of trials, or of not even registering them in the first place. I’m glad to see them join the campaign to get all trials registered and all results reported.

1. Though the plots themselves were being used by at least the 1970s, the term “forest plot” itself was not used in print until 1996 in Pittsburgh in a poster presented at a meeting of the Society for Clinical Trials in May 1996.

2. The 1972 study looks like it should have been clear that corticosteroids are awesome after just one study, but it’s risky to trust just one study. Science works because we’re always testing each other’s theories and questioning our results. If no one else can get the same results, then we throw them out and try something else.

Take that, Sebelius!

A judge ruled today that Plan B can once again be purchased OTC for women of all ages (well, in 30 days it will be)! For now, they’re still behind the counter and only women 17 and over can buy them without a prescription.

My new favorite judge, U.S. District Judge Edward Korman, had a great quote in his ruling:

The invocation of the adverse effect of Plan B on 11- year-olds is an excuse to deprive the overwhelming majority of women of their right to obtain contraceptives without unjustified and burdensome restrictions.

And to think, Judge Korman was appointed by Reagan!

In response to the ruling, Nancy Northup, president of the Center for Reproductive Rights, said,

“Today science has finally prevailed over politics.”

Planned Parenthood said the ruling was,

“good policy, good science and good sense”

It warms my heart to see social justice advocates invoke science in their victory speeches.

It was only a little over a year ago, Dec. 2011, that Kathleen Sebelius, the Secretary of Health & Human Services, made the unprecedented decision to nix the strong FDA recommendation to make Plan B available to all, because of “cognitive and behavioral” differences in girls of the youngest reproductive age.

The case: Tummino v. von Eschenbach, 05-cv-366, U.S. District Court, Eastern District of New York (Brooklyn)