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With perfect use, such as in a laboratory or clinical setting, the OCP is 99% effective. Typical use reflects the rate of unintended pregnancies among all individuals taking the pill. With typical use, the OCP is only 91% effective. This accounts for how women take the pill in everyday life, which may include missing pills, forgetting to take it at the same time every day, and possible interactions with certain supplements and medications (prescribed and over the counter) that may make the pill less effective. Even if a sole focus on saturated fat back in those days was less than a complete view of diet and health, it would have nudged diets in just the right direction. But those days are gone, replaced by an age of low-fat junk foods. The edible poster child for the reduce saturated fat intake message-run-amok, as noted, is Snackwell cookies. For one thing, the message to reduce saturated fat intake was generalized to all sources of dietary fat, even though the relevant early research, such as that of Ancel Keys and colleagues, never really supported that. Again, if we think of this as avoiding dioxin by consuming arsenic, we see how truly silly it is. Third, the food industry aggressively marketed highly-processed, low-fat foods as THE response to scholarly guidance about reducing saturated fat intake. And then, the toxic cascade fulfilled itself predictably when studies looked at variation in saturated fat intake at the population level and found no attendant variation in rates of heart disease! Proof - so goes the cyberspatial shouting - that saturated fat was falsely indicted in the first place. The truth about saturated fat, to the extent we know it, is presented in article 4 . The intent here is simply to illustrate how a sequence of small distortions can translate into a massively misleading conclusion with widespread appeal and uptake. The dead were carted away. Dead dogs adorned the streets. Those who could afford, fled the city--including many doctors. They say that Jules Clement, the accoucheur, delivered the baby blindfolded, as per the king's demand. He did so well that he went on to be the midwife to the Spanish royalty. Engelmann, a nineteenth-century physician, wrote a article about birth among primitive people.

He wrote: I will describe the most important time of life for a woman . He said they do not marry out of their own tribe or race and the head of the child is adapted to the pelvis of the mother through which it is to pass. As soon as there is any deviation from these natural conditions, trouble results; George Engelmann, Labor among Primitive Peoples: Sharing the Development of the Obstetric Science of To-Day, 3rd ed. In our research, many women described struggling to take the pill at the same time every day, including forgetting to take a pill at the right time or missing a pill. One woman said, If I forget, I freak out that it doesn't work the same. According to one young woman, a lot of people forget, especially in college, your lifestyle doesn't make it easy to take [it] at the same time every day. Many women even knew of someone who became pregnant while taking the pill. Still, in our research, women expected perfect use effectiveness for themselves. They believed that the pill could be 99% effective in everyday life. In other words, they described a myth of perfect use whereby they wanted to be in control by taking the pill every day despite imperfect adherence (Sundstrom, Baker-Whitcomb, & DeMaria, 2015). The myth of perfect use impacted how they perceived the effectiveness of the OCP. In fact, some women suggested that perfect daily adherence offered increased control over the method's effectiveness. This led some women to view LARC methods with skepticism because they were not in control of taking it every day. My job requires constant attention to the new studies in nutrition. The evidence to the contrary is little less than overwhelming: the replacement of saturated fat sources with wholesome foods natively low in saturated fat improves health outcomes, and diets natively low in saturated fat because they are comprised predominantly of whole plant foods are associated with good health outcomes. As stated above, there was never a valid claim that saturated fat, per se, or any other nutrient for that matter, is or was the one thing wrong with our diets. We would not. Perhaps the most extreme and potentially the easiest form of message distortion is revisionist history. It is the most extreme because when messages pertaining to a whole period of history are distorted, it shifts dialogue and understanding at the level of the whole culture.

So, for instance, opinions could vary about whether Christopher Columbus was friendly or unfriendly, generous or miserly, and the cultural perspective on Columbus would be unaffected. But once we question whether or not he was the first European to American shores, it is a matter of cultural significance. So, too, for fundamental revisions related to diet and health . Revisionist history is potentially the easiest form of message distortion for the most obvious of reasons: the subjects of such redirected musing are generally not around to defend themselves. Louis: Chambers, 1884), 7. According to rough estimates, some 3 million women today suffer with untreated vaginal fistulas. These women are poor. They live in countries without proper prenatal or birthing care. They had long labors, often without any midwife or doctor. There were no hospitals nearby to repair their birth injuries. According to rough estimates, every year another 100,000 women suffer this miserable birth consequence, one that has an easy solution but is not accessible to so many women. Wall, Obstetric Vesicovaginal Fistula as an International Public-Health Problem, The Lancet 368, no. But as many journalists have pointed out, a huge undertaking is needed--money and a solid health infrastructure--to provide widespread care to every woman who needs it. But as Debby Applegate explained in her Pulitzer Prize-winning article about Henry Ward Beecher, The Most Famous Man in America (Houston: Three Leaves, 2007), New York City was schizophrenic when it came to slavery. What is the paradox of inertia? The paradox of inertia is the tendency to remain on the pill despite strong external forces, such as dissatisfaction, forgetting to take the pill on time, and recognizing LARC as a better option. In talking with women about their birth control practices, a pattern emerged: as the pill becomes part of women's identities and reinforces positive qualities such as responsibility, women are less likely to choose other contraceptive options. The myth of perfect use and women's desire for control when choosing a contraceptive method led to what we coined the paradox of inertia (Sundstrom, Billings & Zenger, 2016). Many women described dissatisfaction with the pill, including forgetting to take it on time. Most women were familiar with LARC methods and could describe the benefits of these options, even suggesting that LARC was a better choice.

Despite this knowledge, women resisted switching to a LARC method, creating a paradox of inertia. The paradox of inertia helps us to understand the strength of the pill as a social norm, the importance of control and responsibility in contraceptive choice, and the myths and misconceptions surrounding LARC methods. The paradox of inertia explains why women haven't simply switched to a LARC method based on the recommendations of experts. What birth control methods do the experts recommend? Whatever conclusions we are going to reach about Columbus, we must reach them without any direct contributions from Christopher himself. So, too, for Ancel Keys - a prime subject of revisionist historians - who died in 2004. As noted in his obituary in the New York Times , he was 100 years old at the time of his death, and had remained intellectually active through his 97th year. Dr Ancel Keys was in the vanguard of those who identified, more than half a century ago, the link between saturated fat from the usual sources (he did NOT make a particular study of coconut oil! So, let's think of this architecturally and use the metaphor that Dr Keys' work and studies are cornerstones of the modern understanding of diet and health, with particular regard to heart disease. This work is part of the foundation, as it were. We will return to this image, invoking a faulty foundation postulate. So, what if you undermine that foundation? What if you contend that Dr Keys was biased in both views and methods, maybe even unscrupulous, and basically cooked the articles? Well, then, you have undermined the foundation of much modern nutritional epidemiology, and the whole house comes tumbling down. Though New York state was home to the first abolitionists, many New York City financiers depended on the slave trade to stay afloat. Applegate said that more than $200 million poured into the city from Southern cotton plantations. Slaves were used as collateral. A local editor told the London Times that if slavery were abolished, the ships would rot at the docks, grass would grow in Wall Street and Broadway, and the glory of New York, like that of Babylon and Rome, would be numbered with the things of the past. The statistics were not combined until 1880, when these states were added to 19 cities from other states, which totaled about 17 percent of the population. In 1837, England and Wales started a vital registration, but causes of death were not listed until 1874.

For detailed information on the history of vital statistics, specifically with reference to maternal mortality, see Irvine Loudon's Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950 (Oxford: Clarendon Press, 1992). Cody, Living and Dying in Georgian London's Lying-In Hospitals, Bulletin of the History of Medicine 78, no. Regardless, the feeling among most women was that if you wanted to survive childbirth, you were better off at home and far away from maternity wards. Apparently, that subscriber did not want the children seeing it. The American College of Obstetricians and Gynecologists (ACOG) recommends LARC methods as the best, first-line contraceptive options for all women and adolescents. ACOG first established this best practice in 2012 and strengthened their recommendation in 2015. The American Academy of Pediatrics (AAP) concurred with this recommendation in 2014, establishing IUDs and the implant as the best options for adolescents and young women. ACOG and AAP agree that LARC methods are safe and effective for all women without limitation based on age or whether they have given birth. LARC methods, including IUDs and the implant are user-independent and more than 99% effective. They can last a long time; According to ACOG, LARC methods offer one solution to the problem of unintended pregnancy. What are long-acting reversible contraceptive methods? LARC methods include IUDs and the implant. In the United States, women have access to five IUDs and one arm implant. Just such an effort has figured rather prominently in the various arguments, both those propagated by individuals with whatever motivations, and those fostered by industries with obvious motivations, to vindicate saturated fat of all its crimes against our coronary arteries. Dr Keys' work has been variously and robustly criticized over much of the time since his death, and beginning only slightly prior. Dr Keys may still have been alive when the revisionist histories began getting traction, but at age 98 or so, one cannot fault him for limited efforts to challenge them . A game of toxic telephone at an exceptional scale ensued. The sequence of reasoning has been something like: Dr Keys misrepresented data to make it appear that saturated fat was implicated in heart disease risk, but it really wasn't.