Bursting!

Dear blog: I am bursting with new ideas but just haven’t had time to sit down and write about them. Five months into my residency, I’ve been to three conferences (CPHA, FMF, and JASP) and a variety of stimulating talks, spent a month at the regional public health directorate, and rotated through a variety of clinical settings. I’ve also started to have trouble remembering the English ways of saying certain things, which is terribly exciting. Les nombreuses questions que j’ai hâte d’aborder dans ce blog comprisent donc:

• Populations dites “défavorisées”/so-called “marginalized” populations:
  • Aboriginal health: the enduring legacy of colonisation, ongoing colonial attitudes, and the harms that can follow from good intentions. What is the ideal role of an outsider in helping a group of people meet its goals?
  • International health: how the colonial mentality of Westerners towards Africans remains alive and well in donor-driven HIV treatment rationing programs (see Vinh-Kim Nguyen)
    • and I never did finish writing about my experiences in Mwanza
• Sex!
  • The legalization or decriminalization of selling sex, the roots of prevalent attitudes and laws about sex work
  • Sex-positivity and the tyranny of monogamy
  • Birth control: why are so many people still starting with the pill?
  • Why did Québec abandon universal sex ed in schools? What should sex ed look like?
  • Kinder and gentler STI screening methods: are cervical and urethral swabs really necessary?
• Disease prevention
  • Cancer screening: not all it’s cracked up to be — breast cancer and prostate cancer screening in particular
  • Smoking: What succeeds in changing patient behaviour? Doctors, among many other things. But what succeeds in changing doctor behaviour?
• Big ideas in public health
  • Harm reduction: how broadly should we apply it? It’s increasingly accepted for drug use, but what about drinking in pregnancy? Domestic violence? Female genital cutting? Diabetes? Why some issues and not others?
  • Mandatory treatment: when does public protection trump individual liberty? We have the legal power to force tuberculosis treatment upon those who refuse, as a matter of protecting the people around them. Why not HIV? Why not any transmissible disease?
  • How do we write guidelines? How should we write guidelines? Do clinicians actually follow guidelines? What determines whether they do? (The Cochrane group has got some good opinions in their GRADE project!)
  • What forms of knowledge are valid? What counts as “science”? How certain can we be in our study of atoms, cells, people, societies? How fallible is the human enterprise of science? How does it propagate power imbalances? Who gets to ask the questions? Whose answers tend to prevail?
  • Population health fundamentals: how do risk and prevention work in individuals vs in populations? See Geoffrey Rose, Link and Phalen, and then Frohlich and Potvin (the latter requires a subscription, sadly)

Ohh, I want to tell you about all of it! You tell me: where should I start?