Archive for the ‘public health’ Category

women’s health, reproductive management | Scoop.it

April 4, 2015
chagall_nativite_nesign.jpg

chagall_nativite_nesign.jpg

For a scoop of my 2015 blog posts on LinkedIn and a couple of other social media, click here: women’s health, reproductive management | Scoop.it.

If my Good Friday philippic denouncing the Pill and its consequences https://lnkd.in/bPZVWKV makes you wonder how all this could be possible, think of the history of the Pill development and use.

History: The Great Bluff That Led To A ‘Magical’ Pill And A Sexual Revolution http://www.npr.org/blogs/health/2014/10/07/354103536/the-great-bluff-that-lead-to-a-magical-pill-and-a-sexual-revolution.

Development & use: Why too many young and not so young ladies could NOT receive flowers on Mothers’ Day: Why so many trying-to-conceive, why so much infertility https://biozhena.wordpress.com/2012/05/14/why-too-many-young-and-not-so-young-ladies-could-not-receive-flowers-on-mothers-day-why-so-many-trying-to-conceive-why-so-much-infertility/

The short URL above, https://lnkd.in/bPZVWKV, stands for http://biozhena.tumblr.com/post/113125522418/recap-2-reason-why-a-non-hormonal-birth-control  Recap #2 reason why a non-hormonal birth control option is a good idea: It’s not all in the head – the bad effects of the Pill.

And the motto in my profile is Contra Nescience Contra Insouciance. It stands for Against Ignorance Against Indifference.

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Seven billion people – after half a century with the Pill

November 14, 2011

More than a week before the numerologically so exciting (!!) date of November 11 this year of AD 2011, the population of the world officially reached the count of 7 billion – and this should not go unnoticed in a blog that is about women’s health and human reproduction management. Why, by the time the 11-11-11 day came about, more than 2.5 million more babies were born around the world.

Eyeball the “infographic” data below here, accepting that the image contains one of the small European languages. You can handle this because it is a graphic representation of the world and its population. The data is based on a United Nations Report about the State of the World Population. I did not find anything like this infographic when I googled for said UN report, and the bigger languages of Europe were presumably preoccupied by other concerns (like the economy, and the associated politics, stupid…).

So, we refer to this source with all those un-English letters with diacritical marks [RB, Lidové noviny. From: http://www.lidovky.cz/je-nas-7-miliard-lidstvo-v-budoucnu-uzivi-jen-zemedelska-revoluce-phq-/ln_zahranici.asp?c=A111031_085513_firmy-trhy_mev ]. It’s the numbers and symbols that matter, including the relative sizes of the circles. And note also that the blue circles represent the size of the respective continents’ populations in 2010 versus the red projected population sizes in the year 2050.

By 2050, only Europe’s population will have decreased (projected by 19 million), while all the other continents’ populations will have continued to grow. North America’s population, by the way, is projected to grow only due to immigration, otherwise it would be dropping, too. At least the USA’s would.

World population

World population

http://www.lidovky.cz/foto.asp?foto1=MEV3ed992_2poulaceTTTa.png

12 years times 365 days/year = 4,380 days

Population growth = 1,000,000,000 people / 4,380 days =  228,310.5 people born per day  (2,511,415.5 babies in 11 days = 1 billion divided by 4,380 days in 12 years times 11 days)

Check out the arithmetic of the global population growth in recent days, if you like. It is based on the birth rate of 1 billion births per 12 years. That is indicated in the bottom part of the infographic, showing the worldwide number of people in increasing billions against the years at which the given billion count was reached up to now, and is projected to be reached in the future [rok means year and pocet obyvatel means number of people]. It’s noticeable that the UN-projected future growth rate slows down: see how 16, 29, 27 years between additional billion increments are projected for the next 3 one-billion increments.

I won’t go into the (serious) economic and political consequences of these numbers. Rather, I ask you to note that the current birth rate (1 billion per 12 years) has held steady for the last 3 or 4 one-billion increases in world population. Over most of the last half a century, world population grew in steps of one billion per 12 years.

We see that reaching the first billion of humans took more than 18 centuries (including BC). The second billion then took 123 years and the third 33 years, both these surely influenced by the two world wars. After that, the Pill notwithstanding, almost quarter of a million new people have been and are born globally every day (1B / 4,380 days of 12 years = 228,310.5 births per day).

Evidently, the introduction of the oral contraceptive pills and related contraceptives has NOT quite stopped the global population explosion. But then, what about the United Nations-projected drop in the population of Europe (which is a continent where the Pill is surely available)?

Well, I propose to share with you some data from Google Ngram Viewer, about the statistics on the recent historical occurrence of certain topics (such as contraception) in all books published in English, the data obtained via http://books.google.com/ngrams/info .

Briefly, when you enter phrases into the Google Books Ngram Viewer, it displays a graph showing how much those phrases have occurred in a corpus of books (here English-language books) over the selected years (here 1900 to 2008).

And an important point, also cited from there.

Question: Many more books are published in modern years. Doesn’t this skew the results?

Answer: It would if we didn’t normalize by the number of books published in each year.

Here is an example of the occurrence of three phrases (topics) in English-language books over the century from 1900 till 2008, the latest year available. The topics are: pregnancy complications, difficult birth, and birth complications.

Ngram 1: pregnancy complications, difficult birth, birth complications

Ngram 1: pregnancy complications, difficult birth, birth complications

http://books.google.com/ngrams/graph?content=pregnancy+complications%2Cdifficult+birth%2Cbirth+complications&year_start=1900&year_end=2008&corpus=0&smoothing=5

The N numbers (or the number of phrase occurrences relative to all books) for the three topics are on the same scale as indicated on the vertical axis, and the graph shows that the number of books on difficult birth (red curve) rose steadily over the century – but the books on pregnancy complications (blue curve) and birth complications (green curve) shot up after 1960. These N numbers eventually level off and/or begin to decline after the year 2000. (As though everything has been written up, nothing new to publish?)

There were many more books written about birth control over the same period of 108 years. We can detect this in the N count on the vertical axis, which here has only 3 leading zeros as opposed to the 5 leading zeros at the maximum level in the previous graph (a hundred times as many books, even in 2008, after the decline from the mid-1970s). The initial rise from 1910 to 1930 must have been not on chemical contraception but (mostly) on the then happening calendar method of Ogino and Knaus, i.e. the later discarded so-called “Vatican Roulette”. That approach to birth control did not work – it could not work – so Margaret Sanger took it on herself (and on her wealthy-widow friend, Katharine McCormick) to cause the “magic bullet” of a pill to be developed. Some magic!

Ngram 2: birth control

Ngram 2: birth control

http://books.google.com/ngrams/graph?content=birth+control&year_start=1900&year_end=2008&corpus=0&smoothing=3

One more Ngram Viewer graph, since they say that three is a charm! The following graph compares the number of books on infertility (blue) with the number of books on contraception (red), and it is on the same scale as the birth control graph above (with only slightly lower maximum level, 0.00035% here vs. 0.00045% above).

Ngram 3: infertility and contraception

Ngram 3: infertility and contraception

http://books.google.com/ngrams/graph?content=infertility%2Ccontraception&year_start=1900&year_end=2008&corpus=0&smoothing=3

Three may be a charm, but I will show you one more, so that you (or your friendly gynecologist) will not accuse me of trying to show that chemical contraception has caused infertility (the infertility epidemic). I have merely shared Google’s Ngram Viewer statistics on books written on given topics. Discourses written on contraception preceded those on infertility by at least 10 years, and the number of infertility books was still rising when contraceptive books were already declining in numbers in the 1980s.

Here then is one more Ngram comparing N numbers of books on behavior problems (blue), mental problems (red), and books on birthing (green curve).

Ngram 4: behavior problems, mental problems, birthing

Ngram 4: behavior problems, mental problems, birthing

http://books.google.com/ngrams/graph?content=behavior+problems%2Cmental+problems%2C+birthing&year_start=1900&year_end=2008&corpus=0&smoothing=3

You see that there are four leading zeros in the scale on the vertical axis, so the order of magnitude of the graphed N numbers is between the two orders of magnitude discussed above (it’s an order of magnitude below infertility and contraception). All three of the numbers in this Ngram rise around 1970, behavior problems books before, birthing books after.

Why did the numbers of books on birthing rise so sharply some 15 years after 1960? I don’t know that there is such a thing as invalid questions. The curves for mental health and birth are correlated, rising around 1970, too (not shown here).

Chemical contraception has not worked to reverse the global population explosive growth although it appears to have reduced the extent of the explosion.

But at what cost? Do look at the last Ngram, below, which compares the number of books on birth control (blue), sexually transmitted diseases (red), STD (green), VD (yellow), and STDs (dark blue). It is on the same scale as the birth control graph above (the second in the series). The green spike after 1960 is STD in singular, as opposed to sexually transmitted diseases (red) and STDs (dark blue), which you see rising slowly after 1980, paralleled by the higher green curve in those years, which starts going up even earlier.

This can be rationalized by the fact that earlier on there was merely one STD (or two), called VD in Britain and in Europe (yellow curve), where the rise occurred somewhat later than in the U.S., along with the slight delay in the “sexual revolution” and its consequences or rather the concerns about those consequences. The broad green, red and dark blue hills of elevated N readings before year 2000 reflect the multitude of STDs today, which numbers did not exist before the sexual revolution. The singular VD has morphed into the plural STDs and sexually transmitted diseases.

Ngram 5: birth control, sexually transmitted diseases, STD, VD, STDs

Ngram 5: birth control, sexually transmitted diseases, STD, VD, STDs

http://books.google.com/ngrams/graph?content=birth+control%2Csexually+transmitted+diseases%2CSTD%2CVD%2CSTDs&year_start=1900&year_end=2008&corpus=0&smoothing=3

I leave the “now what” maybe for another time, but a follower of this blog will have an idea.

As of this writing, to cite the three bioZhena’s Weblog Top Posts (the past week):

Trying to conceive, #ttc, or the frustration of sub-fertility & infertility in 2010/2011          40 views

Saint Nicholas Day, his legend, and our modern day’s prematurity, EDD calculation, gestational age, problem with LMP          33 views

Critique of birth control efficacies in NFP as published by Marquette University researchers          21 views

Why screen for cervical cancer (and for the other STIs, sexually transmitted infections)?

July 29, 2011

Why all women need to screen for cervical tissue health, whether or not they accept that Nature is powerful (only  virgins don’t need to)

I will tell you why screening for this sexually transmitted infection (STI) is much needed, if you promise that you will not shoot the messenger. Exaggerating? Not really, if or when you realize that chances are that you yourself are already infected.

Is it so serious?

I say that because “current evidence suggests that at least 50 percent of sexually active women have been infected with one or more types of HPV”. Most people with HPV have no symptoms. When the infection is present, symptoms may or may not include genital warts.

HPV stands for Human Papilloma Virus. That is the virus that causes cervical cancer, and goes slowly about it, which is both good and bad. Good because the disease can be treated before it kills, and bad because it may take so long before it raises its ugly head that it can come completely unexpected in the mature middle age and even later. That is why vigilance (meaning, screening for it) throughout one’s lifetime is well worth it – unless you are a fatalist.

Collage of drevoryt woodcuts Dekameron, Ceský dekameron, Bakchanálie by Zdenek Mézl 1980

Collage of drevoryt woodcuts Dekameron, Ceský dekameron, Bakchanálie by Zdenek Mézl 1980     Links:      http://www.ikup.cz/item.php?id=600279&lan=EN        http://www.galerieart.cz/mezl_cesky_dekameron_I.JPG              http://www.galerieart.cz/prodej_mezl_staroveke_baje.htm

“Furthermore, the potential risk of infection from non-penetrative sexual contact remains undetermined, including the possible association between oral-penile contact and oral HPV, which is associated with oral cancer.” You can read this online in the peer-reviewed scientific publication Am. J. Epidemiol. (2003) 157(3): 218226. The experts give a reference (ref. 3) for the 50%+ statistic, and elsewhere the Medical Institute for Sexual Health writes http://www.medinstitute.org/public/92.cfm  : “About half of all sexually active 18- to 22-year-old women are infected with it (ref. 10 = J Infect Dis. 2001;183(11):1554-1564)”.

Either way, let’s watch out for the killer disease, which fortunately is curable – if caught early. If not caught early (that is, if not detected, diagnosed and treated), The Ravisher wins.

Cervical cancer causes about the same number of deaths as HIV/AIDS every year [two references for this statement are cited in the above Medical Institute article http://www.medinstitute.org/public/92.cfm ].

Young Woman Attacked By Death (or The Ravisher) - Albrecht Durer

Young Woman Attacked By Death (or The Ravisher) – Albrecht Durer

Get this! The most common STI. Both young and mature women in danger

Get this: The human papilloma virus (HPV) is the most common sexually transmitted infection (STI) in the world, and it is the most important cause of cervical cancer, a major killer of women worldwide (the second biggest).

Another horrible statistic is that, according to a CDC study, one in four (26 percent) young women, girls between the ages of 14 and 19 in the United States – or 3.2 million teenage girls – are now infected with at least one of the most common sexually transmitted diseases. Those are human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis. See http://www.sciencedaily.com/releases/2008/03/080312084645.htm .

A bad news for the mature women, who are past their best years for birthing, is this: “Cervical cancer is the second leading cause of cancer deaths among women worldwide. Human papillomavirus (HPV) has been shown to be the precursor of cervical cancer in over 99% of the cases. … Although women aged 40 and above are not specifically considered high risk for HPV infection, many women are testing positive in this age group and are facing the impact of an HPV diagnosis that implicates a sexually transmitted disease and is known to be a precursor to cervical cancer.” So is written in J Am Acad Nurse Pract. 2010 Feb; 22(2):92-100, in a paper titled “The human papillomavirus in women over 40: implications for practice and recommendations for screening”.

The Plague by Arnold Böcklin, 1898

Arnold Böcklin, The Plague, 1898

Pap smear test. Important. But problematic

While the Pap smear diagnostic screening has significantly improved the situation over the many years since its introduction (first published by the inventor, Dr. Georgios Nicholas Papanikolaou late in the decade of “the swinging 1920s” but only recognized in the 1940s), at least 12,000 women are diagnosed with cervical cancer each year in the United States, accounting for at least 4,000 deaths. Statistics cited from J Sch Nurs. 2007 Dec; 23(6):310-4.

As commented in June 2011 at http://to.ly/aCD3 (http://www.telegraph.co.uk/news/health/news/8554793/Women-making-excuses-to-avoid-cervical-cancer-smear-tests.html ), #Cervical #cancer “smear tests are invasive, uncomfortable, embarrassing, and often are badly diagnosed”. Another reader concluded: “De-stigmatize cervical  cancer and do some work to make the test less unpleasant – more #women will go” (will go to get the expensive test at a clinic, hoping for a negative result – and for not getting an unexpected huge bill, whether insured or uninsured in the U.S.).

Additional to the advantage of an objective electronic test over the subjective evaluation of a Pap smear: Is there a better way to avoid stigmatization than testing for cervical health in the privacy of one’s home, and in so doing making the test incomparably less off-putting, painless and perfectly affordable for anyone?

Similar to what the Pap smear can do, our tissue biosensing technique should detect the pre-cancerous tissue aberration called squamous intraepithelial lesion (SIL) or dysplasia, which is the earliest form of pre-cancerous lesion recognizable by a pathologist. Refer to http://en.wikipedia.org/wiki/Carcinoma_in_situ .

Unlike the pathologist’s subjective assessment of the Pap smear sample, our in vivo monitoring method provides for an objective electronic evaluation.

In countries like India, the cervical cancer prevalence statistics are much worse, an order of magnitude higher. A big problem is that, among the general population, “knowledge about the relationship of HPV to cervical cancer is low even in the United States and the United Kingdom”. [Rapose A., Human papillomavirus and genital cancer. Indian J Dermatol Venereol Leprol 2009;75:236-44.] So therefore, we are trying to do something about that.

Screening is really necessary. Here is why

There are two main reasons why screening for cervical cancer is and will continue to be necessary.

1. One is that the recently introduced HPV vaccines are far from perfect, and they explicitly require continued screening. Even the most expert proponents of HPV vaccination, and not just the vaccine manufacturers, say and write that.

Antonín Procházka, Milenci s knihou, litografie/lithograph, 1941

Antonín Procházka, Milenci s knihou, litografie/lithograph, 1941

2. Then there is the other reason for the necessity of continued cervical cancer vigilance. It is that, contrary to the oft trumpeted exclamations, the classic “invention of a certain doctor Condom” does not make for safe sex, because it (the condom) only reduces, and certainly does not eliminate, not only the chances of becoming pregnant but also the chances of contracting a sexually transmitted infection. These are medico-scientifically proven facts.

The condom and similar barriers do not completely and reliably eliminate the chances of pregnancy if you happen to have sex during the mere three fertile days of your menstrual cycle (when you are outside of the fertile window, pregnancy simply cannot occur). And, condoms and similar barriers do not completely eliminate – they only reduce – the chances of contracting sexually transmitted infections including HPV.

Sources, evidence – cervix is vulnerable

For sources of this statement of fact, see for example the already referenced http://www.medinstitute.org/public/92.cfm : “Each year, there are about 19 million new infections; half of these are in people under 25 (ref. 2). Many of these STIs have no cure. Untreated STIs can cause infertility, cancer and even death.” In that article is also where you see the references for the statements that “If you use condoms every time you have vaginal sex, you can cut your chance of getting HPV by up to half (references 6,7,8,9)… In women, cervical cancer causes about the same number of deaths as HIV/AIDS every year (refs. 12,13).”

Note this: Evidence shows that HPV is contracted if sex is had at too early an age and/or if sex is had promiscuously as a one night stand entertainment, or even too early into a relationship.

The cervix is particularly vulnerable to infection between the first menstruation and the age of sixteen because there are still many undifferentiated cells at the surface of the cervix, which is therefore  susceptible to HPV infection [http://www.mendeley.com/research/early-first-intercourse-risk-factor-cervical-cancer/]. As cancer is a disease of failure of regulation of tissue growth, HPV causes these cells to transform into cancer cells by altering the genes which regulate cell growth and differentiation.

Edgar Degas - Young Spartans Exercising, circa 1860

Edgar Degas – Young Spartans Exercising, circa 1860

An interesting story associated with the Degas painting includes “that the work could encompass a variety of meanings”, and that the fully dressed onlookers in the background are the youths’ mothers with Lycurgus, the legendary lawgiver of Sparta, who established the military-oriented reformation of Spartan society in accordance with the Oracle of Apollo at Delphi.

Reflecting on research findings

This blog post is not some exercise in moralizing. I am merely reporting or reflecting on medico-scientific findings. The above-referenced epidemiologists, Winer et al. [Am J Epidemiol 2003;157:218-26], evaluated young college women in Washington State and found that the risk factors for acquiring a new HPV infection included:

  • sex with a new person in the previous 5-8 months,
  • smoking, and
  • use of oral contraceptives.
  • Always using condoms did not provide protection according to this study.

The experts concluded that “in this population of female university students, the risk of infection associated with new partner acquisition is independent of prior sexual experience”, and that a “…finding suggests that an increased risk of incident HPV infection is more strongly associated with sex with a new partner than with sex with ongoing partners.” Thus written.

Peter Paul Rubens - The Union of Earth and Water, c. 1618

Peter Paul Rubens – The Union of Earth and Water, c. 1618                                  For the sake of appropriate symbolism, her name should be Aphrodite or Venus, of course, the promiscuous  goddess of love, beauty and sexuality!

The authors wrote (and here we cite selected notions to reinforce the mentioned ones).

QUOTE:

  • We detected a significant association between current smoking and incident HPV infection…
  • We also observed a significant association between current oral contraceptive use and incident HPV infection.
  • Having known a new partner for less than 8 months before vaginal intercourse was associated with an increased risk of HPV infection.
  • Reporting a new sex partner who has had one or more or an unknown number of prior female sex partners was also a significant predictor of incident HPV infection.
  • [Data] seems to suggest that the better and longer a woman knows her partner before intercourse, the less her risk of becoming infected with HPV.
  • Consistent with previous studies (4, 7, 11, 17, 29, 30), we observed no protective effect associated with condom use. … Since HPV is transmitted presumably through skin-to-skin contact, condoms may not protect against HPV because the virus can be transmitted through non-penetrative sexual contact.
  • Although vaginal intercourse is clearly the predominant mode of genital HPV transmission … any type of non-penetrative sexual contact was associated with an increased risk of HPV infection in virgins.
  • At 24 months, the cumulative incidence of first-time infection was 32.3%… [FYI: That’s 32% of the 603 young women studied between September 1990 and September 1997 by interview and a standardized pelvic examination every 4 months, including HPV DNA analysis from separate cervical and vulvovaginal swab specimens.]
  • Smoking, oral contraceptive use, and report of a new male sex partner –in particular, one known for less than 8 months before sex occurred or one reporting other partners– were predictive of incident infection. Always using male condoms with a new partner was not protective.
  • The data show that the incidence of HPV associated with acquisition of a new sex partner is high and that non-penetrative sexual contact is a plausible route of transmission in virgins.
  • HPV infections are highly prevalent, and current evidence suggests that at least 50 percent of sexually active women have been infected with one or more types (3).

In conclusion, the present study showed that the incidence of genital HPV associated with acquisition of a new sex partner is high, and that risk of infection is especially high if a partner has been known for less than 8 months and if a partner reports having had sex with other partners.

END OF QUOTES

[from Winer et al., that’s Rachel L. Winer, Shu-Kuang Lee, James P. Hughes, Diane E. Adam, Nancy B. Kiviat and Laura A. Koutsky, in Am J Epidemiol 2003;157:218-26, “Genital Human Papillomavirus Infection: Incidence and Risk Factors in a Cohort of Female University Students”. Let’s also reference http://www.google.com/search?q=Koutsky+LA%2C+Kiviat+NB.+Human+papillomavirus+infections.+In%3A+Holmes+KK%2C+Mardh+PA%2C+Sparling+PF%2C+et+al%2C+eds.+Sexually+transmitted+diseases.+3rd+ed.+New+York%2C+NY%3A+McGraw-Hill%2C+1999%3A347%E2%80%9360.+&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a].

Conclusion: Nature is powerful. Nature regulates

My conclusion for you is no preaching but an observation that all this is because Nature is powerful. As simple as that.

In terms of a clarification, or rather a rationalization of the reported findings, since you have an inkling about tissue rejection problems in organ transplantation (you’ve heard about that, haven’t you), I can draw a parallel for you. Think of the meeting of the male and female flesh as a short-lived tissue implant. If the two tissues don’t know each other, if the female has not known the male for sufficiently long, there is a natural reaction, which the cited experts have found manifested as HPV infection (a hint at how that happens: a stranger’s DNA attacks the recipient).

And what’s all this about that Nature is powerful? Well, it is simply to keep in mind that there are some natural laws and principles, such as the one about action and reaction. And, it’s about that Nature regulates

So, there will be a reaction to too much of a good thing (or a bad thing, any thing). I don’t want to get into this too much except to recall that, since the sexual revolution of the 1960s, there has been an enormous increase in the incidence of sexually transmitted infections. Had Georgios (“Pap”) not invented his test in “the swinging ‘20s”, someone would have had to do it in the “revolutionary ‘60s”

As it was, Mrs. Sanger had persuaded her wealthy-widow investor friend that this particular “magic bullet”, her idea of a “magic pill”, was the right approach to reproductive management. Thanks to the Pap, the Western world was sort of ready for the consequences of the Pill at least in terms of the ensuing epidemic of STDs, if not of the epidemic of infertility and of other as yet poorly recognized consequences of this fooling with Mother Nature (à la Ms. Sanger and Mrs. McCormick – “as easy to take as an aspirin”).

The fact is that “while an estimated 1 in 4 Americans will get an STD (sexually transmitted disease) in their lifetime,4 … the United States continues to have the highest STD rates of any country in the industrialized world.2 No effective national program for STD prevention exists… and the American public remains generally unaware of the risk for STDs and the importance of prevention and screening” (per the Kaiser Family Foundation and American Social Health Association).

The National Cervical Cancer Coalition writes:

“By age 24, at least one in three sexually active people are estimated to have had an STD. Teenage girls are especially vulnerable to contracting gonorrhea and chlamydia, which can more easily infect the immature cervix.”

Perhaps you have gathered, from the various bioZhena’s Weblog articles and from our other web information, that we propose to do something about it – about making possible private screening at home for early warning devoid of the problems associated with the Pap smear test.

Oskar Kokoschka, Rejected lover, 1966

Oskar Kokoschka, Rejected lover, 1966

Originally, I intended to illustrate these concluding thoughts with a painting by the grandson of Sigmund Freud, Lucian or Lucien, who passed away the other day (a painting of a sad woman’s face showing from under a bed cover, with a clothed man – guess who – standing hands in pockets and just staring at her – it’s #5 in http://pul.se/muse_Cleveland-Cleveland-OH-caroline-blackwood-2LYALDu533r,d5oww4DQguiE).

But then, Oskar’s more colorful impressionist image seems, well, more colorful, and less realistic… as paintings go.


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