[HN Gopher] Gilead shot prevents all HIV cases in trial
___________________________________________________________________
Gilead shot prevents all HIV cases in trial
Author : toomuchtodo
Score : 811 points
Date : 2024-06-20 19:12 UTC (1 days ago)
(HTM) web link (www.bloomberg.com)
(TXT) w3m dump (www.bloomberg.com)
| toomuchtodo wrote:
| https://archive.today/7cGmG
|
| Press release: https://www.gilead.com/news-and-press/press-
| room/press-relea...
| nevi-me wrote:
| How do tests for drugs like this get conducted?
|
| "Here's a shot, go have sex with people with HIV"? I hope the
| young women conducting the trials were compensated sufficiently
| for the risk taken, especially those who contracted HIV during
| the period.
| mmh0000 wrote:
| You give the shot to a group and you give no shot to another
| group. Then you compare rates of HIV contractions between the
| two groups.
| tupshin wrote:
| The summary text explicitly called out why that would be
| unethical in this case.
| asveikau wrote:
| They don't ask people to live their lives any differently
| than they would, nor do they expose anyone to HIV on
| purpose; they just track them assuming that x% of people
| get HIV in any given year. So they compare what X is for
| people who got the shot, vs those who did not.
|
| As I skim TFA, they say nobody who got the shot ended up
| getting HIV, which would be statistical anomaly for the
| population they tested.
| smeej wrote:
| It's not "no shot," though. It's other existing, widely
| available forms of pre-exposure prophylaxis.
|
| They're not comparing the new treatment to _nothing._
| They 're comparing it to existing treatments.
| asveikau wrote:
| Oh, ok, I skimmed past this:
|
| > The shot was also superior to once-daily Truvada,
| another Gilead drug that is used for HIV prevention.
|
| That's good news. As I understand it the existing
| treatments were already very good. And these injections
| are only once per year.
| duskwuff wrote:
| Twice a year, but yes. That's a huge benefit -- not only
| is it easier for patients to stay on the treatment, but
| it's likely to be a lot cheaper as well.
| smeej wrote:
| I wonder how much variation there might be in terms of
| margin of error. Like, how close do they have to get to
| keeping people on a rigid 6-month schedule? Would 7 be
| fine? For what percentage of people? I'm assuming they
| have reason to believe once a year isn't enough, so
| that's an upper bound, but what's the lower one?
| adgjlsfhk1 wrote:
| the short answer is no one knows (yet). if/once it gets
| approval, there likely would be a followup study on how
| much you can stretch the timing (possibly with dosage
| variation)
| duskwuff wrote:
| > I wonder how much variation there might be in terms of
| margin of error.
|
| Probably quite a bit. The trial used the same dose of
| lenacapavir as what's used for maintenance in HIV
| patients; it's quite possible that less is needed to
| prevent infection in a healthy patient. Unfortunately,
| there's really no safe/ethical way for them to test lower
| doses.
| oopsallmagic wrote:
| It'll only be cheap once the patent expires. Until then,
| take those pills daily, y'all!
| jghn wrote:
| They're comparing against typical rates of infection over time.
| Svoka wrote:
| How does your mind even go there? Did you consider they just
| give shots and see how many of treated got infected in
| treatment vs control group?
| nevi-me wrote:
| People are sexually active at different rates over different
| times, I also assume that a 100 people having sex with each
| other, where none of them have HIV, would not contract it.
|
| It's like giving police officers new buller-proof vests, and
| then none of them getting in the firing line. You can't say
| that your vests are more efficient than other vests if they
| technically didn't get tested.
|
| So, my thinking was how they ensure that all test groups are
| sexually exposed to other people with HIV, for the trial to
| be effective.
| opprobium wrote:
| South Africa (study was in SA and Uganda) has an adult HIV
| prevalence of 18.3% and 210k new infections per year. It is
| easy to select a high risk group in which you would expect
| to see new HIV infections during the course of the study
| without intervention.
| imzadi wrote:
| They don't need to ensure that all test groups are exposed
| to people with HIV. There is already a known risk factor
| for the specific population. All they need to do is see if
| the people who received the medication had
| more/fewer/similar infection rates as those who didn't.
|
| Think about it like studies on which cars perform better in
| crashes. They don't need to have people drive more
| wrecklessly to determine if the car is safer. They just
| need to look at the expected risk compared to the outcomes
| of the people who drive that car. They are already doing
| the risky thing.
| loeg wrote:
| > So, my thinking was how they ensure that all test groups
| are sexually exposed to other people with HIV, for the
| trial to be effective.
|
| They don't. Some people will organically have sex with
| people with HIV, and some will not. Your study just needs
| to recruit enough participants that it is likely some will.
| Your study absolutely does not tell people to deliberately
| have sex with HIV+ partners.
| langcss wrote:
| I think it is like coin flips, do enough of them and the
| total heads or tails gets very predictable even though
| individual flips are not.
| dekhn wrote:
| Here's the study page. https://www.purposestudies.com/purpose1/
| and extensive details on clinicaltrials.gov
| https://clinicaltrials.gov/study/NCT04994509 It's double-blind
| so the patients do not know if they received the drug or an
| alternative. The investigators inform the patients of the risk
| and tell them to do what they would usually do. The
| participants must meet certain criteria including already being
| sexually active. The investigators would not tell the
| participants to be more sexually active, or active with more
| risky people than they normally would. The prevalence of HIV
| infection in the area is already fairly high so people are
| actively at risk already. I believe there was only very limited
| compensation.
| withinrafael wrote:
| I didn't think the question was unreasonable as some suggest
| and couldn't find an answer in any of the replies to you.
|
| Poking around, it's my understanding that double blind
| procedure only covers treatment _allocation_ --that is, who
| gets the placebo or not--and does not exclude general
| experiment communication to patients. I imagine trial
| communication is something generic along the lines of "We're
| running a novel drug trial, help us gather more data for
| $50/shot."
| bee_rider wrote:
| I don't think the question is inherently unreasonable, but
| they asked it in a really flip and disrespectful way, and
| weirdly went with a very negative assumption. There's also a
| whole field of medical research ethics and, I guess, it is
| hard to believe that somebody could be not aware of that
| (then again, I guess everyone has to learn it at some point).
| nevi-me wrote:
| Yeah, I asked it in a negative way, probably because I hold
| the view that Africa is the dumping ground for unethical
| behaviour/products. Just 2 months ago we were outraged at
| Nestle putting sugar in baby foods [0] in Africa. We have 2
| kids, the eldest of which is addicted to sugar.
|
| As a South African, I appreciate that we're also the most
| unequal country in the world (by Gini coef). So, some of
| what was going on in my mind as I read the Bloomberg piece,
| was:
|
| * did they choose people at random, because the high HIV
| rate is obviously skewed towards vulnerable groups (think a
| young woman who's financially dependent on her boyfriend,
| who has multiple partners)
|
| * just because the HIV rate is prevalent, doesn't mean that
| young sexually active people would have multiple partners,
| so how do they account for situations where we were
| sexually active, but with 1 or safe partners
|
| * condoms are freely available in clinics and often public
| toilets, and we've generally gone past the fear of asking
| for them. So how does safe sex affect their study
|
| [0] https://www.wits.ac.za/news/latest-
| news/opinion/2024/2024-04....
| mlyle wrote:
| > So, some of what was going on in my mind as I read the
| Bloomberg piece, was: did they choose people at random
|
| They chose around 5000 people; they randomized them to
| either try the new shot, or one of two existing PREP
| drugs.
|
| Of the 2000 people in the lenacapavir group, 0 got HIV,
| while dozens got HIV in the existing PREP groups.
|
| When you have that many people and shuffle them, the
| groups end up pretty similar. You'd have to be really
| unlucky to get all the promiscuous people in the PREP
| groups.
|
| PREP is already pretty effective; to have such a crushing
| result over PREP is a breakthrough.
| genewitch wrote:
| i'm gunna bury this here, but pfizer said their tests in
| africa were 100% effective for the sars-ncov-2 vaccines.
|
| It is in their interest to ... fudge the truth a little.
|
| Now pfizer did this a different time by removing 2/3rds
| of the treatment group, and only counting "infections" if
| they occurred after all doses/boosters were administered.
| If you compare actual results to what pfizer published
| and claimed, you see that it was 7 infections in the
| placebo group and over 100 in the test group. they
| claimed <7 in the treatment group (i don't think it was
| 0, but it was like 2), and 7 in the placebo, saying "see,
| reduced infections by 80%!" Well, yeah, if you don't
| count infections and remove 2/3rds of the people who
| would have counted as infections possibly.
|
| which means, and you don't even have to squint very hard,
| that the vaccine was actually increasing the chances of
| infection.
|
| A lot of us are completely burned out and therefore wary
| on multinationals, regardless of their vertical. Pharma
| has a lot to answer for. Nestle has a lot to answer for.
| Chevron (et al) have a lot to answer for.
| kgc wrote:
| Interesting. Could you drop a link to the document you're
| talking about?
| mlyle wrote:
| He's talking about the Pfizer multi-national trial (which
| included a lot of enrollees in South Africa), and greatly
| distorting it.
|
| https://www.nejm.org/doi/full/10.1056/NEJMoa2034577#t2
|
| Yes, the primary endpoint shown in here was comparing 7
| days after dose 2 of the vaccine to 7 days after dose 2
| of the placebo group. (table 2):
|
| https://www.nejm.org/cms/10.1056/NEJMoa2034577/asset/619b
| cb1...
|
| However, figure 3 breaks down the efficacy vs. time, and
| it shows no effect like he describes:
|
| https://www.nejm.org/cms/10.1056/NEJMoa2034577/asset/fe40
| d07...
|
| Instead, the vaccine and control groups were about the
| same until roughly day 10-12 after the first dose, and
| then dramatically diverged (though not as decisively as
| after dose 2).
| genewitch wrote:
| unfortunately the source eludes me for my paragraph, but
| this
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10810638/ is
| some light reading although it has been retracted.
| however, it mentions a bit about it (such as moving
| people from placebo to treatment cohort and using those
| people in the data for the treatment cohort.)
|
| I never made the statement that this was their South
| Africa (or africa) study. It isn't difficult to find the
| CEO of Pfizer saying their vaccine was "100% effective"
| in africa on twitter (there was a video, as well). that
| was my first claim.
|
| Then i said "Now pfizer did this a different time ..."
|
| edit: the source eludes me because i originally saw it on
| my cellphone in a video (the paper) and the bullet points
| were being read by an asian female. I failed to
| bookmark/save the video, and i have a hard time chasing
| down research that is this controversial without a DOI or
| PMC due to the ... tens of thousands of papers containing
| the same keywords.
|
| I'm not claiming it's "buried" or "being kept from us" or
| anything conspiratorial, but it never got any play on
| mainstream media and would obviously get shadowbanned on
| any large site with funding from pfizer (et al) because
| of the "fact checkers want you to know that the vaccine
| has been proven safe and effective!" modal.
|
| this has the 2/3rds participants excluded
| https://www.fda.gov/media/159195/download
|
| but i am done for today, i have to crack some
| hydrogeology textbooks so i hope this stays up so i have
| my own reference for the next time i mention this
| x0x0 wrote:
| It was literally answered directly in the article
|
| > _The trial involved about 5,300 women and female
| adolescents ages 16 to 25 in South Africa and Uganda, some of
| whom who received Gilead lenacapavir, and others who received
| older once-daily drugs from Gilead, including Truvada or
| Descovy._
|
| Not to mention a superficial understanding of how drug trials
| are conducted would exclude that method.
| 3523582908 wrote:
| A while ago I watched this highly disturbing documentary
| produced by Vice about the prevalence of rape in the DRC as a
| weapon of war and terror against women. [1]. I have to imagine
| that this is involved, somehow.
|
| 1:
| https://www.youtube.com/watch?v=-IffpoUQpDc&pp=ygUUdGhlIHZpY...
| folli wrote:
| How so?
| JumpCrisscross wrote:
| > _the prevalence of rape in the DRC_
|
| This was in South Africa. You might as conclude on life in
| America based on observations in Caracas.
| samatman wrote:
| https://www.amnestyusa.org/updates/one-in-four-men-admits-
| to...
|
| This is explicitly referred to as a risk factor in the
| study, although they say "gender-based violence"
| asveikau wrote:
| As I understand it would go like this:
|
| Normally, some percentage of the population will get HIV in any
| given year. So what you do is give a bunch of people the shot
| and track them long term. You count how many got HIV after N
| years, compared to what would be expected in a normal
| population.
|
| Nobody is exposed to HIV as part of the study, that exposure
| would come through the participants living their ordinary
| lives.
| pitaj wrote:
| Close, but it's actually run with two large groups: one that
| gets the real shot, and one that gets a fake shot. You then
| compare the two groups, rather than comparing with the
| population.
| spencerchubb wrote:
| That would be _extremely_ unethical, exposing the control
| group to needless risk. There is already another drug that
| helps prevent hiv, it 's called truvada. They tested this
| new one against truvada, and basically learned it's a lot
| more effective.
| Dylan16807 wrote:
| Ridiculous. As long as most people are taking no
| preventatives, it is not " _extremely_ unethical " to
| have the control group also take no preventatives.
| kjhcvkek77 wrote:
| Who would sign up for your study? The diligent person
| already on truvada - would they risk getting placebo? No.
| Or the person too careless to take truvada? Would they go
| to the trouble of participating in a study for a 50%
| chance of protection? No.
| Dylan16807 wrote:
| That's an entirely different question from ethics.
|
| But paying people to be studied tends to be effective.
| kjhcvkek77 wrote:
| I don't think so. Managing the relationships with the
| public and study participants is an important part of the
| ethics.
| Dylan16807 wrote:
| Ethics and managing relationships with the public
| overlap.
|
| But I don't think the particular aspect of "making sure
| you have enough participants" interacts very much with
| ethics. Especially when the failure state in question is
| an honest failure to attract them.
| stevekemp wrote:
| In general, yes.
|
| In this case the study cites that as being unethical due to
| the high prevalence of HIV in the target population. So the
| actual trial gave some people the shot, and some other
| people the known-working daily pills as a control.
| worldvoyageur wrote:
| From Gilead's press release:
|
| " PURPOSE 1, a Phase 3, double-blind, randomized study, is
| evaluating the safety and efficacy of twice-yearly, subcutaneous
| lenacapavir for pre-exposure prophylaxis (PrEP) and once-daily
| oral Descovy(r) (emtricitabine 200mg and tenofovir alafenamide
| 25mg; F/TAF) in more than 5,300 cisgender women and adolescent
| girls aged 16-25 across 25 sites in South Africa and three sites
| in Uganda. The drugs are being tested in parallel, with one group
| receiving twice-yearly lenacapavir and one group taking once-
| daily oral Descovy. Additionally, a third group was assigned
| once-daily oral Truvada. Study participants were randomized in a
| 2:2:1 ratio to lenacapavir, Descovy and Truvada, respectively.
| Because effective PrEP options already exist, there is broad
| consensus in the PrEP field that a placebo group would be
| unethical; thus, the trial used bHIV as the primary comparator
| and Truvada as a secondary comparator.
|
| There were 0 incident cases of HIV infection among 2,134 women in
| the lenacapavir group (incidence 0.00 per 100 person-years).
| There were 16 incident cases among 1,068 women in the Truvada
| group (incidence 1.69 per 100 person-years). The results
| demonstrated superiority of twice-yearly lenacapavir over bHIV
| (primary endpoint, incidence 2.41 per 100 person-years) and
| superiority of twice-yearly lenacapavir over once-daily Truvada
| (secondary endpoint), with p<0.0001 for both endpoints. In the
| trial, lenacapavir was generally well-tolerated and no
| significant or new safety concerns were identified.
|
| [...]
|
| Gilead expects results in late 2024/early 2025 from the program's
| other pivotal trial, PURPOSE 2, which is assessing twice-yearly
| lenacapavir for PrEP among cisgender men who have sex with men,
| transgender men, transgender women and gender non-binary
| individuals who have sex with partners assigned male at birth in
| Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the
| United States. "
| levocardia wrote:
| This is a legitimately amazing result and a huge win against
| HIV. I hope it replicates in PURPOSE 2. Zero incident cases in
| an at-risk population is, frankly, fantastic, in a country
| where prevalence of HIV ranges from 12-27% depending on the
| province.
| hawk_ wrote:
| VaaS (Vaccine as a Service) suits Gilead as a business model,
| MrLeap wrote:
| A childhood friend of mine died of AIDs related complications a
| few years ago. I hope this saves a lot of people.
| dekhn wrote:
| HIV/AIDS dominated my high school years; it was just starting
| to become known; the first reported US case was in 1981, and in
| 1983, the disease (AIDS) was traced to the virus (HIV). My
| biology class had a poster of all the things AIDS could present
| as (kaposi's sarcoma, etc). At the time HIV was effectively a
| death sentence and it really affected places like SF heavily.
|
| One of my main motivations in college and grad school was to
| work in drug discovery, specifically for HIV. At the time
| (~1995-2000) we were just starting to see positive results from
| protease inhibitors and reverse transcriptase inhibtors came
| somewhat later leading to the current "managment of HIV through
| HART" https://en.wikipedia.org/wiki/Management_of_HIV/AIDS
|
| All of this came slowly - decades between significant new
| technologies/improvements in treatment. many sources of
| infection such as blood transfusions are now much less risky
| (people in the 70s and 80s were getting hep C and HIV from
| blood taken from HIV-positive donors). And the disease presents
| very differently in the US vs. other areas such as Sub-Saharan
| africa. But with extensive effort, prevention has gotten better
| and treatments have gotten much better. If there are truly
| usable preventatives for at-risk populations, and those
| medications are affordable, it will be a huge boon to the
| recipients.
|
| Some interesting things to note:
|
| - there was a lot of controversy about the source of infection
| and a lot of people used this to criticize gay people and
| injected drug users.
|
| - one of the world's most famous virologists,
| https://en.wikipedia.org/wiki/Peter_Duesberg actively denied
| that HIV caused AIDS and instead thought it was transmitted by
| drug use. Note "Duesberg entered a long dispute with John
| Maddox, then-editor of the scientific journal Nature, demanding
| the right to rebut articles that HIV caused AIDS." which I
| think presages the current arguments about what scientists can
| say regarding the origins of COVID. The impact of his
| statements in South Africa was significant. From what I can
| tell he was completely off base and never made any truly
| convincing arguments for his position.
|
| - Fauci, of COVID fame, played a big role in getting NIH and
| the various AIDS community organzations working together and
| making large improvements to HIV/AIDS treatment. Before that,
| Fauci was heavily criticized by various LBGTQ orgs (see
| https://www.nytimes.com/2022/12/31/opinion/anthony-fauci-
| hiv...) "Larry Kramer, one of the group's founders, wrote an
| open letter to Dr. Fauci in The Village Voice calling him a
| murderer and comparing him to the Holocaust organizer Adolf
| Eichmann." Again, all this presages the later treatment of
| Fauci by various political groups during COVID. I often think
| back to Fauci during HIV/AIDS while reflecting on the current
| situation around COVID and I think we got lucky to find
| somebody like him, even if he said a few dumb things, and we'll
| be lucky if any public servants are willing to take up his role
| in the future.
|
| - modern gene therapy often uses variants on HIV as the vector.
| That's right: it's so good at getting into cells and modifying
| the genome, that we use it as the preferred method. it took
| quite some time before the vectors were made safe enough
| (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152689/)
| mrmetanoia wrote:
| One of my in-laws is a full on Fox news nut, but has a rare
| condition that he received treatments for as part of an NIH
| study that did him a world of good and Fauci was one of the
| doctors that worked on it, as a result the bits of nuttery he
| didn't buy into were attempts to discredit Fauci or anti-vax
| stuff. Oddly it didn't pull into question any other beliefs
| he picked up from that station.
| greentxt wrote:
| I believe that's referred to as Gell-Mann Amnesia. Common
| for most educated consumers of tv and print journalism.
| Indeed, even Fauci has made mistakes he has later had to
| correct/retract, like his early herd immunity claim.
| Pxtl wrote:
| I always think Gell-Mann Amnesia is funny because the
| namer of it was a medical doctor who wrote a book about
| about how climate change is fake.
| esalman wrote:
| > even Fauci has made mistakes he has later had to
| correct/retract, like his early herd immunity claim.
|
| You get new evidence and you update your beliefs. This is
| literally how science works and progress is made. If you
| had to put every student of science on the spot for
| everything wrong they said/did, there wouldn't be as much
| progress.
| greentxt wrote:
| Why downvote, that's exactly what I said. I'm glad you
| agree that even experts make mistakes. It would be truly
| strange to argue that point, though many have and do.
| With respect to Gell-Mann amnesia, to be more exlicit
| since it seems that's needed, it's really just a side
| effect of our heuristics. Most of the time you can turn
| your brain off and follow the crowd, widespread consensus
| is a safe bet, but you have to leave room for occasionsl
| mistakes, as you acknowledge. Taking mental shortcuts,
| being lazy conformists is in no way exceptional. Humans
| are mostly stupid creatures, even experts.
| esalman wrote:
| Um I don't really agree. Making mistakes is not the same
| as changing opinion based on new evidence.
|
| Fauci changed opinions, a lot of experts do. It's only
| the lay people with no idea how science works who will
| call it a "mistake".
|
| Actually it's worse than that, people have openly
| harassed and threatened Fauci and his family for doing
| what he did. That's unfair and borderline evil.
| vasco wrote:
| He also made mistakes, like telling us masks didn't work
| to save stock, and then changing guidance when there was
| enough stock. It's ok, as we're saying here anyone is
| entitled some mistakes along the way, but nobody is
| perfect, and overall we got through the worst of it, so
| it wasn't that bad.
| greentxt wrote:
| Well if you think he didn't make mistakes, or think that
| any human is error free, then you have an oppinion that
| is not based on science. Some sort of zealotry or hero
| worship or something along those lines. Fauci made
| mistakes. Science makes mistakes. To err is human. You
| might want to reevaluaute your beliefs and maybe read
| some of the copious amount of scientific and philosophic
| literature on the topic. Everyone makes mistakes.
| YeGoblynQueenne wrote:
| >> one of the world's most famous virologists,
| https://en.wikipedia.org/wiki/Peter_Duesberg actively denied
| that HIV caused AIDS and instead thought it was transmitted
| by drug use.
|
| I'm curious about his claim that retroviruses (retrovirii?)
| must be harmless to survive and multiply. What is the
| mainstream consensus on this?
|
| To be clear: I know next to nothing about viruses (virii? I
| mean I don't even know how to call them) and I have no idea
| whether it really supports Peter Duesberg's claims about AIDS
| in general. I'm just wondering whether he's pointed out an
| interesting peculiarity of HIV that is not further
| investigated by others for fear of being accused of
| denialism.
|
| Scientists can get very like that.
|
| >> (...) the current arguments about what scientists can say
| regarding the origins of COVID.
|
| It reminded me most about John Ioannidi's polemic against the
| way COVID was dealt with, rather than its origin. Ioannidis
| is a leading epidemiologist so he had to be taken seriously,
| although of course his opinion was rejected by most everyone
| else.
| rcxdude wrote:
| I don't see any particular reason why retroviruses would be
| different in that regard: they need the cell they infect to
| live long enough to produce enough viruses, and it is
| advantageous to them that some cells they infect lay
| dormant and reactivate later (a trick not limited to
| retroviruses), but there's not particular reason why they
| should not overall act much like any other virus: keeping
| their host cell alive only long enough to produce enough
| new viruses to continue to propagate. It's an argument
| which you could extent to any pathogen: why would any
| disease kill its host?
| outworlder wrote:
| > It's an argument which you could extent to any
| pathogen: why would any disease kill its host?
|
| Moreover, why would a disease even 'care' about the host?
| As long as it can jump hosts quickly, it can afford to
| kill many of them. If achieving fast transmission is
| tough on the host, so be it. Other diseases may select
| for the opposite approach, of course.
| dekhn wrote:
| Speculating about the shape of the potential energy surface
| of viral evolution is non-trivial.
|
| I don't know enough (my retrovirus knowledge is out of
| date), but if you look at authoritative knowledge (IE,
| textbooks), you will see many non-harmless retroviruses:
|
| - oncoretroviruses: as a side effect of how they integrate,
| they often cause cancer in patients. There is lots of time
| between infection and death for the virus to be
| transmitted.
|
| - lentiviruses (this is also known as a "slow virus").
| There is often lots of time between infection and death for
| the virus to be transmitted.
|
| It's possible that scientists are avoiding directly
| attempting to argue with Deusberg's observations, but in
| general, the consensus seems to be that he brought nothing
| useful to the debate except irrational claims that were
| inconsistent with the evidence. We don't live in an
| ultrarational world where every fringe theory can be
| investigated.
|
| As for Ioannidis... not sure what to say. I think his big
| mistake was going to the white house and trying to make
| Trump an ally and not shut down everything because he
| predicted the virus wouldn't spread and wouldn't be fatal
| at the rates that were later observed. Diseases like COVID
| are multidimensional problems with partial information and
| a high level of politics, corp, and media involvement. I
| think fauci and others have finally admitted that they may
| have made some mistakes in the specific details of the
| shutdowns, in particular, it took people a while to realize
| that the impact on children (who by and large are not at
| risk from COVID) was enormous.
|
| If your goal is to affect public health policy, you have to
| be a truly 4D thinker, and even that's not enough
| dimensions.
| YeGoblynQueenne wrote:
| Thanks.
|
| You reminded me hat Ioannidis made very specific
| predictions that turned out to be false (about the number
| of deaths we could expect). And that, while measures were
| adopted that he claimed were useless. I agree Fauci saved
| lives - and last time I saw him in the news he was being
| attacked by Republican trolls, I don't have any other
| word for those people.
| opprobium wrote:
| You can read a lot about it here:
| https://en.wikipedia.org/wiki/Duesberg_hypothesis
|
| The mainstream consensus is the he was wildly wrong about
| HIV specifically, that HIV causes AIDS, and that his
| influence in South Africa to not deploy anti-viral
| medications killed hundreds of thousands of people before
| the policy was reversed.
|
| Part of his hypothesis was that viruses in general, not
| just retroviruses, were not connected to cancers, the
| consensus view is that this is completely wrong. We have a
| very large body of evidence on many virus caused cancers
| now.
|
| Even at the time he was arguing this, it was clear that the
| retrovirus HTLV was disease causing in humans
| https://en.wikipedia.org/wiki/Primate_T-lymphotropic_virus
|
| So, the two known human retroviruses both cause disease and
| retroviruses cause diseases in animals. Duesberg held on to
| and promoted this concept long after it should have been
| clear to him that there was zero empirical support for his
| idea.
| dekhn wrote:
| To me the most convincing bit that weakens his
| "hypothesis" is that people who received blood
| transfusions from HIV-contaminated blood. Many of those
| people showed none of the risk factors.
|
| See
| https://www.nytimes.com/2024/05/20/world/europe/britain-
| cont... for some recent discussion of the scope and scale
| of HIV contamination.
| WhitneyLand wrote:
| Influenced the deaths of hundreds of thousands of people?
|
| Yet apparently to this day he draws over 200k/yr in
| salary from Berkeley. I believe they are not entirely
| funded by tuition/endowments which means California tax
| payers support him at least in part.
| dekhn wrote:
| He has tenure and hasn't done anything that would force
| the dean to fire him. He hasn't published in ~7 years.
|
| IIUC he's been isolated- doesn't get any real funding
| from NIH, or from the university (beyond the standard
| salary), and doesn't have an active lab.
|
| It would likely cost the university more in legal fees to
| get rid of him than keep him until he goes away.
| opprobium wrote:
| https://en.wikipedia.org/wiki/Peter_Duesberg#Consequences
| _of...
|
| He was investigated but it was dropped as being protected
| by his academic freedom:
| https://www.science.org/content/article/berkeley-drops-
| probe...
|
| He also, that I know of, still supports this position. To
| this day, you will find people getting into this
| particular conspiracy and rejecting treatment. It doesn't
| go well for them.
|
| I do think that freedom of speech is important, and that
| many attempts to squash "misinformation" are misguided,
| but some speech has consequences. Personally I find
| Duesberg utterly reprehensible and morally culpable.
| YeGoblynQueenne wrote:
| Cheers, I read the wikipedia article. It mentions
| Duesberg's claims without going into details about why it
| is wrong, or right.
| opprobium wrote:
| Perhaps I found the article clearer because of
| familiarity with the subject.
|
| On the "retroviruses must be harmless" virology: He's a
| denier of viral involvement in cancers in general, not
| just that HIV must be harmless. He is way outside
| mainstream consensus on all kinds of things.
|
| For instance, he argues that Kaposi sarcoma, a very
| common AIDS related cancer was caused by drug use and not
| opportunistic infection. It is now very well established
| that all KS, which also affects (typically older) HIV-
| people, is caused by HHV-8 infection.
|
| He claims that Hep-B/C can't cause liver cancer.
|
| He claims that HPV doesn't cause cervical cancer (https:/
| /www.academia.edu/31617237/What_if_HPV_does_NOT_cause...)
|
| The core thing he does on all of these topics is just to
| ignore or deny anything that doesn't agree with him, eg:
| Hemophiliacs treated with tainted blood get AIDS, HIV
| viral load directly corresponds to disease progression
| which is clearly halted by dropping HIV load with
| treatment, the HPV vaccine demonstrably prevents cervical
| cancer, etc. He is far off in quack territory.
| IlliOnato wrote:
| In reality HIV does have to deal with pressures described
| by Duesberg, but the virus found a workaround: extremely
| long "incubation period".
|
| As you probably know, it can stay dormant for 10 years or
| more, but then gets into active stage, causes AIDS, and
| relatively quickly kills the host.
| dylan604 wrote:
| > we'll be lucky if any public servants are willing to take
| up his role in the future
|
| Sadly, there will be plenty of people desperately wanting
| that job. It is definitely a prime example of the saying
| those that want the job would not be good at the job and
| those that would be good at the job do not want it.
| Especially in today's environments where it will become a
| bully pulpit to push whatever agenda of whoever is in charge
| ted_dunning wrote:
| Taking the job and taking on the role are two different
| things.
|
| We need somebody who takes on the pivotal role that Fauci
| played in the HIV and COVID epidemics, not just a career-
| motivated seat warmer.
| dylan604 wrote:
| It could go the other way though where anti-science
| agendas are pushed from that position. It all depends on
| who gets to make the appointment really
| outworlder wrote:
| > I often think back to Fauci during HIV/AIDS while
| reflecting on the current situation around COVID and I think
| we got lucky to find somebody like him, even if he said a few
| dumb things, and we'll be lucky if any public servants are
| willing to take up his role in the future.
|
| Hopefully, the next administration doesn't come up with
| Schedule F once again and make all health-related government
| jobs political.
|
| https://en.wikipedia.org/wiki/Schedule_F_appointment
| kennethwolters wrote:
| Don't forget Kary Mullis as another famous scientist thinking
| HIV does not cause AIDS. I personally don't know what to make
| of Mullis' and Duesberg's claims. But I found an interesting
| Mullis article recently in which he presents a hypothesis
| about how AIDS could develop independently of HIV. Quite
| interesting, but I am guessing nothing really more than that.
| https://link.springer.com/article/10.1007/BF01435010 The
| article is unfortunately paywalled.
| musha68k wrote:
| Amazing. I guess SARS-CoV-2 is much less stable in comparison to
| HIV?
|
| Higher mutation rate and other shifts vs broadly neutralizing
| antibodies? Anyways, it would be nice to fully "solve" COVID-19
| as it's still wreaking havoc somewhat silently (?)
|
| I also wonder when or if we'll see therapeutic vaccines against
| either of these and more sooner than later?
|
| Each time I only briefly start staring into the abyss that is
| "wetware" I'm gladly returning to our comparatively trivial
| (self-inflicted) complexity in the world of software / computing.
| frankus wrote:
| I'm not sure if taking e.g. Paxlovid as pre-exposure
| prophylaxis has been studied, but my guess is that the side
| effects from the drug are worse in the long run than the
| disease itself (especially if the seriousness can be blunted
| via vaccination).
|
| Since people don't spontaneously recover from HIV infection,
| and the PrEP drugs have relatively few side-effects, the
| tradeoff is more favorable.
| ds_opseeker wrote:
| In the long run, the side effect of HIV is death due to total
| collapse of the immune system.
| worstspotgain wrote:
| Turns out you can do Covid PrEP with just Neosporin in your
| nose. It works for other pathogens too:
|
| https://www.pnas.org/doi/10.1073/pnas.2319566121
|
| In case you're wondering, this paper is 100% legit, see e.g.
| the bio for the big-shot author:
| https://en.wikipedia.org/wiki/Akiko_Iwasaki
|
| No clue if this _easy trick_ would induce immune escape if a
| large number of people started using it. I guess it 's a good
| time to get in on the ground floor.
| youainti wrote:
| To be a little more precise:
|
| 1. "Prophylactic or therapeutic administration of neomycin
| provided significant protection against upper respiratory
| infection and lethal disease in a mouse model of COVID-19."
| 2. "Furthermore, neomycin treatment protected Mx1 congenic
| mice from upper and lower respiratory infections with a
| highly virulent strain of influenza A virus. " 3. "In
| Syrian hamsters, neomycin treatment potently mitigated
| contact transmission of severe acute respiratory syndrome
| coronavirus 2 (SARS-CoV-2)." 4. "In healthy humans,
| intranasal application of neomycin-containing Neosporin
| ointment was well tolerated and effective at inducing ISG
| expression in the nose in a subset of participants."
|
| The mechanism appears to be that Neosporin triggers an
| ISG[1] (immune) response? Not a biologist etc, but the
| results showing that it prevents transmission is only in
| rodent models, and then showing that a similar biomarker
| shows up in (some of) the participants and the rodent
| models. They authors say:
|
| > "These findings suggest that neomycin has the potential
| to be harnessed as a host-directed antiviral strategy for
| the prevention and treatment of respiratory viral
| infections."
|
| [1]
| worstspotgain wrote:
| Still early in the research, to be sure. Here's the human
| clinical study:
|
| https://classic.clinicaltrials.gov/ct2/show/NCT05449392
|
| Here's Eric Topol's chat with Iwasaki discussing the
| finding. Topol's blog may well be the best source for
| Covid research out there:
|
| https://erictopol.substack.com/p/akiko-iwasaki-the-
| immunolog...
| aardvark92 wrote:
| This paper gets ripped into in my favorite podcast, TWiV
| (This Week in Virology)!
|
| Essentially, yes, neomycin in the nose, if timed perfectly,
| can activate the innate immune system, but en mass this
| practice would cause the spread of antibiotic resistance.
|
| Link: https://podcasts.apple.com/us/podcast/this-week-in-
| virology/...
| worstspotgain wrote:
| If it turned out to work great in practice and people
| started using it en masse, the benefits would greatly
| outweigh the costs IMO, particularly if it snuffed out
| Covid and/or the flu. If it ends up being a niche thing,
| I doubt it would bite into the resistance numbers.
|
| Besides, we're already spiraling down the resistance
| chasm with antibacterial soaps, stuffing cattle with
| antibiotics, overprescribing, and so on.
| AuryGlenz wrote:
| You don't even need that. Carrageenan works:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493111/
|
| Obviously it's not stimulating the immune system but it
| works as an antiviral barrier. I've been using it since I
| read that study and I've avoid 2 of my daughter's colds
| since (and still got 3). That might not sound impressive
| but I have a terrible immune system and haven't avoided a
| cold from someone I've had close exposure to in as long as
| I can remember.
|
| That said, I might need to add some Neosporin to my mixture
| when she comes home with her nose running.
| Fomite wrote:
| HIV is notoriously unstable - RNA viruses don't contain any
| error checking during replication. Which is one reason HIV
| drugs, including those one, are almost always used in
| combination.
| uiberto wrote:
| coronaviruses are also RNA viruses, fwiw
| Horffupolde wrote:
| It's a different kind. HIV is a retrovirus in that RNA is
| reverse transcribed into DNA. Coronavirus transcribes to
| RNA directly.
| worstspotgain wrote:
| There are several variant-resistant pan-Covid/pan-
| Sarbecovirus/etc. vaccines under development [1], including one
| by the US Army [2].
|
| Vaccines are notoriously slow to develop, perfect, and test for
| safety and efficacy. The original Covid mRNA vaccines were
| developed at breakneck speeds as far as vaccines go.
| Unfortunately, much of the funding has since dried up.
|
| In fact, it's HIV that's much harder to develop a vaccine for.
| HIV vaccine research has been going on for 40 years and hasn't
| really had any candidates that went beyond "plausible" until
| recently.
|
| [1] https://www.nature.com/articles/s41423-023-01116-8
|
| [2]
| https://mrdc.health.mil/index.cfm/media/news_releases/2021/p...
| nothercastle wrote:
| The covid vaccine was barely a vaccine. It was more like a
| flu shot in its efficacy and with significant more side
| effects
| worstspotgain wrote:
| Uh, no. It's actually extremely effective against the
| _target variant_. The original Wuhan strain is extinct as a
| result. In areas with high vaccine uptake, the population
| has very high levels of neutralizing antibodies against it,
| to this day. Even if it somehow broke out again, it would
| die off within weeks, as most of the population is immune
| to it.
|
| Evolution has driven the virus away from the neutralizing
| antibodies. This is called immune escape. Recent variants
| have very little antigenic overlap with the original
| strain. The original antibodies are not very effective, so
| people can actually get sick once again.
|
| The FDA now updates the vaccine formulation every year.
| This means that every year, there is a time window during
| which the vaccine formulation and the circulating variant
| are the same. If you get an updated shot as soon as it
| becomes available, you're immune for all practical purposes
| until a new variant emerges.
| AuryGlenz wrote:
| Right, but most diseases we have vaccines for can't
| easily evolve their way out of them like in this case.
| That's kind of the point.
|
| And you're far from immune with the newest formulations.
| From the CDC: "People who received the updated COVID-19
| vaccine were 54% less likely to get COVID-19 during the
| four-month period from mid-September 2023 to January
| 2024."
|
| https://www.cdc.gov/ncird/whats-new/covid-19-vaccine-
| effecti...
|
| Even with the original strain/vaccine, effectiveness
| waned after 6 months.
| worstspotgain wrote:
| The updated 2023 vaccine was based on XBB.1.5. In the
| period you quoted, the variants based on the massive
| BA.2.86 saltation took over, including JN.1 which was
| fully dominant by January. XBB.1.5 and BA.2.86 are
| antigenically very different. I would not be surprised if
| the case ratio between the two branches during the period
| was in fact 55:45, i.e. matching the CDC's 54%.
|
| Regrettably, this is one's on the FDA, as XBB.1.5 was
| already on the way out when the FDA chose it. Part of the
| problem was their desire to include Novavax in the
| lineup. It has a much longer update turnaround time than
| Moderna and Pfizer, and Novavax had already committed to
| XBB.1.5 by the time the 2023 VRBPAC meeting took place.
|
| As for the original vaccine, the waning measurements were
| in terms of antibody titers, not in terms of actual
| effectiveness against the target variant. Delta emerged
| in the spring of 2021, and it had significant immune
| escape from WT (Wuhan.) By the time the population was
| immunized against WT, Delta had already driven WT out.
|
| There have not been many reported cases of non-
| immunocompromised people getting infected with the _exact
| same variant_ they had been vaccinated against or
| previously infected with, particularly with WT. There has
| been too much evolution in the timeline to even dig out
| the signal.
|
| The original WT mRNA effectiveness measurements were
| 92-95% IIRC. For all we know, the missing 5-8% might be
| attributable to immune deficits, early infections, and/or
| incomplete B-cell maturation. I haven't noticed any
| research that measured the likelihood of single-variant
| breakthrough infection, but if you find some I'd like to
| look at it.
|
| As for other diseases, they are not in the pandemic
| phase, so their vaccines can be optimized accordingly.
|
| I would dispute that "easily evolve" notion, though.
| There have been billions of Covid cases since 2019,
| including countless immunocompromised patients who are
| basically walking virus incubators. Yet there have only
| been a handful of major saltations. It's actually quite
| likely that Covid will eventually be defeated completely.
| CyberDildonics wrote:
| This is anti-vax misinformation. I don't think actual
| evidence, studies or data would support this. Let's take a
| look at real information and refresh our memories.
|
| https://static.dw.com/image/59546575_7.png
|
| https://healthnewshub.org/wp-
| content/uploads/2021/10/CDCcase...
|
| https://arc-anglerfish-washpost-prod-
| washpost.s3.amazonaws.c...
|
| https://static01.nyt.com/images/2021/10/28/us/virus-
| breakthr...
|
| https://static01.nyt.com/images/2022/01/10/briefing/11-MORN
| I...
| opprobium wrote:
| This injection isn't a vaccine, it's an anti-viral drug being
| used as pre-exposure prophylaxis. The first approval of this
| approach was in 2012, but using an oral pill with a short half-
| life taken daily.
|
| That drug is still in use and also highly effective, the new
| improvement is to provide the same approach with a longer
| acting injected drug. One reason there has been great interest
| in this, despite the already effective oral PREP, is that there
| are thought to be socio-behavior advantages for cases like
| women in Africa as in this study. For example: the woman does
| not have to keep a supply of daily pills that a partner can
| find. Also possibly improved adherence with no missed doses.
|
| The drug itself is not thought to be more biologically
| effective than the oral drugs, which are basically already at
| close to 100% effective assuming the patient actually takes
| them as scheduled.
| mywacaday wrote:
| I tested positive for COVID last weekend, was out of action for
| three days and spiked a 40.3C/104.5f fever. It was worse than
| when I got it three years ago.
| Lammy wrote:
| Relevant Bill Hicks (1989) :)
| https://www.youtube.com/watch?v=lxjyg5dTx6k
| kbos87 wrote:
| We've been on the road to this for a while, and it's so exciting
| to see. I switched to injectable prep a few months ago to avoid
| having to take a daily pill - it's an injection once every two
| months, and my doctor told me that the guidance might soon change
| to once every three months.
|
| It sounds simple but for a lot of people it's not a trivial thing
| to take a pill every day or adhere to a strict appointment
| schedule to get an injection. I'd imagine that adoption &
| compliance goes way up if it's that much easier.
| nerdjon wrote:
| I have been debating on switching to the shot but Havnt yet.
|
| Just to avoid the accidentally missing a dose or the chance
| interactions (lower efficacy) with dairy and many fiber
| supplements, this would be amazing.
|
| Would be nice to never need to worry about that or think, hey I
| missed a dose is it actually true that it doesn't matter or do
| I need to wait a full week. Half a week?
|
| My only concern here though, if it's in your system for 6
| months what if you have an adverse reaction or just some
| unpleasant symptoms.
| schlipity wrote:
| I'm going to assume a bit and for that I'll apologize in
| advance. I'm assuming you're in a high risk group for HIV.
| Why not just use condoms? Is it because they aren't 100%
| effective?
| halfmatthalfcat wrote:
| Isn't this like asking by do we have multiple methods of
| birth control? Pill, IUD, etc?
| schlipity wrote:
| This is a great way of looking at it, thank you for that.
| granfaffalo wrote:
| I'm not going to make such an assumption, but two reasons
| people prefer PrEP generally:
|
| 1. in sex work, "not using a condom" is an "extra" that
| clients will pay quite a bit for
|
| 2. people who "party and play" tend to be in an altered
| state of consciousness that biases against use of condoms
| justinclift wrote:
| > in sex work, "not using a condom" is an "extra" that
| clients will pay quite a bit for
|
| To me, that is such a weird thing.
|
| People literally paying money for something that can
| damage them for life and may even kill them.
|
| Though the same can be said of addictive things (smoking
| comes to mind), is this some form of that maybe?
| shiroiushi wrote:
| >People literally paying money for something that can
| damage them for life and may even kill them.
|
| You could say the same about sky-diving.
| justinclift wrote:
| Yep, sure could. :)
| mattmaroon wrote:
| Risk always entails a premium.
| mypalmike wrote:
| Not generally, no. Driving that car with the sketchy
| suspension is cheaper than getting it fixed.
| danielxt wrote:
| it does, because the chances of you needing expensive
| medical care after using the sketchy vehicle go up
| thfuran wrote:
| If you drive faster still in a car that also lacks
| crumple zones and airbags, your expected medical bill
| probably decreases.
| mypalmike wrote:
| Yes it's easy to strain metaphors.
| vidarh wrote:
| This is obtuse. The intent of expressing that if you are
| _paying someone else_ for a service, it predisposes them
| to demand a higher price if you 're asking them to take
| additional risks if they have any negotiating power at
| all was pretty obvious.
| mypalmike wrote:
| The discussion was about the additional risk to the
| customer, not the vendor.
| vidarh wrote:
| The comment above the one you replied to was. The comment
| you replied to was not, and it'd be reasonable to suggest
| it didn't really address what it replied to. But its
| intent was clear.
| amyjess wrote:
| A better analogy would be to buy a '60s sports car that
| predates nearly all modern safety tech at auction for
| $$$$$$ instead of just buying a 2024 Corolla with modern
| safety features.
| vidarh wrote:
| People have a risk level they're comfortable with, and
| sometimes people feel added excitement pushing right up
| to or past that level, and sometimes they're just happy
| to pay extra for something they feel is within that risk
| level if they enjoy it more.
|
| We all choose to take risks all the time and often pay
| for the privilege, sometimes explicitly seeking out the
| thrill of a risk.
|
| I'm guessing what makes _this specific_ scenario weird
| for you is more likely that this risk doesn 't seem
| worthwhile to you relative to what you get from it (and I
| agree with _that_ - I 've never had an appetite for
| taking risks with STDs)
| pasquinelli wrote:
| > To me, that is such a weird thing.
|
| i'm confused. are we acting like we don't full-well know
| that using a condom sucks for everyone involved? it's
| like wondering why people didn't like using a face mask
| during covid: because it sucks. that, of course, is
| independent from whether it's prudent, but if something
| sucks, it's no surprise when people avoid it, right?
| sdwr wrote:
| There's that middle ground!
| wvh wrote:
| Maybe you want the real thing. I get that, even though I
| have never had sex with a prostitute or fall into the
| risky sex category. I'm not going to go as far as to be
| childishly disrespectful and say I'd rather die doing the
| real thing, but I do understand the apprehension of using
| artificial barriers during the most intimate act know to
| humankind.
| mock-possum wrote:
| Yes but _it feels good_
| sureIy wrote:
| Being horny also counts as being "in an altered state of
| consciousness that biases against use of condoms."
|
| As someone who took the condom off in a risky situation
| recently, there's no comparison between the on and off
| feeling. It's like licking a piece of candy vs crushing
| it with your teeth and sucking it all at once.
| odyssey7 wrote:
| It's not that complicated. A lot of people don't like
| condoms, either wearing them or having a partner wear
| them. PrEP, to many, has rendered condoms unnecessary.
| snapplebobapple wrote:
| Have you had sex wearing a condom vs not? Its gotten better
| in the last twenty years but it is still noticeably worse
| iknowstuff wrote:
| Condoms are less effective at HIV prevention, but also
| they're unpleasant and don't prevent most STIs because of
| oral sex. Nobody's giving or getting head with a condom.
| People who stay on top of preventative measures tend to not
| bother with condoms since PrEP became prevalent.
|
| Preventative:
|
| 1. Gardasil 9 (vaccine against 9 strains of HPV, prevents
| genital warts and cancers caused by HPV)
|
| 2. Monkeypox vaccine
|
| 3. Meningitis ACYW vax
|
| 4. Meningitis B vax (35% effective against gonorrhea)
|
| 5. doxyPEP (two pills of doxycycline taken after sex, 90%
| effective against syphilis, 80% chlamydia, 50% gonorrhea)
|
| 6. PrEP (prevents HIV infections)
|
| 7. and the usual suite of vaccines against the rest like
| hepatitis A/B, mumps etc
|
| Treatment of the bacterial ones (which transmit through
| oral too):
|
| 1. syphilis - butt shot of penicillin 2. chlamydia - 1 pill
| of an antibiotic 3. gonorrhea - a week of doxycycline pills
| or one butt shot of ceftriaxone
|
| Remaining: HSV. Half of the population has it, so no big
| deal. Condoms dont prevent it either.
|
| As for hepatitis: even though it requires blood contact and
| as such is not necessarily considered an STI, hepatitis c
| is curable these days thanks to DAAs taken over the course
| of 8-12 weeks. a/b have vaccines.
| anjel wrote:
| ...And your odds of making it through that pharma-
| minefield with zero side effects are not encouraging.
|
| Worse still--large scale casual sex is a great way to
| introduce new, novel and un-contemplated STDs into the
| population. STDs are opportunistic that way, just ask Mr.
| triple-resistant Gonorrhea.
|
| It's decidedly not the way I want it to be, but that's
| just how it works. For casual sex to be safe I think its
| more like "Hi, please spit into this tube so we can get
| busy" and red means HIV, Green means Monkeypox,
| comprehensively.
| autoexec wrote:
| It's not just about casual sex though is it. There are
| _many_ people in long term monogamous relationships with
| a partner who has an STD, but who don 't want to catch it
| themselves. Vaccines and medications can allow them to
| have active sex lives while staying healthy and in some
| cases even help women go through pregnancy and childbirth
| while preventing the spread of an STD to the child. For
| these people minor side effects (and at times even more
| severe ones) can be entirely worthwhile.
| tcmart14 wrote:
| Or perhaps maybe a future for occupational health. My
| wife is a nurse. Needle sticks happen. When it does, she
| has to get tested, full works. The hospital pays for that
| and the treatment. Maybe with a shot that lasts a year
| rather than the current 2-3 months(?), hospital staff can
| just opt that route then the test and treatment.
| Apparently the treatment is rather gnarly.
| pknomad wrote:
| Inefficacy against HSV is interesting. I had no idea. Why
| is it ineffective?
| gumby wrote:
| Oral sex is a big reason. Michael Douglas got tongue
| cancer* from HPV.
|
| Actually it appears the 9-polyvalent HPV vaccine protects
| against multiple cancers but insurance won't pay for it
| once your outside the age window.
|
| * originally he said "throat cancer" at the advice of his
| agent!
|
| [edited: wityl pointed out I'd typed H _S_ V for some
| reason]
| wityl wrote:
| You are thinking of HPV, HSV is herpes.
|
| There is no vaccine, it doesn't cause cancer (that we
| know of, at least not like HPV), and spreads via skin
| contact on the genital area.
|
| Since fluids are not required for HPV or HSV and it's
| present on the area that a condom won't cover, condoms
| aren't effective for either.
| gumby wrote:
| Yes it was a brain fart -- fixed!
| creer wrote:
| HSV-1 and -2 transmit through contact from skin location
| to skin. Including through asymptomatic shedding. Only
| sometimes is that location covered by a condom - in
| location and in timing.
|
| See also: Wrestlers' "Herpes gladiatorum" which is just
| HSV-1. Which demonstrates how HSV-1 survives for
| transmission far more easily or broadly than just genital
| contact. Is there "HSV-2 gladiatorum"? Apparently it's
| usually HSV-1 but probably yes - neither HSV-1 or HSV-2
| are really location specific.
| projektfu wrote:
| I looked through the literature and it seems that condoms
| are quite effective at preventing HSV infection when
| used, especially from male to female (on the order of
| 99%), and less so for female to male (around 60-70%). I
| would suspect the reason for failure is behavioral.
| People probably don't apply the condom until after most
| of foreplay is over and HSV-2 can be transmitted during
| "outercourse".
| gumby wrote:
| > Nobody's giving or getting head with a condom.
|
| In the early days of AIDS (wasn't called HIV back then)
| the recommendation was to use a condom or dental dam
| (depending on the hardware of the recipient). That's how
| I learned what a dental dam was. Later it was suggested
| that plastic food wrap would work (the jokes just write
| themselves).
|
| Sadly the ubiquity of paper toilet sheet covers in US
| bathrooms dates back to the 80s due to straight paranoia
| over AIDs + widespread and overt anti-gay prejudice, so
| every time I see one of those dispensers I grit my teeth.
|
| Reminds me of the early days of COVID (not the anti-gay
| part, but the weird practices when nobody really had yet
| a good theory of what's going on).
| everforward wrote:
| HIV (human immunodeficiency virus) is the virus, AIDS
| (Acquired Immune Deficiency Syndrome) is the syndrome
| caused by untreated HIV. Everybody with AIDS has HIV, but
| not everyone with HIV has AIDS.
|
| The reason for the reversal in terms is treatment
| options. When HIV was first found, there were no
| treatments so AIDS was inevitable. Nowadays, medication
| can permanently prevent HIV from progressing to AIDS, so
| AIDS is much less common than HIV.
| close04 wrote:
| > In the early days of AIDS (wasn't called HIV back then)
|
| You might be thinking of "GRID" (gay related immuno
| deficiency), the original name of AIDS when it was
| believed it only affects gay people. Once the virus
| causing the illness was identified it was called HIV.
| giantg2 wrote:
| PreP actually reduces the chances of acquiring other
| viral STDs to varying degrees.
| alwa wrote:
| Although we have to admit the moral hazard element too:
| by altering the risk calculus, it does seem to have
| helped weaken cultural norms around condom use and risky
| sexual behavior. Business is booming for bacterial
| infections.
|
| Personally I'd say that's a pretty good tradeoff: fear,
| stigma, and death for a different problem that's more an
| annoyance than a mortal threat right now.
| giantg2 wrote:
| I think another overlooked portion is that we shouldn't
| be using meds (for infectious diseases) to enable fun
| (which seems common with sex). Eventually those meds will
| lose effectiveness, that's just evolution. Then the
| people who really do need them will be out of luck.
| cycomanic wrote:
| > 5. doxyPEP (two pills of doxycycline taken after sex,
| 90% effective against syphilis, 80% chlamydia, 50%
| gonorrhea)
|
| Preventatively using antibiotics is a horrible idea, for
| one it increases the risk of creating resisitant strains,
| and we are already running out of antibiotics (especially
| broadband ones). Moreover, antibiotics in general are
| known to mess with you gut biome whose importance we are
| just beginning to understand (we know it plays a role in
| many physical and mental illnesses for example). Then
| there are the side effects which for doxycyline include
| diarrhea, increased risk of bowel cancer, higher
| sensitivity to the sun (and associated risk of skin
| cancer).
| loopdoend wrote:
| Been taking it every day for 15 years with no problems
| and actually I seem to look 10 years younger than
| everyone in my age group.
| vasco wrote:
| The problems are for humanity not for you, with spurious
| use of antibiotics. Resistant strains can kill everyone.
| simianparrot wrote:
| Please tell me this is a joke / satire
| rswskg wrote:
| No, there are many many people who are this entitled.
| snowwrestler wrote:
| This is really surprising to me since there is a lot of
| evidence that oral antibiotics can mess up your gut
| flora, creating all sorts of bad side effects. Do you
| have any digestive issues?
| alwa wrote:
| The people responding to this seem to assume you're doing
| so for funsies, which might be true. But that's not what
| you said. So for their benefit, it's worth pointing out
| that daily doxycycline is a pretty normal therapy for a
| range of chronic stuff--malaria prophylaxis, rosacea and
| skin that's prone to infections, I'm sure there's more.
|
| If loopdoend's doing this, it feels like a good bet that
| there's a doctor in the mix judging that it's medically
| appropriate for them.
| alwa wrote:
| This all feels really general--precipitated on the idea
| that there's one Right Way for everyone to use these
| drugs, about which the doctors and public health
| professionals recommending doxyPEP are somehow
| uninformed.
|
| Suppose you're immunocompromised. Wouldn't it be worth
| the diarrhea to avoid infections your body couldn't fight
| off?
|
| Suppose you're in a situation where you're having lots of
| opportunities for infection. Whether you can or can't
| control that situation, the end result is the same: you
| know your body is going to be challenged by infectious
| disease frequently in a way that most people's bodies
| aren't. Isn't it plausible that the infectious agent may
| have less opportunity to evolve if you didn't contract it
| as frequently?
|
| Different forms of therapy might be both individually and
| collectively optimal for people in different situations.
| What's right for a person who isn't at risk isn't the
| same as what's right for a person who is at risk.
| bobthepanda wrote:
| Doxy is already prescribed in the US as a treatment
| regimen for acne, so if that's going to be allowed STI
| prevention seems way more useful.
|
| The overuse of antibiotics is mostly in farm animals,
| which represent 73% of global antibiotics use, and 90% of
| American antibiotics use.
| verulito wrote:
| antibiotics are toxic in general, likely affecting way
| more than bowels. many are ototoxic for example.
| droptablemain wrote:
| Pardon my puritanism, but this seems like an awful lot to
| put your body through to get your rocks off and engage in
| this sort of indulgence.
| Bluescreenbuddy wrote:
| "doxyPEP (two pills of doxycycline taken after sex, 90%
| effective against syphilis, 80% chlamydia, 50%
| gonorrhea)"
|
| This is how you end up with super STD's
| HaZeust wrote:
| >Condoms are less effective at HIV prevention
|
| lol what
|
| https://www.cdc.gov/hiv/risk/condoms.html "condoms are
| highly effective in preventing HIV"
|
| https://pubmed.ncbi.nlm.nih.gov/9141163/ 1997,
| "reexamination of HIV seroconversion studies suggests
| that condoms are 90 to 95% effective when used
| consistently"
|
| https://www.cdc.gov/hiv/prevention/condoms.html "Most
| condoms are effective in preventing HIV and certain other
| STIs"
| heavyset_go wrote:
| People lie and condoms break.
| JanetToolsmith wrote:
| > Why not just use condoms?
|
| Why not just save money and not install those ECP brakes on
| your vinyl chloride freight train?
|
| Why not just use one unshielded Raspberry Pi on that
| spacecraft instead of a 3-of-5 quorum from the output of 5
| identical engineered-for-space systems?
|
| Using/requiring condoms AND being on PrEP helps me live my
| best life with less fear-based inhibition and cognitive
| load.
| Flumtioniro wrote:
| The same reason why not everyone drives the safest car:
| cost and other negatives.
|
| In case of a pill perhaps negative side effects.
|
| I have no clue how often a person in high HIV risk has
| sex or behaves.
|
| It should be fine to ask that question
| brunoTbear wrote:
| Some of us prefer to enjoy sex as a beautiful act of human
| connection and condoms detract from being in the moment of
| joy.
|
| This is like saying to someone killed in a motorcycle
| accident why didn't you use a car. It's a reductive,
| unempathetic and frankly unproductive take. Please think
| before asking this again.
| oopsallmagic wrote:
| Condoms aren't perfect, and PrEP is cheap and has basically
| zero side effects. Plus, rapists don't use condoms, no
| matter how nicely you ask.
|
| Edit: lmao touched a nerve? I will never understand why
| folks here get so prudish when we talk about sex... "Just
| wear a condom!" is remarkably insensitive, as though 100%
| of HIV transmission is your own fault, and not, say,
| someone else who has bad intentions.
| 39896880 wrote:
| It's because they're no fun.
| throwaway7ahgb wrote:
| Why not just not have sex unless trying to procreate? It's
| amazing in 2024 this line of discussion is happening.
|
| We all know exactly at a individual level what to do and
| not. We can keep asking "Why not just use a condom?" and
| see how far that gets us, or actually understand psychology
| and use patterns and work with what people actually do
| (good or bad).
|
| Same can be said about (illicit) drugs, why not just not do
| drugs? Simple!
| rswskg wrote:
| I guess you aren't assuming to be around when the
| osteoporosis kicks in?
| throwaway7ahgb wrote:
| What are you implying, if I have sex without a condom
| I'll die sooner?
| AlexandrB wrote:
| > Same can be said about (illicit) drugs, why not just
| not do drugs? Simple!
|
| It _is_ actually simple. Just not _easy_. Same with
| losing weight - consume fewer calories than you burn.
| hn_throwaway_99 wrote:
| Who prefers to chew gum with the wrapper on?
| bravura wrote:
| Besides the other nice reasons people offered, because
| "stealthing" (when someone removes a condom during sex
| without the other person's consent or lies about having put
| one) is remarkably common, and not as easily noticed as you
| might expect.
| whimsicalism wrote:
| this might be news to HN, but condomless sex feels
| significantly better
|
| moreover, condoms can have numerous issues like tearing or
| stealthing
| fullspectrumdev wrote:
| They can break, so multiple protective elements is better.
| iknowstuff wrote:
| The drug is cabotegravir and if you want to feel safer you
| can take the pill form of it first to test it out.
| throwaway7ahgb wrote:
| Any chance these will ever be self injectable (with Rx)?
| barfingclouds wrote:
| From my understanding they make you do it in pill form for a
| bit first to see how you react
| ffrghdbsbd wrote:
| Agreed, it's another treatment in a continuum of adherence--
| pre relations testing, barrier precautions, daily pills,
| semiannual injections. All running up to the eventual asymptote
| of cure and eradication.
| OptionOfT wrote:
| Couldn't you get an injection like Ozempic/Wegovy? Just have it
| in the fridge? Does it have to be administered in a physician's
| office?
| mullen wrote:
| A lot of these medicines that require patients to inject
| themselves come in a self administrating auto-injector. There
| are really simple to use, I mean literally anyone can inject
| themselves, then throw the one-use auto-injector out.
| kelseyfrog wrote:
| There's also needle guides[1] which provide a lot of
| flexibility for those who self-administer.
|
| 1. https://unionmedico.com/45-reusable-s1/
| kbos87 wrote:
| I think the GLP-1s are subcutaneous injections - tiny, tiny
| needles you can stick in a variety of locations - Apertude is
| intramuscular, it's a much larger needle, I'm guessing
| there's some level of skill involved.
| httpsterio wrote:
| I get an intra muscular injection of testosterone every two
| weeks and it's true that it's not as easy as a sub q
| injection would be, but it also definitely doesn't require
| a nurse.
|
| there's a few good injection sites (upper arm, buttock,
| thigh or even pecs) and after I was shown once how it's
| done, I can do it myself. it's also essentially painless.
| AuryGlenz wrote:
| Unless, of course, you hit a nerve. Every damned time I
| try my thigh..
|
| For what it's worth you might want to try a weekly dose
| if you haven't. Most do better on it.
| swat535 wrote:
| Off topic, feel free not to answer if it's too personal
| but I'm curious how is every two week injections working
| for you for Testosterone? Are you on TRT for Hypogonadism
| or is it something else? I haven't heard too many people
| be on that kind of protocol..
|
| I'm Hypogonad and I'm on self administration of sub q
| injections twice a week and it's quite annoying. My
| urologist told me it's best to split it this way since
| more frequent injections avoids a "crash".
|
| I would like to have less frequent injections if I could!
| thesaintlives wrote:
| Sub q is complete nonsense. Once every 10 days or so is
| fine. You simply feel like you need another shot and take
| it. No advantage and not necessary.
| phil21 wrote:
| It depends on the exact type of Testosterone being used.
| Each type has a different half-life and absorption
| profile.
|
| The most common - Testosterone Cypionate should be best
| used twice a week to avoid the "crashes" - if you care
| about keeping your levels relatively stable. Other forms
| of Testosterone have different half-lives and should be
| taken at differing schedules.
|
| I never saw the point in subq shots for TRT. They are
| less effective, and are recommended solely for patient
| comfort and compliance. If you can manage a twice-weekly
| deep IM injection, I personally have had great results
| with that once I learned the locations. Nearly as
| painless as subq and better more consistent results.
|
| Overall it doesn't matter a whole ton unless you are
| doing it for specific performance enhancing reasons.
| Being off "optimal schedule" a few days isn't going to
| make a meaningful difference for most.
| throwaway7ahgb wrote:
| I take subq TRT twice a week (cypionate). I may lose some
| efficiency in fat vs muscle but it is easy, painless and
| my levels are perfectly fine.
|
| I don't see why I change and my doctor essentially said
| the same.
| moneywoes wrote:
| how much does it cost?
| david38 wrote:
| Like birth control. The pill has a higher "failure" rate than
| many people think. It's of course "user error"
| spacebanana7 wrote:
| As evidence, despite theoretically being over 99% effective
| most birth control pills are around 91% effective in ordinary
| use.
|
| https://www.nhs.uk/contraception/choosing-
| contraception/how-...
| 39896880 wrote:
| Do you mind sharing how you got insurance approval? I looked
| into it but it was needlessly complicated. I couldn't even get
| a cash price quoted.
| barfingclouds wrote:
| Well and I have to go in to get tested every 3 months anyways
| wouldbecouldbe wrote:
| Can't read the full article but how is this different from prep?
| It's widely used in prevention in the gay community.
|
| [edit] it's prep, it's been in use for several years already, but
| this injection last longer
| wrs wrote:
| Twice-yearly shot rather than daily pill.
| retrac wrote:
| Just to be clear, this is not a vaccine. It is an antiviral drug
| delivered by a long-lasting subdermal delivery implant. It has
| been known that antiviral drugs effectively prevent HIV infection
| for some time now (about 20 years). Recent work has been on
| better-tolerated and longer-lasting formulations.
|
| Treatment of HIV+ people also reduces their infectiousness, and
| good treatment reduces the risk of passing the infection on
| nearly to zero. Providing sufficient HIV antivirals and medical
| care to everyone in the population, both HIV+ and at risk for
| HIV, in theory, could be enough to halt the pandemic. Some
| wealthy countries with sensible policies have seen remarkable
| gains. The UK is reasonably effective at getting drugs to both
| the HIV+ and to at-risk populations, and the number of new HIV
| infections there, has been reduced by approximately half in the
| last decade.
| cj wrote:
| It's not a vaccine, but it's close to one at twice a year.
|
| Even if we can consider HIV "cured" in the developed world
| (where PrEP is available to anyone who wants it) there's no way
| we eradicate HIV from impoverished countries with limited
| healthcare access until we either have 1) a vaccine, or 2) a
| shot (or something) that prevents HIV for a really _freaking_
| long time.
|
| Not sure if 6 months will quite cut it, but it's great to see
| progress in the right direction. More advancement is needed.
| Frost1x wrote:
| I assume you're referring to things like the flu vaccine.
| Many vaccines can last 10, 20 years or more which this
| doesn't come close to.
|
| That's not to say it's not a great improvement, I happily
| await the day we can nearly eliminate some of these
| infectious diseases that plague humanity.
| duskwuff wrote:
| > It is an antiviral drug delivered by a long-lasting subdermal
| delivery implant.
|
| I don't see anything to indicate it's an implant - the
| prescribing information [1] says it's a subQ injection, and the
| trial information [2] seems consistent with that.
|
| [1]:
| https://www.gilead.com/-/media/files/pdfs/medicines/hiv/sunl...
|
| [2]: https://classic.clinicaltrials.gov/ct2/show/NCT04994509
| retrac wrote:
| You're right. I blithely assumed any drug with such a long
| half-life must have some sort of delayed dose mechanism. But
| it seems it's just extraordinarily stable and is very, very
| slowly absorbed. Remarkable.
| xs83 wrote:
| Awesome news - we will eradicate HIV within the a single
| generation at this rate!
| greazy wrote:
| Only if we push for treatments to be cheap and widely available
| throughout the world and especially in Africa.
|
| Unfortunately it takes many years or evens decades for
| developing countries to afford these treatments.
| dashundchen wrote:
| Programs like George Bush's PEPFAR have made great strides in
| fighting HIV globally through treatment and prevention.
| Estimated at 25 millions lives saved in 20 years, mostly in
| Africa.
|
| https://en.m.wikipedia.org/wiki/President%27s_Emergency_Plan.
| ..
|
| Unfortunately it's become a target of the right wing culture
| warriors and certain groups are trying to gut it, after huge
| strides have been made in reducing global transmission of
| HIV.
| vasco wrote:
| Yeah but the united states is also the main cause of
| developing countries not having access to cheap medicines
| through the enforcement of IP laws. You can look up the
| special case of India and Brazil who managed to negotiate
| in a much better way and so are entitled to cheaper
| treatments.
|
| I know someone from a EU country that had to do medical
| tourism to Brazil to afford hepatitis and HIV treatment as
| the drugs are so expensive that the doctors at public
| hospitals (in that country at least) will not prescribed
| them and instead manage the illness in other ways for the
| first few years. This is bad because the disease progresses
| faster.
| JumpCrisscross wrote:
| > _we will eradicate HIV within the a single generation at this
| rate_
|
| If there is one place socialised medicine makes so much sense
| that almost any argument against it is invalid, it's around
| contagious diseases. The prevention and treatment, inasmuch as
| it reduces transmission, which is true of virtually all HIV
| treatments, should be as effortless as possible. That _starts_
| with making it free.
| oopsallmagic wrote:
| We had a taste when COVID shots were free, and it was
| magical. So nice not having to make 16 phone calls and then
| getting billed $800 "by mistake", followed by 20 more phone
| calls to fix it, only to find out that the pharmacist's
| sister's mailman was out of network, so we're sending your
| bill to collections because it got lost in the mail.
| xeonmc wrote:
| These are really Aladeen news!
| yieldcrv wrote:
| not this generation given how long approvals take, but a single
| one when we get around to it!
| Klaster_1 wrote:
| Wouldn't complete eradication mean eradication in all
| countries? Given HIV policies degradation in Russia, which is
| significantly affected and has a sizeable population, your
| assumptions sounds too optimistic, even though I agree that
| would be a great achievement.
| DoreenMichele wrote:
| Excellent news. HIV is nasty stuff. It acts sort of like an
| acquired genetic disorder.
|
| It's a retrovirus, so it makes two copies of itself and replaces
| cellular DNA. Two RNA welded together make up DNA, so it more or
| less gives you the equivalent of a genetic disorder.
| observer987 wrote:
| The paradox of living in this day and age is witnessing
| astonishing advances in science, while enduring the increasing
| levels of anti-intellectualism that pervades society like a
| cancer.
| teh_infallible wrote:
| I suppose that's another way of saying we're seeing
| controversial advances in science.
| javawizard wrote:
| Not sure what you're saying, can you elaborate?
| speed_spread wrote:
| Anything new can be controversial if you're allergic to
| change.
| oopsallmagic wrote:
| You don't need to take HIV medication, but you don't need to
| prevent the rest of us from enjoying the benefits of
| modernity, too.
| beaeglebeachedd wrote:
| I think you'll find certain parties on both sides secretly
| want things to be framed as controversial to drum up the
| useful idiots to their cause or open their checkbook.
| yieldcrv wrote:
| its only been a small gap in time where anti-intellectualism
| was segregated from society. you could always just be in your
| tiny circles of elite higher education.
|
| only thing thats changed this time is anti-intellectualism is
| given a microphone.
| EnigmaFlare wrote:
| I think all the really obvious and influential products of
| science and technology happened in the 20th century and now
| we're so comfortable because of those that we take it for
| granted. Then people find reasons to hate it because they
| forget how bad things were without it (previous generations).
| Same goes for political stability.
|
| Another aspect is that a lot of intellectualism is really
| activism with "intellectuals" trying to impede other people's
| lives for the sake of some arrogant moral purpose.
| autoexec wrote:
| > now we're so comfortable because of those that we take it
| for granted. Then people find reasons to hate it because they
| forget how bad things were without it (previous generations).
| Same goes for political stability.
|
| I'm not sure that most people are really all that
| comfortable. They're a lot more distracted though certainly.
|
| I think there are a lot of different reasons people today
| have a problem with science and technology. Some are scared
| of it. Some just don't trust it, which can be entirely fair
| depending on the degree/situation. Some see that the
| regulations, oversight, and accountability we expect and
| depend on to keep us safe aren't working like they used to or
| like we thought they would.
|
| Mostly I think people see not only what we've gained, but
| also what we've lost and could/should have again. Reliable
| and repairable products that weren't designed to exploit and
| work against the interests of the person who paid for them
| for just one example. We've had many trade offs, where
| they've improved things in some areas while making them worse
| in others. It hasn't always worked out in our favor. It's
| also frustrating when you see that amazing things are now
| possible, but we can't have them because of politics, or
| greed, or fear of change.
|
| Personally, I hope people never stop wanting and expecting
| better from science and technology. Especially in those cases
| where what previous generations had was better than what
| we're expected to accept today or where we've created
| problems previous generations never had to put up with.
| armada651 wrote:
| > I think there are a lot of different reasons people today
| have a problem with science and technology. Some are scared
| of it. Some just don't trust it, which can be entirely fair
| depending on the degree/situation. Some see that the
| regulations, oversight, and accountability we expect and
| depend on to keep us safe aren't working like they used to
| or like we thought they would.
|
| We often forget that many people have been genuinely
| negatively affected by technology or science or know
| someone who has. Let's not forget that many technological
| and medical advances have come at a real human cost. People
| have been poisoned by harmful chemicals either during their
| occupation or because an entire community has been exposed.
| Entire communities have been devastated by the opioid
| epidemic which the medical community is directly
| responsible for. Not to mention the countless people who
| have lost their jobs or will lose them soon to automation.
|
| There are people with genuine concerns about the way
| science and technology are heading and pretending anyone
| skeptical of modern science is simply uneducated or stupid
| is extremely counter-productive.
| autoexec wrote:
| I think things like the opioid crisis where doctors were
| getting outright bribes from pharmaceutical companies who
| knew they were killing people has done a massive amount
| of harm to the trust people had in medical science. It's
| been a problem for a long time, even going back to the
| tobacco industry hiring researchers to lie about the
| dangers of smoking. Those researchers didn't lose their
| jobs and become unhireable in their fields. They just
| went on to work for the oil companies to lie about how
| climate change isn't real and are now working for
| companies currently trying to convince the FDA about the
| safety of food additives.
|
| Between corporations being able to buy whatever research
| they think will get them a favorable headline, peer
| reviewed journals accepting any paper if you pay them to
| publish it (this one being a personal favorite
| https://www.sciencealert.com/a-neuroscientist-just-
| tricked-4...), the reproducibility crisis more generally,
| the total lack of any meaningful consequences when
| companies are caught outright knowingly poisoning people
| or selling dangerous drugs, it's really getting harder to
| explain to people at the fringes like antivaxxers why
| they should have more faith in the data we have and on
| the systems put in place to protect them.
|
| If the people aren't held accountable for causing harm
| and scientists don't do a much better job self-policing I
| think the situation is only going to get much worse. Even
| if things do change it will likely take generations to
| undo the damage already done.
| ithkuil wrote:
| People don't _feel_ comfortable but they objectively are
| much more comfortable that 120 years ago or more.
| Unfortunately being objectively more comfortable doesn't
| make you feel more comfortable and ultimately it matters
| how you feel and want to fix whatever is causing them to
| feel like shit.
| UniverseHacker wrote:
| > I'm not sure that most people are really all that
| comfortable. They're a lot more distracted though
| certainly.
|
| I think people in wealthy countries like the USA are very
| physically comfortable, but also quite unhappy- possibly
| much more unhappy day to day than they were historically
| when there was a lot more disease and discomfort- and a lot
| of that is directly a result of excess comfort combined
| with a life without any real difficulty, challenge, or
| sense of meaningful purpose. We feel like we want comfort,
| but it's mostly harmful to us. Humans just aren't built to
| be "house pets." People need a sense of purpose, of
| overcoming difficult challenge, and an ability to directly
| see positive results from their efforts. The challenges
| need to be both mental, and physical.
|
| What we have now is lots of empty entertainment, stupor
| inducing comfort, and lots of sedentary careers that feel
| pointless, where nobody even notices the difference if you
| work hard or not. More and more people are burned out at
| work, and socially isolated.
|
| I don't think the answer is to go "backwards" and lose all
| of our progress in treating disease, making labor easier,
| etc. but in a cultural and personal change where we find
| some new meaning and challenges, to grow even more.
| Personally, I've found this through being a scientist where
| I can work on hard problems, as well as doing physically
| demanding and uncomfortable hobbies like weight training,
| fasting, and cold water swimming.
|
| I've noticed that the more intentional physical discomfort
| I experience, e.g. from cold, the more content I feel, and
| the less I crave comfort, or other addictive things like
| social media and overeating.
| Aerroon wrote:
| I think what societies need is a feeling of hope and
| improvement. As long as people feel that things are getting
| better they are happy.
| Angostura wrote:
| > Another aspect is that a lot of intellectualism is really
| activism with "intellectuals" trying to impede other people's
| lives for the sake of some arrogant moral purpose.
|
| OK, I'll bite -examples?
| jstanley wrote:
| You won't get any because of
| https://www.paulgraham.com/say.html
| nathan_compton wrote:
| This is such a cop out, especially given this is a fairly
| anonymous space AND pretty friendly to "cancelled" ideas.
| tim333 wrote:
| A historical example might be communism which impeded a lot
| of people's lives and was pushed by intellectuals going
| back to Marx himself.
|
| More recently some people are unenthusiastic about
| promoting trans stuff and affirmative action.
| mschuster91 wrote:
| In Germany, unlike every other European country (maybe except
| the Polish, not sure if they're doing the same with
| Auschwitz?), we have every generation of school children
| visit a Nazi Konzentrationslager once - precisely to avoid
| forgetting how bad it was, by showing the actual, undeniable
| evidence. And on top of that the Nazi dictatorship is usually
| an entire year's worth of history lessons in schools.
|
| Despite the far-right being on the rise as well as everywhere
| in Europe, they still have a harder time here, which I think
| is mostly due to these two education policies.
| Maken wrote:
| I do not think it's working. The AfD was the second most
| voted party for the European parliament, despite their
| candidate literally defending the SS a few weeks prior.
| mschuster91 wrote:
| European elections are usually used to deliver a
| "Denkzettel" to the currently governing party, it's the
| same across Europe as these elections are (wrongly) seen
| as consequenceless.
|
| Federally, the AfD is around 15-18% [1], which is still
| way too high in my opinion, but they're far from any
| chance to gain relevant influence on politics.
| _Statewide_ is a different beast, sadly in Eastern
| Germany (the equivalent of the "flyover states" in the
| US) they're almost at the 33% required to block major
| legislation [2]. I'm honestly not sure how to combat that
| any more, outside of a (well deserved, given e.g Hocke
| directly using banned NS slogans) ban on the party.
|
| [1] https://www.wahlrecht.de/umfragen/
|
| [2] https://dawum.de/Sachsen/
| racional wrote:
| _I 'm honestly not sure how to combat that any more,
| outside of a ban on the party._
|
| Perhaps by getting rid of these haughty, and one simply
| has to say: _typisch-Wessi_ notions of the new _Lander_
| as being "flyover territory". Which is part of what
| drives people to vote for AfD in the first place. As if
| the former West Germany doesn't have its own
| stereotypically maligned areas as well.
| bartekpacia wrote:
| Yes, in Poland we do the same (mandatory visit to
| Auschwitz)
| codesnik wrote:
| I wonder, how it is usually spinned? I'm asking as
| Russian and I see direct evidence of how people who grew
| up in the constant narrative "fascism is awful, that war
| was important, our grandparents are heroes" also, it
| seems, consumed it in easy/stupid form of "fascism is
| something that those weird germans do, they attacked us,
| and we won, so we can't be fascists ever".
| garaetjjte wrote:
| No, it isn't. I think it's rather weird tourist
| attraction to pick for a trip.
| literallycancer wrote:
| I'm pretty sure there are places in Europe where the AfD
| equivalent doesn't get 15%.
|
| Trip to a holocaust museum is nice and all, but it probably
| fails at making people understand the problem. They'll kind
| of nod that yeah, Nazis were bad but then happily go and
| blame others for their bad decisions and vote for populists
| with easy solutions.
|
| Somehow half of Germany thinks Russia is OK, because they
| "saved Europe", hammer and sickle symbols are still not
| treated the same as swastikas and, of course, the main
| outcome of the kind of education you mention is that
| Germany is basically freeloading wrt defense and very
| unwilling to do the only reasonable thing, i.e. help
| prevent another genocide as it unfolds in Europe.
|
| Hopefully something has changed in the last 2 years, but
| the preceding decade, spending over 100 million euros daily
| on Russian natural gas is hard to undo. And that's with
| pre-war historical minimum prices. Since you all didn't get
| the memo that you need to stop buying Russian stuff until
| NS2 got blown up, the flow of money for natural gas from
| Germany to Russia in 2022 and 2023 is likely several times
| the pre-war annual number.
|
| And then you have people saying shit like "we have spent
| enough on Ukraine" or "Ukrainian refugees are coming
| because of our social safety net", not even from AfD
| politicians (I think some CDU idiot, lol). Yeah sure, but
| you gave 100x the money to Russia, who of course spent it
| on weapons because they don't give two fucks about their
| own people.
|
| Being sorry about things from the last century, while
| failing completely to judge the situation in the present
| doesn't really help. Not to mention Poland still didn't get
| the war reparations for WW2 last I checked. They probably
| don't want to shake the boat too much and just hope Germany
| will at least stop being useless.
| agumonkey wrote:
| when the ratio between education and society sophistication
| flips you get problems. It's a strange group dynamics still.
| nathan_compton wrote:
| Do you really think there is no intellectual work to be done
| on moral subjects? That morality is entirely in the realm of
| folk intuition? If you thought very hard about some moral
| question and came to another conclusion than most of society,
| what would you do about it?
|
| Would you have called intellectual abolitionists people
| trying to impede other people's lives for some arrogant moral
| purpose?
|
| Like, I get it, nobody likes a woke-scold, but it is still
| weird to complain about the idea that an intellectual who
| comes to a moral understanding might want to act on that new
| understanding/change the world/convince others.
| autoexec wrote:
| In the US you also have situations where all that science means
| that effective treatments exist but they are entirely out of
| your reach because of insane healthcare costs.
|
| I can't imagine having to watch a loved one slowly die knowing
| that you are surrounded by doctors who could save them if you
| only had the tens to hundreds of thousands of dollars they
| demand or if you'd been living in basically any other developed
| nation on Earth.
| beaeglebeachedd wrote:
| That's because we subsidize the world by investing in a
| massive portion of the science and tech for producing
| medicines. Then when those costs are recouped via sales to
| our consumers the whole world laughs at us while ironically
| many of them would be up shits creek without the advancements
| they get to piggy back off of.
|
| Healthcare and medicine needs overhauling but it's maddening
| watching these downstream foreign benefactors damn the golden
| goose they'd be fucked without.
| autoexec wrote:
| I don't think it's necessarily true that we need to keep
| letting Americans needlessly die due to unaffordable
| healthcare in order to maintain our nation's lead in
| innovation. We should be able to continue to invest in
| medical science without continuing to fall behind other
| developed nations in actual health outcomes for patients.
| There are certainly many opportunities to drastically
| reduce the costs of healthcare without impacting the
| budgets for research.
| Aerroon wrote:
| Does the US actually fall behind other nations in health
| outcomes? The US has two big factors working against
| them: much more widespread obesity (and the level of
| morbid obesity) and the insurance bureaucracy. These two
| factors should negatively impact health statistics
| without the treatments being worse.
| autoexec wrote:
| > Does the US actually fall behind other nations in
| health outcomes?
|
| For the world's richest people you couldn't do better
| than to be a patient in America. For most Americans
| though, the US healthcare system is failing them. America
| does worse compared to other nations in some very basic
| measures like having a lower average life expectancy, a
| higher infant morality rate, more obesity and congestive
| heart failure and more hospital/pharmacy screw ups. A
| child or teenager in the US is less likely to live to
| adulthood compared to those in other developed countries.
| It's not any better when it comes to mental health
| either. The US is one of the worst nations when it comes
| to mental health outcomes and suicide and drug related
| deaths are higher in the US. Over thirty percent of the
| US population has been forced to put off getting the care
| they need due to the cost and preventative care is
| usually the first thing that people cut back on leading
| to bigger problems that could have been avoided entirely.
| nxm wrote:
| - 90% of Americans have health insurance - I would say it
| works for more than half (most) of Americans. Granted,
| not all health insurance is created equally.
|
| - The obesity and congestive heart failure issues is a
| function of poor dietary choices most Americans make
| (choosing fast/process food over cooking/making healthy
| foods), and not a function of healthcare access
| autoexec wrote:
| > 90% of Americans have health insurance
|
| Clearly having health insurance isn't enough to make
| healthcare affordable or prevent patient outcomes from
| being worse for Americans than patients in other nations.
|
| > The obesity and congestive heart failure issues is a
| function of poor dietary choices
|
| I also suspect that obesity and congestive heart failure
| issues are heavily influenced by diet, although I think
| that "choices" might be misleading here and that being
| unable to afford basic and preventative healthcare likely
| does have a major impact in healthcare outcomes even when
| the problems come from obesity and heart failure.
|
| It's certainly not as if people in other nations don't
| also enjoy ultra-processed foods or are any less fond of
| sugar, fat, and salt. They just often have better access
| to healthier foods, and more stringent regulations
| concerning what companies are and aren't allowed to put
| in foods, what they are allowed to advertise, and how
| they are sold.
|
| There is a huge difference between the number of people
| in the US who have little to no access to healthy foods
| when compared to those in other developed nations.
| Sometimes it's physical access (food deserts) and
| sometimes it's a matter of costs, but I don't think
| there's anything inherent to Americans that forces them
| to make bad choices. I'm guessing that instead Americans
| tend to have less choice and fewer opportunities for
| healthy foods in the first place, while having unhealthy
| ultra-processed foods that would be banned in other
| countries readily available, easily affordable, and
| heavily advertised to them.
| Aerroon wrote:
| I call bs on the second part. It's not unhealthy food
| that makes you gain weight, it's how much food you have.
|
| On top of that, the healthiest foods are among the
| cheapest foods you can buy. Milk, oatmeal, potatoes,
| rice, macaroni, chicken are all cheap compared to most
| foods you can get. This stuff is available almost
| everywhere.
|
| > _but I don 't think there's anything inherent to
| Americans that forces them to make bad choices._
|
| It's partly cultural. But this isn't a uniquely American
| problem. It's just worse in the US. 72% of Americans are
| obese or overweight.
|
| On top of that there was a recent study that found that
| BMR has decreased in the last ~30 years. Among men it was
| even up to 7%. That's a big enough difference to take
| someone from barely overweight to obese over a lifetime.
| But this is only a single study so far.
| autoexec wrote:
| > I call bs on the second part. It's not unhealthy food
| that makes you gain weight, it's how much food you have.
|
| I'd argue that unhealthy food can cause a person to eat
| more. See for example https://www.cell.com/cell-
| metabolism/fulltext/S1550-4131(19)...
|
| > On top of that, the healthiest foods are among the
| cheapest foods you can buy.
|
| The usual argument here calls out "bulk beans and rice"
| instead of potatoes and chicken, but in both cases you
| aren't going to find that in a gas station or convince
| store which for many Americans (some 40+ million) is the
| only place they can get groceries. If they're getting
| chicken it's not going to be whole and uncooked. It'll be
| sold in a plastic bag leaching PFAS into the food and be
| coated in high fructose corn syrup (most packaged lunch
| meats have sugar or HFCS added). Those kinds of places
| tend to have very little fresh fruit and veg as well.
|
| If you're looking at cost per calorie unhealthy food will
| often win out as less costly, not just in terms of money
| but also time and effort. Someone who works two jobs and
| spends hours sitting on or walking to/from the bus isn't
| always going to have the energy or time to roast a
| chicken. It's easy to see why they'd choose what's
| fastest, highly satisfying, requires less preparation and
| clean up, and is inexpensive.
|
| Not that I'm suggesting that the 72% of Americans who are
| obese/overweight have those kinds of problems... just
| that you'll find more Americans who are in that position
| than you'll find somewhere like the UK.
|
| I found the study on the decrease in BMR. That's pretty
| wild and if true, I wouldn't be surprised if it was a
| factor in the obesity problem.
| Aerroon wrote:
| > _If you 're looking at cost per calorie unhealthy food
| will often win out as less costly_
|
| What you should be looking for is cost per gram of
| protein. That's the only macro nutrient you need large
| amounts of. Calories per gram of protein are important
| too - oatmeal and dried pasta are the cheapest protein/$,
| but their protein/kcal is too low.
|
| I think it comes down to 'not caring enough' to try to
| get it under control. All the obfuscation and noise
| around nutrition ("healthy food") doesn't help either,
| but it's doable.
|
| > _I found the study on the decrease in BMR. That 's
| pretty wild and if true, I wouldn't be surprised if it
| was a factor in the obesity problem._
|
| It might even be the main part, at least for men. If your
| normal TDEE is 2136 kcal and you eat at maintenance, but
| then your BMR drops by 7.7% (165 kcal) then you'll gain
| weight until your TDEE is at 2136 kcal again. During this
| you would go from ~80 kg to ~95 kg taking you from 24.7
| BMI to 29.3.
|
| An argument against the study is that it could be due to
| different measuring techniques. On the other hand, we
| have found that the average temperature of humans is
| slowly decreasing, so maybe it's true.
| hgomersall wrote:
| The US has significant problems with over-treatment. I
| struggle to believe this isn't worse for the wealthy.
| autoexec wrote:
| It's not all roses. I'm sure that even the wealthy who
| get healthcare in the US do have to deal with things like
| over-treatment, a lack of regulations, excessive costs,
| etc. It doesn't seem to hurt their outcomes enough to
| offset the fact that they'll have far more options,
| greater access to the best avilable
| technology/treatments, and that they'll be treated like
| absolute royalty.
| ffgjgf1 wrote:
| If you adjust by factors like obesity, state and drug use
| US is quite close or more or less on the same level as
| Western European countries.
|
| Even if you don't do that there is a higher variance in
| life expectancy between different US states than inside
| the EU. e.g. California is about on par with the
| Netherlands, Germany, Britain while Mississippi and West
| Virginia are slightly below Bulgaria (of course mainly
| because of drugs..). IMHO that kinds of makes generalized
| comparisons semi-meaningless.
| allendoerfer wrote:
| "The US has a poverty problem. People are dying."
|
| "Yeah, but just unimportant people from flyover states.
| We have to divide our analysis of the _United_ States:
| Over here in California - you now were the people we care
| about live - life is just as good as in these other fancy
| European countries we don 't look down upon."
| ffgjgf1 wrote:
| > Yeah, but just unimportant people from flyover states
|
| That's not what I said at all..
| allendoerfer wrote:
| Why does it matter which Americans are dying? Other
| countries are not uniform either, averages are still
| applicable.
| ffgjgf1 wrote:
| > Why does it matter which Americans are dying?
|
| Because they are dying due to different reasons which
| can't be solved all at once using the same methods.
|
| > averages are still applicable.
|
| For what? What do you think is the purpose of any
| statistics or metrics?
| literallycancer wrote:
| People who can't do basic math and skip prevention are
| responsible for their own shit outcome.
|
| People in Portugal, where healthcare is "free", i.e. the
| government pays for it, frequently wait for years before
| being able to see a specialist due to long waitlists. The
| obvious outcome is that only poor people use the system
| and if you can you use private healthcare.
|
| People in Czechia with single payer healthcare system
| with e.g. average wage of 2000 USD pay from 100 euros a
| month for health insurance (unemployed) to e.g. 500 euros
| (with 4000 USD salary) or more if you make more. You get
| the same shitty service (something like 20 years behid
| the US), you just pay a lot more if you make anything
| resembling a US salary.
|
| There's no such thing as free healthcare. Can you make a
| single payer healthcare system that works better? Sure,
| it's just hard and even if everything is ideal you get
| maybe 50% discount. The main way to make healthcare
| cheaper is to drop coverage for diseases that are
| expensive to treat.
| dyauspitr wrote:
| I mean we have Medicaid, if you're poor don't you get
| healthcare for free?
| autoexec wrote:
| No. If you get something like cancer, at best you can
| expect Medicaid to be comparable to basic private health
| insurance, which can easily leave people with out of
| pocket costs they can't possibly afford.
|
| Medicaid has a ton of other problems starting with
| eligibility, but even if you are eligible and you
| successfully jump through all the hoops to keep it (which
| are sometimes totally insane:
| https://youtube.com/watch?v=bVIsnOfNfCo), you still may
| not be able to get the services you need. Many doctors
| won't accept it and you can die just waiting for an
| appointment. Studies have shown there was effectively one
| psychiatrist for every 8,834 Medicaid beneficiaries and
| just one cardiologist for every 4,543 Medicaid
| beneficiaries. These doctors can't possibly see, let
| alone adequately treat and manage the care of, everyone
| who needs them.
|
| The closest we get to free healthcare in the US is care
| in the emergency room which is only required to
| "stabilize" you. They'll try their best to keep you alive
| if you're actively dying, but then they push you out the
| door and send you a massive bill. They won't give you
| chemo or radiation to keep your cancer from spreading
| outworlder wrote:
| > That's because we subsidize the world by investing in a
| massive portion of the science and tech for producing
| medicines.
|
| Even if we assume that's the case - as in, normal margins
| would be insufficient to finance the research - that does
| not account for the medical treatments themselves.
|
| > the whole world laughs at us
|
| Most of the world doesn't care.
| 2Gkashmiri wrote:
| if US government is paying for research, advancement and
| what not, why should the end result not be free for
| citizens? let them spend a trillion dollars on a new drug
| developed by bayer or whoever, why should the company then
| charge anything more than say a generic paracetemol?
| autoexec wrote:
| All research done using any amount of money from the US
| government should be open and easily accessible to every
| American (with exceptions for national security), but
| that doesn't mean we should get the products resulting
| from it without cost.
|
| If the government funded research that resulted in a more
| eco-friendly car I wouldn't expect to see one delivered
| to my driveway or that the car with the fancy new tech
| (which might be a lot more involved in terms of costs)
| should be priced the same as the old tech.
|
| Healthcare should just be made accessible and affordable
| to everyone. It looks like the best way to do that is
| with publicly funded health systems.
| 2Gkashmiri wrote:
| accessible is what i mean.
|
| >I wouldn't expect to see one delivered to my driveway or
| that the car with the fancy new tech (which might be a
| lot more involved in terms of costs) should be priced the
| same as the old tech.
|
| we often pay a new user tax, or monopoly tax like the
| epipen thing. that should not be possible.
| adwn wrote:
| > _That 's because we subsidize the world by investing in a
| massive portion of the science and tech for producing
| medicines._
|
| How much of the money that flows into the US healthcare
| system _really_ goes towards medical R &D, and how much is
| effectively wasted due to the inefficient bureaucracy and
| out-of-control litigation?
| autoexec wrote:
| > How much of the money that flows into the US healthcare
| system really goes towards medical R&D, and how much is
| effectively wasted due to the inefficient bureaucracy and
| out-of-control litigation?
|
| Literally tens of billions are wasted annually on
| _advertising_. The cost is pushed to the sick and hurting
| while doctors are bribed to overprescribe whatever drug
| people are being trained to "ask their doctor about".
| I'd worry about that way before I gave a thought to "out-
| of-control litigation". Especially considering how
| companies like Purdue Pharma and Philips Respironics can
| knowingly kill people with their drugs and medical
| devices, try to hide the fact they were doing it, yet
| face no meaningful consequences and not one person is put
| behind bars. If anything, I'd say America should be
| demanding more justice from the legal system not less.
| anakaine wrote:
| This is such a rotten take. America, saviours of the world.
| It entirely discounts the contributions that other
| countries globally make. Countries in the European Union,
| Australasia, etc.
|
| The US cost of healthcare is about 17% of GDP. In other
| first world nations it's about 11%. This isn't service
| delivery or value, it's underlying cost. Per capita
| healthcare costs over twice of what it does in the UK.
| Similar for Australia. Both those are socialised and have
| very active R&D communities.
|
| The average life expectancy in the US is about 78. In other
| first world nations it's almost unilaterally closer to 84.
|
| The US is ranked 69th globally in terms.of health system
| performance. The US is also ranked worse than the OECD38
| average for death by preventable causes.
|
| The biggest difference between those places I mention and
| the above is that the US views healthcare as a capitalist
| endeavour and tries to claim that competition will lower
| prices. Quite the opposite has occurred, and the system has
| become perverted. Intellectual property laws applied in
| this fashion ensure that you cannot have competition for
| health care since drugs are limited to a single supplier.
| You also don't get a choice in hospital care or doctors in
| most cases when you really look at how medical competition
| works.
|
| In other places, the costs are socialised through taxation.
| Drugs are purchased through nationalised efforts where
| suppliers must either come to the table and negotiate
| prices properly or lose access to entire markets. It's
| funny how they can still be quite profitable even under
| this scenario, and yet the prices still be so significantly
| less by orders of magnitude than US pricing per
| patient/dose.
|
| American exceptionalism ceases to be felt when you go spend
| time in other first world nations for any meaningful length
| of time. You realise it's reassurance of self rather than
| truth on basically all but defence technology spending.
| ffgjgf1 wrote:
| > The average life expectancy in the US is about 78. In
| other first world nations it's almost unilaterally closer
| to 84.
|
| It doesn't help that (at least when it comes to
| healthcare) US is a dozen of different countries in a
| trench coat.
|
| Life expectancy in richer states like California or New
| York is very close to that in Germany, the Netherlands,
| Britain etc. (and if adjusted for the massive disparity
| in drug related deaths they'd probably be closer to
| Italy, France or even Switzerland) while the poorest
| states are about on par with Eastern European countries
| where it's barely above 75 years or so. So any average
| figure is semi meaningless.
| DocTomoe wrote:
| Well, if the US decided to not offer medicine on a
| realistic price point, other nations would do what the US
| did with Germany's Bayer, back when Anthrax was a concern:
| Cancel the patent on the only Anthrax medicine available
| due to "national security".
|
| Don't blame the world for your Pharma executives needing a
| third private jet for their mistresses.
| ffgjgf1 wrote:
| > Cancel the patent on the only Anthrax medicine
| available due to "national security".
|
| Wouldn't that discourage these companies from spending
| money to develop new drugs on their own in the future?
| DocTomoe wrote:
| Didn't stop Bayer from doing R&D. They even ate the dead
| rat that was Monsanto.
| ffgjgf1 wrote:
| Well it's not something that happens regularly or even at
| all outside of very exceptional circumstances, so I'm not
| sure how can you claim that..
| walrushunter wrote:
| It's a tragedy of the commons. US lawmakers need to ban
| pharmaceutical companies from selling their drugs in the US
| at substantially higher prices than the drugs are sold
| elsewhere.
| ffgjgf1 wrote:
| > In the US
|
| I'm certain that the US is in no way unique in that.
| Countries with universal public healthcare care systems do
| cost-benefit analysis all the time and access to the newest
| effective treatment options outside of the richest/most
| developed countries (or even in them) is far from guaranteed.
| e.g good luck buying latest cancer drugs from the US on an
| East European salary after your local healthcare system
| bureaucrats have rejected them because they are too expensive
| and/or are taking a year or two to decide of they are worth
| buying.
|
| > or if you'd been living in basically any other developed
| nation on Earth.
|
| That's just beyond absurd, unless you think that only
| Switzerland and a handful of other rich countries are
| "developed". Yes getting some minimum/acceptable level of
| care when you're not rich might generally be easier. Getting
| access to latest or even experimental drugs (most of which
| are developed in the US)? Not so much..
| kevincox wrote:
| This is partially true but for many things the price is
| different. In the US drugs are priced assuming that there
| are some number of rich people who can afford them. This
| often results in higher margin pricing which is more
| profitable even if the volume is lower and puts them out of
| reach of many. In countries with public health care,
| setting the price that high will typically result in near-
| zero sales, so the price gets set closet to the cost-
| benefit point to make profit in lower margins but higher
| volumes.
|
| It doesn't always work like this. Some drugs are just too
| expensive to manufacture and the minimum profitable price
| is too high for the benefit in public health care. But
| often the bargaining and purchasing power of a public
| health care system can achieve lower prices for drugs and
| other tools.
| ffgjgf1 wrote:
| > In countries with public health care, setting the price
| that high will typically result in near-zero sales,
|
| I'm not sure that's strictly true at least when it comes
| to the most expensive/newly developed drugs:
|
| https://www.investigate-europe.eu/posts/deadly-prices-
| medici...
|
| Doesn't seem that massively different from the
| relationship between insurance companies and drug
| companies in the US.
|
| > In countries with public health care, setting the price
| that high will typically result in near-zero sales
|
| Interestingly enough it seems like the poorer
| Central/East European countries end up paying more than
| the richer ones.
| tonymet wrote:
| what does this have to do with the story?
| cm2187 wrote:
| Some of the anti-vax movement during covid (I presume that's
| what you have in mind) is anti-intellectualism but some of it
| is not.
|
| You can hold both opinions that an mRNA vaccine is an
| incredible new technology that has enormous potential, while a
| new technology that had never been tested on humans shouldn't
| be forced on people for whom the benefit was marginal at best
| (kids, healthy population under 50, people who already had
| covid).
|
| And you can hold both opinions that health authorities clearly
| misbehaved or acted in a moronic way (lying about masks, origin
| of the virus, forcing vaccines on people who had already been
| infected, telling you you can't go outside, except if it's to
| protest for BLM, etc) while acknowledging that coming up with a
| vaccine against a new virus in only weeks is a technological
| wonder.
|
| It's absurd to be systematically anti-intellectual, but also
| some healthy skepticism is well warranted.
| account42 wrote:
| Right, a lot of the problem with anti-intellectualism is
| actually the people who define their viewpoint as The Science
| and try to shut down those who disagree as being "against the
| science".
| Propelloni wrote:
| It's like poker. You can have this lucky draw on the river,
| but most often you don't. You cannot built your strategy on
| lucky draws and those people weren't, even when not
| everything worked out. You and I are still alive, so I think
| they did a good job.
| tim333 wrote:
| I'm not so sure about rising levels of anti-intellectualism
| overall if you look globally. I looked at some stats over my
| lifetime and globally from Our World in Data 67m people had
| post secondary education in 1965 vs about 1.07bn now so up 16x.
| (https://ourworldindata.org/grapher/world-population-level-
| ed...)
|
| Also in the 1970s the Cambodians were searching out their
| intellectuals and executing them and the Chinese did a slightly
| less extreme version in the cultural revolution whereas now you
| get none of that and China is becoming a science superpower.
|
| Admittedly some in the US seem to be pushing antivax and
| climate denial but it's not like the past events. Also it seems
| a bit local. I'm a Brit for example and see almost no climate
| denial here. A bit of antivax maybe.
| __rito__ wrote:
| It's because of absolute penetration of social media in all
| levels of society everywhere.
|
| It makes the most stupid and uneducated person think that they
| are equal to the top minds of present day in many aspects.
| ted_dunning wrote:
| There is the metaphorical irony as well. That cancer of anti-
| intellectualism is often caused by the viral misinformation.
| dang wrote:
| Ok, but please don't post generic tangents to HN. They make the
| threads less interesting, more tedious, and (possibly as a
| result) tend to turn them nasty.
| ryanhunt wrote:
| This is amazing, but surely I'm not the only one who is struck by
| the irony of a company called 'Gilead' who is trying to save the
| human race? (Handmaid's tale reference)
| alpinisme wrote:
| Gilead is a biblical place, and its presence in Handmaid's Tale
| is an allusion to that (ditto for the novel Gilead by Marilynne
| Robinson).
|
| It appears the company name is an allusion to the balm of
| Gilead (https://en.m.wikipedia.org/wiki/Balm_of_Gilead)
| yieldcrv wrote:
| The book and show is the irony
|
| But maybe this company can incorporate all that in their market
| to targeted ad the nation's schizophrenics, the ones that will
| draw a connection where there is none
| ffgjgf1 wrote:
| Not particularly? Considering that they had this same name for
| > 30 years..
| photochemsyn wrote:
| There are side effects in healthy peopple that might make
| prophylactic use of this drug unpopular:
|
| https://www.mayoclinic.org/drugs-supplements/lenacapavir-sub...
| xucheng wrote:
| Maybe better url, the official press release :
| https://www.gilead.com/news-and-press/press-room/press-relea...
|
| @dang
| devonsolomon wrote:
| I briefly did some work with an HIV research organization in
| South Africa.
|
| One dynamic I was shocked to hear was the prevalence of marriages
| where one partner (always the husband in this context) is HIV
| positive and the other is secretly on prep. In this context
| infidelity may be a norm and traditional cultural and gender
| norms may look negatively or skeptically at anti-retrovirals.
|
| While this isn't the majority of the HIV experience in South
| Africa, it's certainly a sizable group.
|
| Further, adherence more generally is a massive problem. The cost
| of travel to a clinic in both rural and urban settings can be
| prohibitive for many and cause major adherence drop-off.
|
| Drugs like this, if made affordable, will go a long way to
| immediately easing pressure on these groups - and that's
| exciting.
| jncfhnb wrote:
| Why would someone secretly be on prep
| ttul wrote:
| So that their partner doesn't think they are cheating.
| jncfhnb wrote:
| Why would it imply they are cheating and not simply
| protecting themselves from their partner's HIV?
| ttul wrote:
| We are used to a western perspective on marriage, where
| the playing field is generally level between partners. In
| Africa, there is often a huge power imbalance between men
| and women in marriage. A woman particularly might want to
| keep her prescription status a secret because it suggests
| that she might be cheating on her husband. Even though it
| may seem obvious to us in the west that taking medication
| to avoid contracting HIV from our spouse is an obvious
| and reasonable thing to do, in Africa, it would be more
| culturally acceptable for the wife to remain vulnerable
| to contracting HIV from her husband because that would
| also infer that she is not sneaking around having sex
| with other men.
|
| Source: Was born in South Africa.
| jncfhnb wrote:
| Why would the woman getting HIV imply she cannot be
| cheating on her husband?
| opprobium wrote:
| From the perspective of the husband, the woman taking
| prep implies she is cheating. He either doesn't get
| tested or doesn't care, it's more important that she not
| do the thing that implies she could be cheating than that
| she not get HIV, and that she be sexually available to
| him.
|
| You're digging for a logical explanation for a
| fundamentally illogical cultural problem and you aren't
| going to get it.
| cubefox wrote:
| > From the perspective of the husband, the woman taking
| prep implies she is cheating.
|
| But that only makes sense if the husband thinks his wife
| doesn't believe he has HIV.
| vlovich123 wrote:
| >> You're digging for a logical explanation for a
| fundamentally illogical cultural problem and you aren't
| going to get it.
|
| > But that only makes sense if
|
| Reread and if you're still not getting it, keep rereading
| your parent's line that I highlighted for you.
| jncfhnb wrote:
| Quoting this line is not a blanket pass to say whatever
| you want about a culture credibly.
| vlovich123 wrote:
| Well, you have an anecdote from someone claiming to be
| from SA saying that's culturally the perception. Here's a
| summary of research [1] on the topic concluding similar
| reasons (among others):
|
| > Several participants felt that they could stop taking
| PrEP when the need, as they saw it, had passed. Often
| this was to do with the nature of their current
| relationship, for example with a person regarded as
| unfaithful: "If I find someone that I will be in a
| relationship with and if he is not faithful, or I have
| started being unfaithful, then I will come back and get
| them."
|
| And
|
| > On the basis of these findings, the authors suggest
| that take-up and continued use of PrEP is likely to
| remain subject to established social norms. These norms
| often relate to gender and they determine, for example,
| who decides what HIV prevention methods to use, and the
| extent to which a woman in a relationship might - or
| might not - be able to make and implement such choices.
|
| Just because something seems logical to you, doesn't mean
| that social norms and pressures don't superseded it. In
| fact, we even see it in our own cultural with people
| believing vaccines cause autism, the whole belief that
| ivermectin cures COVID-19, or flat earthers. What's
| really impressive though is you having such a problem
| with this idea despite overwhelming objective evidence to
| the contrary being available online and people telling
| you their lived experience on this very website and you
| significantly discount the very real possibility that
| people can be illogical in their strongly held beliefs
| even if it seems nonsensical to you. If you know nothing
| about a subject, you're likely to believe what all your
| peers tell you which is how misinformation gets a
| foothold. This misinformation can even come from nowhere.
| The point is that if enough people believe it, they can
| get others to believe it to. That's literally how human
| belief systems work where beliefs spring out of nothing.
|
| [1] https://www.aidsmap.com/news/sep-2020/why-do-people-
| southern...
| jncfhnb wrote:
| No, that doesn't make sense. And writing it off as an
| illogical cultural problem is just lazy. I'll believe
| these guys are assholes. I don't believe they're just
| consistently idiots. If the men refused to acknowledge
| that they had HIV and refused to allow their wives to get
| prep, then the logical consequence is that the wife gets
| HIV and the men are forced to confront the fact that
| either the husbands themselves have HIV or the wife is
| cheating and got it from someone else.
|
| It seems much more likely that the husbands refuse to
| allow their wives to get prep out of spite. The
| implication of infidelity angle does not feel plausible.
|
| Otherwise the men are setting themselves up for a
| lose:lose scenario regardless of what the wife does.
| opprobium wrote:
| "the men are forced to confront the fact..." No they
| aren't, they simply never confront it. People go to their
| graves denying that they have HIV, denying that they ever
| tested positive, denying that a positive HIV test has
| anything to do with illness.
|
| "Otherwise the men are setting themselves up for a
| lose:lose scenario regardless of what the wife does." -
| Of course.
|
| I mean, the most rational win:win thing to do is to get
| an HIV test and get treated if positive. They then both
| don't get sick and die and can't pass along HIV. Many
| people don't do that either. What's the mindset that
| explains this behavior? You can't work backwards from the
| most rational thing to do to what people actually do.
| jncfhnb wrote:
| You are the one injecting this narrative about women
| cheating though. It seems to me you're just making this
| up. It doesn't make sense.
|
| Establishing the narrative that if my wife gets HIV that
| she must be cheating on me is a losing proposition for
| the man that only increases the probability that his wife
| will appear to be cheating. There is no motivation for
| it.
|
| Simply being a dick and saying women can't use prep
| because I don't want them to is a much simpler narrative.
|
| Your reasoning here is similar to arguing they're a
| stupid people ergo they don't use prep because of aliens.
| It's not compelling even if you're willing to believe
| they may engage in irrational behavior.
| opprobium wrote:
| You asked "why would someone hide prep", you got one
| example. It is by no means an exhaustive list. For
| example, a big fear is being perceived as having HIV
| (since prep drugs are also part of HIV treatment).
|
| If you do actually have interest in this topic you could
| read about it:
|
| https://www.aidsmap.com/news/feb-2020/your-partner-not-
| angel...
|
| "Men were able to initiate PrEP without discussing it
| with their partners, whereas some women said they needed
| to get permission. Discussions around starting PrEP could
| raise questions about trust and infidelity and act as a
| barrier to PrEP use."
| wityl wrote:
| Because the partner doesn't test for HIV and/or is in
| denial that they have it or that it will affect them.
|
| These are cultural contexts where the woman has no right
| to question any of this.
| jncfhnb wrote:
| Well that's a stupid answer but it seems consistent and
| feasible I guess.
| esond wrote:
| Because their husband secretly has HIV? Secret outside of the
| relationship, that is.
| jncfhnb wrote:
| You're implying that the prep and HIV are known internally
| to the marriage but secret externally? That seems unlikely.
| Taking medication in private does not seem to qualify as a
| "secret" to me
| opprobium wrote:
| Because they can get HIV from their husband, but also cannot
| discuss HIV, refuse sex, or take prevention steps for
| themselves without reprisal.
| b800h wrote:
| Do any of these drugs cross the placenta?
| cassepipe wrote:
| I don't understand your point, can you elaborate on the
| dynamics at play ?
| whimsicalism wrote:
| there are a lot of conspiracy theories around hiv treatment
| in Africa, particularly SA
| m3kw9 wrote:
| Make it cheap, have high risk ppl get it free and eradicate it
| HaZeust wrote:
| Beautiful news to see. I've often heard that cracking an HIV
| preventative cure would be the end-all-be-all to creating
| preventative cures for most viruses within the decade of its
| discovery; I wonder if this optimism is still there.
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