Hi Larry, My perception is that there is a sizable segment of the population that is inclined to distrust the medical establishment no matter how perfectly the latter perform or whether damning revelations are publicized or not. I think the term was "medical tyranny." I tend to trust authority, but not require of it perfection.
But don't let the perfect be the enemy of the good. As Lucillius said, "O quantum est in rebus inane.". What folly there is in human affairs. All our endeavors have a certain ramshackle, improvisatory aspect to them..public health is no exception!
There were, indeed, political decisions made. Some were made at CDC, but most were make at a higher level and promulgated by CDC and FDA. Hahn at FDA had a stellar record before taking a politicized job. He bowed to pressure several times but usually corrected pretty quickly. Redfield was, in my opinion, a somewhat bigger problem, but again, when Nancy Messonnier was thrown under the bus for stating the obvious (at least to those studying the pandemic already) Redfield failed to protect her and went along with sidelining her permanently.
What we needed to do was communicate the science in a manner that was unambiguous and understandable, but... both are hard, and the first is almost impossible when the mis-/disinformation process is already in full swing. You might find https://www.newyorker.com/magazine/2021/01/04/the-plague-year an interesting read.
It would appear that now there is a better understanding how political the past 2 years have been. You appear to know more
About what is happening in the trenches while common folks saw and see that science is not taking a priority.
My fear and YLE clearly articulate that peoples feelings are invoked in MP.
For me this is over reach.
Smoke cigarettes is as dangerous and as avoidable as MP. In fact M0 is more avoidable than quitting smoking since itтАЩs a chemical dependance not a voluntary act.
In the past medical treatments were attempting to stop the cause instead of mitigate the effect.
I take issue with the presentation of MP as anything but what is so far presents as - a STD in the gay community. In fact,a good case can be made that if it spread to the whole population that it incubated in the gay community due to dangerous behaviors not happenstance. ThatтАЩs as of today.
Stigma ? Worrying about stigma or
Dead people? apparently much of the public health officials are worried about stigma. (BTW this political sensitivity is destroying our military- recruitment is down 40% this year)
I've had a clinical background at several levels, so I should know more about what's happening in the trenches. And over my career(s) I've met some people who are influential today, so I often get their impressions early on.
Science is, indeed, taking a priority when we attempt to deal with this new emergency as best we can. One of the shortfalls is, indeed, political. We need more vaccines in this country and in the hands of health departments and providers. But the stores of MPV vaccine are relatively small overall, and that's political as well. Countries in Africa generally fall into the middle- or low-income range. It is incumbent on wealthier countries to assist with treating and preventing communicable diseases if for no other reason than self-preservation. That both recognized strains of MPV, one with a 10% mortality, are considered endemic in Africa only highlights that it's probably time to address this disease with a massive vaccination program there. And had we paid attention over the last 20 years we'd not be having this discussion because the wealthier nations, assuming cooler heads prevailed, would have accomplished this.
Peoples' feelings are involved, and like the original presentation of HIV/AIDS, people are likely to go, "STD for Gay Men", and promptly ignore it. That's MY fear.
For a variety of reasons, and assuming your premise that MPV infection is solely an STD, your analogy vice smoking is flawed. A chemical dependence is no less a driving force than the need in humans for physical intimacy. What we don't know is if barrier protection is effective (I suspect not), because that would be a good way to mitigate the impact.
We treat to mitigate as well as prevent. That's been the case for a long time, although I could reasonably argue insurance companies are less interested in preventative care than treating preventable diseases. That's a discussion for another time. However, I can assure you that counseling on abstinence, reducing partner count, and use of barrier protection are ongoing in an attempt to slow this process.
We keep coming back to "a STD in the gay community". HIV remains a worldwide problem regardless of sexual orientation. It's somewhat less prominent in the heterosexual community in the US, but this is a pretty small planet: We have to think outside of our little political enclave. It IS a problem in other areas of the world in other communities than solely the gay community. We've seen population outbreaks before. HIV/AIDS was first seen in the same community but since we couldn't SEE a virus we had a difficult starting point and plenty of bacterial confounders. The 1918 Flu outbreak was first seen in this country in Ft Riley, KS, if I recall correctly (at least en masse); note that it was called the "Spanish Flu" because Spain didn't hide statistics, while the US was worried about having the enemy learn of all the ill troops on our side and take advantage of the situation. Zika was first identified in Brazil, then Haiti.
We worry about stigma because stigmatized people will also be subject to poorer care to treat disease, and this creates an environment where, without appropriate care a disease can worsen underserved or perhaps stigmatized individual who was likely immunocompromised and thus didn't clear the original viral infection but was a fertile ground for modifications and substitutions, especially if they were reinfected before clearing the active virus.
And: Military recruiting is, indeed, down. But civilian unemployment is significantly lower, at least among those seeking jobs (and Veterans are likely to be in that group). We just ended a "war" and Congress determined the need for troops was significantly lower than before, so we entered a Reduction In Force period. The Services are offering bonuses to retain and recruit, now, because they have to compete with the private sector, and as the needs of the service are shifting, they need smarter, better and brighter folks: The same people business is recruiting, often with higher wages and better schedules (although it's really hard to beat MTF and Tricare for benefits).
You and I look at this through different lenses. I am, by nature, a pessimist: I look for what can go wrong, because I suspect it will, but then work hard to mitigate or prevent the adverse outcomes. You'll have to determine what your life view is. For me, expecting the worst and planning for it, while seen as odd by someone who hasn't seen what I've seen is odd, but overall, the people I've cared for benefited from such planning on my part.
And why do тАЬ stigmatized people will also be subject to poorer care to treat disease,тАЭ?
I suggest that not know if condoms help is a serious failing of the healthcare community.
I would strongly disagree about smoking and sex. Smoking is chemical dependency and sex with multiple partners that is high risk for spreading a virus is downright selfish. Physical intimacy with multiple partners is as strong a need a chemical dependency is, on the face of it all, political pandering. Is that now a new conatituoright?
Back to not know if a condom protects - there is no excuse. You should be more outraged At that than no money for a
Vaccine. Mitigating the disease ( wear a mask and stand 6ft apart) should be more important than treating it.
Not wanting To mitigate MP is likely the
Politics. We wore useles masks and still require them in some schools today, that we know are ineffective.
Sorry - itтАЩs all political pandering by the public health officials and in some way, you too appear, to tacitly support risky behavior as a need instead of a danger. I just donтАЩt get it.
We know that it's more than condom use. Condoms do NOT stop transmission of MPV because contact with the lesions on the skin, or contaminated saliva, etc., is sufficient. You're ascribing to politics your own beliefs and biases, from what I can tell. PH personnel are not pandering to anyone. We are emphasizing that MPV is not an STI, and can affect anyone.
You don't get it.
I'm not trying to be severe, but you are apparently lacking a holistic view of what we do and are trying to accomplish.
OK - its not a STI - 95% of all cases are transmitted by sexual encounters.... Not my #'s.
Call it what you will be it is being spread overwhelmingly by M2M sexual encounters - NEJM is the source.
Please tell me what i do not get. If the disease was called applepox and spread by eating apples you would suggest (I hope) that people stop eating those apples until the curve was flattened. sheeeshhh...
thats my point. Everyone fighting the concept that the source should be addressed and stigmatized if that is what it takes to stop the spread. If you get rid of the source you do not need to worry about the effect IF...
The correct approach to this is to initiate ring vaccination protocols and contact tracing for anyone/everyone involved and not to worry about what to call it or which group to blame. The gay community is already aware of the issues and public health outreach to them is already in full swing. That the spread is currently primarily transmitted by sexual activity won't persist because it's contact with lesions that's the primary cause.
Dont you think that during the pandemic decisions were made for political reasons not scientific reasons is eroding the trust at breakneck speed?
Dr. Brix admitted to manipulated data and false statements (ie the vaccine will stop you from getting it? OR flatten the curve in 2 weeks)
Hi Larry, My perception is that there is a sizable segment of the population that is inclined to distrust the medical establishment no matter how perfectly the latter perform or whether damning revelations are publicized or not. I think the term was "medical tyranny." I tend to trust authority, but not require of it perfection.
Agreed - but as in all aspects of our lives, do not give people ammunition...
i like to think we should try to be so good they can not ignore you...
But don't let the perfect be the enemy of the good. As Lucillius said, "O quantum est in rebus inane.". What folly there is in human affairs. All our endeavors have a certain ramshackle, improvisatory aspect to them..public health is no exception!
There were, indeed, political decisions made. Some were made at CDC, but most were make at a higher level and promulgated by CDC and FDA. Hahn at FDA had a stellar record before taking a politicized job. He bowed to pressure several times but usually corrected pretty quickly. Redfield was, in my opinion, a somewhat bigger problem, but again, when Nancy Messonnier was thrown under the bus for stating the obvious (at least to those studying the pandemic already) Redfield failed to protect her and went along with sidelining her permanently.
What we needed to do was communicate the science in a manner that was unambiguous and understandable, but... both are hard, and the first is almost impossible when the mis-/disinformation process is already in full swing. You might find https://www.newyorker.com/magazine/2021/01/04/the-plague-year an interesting read.
We had a conversation in the past.
It would appear that now there is a better understanding how political the past 2 years have been. You appear to know more
About what is happening in the trenches while common folks saw and see that science is not taking a priority.
My fear and YLE clearly articulate that peoples feelings are invoked in MP.
For me this is over reach.
Smoke cigarettes is as dangerous and as avoidable as MP. In fact M0 is more avoidable than quitting smoking since itтАЩs a chemical dependance not a voluntary act.
In the past medical treatments were attempting to stop the cause instead of mitigate the effect.
I take issue with the presentation of MP as anything but what is so far presents as - a STD in the gay community. In fact,a good case can be made that if it spread to the whole population that it incubated in the gay community due to dangerous behaviors not happenstance. ThatтАЩs as of today.
Stigma ? Worrying about stigma or
Dead people? apparently much of the public health officials are worried about stigma. (BTW this political sensitivity is destroying our military- recruitment is down 40% this year)
And so it goes.
I've had a clinical background at several levels, so I should know more about what's happening in the trenches. And over my career(s) I've met some people who are influential today, so I often get their impressions early on.
Science is, indeed, taking a priority when we attempt to deal with this new emergency as best we can. One of the shortfalls is, indeed, political. We need more vaccines in this country and in the hands of health departments and providers. But the stores of MPV vaccine are relatively small overall, and that's political as well. Countries in Africa generally fall into the middle- or low-income range. It is incumbent on wealthier countries to assist with treating and preventing communicable diseases if for no other reason than self-preservation. That both recognized strains of MPV, one with a 10% mortality, are considered endemic in Africa only highlights that it's probably time to address this disease with a massive vaccination program there. And had we paid attention over the last 20 years we'd not be having this discussion because the wealthier nations, assuming cooler heads prevailed, would have accomplished this.
Peoples' feelings are involved, and like the original presentation of HIV/AIDS, people are likely to go, "STD for Gay Men", and promptly ignore it. That's MY fear.
For a variety of reasons, and assuming your premise that MPV infection is solely an STD, your analogy vice smoking is flawed. A chemical dependence is no less a driving force than the need in humans for physical intimacy. What we don't know is if barrier protection is effective (I suspect not), because that would be a good way to mitigate the impact.
We treat to mitigate as well as prevent. That's been the case for a long time, although I could reasonably argue insurance companies are less interested in preventative care than treating preventable diseases. That's a discussion for another time. However, I can assure you that counseling on abstinence, reducing partner count, and use of barrier protection are ongoing in an attempt to slow this process.
We keep coming back to "a STD in the gay community". HIV remains a worldwide problem regardless of sexual orientation. It's somewhat less prominent in the heterosexual community in the US, but this is a pretty small planet: We have to think outside of our little political enclave. It IS a problem in other areas of the world in other communities than solely the gay community. We've seen population outbreaks before. HIV/AIDS was first seen in the same community but since we couldn't SEE a virus we had a difficult starting point and plenty of bacterial confounders. The 1918 Flu outbreak was first seen in this country in Ft Riley, KS, if I recall correctly (at least en masse); note that it was called the "Spanish Flu" because Spain didn't hide statistics, while the US was worried about having the enemy learn of all the ill troops on our side and take advantage of the situation. Zika was first identified in Brazil, then Haiti.
We worry about stigma because stigmatized people will also be subject to poorer care to treat disease, and this creates an environment where, without appropriate care a disease can worsen underserved or perhaps stigmatized individual who was likely immunocompromised and thus didn't clear the original viral infection but was a fertile ground for modifications and substitutions, especially if they were reinfected before clearing the active virus.
And: Military recruiting is, indeed, down. But civilian unemployment is significantly lower, at least among those seeking jobs (and Veterans are likely to be in that group). We just ended a "war" and Congress determined the need for troops was significantly lower than before, so we entered a Reduction In Force period. The Services are offering bonuses to retain and recruit, now, because they have to compete with the private sector, and as the needs of the service are shifting, they need smarter, better and brighter folks: The same people business is recruiting, often with higher wages and better schedules (although it's really hard to beat MTF and Tricare for benefits).
You and I look at this through different lenses. I am, by nature, a pessimist: I look for what can go wrong, because I suspect it will, but then work hard to mitigate or prevent the adverse outcomes. You'll have to determine what your life view is. For me, expecting the worst and planning for it, while seen as odd by someone who hasn't seen what I've seen is odd, but overall, the people I've cared for benefited from such planning on my part.
And why do тАЬ stigmatized people will also be subject to poorer care to treat disease,тАЭ?
I suggest that not know if condoms help is a serious failing of the healthcare community.
I would strongly disagree about smoking and sex. Smoking is chemical dependency and sex with multiple partners that is high risk for spreading a virus is downright selfish. Physical intimacy with multiple partners is as strong a need a chemical dependency is, on the face of it all, political pandering. Is that now a new conatituoright?
Back to not know if a condom protects - there is no excuse. You should be more outraged At that than no money for a
Vaccine. Mitigating the disease ( wear a mask and stand 6ft apart) should be more important than treating it.
Not wanting To mitigate MP is likely the
Politics. We wore useles masks and still require them in some schools today, that we know are ineffective.
Sorry - itтАЩs all political pandering by the public health officials and in some way, you too appear, to tacitly support risky behavior as a need instead of a danger. I just donтАЩt get it.
We know that it's more than condom use. Condoms do NOT stop transmission of MPV because contact with the lesions on the skin, or contaminated saliva, etc., is sufficient. You're ascribing to politics your own beliefs and biases, from what I can tell. PH personnel are not pandering to anyone. We are emphasizing that MPV is not an STI, and can affect anyone.
You don't get it.
I'm not trying to be severe, but you are apparently lacking a holistic view of what we do and are trying to accomplish.
OK - its not a STI - 95% of all cases are transmitted by sexual encounters.... Not my #'s.
Call it what you will be it is being spread overwhelmingly by M2M sexual encounters - NEJM is the source.
Please tell me what i do not get. If the disease was called applepox and spread by eating apples you would suggest (I hope) that people stop eating those apples until the curve was flattened. sheeeshhh...
thats my point. Everyone fighting the concept that the source should be addressed and stigmatized if that is what it takes to stop the spread. If you get rid of the source you do not need to worry about the effect IF...
https://www.nbcnews.com/nbc-out/out-health-and-wellness/monkeypox-driven-overwhelmingly-sex-men-major-study-finds-rcna39564
The correct approach to this is to initiate ring vaccination protocols and contact tracing for anyone/everyone involved and not to worry about what to call it or which group to blame. The gay community is already aware of the issues and public health outreach to them is already in full swing. That the spread is currently primarily transmitted by sexual activity won't persist because it's contact with lesions that's the primary cause.