I think it needs to kill more than 6-9's before it has a good chance at being a cure.
A given strain can have some variability but will share general traits.
HIV strains are named and numbered: https://en.wikipedia.org/wiki/Subtypes_of_HIV
An efficient treatment against a specific strain would save millions of lives. An efficient treatment against the 99% of them that are the most prevalent would basically solve the epidemics.
The problem is that people often end up with more than one strain. This is why doctors tell HIV+ people to continue protect themselves and were worried about the appearance of "free-sex parties" for HIV+ individuals. Most people do not differentiate between strains but if you got HIV from a partner, you may have had only a part of their strains, you should not have unprotected sex if you want to maximize your chances.
Given this drug kills 99/100 HIV virus units, then this really only helps you for log2(100) or ~7 generations
The math is pretty easy, but the results are something that always surprise me: it turns out humans are pretty bad at estimating exponential growth.
0: real life conditions are probably slower than this, I concede.
Which is long enough for you to complete your lunch! :-)
Another illustration of that is, if 99.99% equates to 1/10000 survivors, the meaning of it depends on how many bacteria exist on the area in the first place. It has quite a different meaning if the typical number is 10000 vs if it's 100000000
Then avoid dipping your hand into beef stew for too long. Most of time, germs grow like sigmoid function.
Not that we should consider in insurmountable nor ungrasp-able. But that we -- or parts of our society and professional institutions -- should lose some of our arrogance.
On the upside, that complexity also harbors enormous opportunity. Just, don't be simplistic about it an let your ignorance take you into disaster.
Granted, also, that there are lots of doctors who do follow research.
That's basically what HAART (the technique we've used to treat HIV successfully for the last 25 years) is. People take three antiretrovirals simultaneously. They're designed such that, for the virus to adapt to one, it has to make itself more susceptible to one of the other two.
I think the problem with a widespread, highly studied virus like HIV is that a "good enough" treatment isn't "good enough." Any treatment will be deployed in a limited manner to test the efficacy, which will in turn give it a chance to develop a resistance and spread.
That having been said, if the treatment CAN treat 99% of current infections, it will be a boon for at least a couple generations of gay and minority communities in the developed world.
"I have a common but chronic ailment so all I had to do was re-route the phase-converter to the deflector shield and invert the chromaton particles in Shelk-Einstein space and we're done!"
:/
(Related personal anecdote and why I recommend them so highly: I'd been listening to them for awhile, then a research paper came out showing a possible link between Chronic Fatigue Syndrome and XMRV in mice. People online had taken the paper and went crazy with it and some people were finding sources for murine (mouse) cancer drugs and dosing themselves with it in hopes of curing their CFS. They went through the paper and recognized the researcher and lab who wrote it. And noted that the lab had previously published XMRV research. XMRV is apparently remarkably difficult to eliminate contamination from. Basically if a lab has ever worked with it, you have to burn down the lab and build anew if you want to be sure it isn't around. So they advocated skepticism and said wait for independent verification before getting too worked up. A couple months later, the original paper was retracted as the researchers announced no other lab could reproduce their findings and it was down to XMRV contamination of their samples. That is the kind of thing you only get when you're listening to bona fide experts in their field and it blew my mind.
In the 2010s, getting HIV means that you are likely to live until... Your 70s. (Assuming you have access to medication.)
The problem is that you need to take expensive medication for the rest of your life. And that you can infect other people.
https://www.reuters.com/article/us-health-hiv-transmission/p...
This is why "treatment as prevention" is important part of stopping further spread.
It has never been quick.
> Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype
https://en.wikipedia.org/wiki/HIV/AIDS#Prognosis
You may be thinking of the ~1 year survival times after an AIDS diagnosis, but HIV is usually latent for a decade after initial infection.
Actually getting the vaccines that cover the high risk strains into the developing world is a much more obtainable goal, and even that is extremely challenging for a number of reasons.
I mean does the UN have existing programs that offer vaccines in the third world?
I mean it would be a shame to have a vaccine and not see it being used.
I like how the ID is 71neat
-what about that 1%? I'd fear if it became the new super HIV
--Can you not appreciate the 99%?
---He's a 1%er for sure...
----Let's git im!
-----ANGRY AT OP? WANT TO JOIN THE MOB? I'VE GOT YOU COVERED! COME ON DOWN TO /r/pitchforkemporium...
------Here you go Comrade
-------!redditsilver
--------Here's your Reddit Silver, ZarathustraV!
---------Good botthankfully, /r/science has you covered. https://www.reddit.com/r/science/comments/71ndtd/scientists_...
*I'm South African, antiretrovirals are free.
For those downvoting: His foundation made sure the WHO subcontracts all studies to companies he has a stake in. He isn't a saint, he is a capitalist.
Can you elaborate on this? I thought he was a type of person who does more than he talks.
He's doing it to win a Nobel prize, not for money.
The way you've phrased this, it sounds like you are casting "other hard to cure STDs" as a protective measure against the "threat of 1960s style of unprotected sex wave."
Isn't sexual freedom a goal?
You always have the risk of undesired pregnancy and the best cure for that is the condom, since birth control pills are basically hormone bombs, not very healthy for women in the long run, or you could undergo surgery, which is invasive and not without peril. So just use the condom already, those minty ones are actually cool.
And if we don't have "sexual freedom" it's probably because there are really good reasons for it. We shouldn't dismiss taboos without considering that some of them is why we've survived for so long.
I read it as him casting the threat of those 'hard to cure STDs' as an incentive for people to not take the 1% risk of HIV infection.
So no, unprotected sexual freedom isn't a practical goal for medical science. Better to use condoms instead.
For whom? Not for me.
Even then, knowledge of condoms wasn't widespread like it is now. My grandmother was super-pissed-off when my grandfather told her about them after she was pregnant for 18 months straight! She made it a point to tell me that I had to tell my future wife about birth control! (What made it funnier was that, at the time, if you didn't know what a condom was you were living under a very large rock!)
Also the legalization of abortion in 1972 contributed to this as well.
The most likely significant health threat as far as STDs go in the future are anti-biotic resistant gonorrhea. There were a couple of those spreading in Asia a couple years ago that were positively nightmarish.
If AIDS is actually curable, I would bet that all other STD would explode in the short term
Aiming for 'less sexual activity' is a very bad goal. Abstinence is harmful. The tremendous health benefits of sexual activity are myriad. The amount of research backing up the idea that modern society is dangerously sexless is huge. One of my favorites was a study of ALL men, across all ages, socioeconomic groups, everything, of an entire town I believe somewhere in northern Scotland (maybe Ireland?)... those who had the most frequent orgasms had a 50% lower chance of having died of any cause over the 15 year period of their study. They also had very significantly reduced incidence of heart disease, cancer, and other health problems. But, of course, such things get reported as 'health benefits of sex' and not 'health dangers of abstinence' because they assume people are abstinent by default which is ludicrous. We'll know if public sentiment is changing when the headlines change.
So what you're saying is, they don't always have sex, but when they do it's unprotected? That sounds pretty normal to me.
And while condom use has fallen a little since its height, it still remains significantly higher amongst the young than any older generation or group.
[0] http://www.nationalsexstudy.indiana.edu/ [1] http://www.nationalsexstudy.indiana.edu/condomgraph.html
If one assumes that the different strains also compete against each other the total number of infections may not go down much, and if it does, that may only be temporarily.
We still haven't come close to "eradicating" or curing HIV/AIDS; the issue lies in the virus' insidious biology. HIV is a retrovirus, meaning it incorporates into the target cell's genome, specifically CD4+ T-cells. An obvious barrier to "only" 1% of virions is that an infected person produces billions of virus particles every single day[2]. A less obvious barrier is the "latent" reservoir of the virus in cells.
Essentially, not all cells with an incorporated HIV genome are producing virus, and thus these proviruses can evade detection. A 2013 paper in cell[3] provides what I think is the most devastating example of this. Basically, an idea that has gained more traction lately has been to activate these T-cells, thus alerting the immune system and hopefully clearing the virus. It turns out that not all cells are activated, and the size of this reservoir is ~60X larger than previously thought.
When it comes to something like cancer, we often define "cure" or "beating it" differently — look no further than Randall Munroe's heartbreaking visualization, Lanes.[4] We need to do something similar for HIV. We can't get rid of the virus, but we're already pretty good at making life not so bad if you have it. Access and affordability are larger barriers to preventing mortality/morbidity.
There's also a quiet undercurrent that a standard vaccine for HIV is biologically impossible, but that's for another day.
tl;dr HIV sucks but we're okay at managing it. 99% sounds good but it's probably not enough.
1: Read: moderately well-off people with health insurance in wealthy, industrialized nations.
2: DOI: 10.1038/nrg1246 The oft-cited rule of the thumb is that every base of the viral genome is mutated every day.
3: DOI: 10.1016/j.cell.2013.09.020 This one is absolutely worth reading.
Isn't it pretty weird that, despite this massive diversity, infections seem to be only caused a single, or sometimes a few, distinct virus particle(s):
>"we show that 78% of infections involved single variant transmission and 22% involved multiple variant transmissions (median of 3)" https://www.ncbi.nlm.nih.gov/pubmed/19193811
To me that means something is horribly wrong with our understanding of HIV.
This is assuming that we can get the vaccine to everyone. In first world countries with developed and trusted this is mostly possible, but would still be a massive undertaking.
That's your takeaway from this interesting news? I don't understand how you jumped from this article to immediately drawing some opinions about sexual responsibility and behavior. The article has nothing to do with sex behavior, and HIV is hardly the sole deterrent for reckless sex.
At least, that's where the idea of tying sexuality to economic considerations like 'responsibility' and phrases like 'saving yourself' come from.
Are you implying that unprotected sex is bad in itself?
Edit: It was an honest question.
https://www.brainpickings.org/2014/03/28/daniel-dennett-rapo...
That most virulent 1% then multiplies and infects systemwide... and adds new mutations all the time.
This is true not just for bacteria but also for other living creatures; for example animals that have lots of children have very short average lifespans.
It makes me think that every living species must be at the absolute cutting edge of its capabilities genetically-speaking.
That's not really accurate. HAART works because the 3 drugs are taken simultaneously, and it's extremely unlikely for a virus to get random mutations that confer resistance to all three in one generation.
That is literally exactly what I said. The drugs are taken simultaneously, and it is very difficult to develop resistance to all three simultaneously, because becoming more resistant to one means becoming more susceptible to another.
For example, suppose you take ATripla, which is a combination of efavirenz, emtricitabine, and tenofovir. If a viral particle has a random mutation that confers resistance to, say, efavirenz, that mutation does not make the virus more susceptible to emtricabine or tenofovir. The fact is the virus was already susceptible to those two drugs (that's why you take tests that specify your viral strain's pre-existing resistances to determine the best drugs for you before you start HAART), so it still is unable to replicate.
It's just a matter of statistics, not that resistance-granting mutations naturally make the virus more susceptible to other drugs.
During those times there were lots of people having lots of sex. Unwashed sex with a string scent of sandalwood and patchouli, but still lots of sex, drugs, and rock n roll.
Then you had the disco era, fueled by fruity drinks and cocaine, sideburns, and lots of finger guns. There was still a bunch of sex. Those people would become yuppies, while many of the Free Love people would have moved into the woods to eat tree bark and become one with Gaia.
Obviously people mean the economic term. Couldn't possibly be the everyday meaning.
I'm a little tired of the disconnect between medical advice and reality when it comes to sexual practices. Dental dams, anyone? Sure they're smart; I don't think I've seen one outside of health class. Doctors could easily provide more helpful advice.
But... it was a question...
The topic is sensitive and you will see a lot of people hide their moral beliefs behind "health concerns".
I'd rather make a blunt and direct question rather than play hide and seek and be lured into a masqueraded conversation about morals and believes.
Which is why I addressed this in the next sentence:
> If you have an honest question that will move the discussion productively forward, please, by all means ask it.
Does it move the discussion productively forward? What is the motivation for your question? Where do you expect the discussion to go from here? This isn't a question like "Where's the post office?" where the expected response is likely the effective end of the conversation. You're asking about morality. Do you think your parent has the same values as you? Are you looking to tease out some difference so you can argue about them? Show them that they're wrong? Find some points of agreement? Solve some underlying common issue? HN really isn't the place for general ideological debates. They're by definition off-topic. And regardless of what another has commented, we can show restraint and not continue a thread that is wandering off into incendiary weeds.
Edit (in reply to your addendum above): It does seem clear that you're looking for some kind of argument. Please don't. Let the thread die on the vine.
I don't intend to continue this any further. I do encourage you to review the link I provided, and perhaps review the recently updated HN guidelines, which includes similar points.
Yes.
> What is the motivation for your question?
To know if we are discussing about public health issues or moral believes. If it is the later, then there is no point continuing the discussion.
> Where do you expect the discussion to go from here?
If the motivation behind his comment was morals, then I don't expect the discussion to go anywhere. It is a dead end.
If it is about public health, we can continue the discussion.
You are doing the exact same thing you are accusing me of. It would be a good time to follow your advice: "Please default to the strongest possible interpretation of another's comment. Give them the benefit of the doubt."
As I mentioned all I wanted to know is if he is trying to have a discussion about morals or public health. Because if it is the first then I don't want to be part of the discussion.
(Edit in response to your edit) You are starting an argument on my post, and when I reply to your argument you make a passive aggressive edit to your post accusing me of not dropping the argument. And you drop it, by making a non-reply reply?
I mean, on the net you'll often hear stories about kids scoring big but that's survivor bias. You don't hear anything from those who didn't bang.
[1] http://www.telegraph.co.uk/women/sex/no-sex-please-were-mill... [2] http://time.com/4435058/millennials-virgins-sex/
could be but those two things needn't be mutually exclusive. maybe the youth is just more extreme in both directions whereas earlier people might have been more similar.
I've tried to do a brief search for earliest HIV (non-AIDS) diagnosis, but many websites use AIDS and HIV interchangeably.
What do you mean?
That I do not believe that sexual freedom is a goal.
There seems to be a causality, but to me it is not obvious, what its direction is. The most healthy men, are probably also the most attractive.
We could have evolved to have a 'mating season' as almost all animals have. We could have evolved for females to give visible indication of fertility. We could have saved "wasting" the positively monumental amount of energy we pour into pursuing sex. We could have evolved so that sex was not even pleasurable but driven by instinct. We didn't have to evolve women going through menopause (and living a substantial amount of time afterward). Almost every single facet of human sexuality, if viewed through the lens of "sex is for reproduction", looks nonsensical if not evolutionarily suicidal. But through the lens of "sex is primarily for pleasure and social bonding," every bit of it makes sense. It explains why we stuck together in groups, the only thing that let weak, slow, stupid chimps without fangs, claws, venom, natural armor, or other similar natural advantages (except maybe endurance) survive long enough to have our social environment provide pressure for brain development and development of speech. We stuck together to preserve access to sexual partners, because it was pleasurable, and it made us the most powerful species on the planet. It makes sense that those who 'needed' it more were the ones to pass on their genes the most often.
It is a reasonably simple, safe, and effective drug, so it really should be available from any PCP. However, some community physicians do not prescribe it for one reason or another. HIV/STD clinics are almost always happy to see HIV(-) patients who are interested in PrEP.
Thus, if someone is undetectable but then their treatment fails, they would become detectable and able to transmit the virus. But they could still infect someone else before they discovered their treatment failed.
Can you please put this into simpler terms? I am pretty confused. Because HIV transmission is not a theoretical and is not a myth. My understanding is, OP meant to say "transmission of HIV via known risky activities."
--EDIT--
Thank you for those clarifying. Often the unfamiliar technical terms can throw me off.
It's possible, with treatment, for people with HIV to have a viral load labelled undetectable.
To date, from an article I read, there have been no recorded transmissions from people with an undetectable viral load.
How many people taking retrovirals have undetectable levels of HIV?
Are those people using condoms?
They are saying that there are no recorded instances of someone that is taking antiretroviral drugs and has an undetectable viral load actually transmitting the virus.
Until a few years ago, C-section was recommended, but the current wisdom is that vaginal birth poses no greater risk for the baby.
Same with breastfeeding. Until a few years doctors would call CPS if a HIV+ woman admitted to breastfeeding her child. Now, our doctors encouraged my HIV+ wife to breastfeed.
OTOH she was the second (or third?) HIV+ woman in our city who dared to.
Worked out for us. Both kids are HIV-, as am I.
For example, a measles vaccine doesn't work on a small percentage of the population. Herd immunity says though that as long as some large percentage of the population is immune, those which the vaccine do not work will be fine. The anti-vaxx people end up pushing the percentage vaccinated below what's required for herd immunity and hose the whole population. Idiots.
When I see that a discussion is not progressing constructively (as I observed from your first response to me), I try to make clear in a response that am indeed dropping the thread: I'm not interested in tit-for-tat back and forth, and know that it takes both parties to work toward a common goal for such discussions to be productive: I'm as much responsible as any other party. I do hope you find the constructive discussion you're looking for, and apologize for taking this off-topic as far as it has.
You offered unsolicited advice. I didn't take it personally, I tried to reply with arguments.
> I'm not interested in tit-for-tat back and forth
Just because I don't agree with the arguments you make it doesn't mean I have anything personal with you or that it is tit-for-tat or don't like conversing with you. Quite the opposite, the more difficult and challenging your arguments are, the more I enjoy the conversation.
Edit: Removed the "I am having doubts if you were interested in an open discussion in the first place." Please disregard it.
https://www.globaljustice.org.uk/sites/default/files/files/r...
They even advised not to lower prices for vaccines, because then pharma corporations wouldn't invest in the global south anymore.
Americans please correct me, but here it's more symptomatic with sexual health: You have a rash/etc, so you go see the doctor. There's no early-detection system where you are reminded to get into a clinic every 2-3 months and get a full test (blood test, swabs, etc) for all the usual suspects: HIV, herpes, chlamydia, etc.
If that's the way you want to live your life, it is fine. But don't try to impose your ideas to other people.
Because the way I see it, this is more than the health of the individual at risk, being about the health of the group.
If you don't see the difference about public smoking and unprotected sex, then I don't think there is any point discussing this.
However your original comment sounded more concerned about morals than public health.
If it was the later and I misunderstood it, then please forgive me.
Lots of women, including my wife, are perfectly happy with hormonal birth control. For others, there are lots of other options, and even more in development. It’s a very personal decision, but condoms are by far among the least effective techniques.
> And if we don't have "sexual freedom" it's probably because there are really good reasons for it. We shouldn't dismiss taboos without considering that some of them is why we've survived for so long.
The entire parable of Chesterson’s fence suggests that we shouldn’t get rid of something in society without knowing what function it was serving. It doesn’t suggest never reforming society at all.
The taboo against fornication is obviously there to prevent the spread of disease and unwanted pregnancy. If we have other ways to prevent these side-effects, there is no longer any reason for the taboo; much as the religious taboo of not eating pork or shellfish no longer serve the same useful purpose they did in the ancient Middle East.
A condom is not the best option for birth control, merely one of the options. The best would be voluntary sterilization for both the man and the woman. There are other non-hormonal birth control methods, such as a copper IUD and other barrier methods that work, some better than a condom and some worse.
The main benefit from a condom is STD protection, but for that to be effective they need to be readily available to everyone and cheap enough to afford.
I've heard this a few times but I'm curious for sources on the fact that they're not healthy. They're certainly not natural, but, like, living until you're 80 years old isn't particularly natural either. Do you mind expanding on this?
The Gates Foundation does great things. I've never understood the complaints. They are pretty heavily scrutinized and their actions are fairly public. It's not some nefarious organization, at least it isn't from what I've read.
Edited to add: Hmm... They responded with a stange, now dead, comment. I am no longer sure what they meant. It'd appear they think Jobs is my false god. I remain baffled.
The real solution will be when you have male birth control available as well; and then it comes down to only having sex with people you trust. I great partner is better than a bunch of lousy partners anyways.
"Shit, I got HIV/warts from hooking up" just isn't something I ever heard in uni. It just isn't part of the discourse. Those just don't seem to penetrate the uni bubble.
But everyone I know had to deal with the clap.
http://www.aidsmap.com/No-one-with-an-undetectable-viral-loa...
Frequent testing and early intervention are very effective to achieving an undetectable viral load. The adoption of these as public health policy, as well as making available of prophylactic measures for at risk populations, has been effective at combating the spread of HIV - e.g. in San Francisco, where infection rate has been declining significantly over the last 5 or so years.
The studies on transmission are using sero-discordant couples who are not using condoms. The evidence/confidence has been building over time with multiple studies in which no transmissions were observed.
http://www.catie.ca/en/catienews/2016-09-06/negligible-risk-...
The HPTN 052 randomized study was halted early because the evidence so strongly favored the treatment arm. In the PARTNER observational study, no transmissions were observed in the study at all. The evidence is very strong.
> How many people taking retrovirals have undetectable levels of HIV?
According to my wife's doctor, most of them. And if that changes, they attempt to adjust treatment to return to that state.
BTW, undetectable appears to mean 20 copies of viral DNA per ml of blood.
> Are those people using condoms?
Well, we were, for many years. But we wanted children, and so after her doctor actually encouraged us we conceived them the old-fashioned way. I really, really enjoyed sex without a condom after so many years, I must say.
Now we have all the children we want, and we ought to go back to condoms, but I find myself wondering about the risk vs. reward. I suppose we'll go back to condoms, but I yearn to forgo them -- it's just less intimate. I wonder how other couples feel.
https://www.intomore.com/impact/cdc-acknowledges-that-undete...
Don't take my word for it though, would check with doctors.
I'm South African, antiretrovirals are free.*
Almost got it right: Drugs elsewhere are cheaper and largely subsidized by USA citizens.
Those drugs cost a fortune to make and the companies make their money in USA https://www.reuters.com/article/us-pharmaceuticals-usa-compa...
https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...
https://www.sciencedaily.com/releases/2008/01/080105140107.h...
First off, that's not sales and marketing expense. It's what accountants called "sales and general administration" which yes, marketing falls into, but so do a number of other items. It's not 100% marketing.
Second, the only reason why a company would spend money on promotion is if the return is >100%. So, if drug companies were to stop all promotion, their profit would actually fall, not go up. So it's not going to reduce the cost of drugs.
Third, I've talked to a number of physicians would appreciate the marketing that drug companies do. They don't have time to keep up on the latest, so a 15 minute chat with a drug rep might save them a lot of time. Of course, they know the marketing is biased, but it at least gives them a sense as to what's out there.
* Correction, by U.S. government (through law).
> Those drugs cost a fortune to make and the companies make their money in USA.
Yes R&D is expensive, but pharma is extremely profitable. Here in the U.S. and abroad.
The blockbuster hepatitis C drug will cost about $900 (around Rs 54,000) in India for a 12-week course of treatment. That would be a fraction of the $84,000 (over Rs 50 lakh) price tag for the same treatment in US.
I'm sure that they wouldn't be that profitable if USA paid $900 for that drug, especially the first few years.
https://www.nytimes.com/2015/02/04/business/sales-of-sovaldi... 140,000 patients in USA and going to 250,000
That's survivorship bias. Yes, the successful pharma companies are quite profitable, but there are 10 failed companies for every successful one.
I remember reading a paper that said the overall returns for the industry are either single digit or negative.
I'm 29, and so far every woman I've fucked, I ended up deciding I didn't want to marry / have children with. But that's still on the table like it is for the vast majority of men, so vasectomy is not an option.
Vaccinations are indeed something of an affront to one's physical person. So is collecting DNA evidence. I think that you will find upon further reflection that the physical integrity of one's body is not much affected by a vaccination, and that personal liberties do not extend to causing grievous bodily harm to others.
In this case, the patient (A) may be getting the drug from a pharmacy (B), and the pharmacy bought the drug from the manufacturer (C), but the patient's insurance (D) is paying part of the cost of the drug, but so is the manufacturer, and insurance is paid for partially by the patient, and partially by the employer (E). There may also be direct government subsidies, and there are certainly indirect subsidies as well. Of course none of the 5 parties can really know how much anything costs, or how to reduce costs. Not to mention all the extra labor involved in administration of this complex system.
This sounds like a nice, generous thing to do, but basically it means that the drug company is bribing the customer to force their insurance company to spend more money on their behalf.
So, imagine that a drug costs $1000 and the customer's copay is $200. The drug company can give the customer a $200 coupon to recover their copay and then raise the price of the drug to $1200. They've basically shifted the price from the customer (who decides whether or not to get the drug and is probably very sensitive to price) to the insurer. They make the same profit, but can probably sell to a lot more customers because it's "free". While they're at it, they could raise the price to $1500 or $2000, and it's still free to the customer.
I think this is a corrupt practice and it's crazy that it's even legal, but it's just one small part of the complexity and perverse incentives of our health care system.
It doesn't work like that unless you're the only drug in class. If there are alternatives, then you'll get kicked off the formulary for a 20% price increase.
Fun fact: A lot of the original Star Trek screenplays were written with [tech] everywhere and the science writers came in and tried to right some jargon that was believable.
In regards to health care, it's a mess. I spent years working in the industry and it's truly a little frightening. I've been in other country's systems before and recently put together a writeup on it:
http://fightthefuture.org/article/returning-to-america-and-t...
For reference, I pay about ~$200 Australian to my personal insurance, which is a pretty generous plan with lots of extras, basic health care such has visiting a doctor for prescriptions, etc... I haven't paid a dollar for in 3 years, before that I used to pay $20 for convenience of a clinic that was open late and they didn't bill the government for the entire cost, which is common, but almost always a reasonably small fee in the multiples of $20 depending on how long you spend with the doctor. I paid this when I was a government employee, a private employee contracted to the government, and I continued to pay it when I quit to become a freelance developer, my cover has nothing to do with my job and I cannot even fathom why in the most awful circles of hell I would want my health care tied to my job. Hence my trepidation at ever subjecting myself to the American health care system.
I know I might have good options for my therapy in US, but the risks are just too big and depending where you are the monthly expenses only for the insulin analogs might be just way too much in the worst case.
It's certainly a manageable one, and the stigma around it is silly, but if the common cold is a disease, then herpes is.
https://broadly.vice.com/en_us/article/ypa8nb/did-big-pharma...
The big ones buy up the small generic producers and single new drug companies and get slightly bigger.
The ones who can't pass trials fail. That's business, especially in R&D.
Hepatitis C isn't a retrovirus, so I don't understand what you're saying.
What is this if not trying to make other people live their lives following your way of thinking?
This is the same misguided logic you tried to use on bad_user. You really don't get it and honestly I don't care if you ever do or not.
Free speech does not mean freedom from criticism.
"> I am for social pressures against unprotected sex. What is this if not trying to make other people live their lives following your way of thinking?"
Yes, I really don't get it how is this preventing you to voice your opinion.
I honestly don't care what you think or support, but when you are suggesting "social pressure" in order for people follow your opinion then you will find me calling you out.
Does it really take a company to make people think of it as a disease?
"Oh my penis feels like it's on fire and oozing all over me. However, I wouldn't call it a disease."
But the answer is still, yes, there is profitability. Just not as much as with the hyper inflated prices in the US.
In short: Does the extreme cost for drugs in the US cause groundbreaking research to benefit the whole world?
No, same results could be had with way less profit. Money to fund moonshot research is still important though.
Not necessarily. Advertising is often a negative-sum game. To give a simplified, quasi-hypothetical example, if neither Coke nor Pepsi advertised, they would still have very similar market shares and revenues. But then Pepsi realizes they can spend $1MM advertising to swing $1.25MM of revenue from Coke, and Coke spends $1MM to swing $1.25MM revenue back, and now both companies are $1MM in the hole for no gain. In this case, everyone—Coke, Pepsi, and the consumer—is better off if the government just banned soda advertising. Well, maybe not the ad agencies, TV networks, and celebrity sponsors, but there’s still a net economic loss to society.
Lots of drug advertising is of this useless, competitive type. If no one advertised erection drugs, people would just go to the doctor and take whatever was prescribed to them. But if Cialis blankets the airwaves, they can swing market share from Viagra.
I don't hear a lot of complaints about medicare not covering important things (but I only have limited exposure to that), and I assume a US single payer system would essentially be Medicare for all. I do hear complaints about Medicare not paying providers enough, and a lack of available providers.
A rational method of rationing care seems preferable to the current byzantine methods. My (likely naive) hope would be that spending the same amount of money on healthcare, but with fewer parties involved would provide more and better healthcare. At least we haven't reached the point where the government encourages smoking to decrease long term healthcare costs.
bad_user and myself are both influencing others. We're not imposing anything at all. He's fine to criticize if he wants, that wasn't the issue at all. He didn't understand the difference between social pressure (which I'm advocating along with bad_user) and imposing. They aren't the same thing.
He's trying to split hairs with everyone on HN and not be intellectually honest so it's not worth discussing. Very easy to see what bad_user and myself meant. But the downvotes on noncoml's post speak for itself, most people are getting it.
Now you're repeating the complaints, and on top of that splitting hairs while complaining about others splitting hairs while doing so.
To me your responses just makes this whole exchange look sillier.
Just because someone disagrees with you, it doesn’t mean you have the intellectual honestly and he doesn’t.
Also, if it’s not worth discussing, just stop discussing. What’s with this passive aggressive statement?
Btw, since downvotes seem to be important to you: every single reply of yours in this thread is negative.
Reagents are getting cheaper and better as well.
Yesteryears low hanging fruit costs the same as today's low hanging fruit. They are harder to solve though.
And no, I'm not saying everyone single biotech startup is like this or every single researcher does this. And yes many fail, but that's the cost of doing business and it's something that makes things progress.
You mentioned my name. What did you expect?
Furthermore I never said I stopped discussing, unlike you.
Finally, you are the one who is trying to split a hair: “Imposing your opinion” might be a bit strong, but it’s closer to “social pressure” than “influencing” is.
Discussing with you can be considered influencing.
“Social pressure” can be a whole town marginalizing you and your family because you are gay.
I don’t think I am trying to split hair. They are very different things.