self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
I have a "want to get married and live like normal people!" gay brother, and even before he came out to me, the people who reliably made my skin crawl were the moralizers, the ones who can't watch someone live an alternative lifestyle without reaching for the pulpit. That impulse disturbs me more than anything happening behind the bush.
And yes, there are millions of gay men getting their backs blown out and gagging on cock behind that bush, and I seem to know half of them. That's what happens when you spend a questionable amount of time in gay spaces because the conversation is genuinely good (and the drinks are cheap). I'll keep it simple. When two consenting adults do something gross in a way that touches only the two of them, the harm doesn't fuck you in the ass or to the kid down the street. When their lifestyle does turn harmful, the fallout lands almost entirely on the people who opted in. I have zero appetite for assless chaps or golden showers. As long as nobody touches me up, which has never happened because I'd sock them, it stays squarely none of my business.
I'll turn my gaze to the strongest version of the other side, because I'm an even handed and bored person. Bugchasing is "real". The documentary exists. The visibly sick guy saying he doesn't care if he spreads it exists. The tail of the distribution is not empty.
There. Done being even handed. The "standard fuck party" clip recirculates on /pol/ for the same reason 2003 Rolling Stone "Bug Chasers" article went viral. It happened to be lurid, enraging, and claimed bugchasing accounted for up to a quarter of new HIV infections among gay men. That figure was downstream of a single source and fell apart on contact with reality, in part because Freeman had casually reclassified every barebacker as a bugchaser regardless of intent. When researchers actually combed profiles on a bareback-centric site, the share of HIV-positive men actually trying to infect partners came out around 1 percent. Most self-described "bugchasers" were roleplaying a fantasy they never acted on. Your feed is tuned to churn up that 1 percent because it enrages you, which means the sample is poisoned before you ever start counting. Base rates people. Look them up.
The most questionable things get signal-boosted to awareness. That is how the internet works. Nobody forwards clips of a gay accountant making lasagne for his husband, two mildly overweight lesbians arguing over oat milk, or some HIV-positive man taking his ART, remaining undetectable, and living a life so boring it would put /pol/ into a coma. The transgressive, and morally alarming material travels. Normality is busy tying laces. You can build an entire worldview out of the most alarming 0.1% of a group, but at that point you've given up on sociology. You've ended up producing pornography for your prejudices. And whoever enjoys that hobby should take up yoga and go fuck themselves.
My own anec-data, for whatever an n-of-my-social-graph is worth? I have the ethnographic essays, and after snowball sampling through the gay men I actually know, nobody could name a living bugchaser. Only the gray-haired ones remembered a few, and those few were dead. AIDS, obviously.
The calculus of harm has gone to bed, while some of the panic remains like a bad hangover from 2003. A virally suppressed person on antiretrovirals transmits HIV to sexual partners at a measured rate of zero. Howdy, PARTNER: we've logged tens of thousands of condomless acts between serodiscordant couples and recorded not one linked transmission when the positive partner was suppressed. "Undetectable equals untransmittable" is the CDC's official position, and that happens to be backed by the largest prospective evidence we have. Is there any problem better drugs can't cure?
Sigh. I really can't spare more effort for the old "some members of group X do something disgusting, therefore contempt for all of X is warranted." Run it against any large population and watch it generate nonsense. The worst 1 percent of evangelicals, of soldiers, of parents, of whatever demographic you happen to belong to, or dislike. That's where the ruin lies.
So sure, go off, kings (or queens) who disagree. I've made my peace with being one of the rare freaks in this thread who is actually open-minded and willing live, let other people live, or die.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
5d ago
Nothing to report on the fitness front. I am particularly annoyed that when I do have the occasional twinge to pay it a visit (on the way back from work), it's overrun with women hogging the leg press machine. Well, at least it's a nice view. I just don't like sitting around waiting for a machine.
Doing aight in other ways. We have a pharmacist who loves his job. Perhaps too much. No, cyclizine is not particularly a drug of abuse, and I didn't need him breathing down my neck about it. Aggressively gay, in an anal way. Owns a Chihuahua too. But he's a pretty nice guy, barring possible OCD, and I have other hills to die on. If you thought I was dedicated to my job...
I've also realized that my colleagues are on to the fact that I seem to own only three shirts. Which isn't correct, I do own at least 5, but I used that as impetus to go raiding Vinted and I'm in the process of discovering my Inner Indian and the joys of getting nice clothing at reasonable prices. I seem to have spent all of £90 on half a dozen items in a week, which is practically profligate spending on clothing by my usual standards.
I suppose some might be surprised to learn that clothing prices are much the same in the India and the UK, in absolute terms. In relative ones? Might be cheaper to get new shirts and throw them away rather than launder them.
I've been getting out and about. Taking pictures. Being a pub psychiatrist and giving free advice, with people getting what they paid for. Doing a reasonably good job at actual work - where they don't pay me either. Today, I happened to run into a lovely old lady I'd screened for cognitive impairment and taken a history off while her husband and his brother wheeled her out. Did my usual song and dance and advised her to enjoy the fresh air. As I turned the corridor, I heard her say "isn't he such a great doctor" and that made me ache. Well, I try.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
12d ago
My junior survived her internship. Genuinely survived, she had an awful time, and now has a job in Australia waiting: more money, more sun, the universe settling a debt. Very inspirational, I'd be off to the Sunshine Coast if I could, instead I must endure the Scottish sun and coast.
I offered to get her something to celebrate the occasion. She declined. I bought cupcakes anyway, nice ones from M&S, on the medical grounds that her caloric intake is a matter of public concern and I have a firm policy of not listening to women about whether they need to eat. Success rate: non-zero. Still going.
Then I got a migraine and microwaved the cupcakes. Not my food. The cupcakes. She was touched. Took a photo for TikTok, laughed maniacally till she had tears in her eyes, and ate none of them, because she doesn't eat cake. Except when PMSing. Allegedly. I asked how I was meant to know when that was.
"Don't worry, self_made_human. You'll find out."
I have never been more afraid. I couldn't even fob them off on the very broke German med student, mostly because I was too honest and described them as cupcakes from Chernobyl.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
12d ago
Working out when I can be bothered, which is not never but also nothing to write home about. Otherwise? Life isn't bad.
I stayed back late yesterday, on my own terms, for a patient. Nobody asked me to do a cognitive history, just the MMSE. But I did it anyway. The hospitalist who requested it is probably very skilled in his his chosen field, but I am of the strong opinion that a cognitive test that doesn't take into account the full context isn't worth the paper, or the ink. A lovely old lady, with a shopping addiction that her just as lovely husband had to put a pause to a few years earlier. And much more serious issues, which warranted the admission to what isn't a psych ward. I took my time. I enjoyed myself. She had attention issues and hadn't finished previous cognitive screens because she got bored in the process. I am many things, but not boring. And somehow I managed to hold her interest, and get the annoying instrument completed, and also get her tissues when she broke down halfway while writing a sentence about how much she missed her parents.
I said that my history might be superfluous, since they're seeing a better psychiatrist (a nice enough cons I knew), but they made me blush by telling me that I was the better psychiatrist. I'll take it, bashfully.
And of course, as I slightly hoped for but was prepared to never receive, the hospitalist consultant said very nice things about me during the ward round this morning. I wasn't there to hear it, but I'm not very secretly pleased. By which I was very pleased, but tried to keep it a secret. And failed miserably.
No, I'm doing just fine.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
12d ago
The Rising Son Meets The Falling Father
It's not fun, looking in the mirror and seeing your dad looking back at you. Fun would be the wrong word for it. "Interesting" is more accurate, and "oh god, I understand him now" is more accurate still, and more helpful besides.
More hair. Or at least as much hair as he had at my age. The same facial features, remixed. Half a foot of extra height on him, because he grew up poor and didn't get to eat as much as a boy should. The intensity of the gaze. That's what you can see from the outside.
What you can't see so easily from the outside is what matters more. My father is quite possibly the hardest working man I know, to a degree that is frankly concerning, and also responsible for most of the good things in my life. His retirement planning is... to not retire. If he can help it. At a certain point I came to the painful realization that he doesn't have much of a life outside work, and that he's never been looking for one. He's happier about this than I am. Or at least the same "grumble very loudly but keep doing it anyway" impulse runs in me too.
I've told my mother that, in the unfortunate but real event that he develops dementia, the kindest thing would be to build him a fake OR and hire some very long-suffering and competent actors (or actresses, given his gynecological competencies, or your tolerance for gendered language). Hand him a scalpel and a few laparoscopic instruments I can't even name, and he'd do a better job than most surgeons, even cognitively impaired. Hmm. Perhaps we could hire actors with uterine fibroids or complicated pregnancies. And possibly charge them for the process.
It seems I've just reinvented his day job. Good. He prefers it that way, to the point that he does it half the night too. He'd get so much over-time if he wasn't self-employed.
I used to be intimidated. To be fair, I still am, slightly. I had many reasons for opting for psychiatry (a better work-life balance, and being able to yap at people and get paid for it), but one of them was the desire to avoid unflattering comparisons to my dad if I followed directly in his footsteps. Those are big shoes to fill, even if my own feet are bigger than the shoes. I can't be the surgeon he is, even with age slowing him down. I can't be the man he is either. But luckily, even half a dose of self_made_human Sr.'s genes is a strong potion. I have my own skills and my own talents, ones my dad was always proud of. He never expected me to be him. He was always going to be happy if I turned out the best possible version of myself.
Then, after a video call not long ago, I came to the aching realization that we're at the point where I am just as concerned about his health as he is about mine, if not more. That while he might be a world-class surgeon, he does not belong in a psych ward (except on the side with the comfy beds), and vice versa. And that he takes my opinions, including the psychiatric ones, seriously these days. Though not as seriously as I'd like. Vice versa on that too.
Like I said, age has caught up to him, but it won't stop him running. An episode of atrial fibrillation, requiring hospitalization, which my family didn't tell me about until he was stable. You can imagine my feelings. An obscure heart condition once thought to affect only Japanese men, which raises questions about my ancestry that the rest of my family answers anyway. No, they didn't get past Burma or into any pants. We're not weebs.
I've been trying to buy him an Apple Watch for a while. ECG monitoring, if nothing else. He doesn't need a watch to tell him the time, he has no time. I want him to have more. Like most semi-luxury purchases in our family, this was debated endlessly, until I put my foot down. I told my brother to buy him one for Father's Day and bill me later. The whole point of earning money is so you can spend it. On the ones you love. On what you need. On what they need, but are too cheap to buy for themselves.
I told my dad about this. He hemmed and hawed. Of course he did. That's what I'd do too. I'd had a bit of a scare myself at work, and asked my own boss how much his fancy FitBit cost. On hearing the price I winced, and said a trip to the ED was cheaper. But unlike him, I'm in excellent cardiovascular health. Or at least my questionable lifestyle choices have yet to catch up with me. My dad grumbled about the expense, but I know the gentleman very well. I could tell he was touched. Slightly shaken. So used to being the one doing the worrying and the caring, in his own gruff but loving way, that he found it deeply pleasurable and enormously uncomfortable to be the one receiving it. I get it, dad. I really do. I'm not sure your little boy is all grown up, but they seem to trust him with people's lives, and he hasn't been fired just yet.
All it took was being knocked flat on my ass, and getting back to my feet. With a few helping hands. Or a lot of helping hands. A surprising number of people who cared, despite all the reasons I felt I didn't deserve the concern. Realizing that I'm very tired, barely half a decade into my career, and willing to do it tired anyway. To go down swinging, and to refuse to let the bastards grind me down. I'm not a bastard myself. I know very well who my dad is. And that means a lot to me.
It's not easy, being a man. The cause of and solution to more than our fair share of the world's problems. The higher-variance sex, the idiots and the savants. The ones who dish out the violence, and the ones who protect from it. Broad shoulders, to hold up the weight of the world. Strong jaws, to take a punch. Mostly from other men.
So we do it. So I do it. Can't trust anyone else to. Women? They belong in the kitchen, because that's where all the good food is, and because they've had a bad day at the office and need someone leaning on the counter making ridiculous jokes and telling them they're cooking up a storm. The kitchen is where I clearly don't belong, since the best I can say for my culinary skills is that I haven't given anyone food poisoning yet. At least I don't need much prodding to do the dishes.
But with growing dismay, I've found myself in complicated situations, looking around for the adult in the room. And realizing, with very mixed emotions, that I'm the adult. The one responsible for this mess, a mess that's largely not even my fault. Fucking hell, how did I get away with it? How did no one see through me on day one?
Then I remind myself that pretending is the point. Some masks stick when you put them on and rarely come off. They adhere. That's what the blood, sweat and tears are for. If I can consistently pretend to be a functional human being, one who can be entrusted with the lives and safety of others, then maybe I am that man. And I'm in no real hurry to take the mask off. Not until I can hand it on. Hand it over, and enjoy a retirement. Possibly an early one, given the pace at which things are moving.
I'm not entirely at peace with my impending obsolescence. The fact that we are clearly building machines smarter than us, while hoping they turn out kinder than us. I want to be the psychiatrist Anthropic hires to psychoanalyze its latest models. I'm genuinely unsure whether I can be that man in time for it to matter, before I'm laid bare. That's fine. We undress you before surgery for good reason. Lay my psyche bare, and let something smarter and wiser than me strip away the tumor and leave the parts of me I want to keep. I did say I'm not quite at peace, but I choose to pretend to be. Pretending is the point. Judge a man, or a woman, more by what they do than by what they say. Talk is cheap. I give this away for free, and you get what you paid for.
I'm a broken man. Thankfully not broke, and just about at peace with being a man. My reasons for opting for psychiatry are myriad, but one was that I was always slightly hoping I'd run into people who knew better, who knew what they were doing. Sometimes I do, and I'm suitably grateful for it. But they can't seem to fix me. And I assure you, I need some fixing.
Man is somewhere between the falling angel and the rising ape. I feel for all the broken monkeys out there, and sometimes they put me in charge of the circus. I try my best. I really do. On good days my best is more than good enough. But I suspect the bad days are awful, and that fixing them might be an AGI-complete problem. Or rather, that we'll have AGI before we finish the job
I told my little brother, who I love dearly, that it's about time he manned the fuck up. I said it with love. He's got the certificate, he's another not-entirely-self_made_human (Jr and Jr), and his approach to academics horrifies me. My approach to working out horrifies him, and I... have to concede that one. He's alone at home. We're all alone, but I'm not at home. We're all lonely, but never as lonely as you might think. He has easy access to a family that loves him, and one we love back. Two dogs that can be absolute bitches, but are lovable in their dumb, goofy way. He's got two increasingly elderly parents who made many, many sacrifices to get us where we are, and who only ask that we do our best. I try. I worry about them, because worrying about the people I love is my love language. And I'm really not going to bother learning Italian.
Some of the broken monkeys really don't know better. They come to me, sometimes. The poor bastards. I might get paid peanuts, but there's worse remuneration for an overworked ape. I try to be the doctor they deserve, and these days I even believe the compliments I get in return.
I put on my Sunday best on a Monday, because I'm dressing for the job I want and not the one I have: that of a better-paid and probably more qualified shrink. My old boss's job, because the asshole can't be trusted to do it right. The new guy? I can't say a word against him. He's a good man, much like my dad, but with an even worse sense of humor. He has a son he dotes on and doesn't need another, so I just tell him he's a very good boss, and that I'm trying not to let him down either. He seems to believe me, poor guy.
I look at my hands. Surgeon's hands, according to a surgeon, who is hopelessly biased on the grounds that they're his own hands, only larger and possibly more slender. But a surgeon nonetheless, and a good father. He might doze off at the cinema, and consider walks with friends and reading the newspaper to be the peak of entertainment, but I'm here to make him proud. Not letting the people who love me down is the best way I've got of getting away with my antics.
So man the fuck up. Or woman the fuck up. Or be an enbie and give me no reason for envy. You might be broken. You might be laudably sane. Either way, be more than your genes, be more than your circumstances. Be the cause, and not just the effect. It's worth it. I promise you that. The world has more than its fair share of assholes, and not enough good men. Or even men trying their best. I do what I can, when I can.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
14d ago
"He's not here right now" would be slightly more menacing, or come across as gay.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
14d ago
I register your opinion, since you, unlike someone else, said so politely. But I think that's an awful lot of fuss for what is intentionally a dad joke.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
14d ago
If I do, then I don't know about it. Or the unpaid child support didn't follow me across continents.
I see your sense of humor could do with a tune-up. Or you could use a proper nap so you're less sleepy.
To be painfully specific: I was having a meal by myself (as one does), and it's standard practice for servers to ask about allergies here. I have no allergies, except to bullshit and painfully pedantic eggs. I've broken out into a rash. But since you asked so nicely, it's a silly joke, along the lines of the "old ball and chain" and not a reference to any woman in particular.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15d ago
I just used the "she's not here right now" classic in response to an "any allergies" while out for dinner. She was too nice to groan audibly. Any other excellent ideas?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16d ago
I set it to the hardest task there is: understanding me. It did very well. As well as me. I want so badly to be the psychiatrist that Anthropic hired to analyze Mythos, as detailed in the system card. Probably can't be that person, not enough time. But Fable is a very good psychiatrist. Once the regulatory and legal barriers fall, I'm hoping I have enough money to enjoy the fireworks from a safe distance.
Opus is very good. But I wouldn't use it for anything at all, if Fable was available.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16d ago
I have nothing new to say about the ban itself, or to be more accurate, I can't be arsed to.
I did use Fable from the moment it was available, quite intensively, and I can promise you that it's a feel-the-AGI moment. Is it an AGI? Nope. But it only took a little use to realize that it was clearly ahead of the pack, and we're only a small n number of iterations away. The only reason I'm not updating my timelines harder is because something like this is priced in.
Speaking of price, Fable tempts me to buy a Max plan. That is not something even a large amount of tokens for Opus 4.6 and later managed. I'll do so if this kerfuffle sorts itself out, but until then, using Opus 4.8 feels like a Flowers for Algernon moment.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
17d ago
I can't help being too cool for school, which is why I'm in higher education.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
17d ago
Sorry, can't hear you. Because I'm on the sidelines waving the red flag too, and so is she.
I do know. Very well. Uncomfortably, painfully well. Falling in love is not a choice, at least for me. And I am genuinely okay with being just friends with her, which is most likely outcome.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
18d ago
Not just me, and not everyone. Somewhere in the middle. I'm just honest about things.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
19d ago
is it time for @self_made_human to do the British would-be-NEETs of TheMotte a favor?
Hey I'm pretty sure I bought @Corvos a drink at some point. That's technically an anxiolytic and possibly a favor. And I don't think I'm the right person for disability adjustments, though they do take psychiatric inputs.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
19d ago
Not the asexual lesbian, because she probably is an asexual lesbian with incredible sexual trauma. But I'm sure I'll write about her (the lucky one) at some point.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
19d ago
No workouts, well, barring some push-ups. I have too much going on. Good and bad. Mostly good, thank fucking God. I am holding myself accountable to more important things right now, and still getting laid so the physique isn't too bad.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
Writing screen plays? Strong proof of mental illness. I've never been tempted, sorry, can't relate at all.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
I'm not a trauma surgeon, and he'd definitely have died if I was the one responsible for his care. I'm definitely not qualified to gainsay the pathologist here. If that's the subclavian or axillary vein, my hunch is that the odds were very poor, but I'm not going to pretend I'm an expert here. I suppose it also depends on if they had blood products, if the lungs were punctured, and whether a chest drain was available.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
I mean, I'm not wearing a tie. And if I did succumb to temptation, I'd make sure it's one of those ones that clips on and tears off easy. Only hot women get to choke me, on my own terms.
I'll look into things, really. I have learned the hard way to take good advice.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
I'll consider it, thank you. I just make a point of dressing well these days, even at work, when it would be so easy to devolve into scrubs (and look decent in them). A proper shirt. Nice trousers. The shoes. I'm not insane enough to wear a tie just yet. I used to wear crocs to work, once, but while they're perfectly cromulent footwear, I've outgrown them.
I try to get some stretches in when I can. Even if it's while I'm vaping in the shitter. But the pain really is probably psychosomatic, and it's nasty.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
I wrote an essay. It's beautiful. Too beautiful. I'm probably not going to post it, and my reasons for not wanting to post it are sensible and ugly.
Why? Well, I'm the best shrink I've ever had. Or the worst one. This is mostly because I'm still awaiting a more senior psychiatrist (no comments on their merit, since I haven't met them yet, and that's the fucking problem). I had to take drastic measures. I did the right thing, for mostly right reasons; I knew the odds, and still flew too close to the sun.
I've complained to myself that I'm too sane for my own good. And that it might not be an entirely bad idea to exchange a little bit of sanity for a medium dose of happiness. Well, my brain red-lined, I saw an amber light, I asked people I trust if I was worrying them (I was worrying myself). The answer was a yes. I listen and I learn. I hit abort. I realized that being too happy is almost as bad as being too sad. I fixed that problem, because you can't get more insight into your condition without being a laparoscopic surgeon operating on her own endometriosis. The moment I hit my own threshold for concern, I did extremely sensible and extremely annoying things, like calling people and telling them where to find me if things went south. I was confident they wouldn't go south, but not confident enough.
They didn't go south. I'm stuck in the northern end of a cold and damp country, which is cold and damp in the summer. I did not go insane, because I do not want to go insane. Not even if the prospect of going insane felt very good.
The best/worst part? When I was sensible and fired off another cry for help to my doctor, it turned out that my beautiful self-referral and psychiatric history had never reached them. It's clearly been sent. I believe them when they say it hasn't been received. NHS IT is trying to kill me, more literally than I'd like, but I'm still here.
That essay? You should wish you could see it. I've looked at it fully sober. I can tell you that even when my brain is melting from the heat, the metabolic waste glows in the dark like radium. You want to lick it off clean. Or at least I do. That really is part of the problem, and many parts of me are telling me "I told you so", and they are correct. I intend to never go out if I can help it, but if I do, you know it'll be in style.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
Uh... I think so? I wear Chelsea boots at work. But one of the reasons I'm not a surgeon (there are others, and too many to list) is that I fucking hate standing. I've tried a bunch of different shoes, I suppose, but my back and legs get sore. I'm literally surviving the ward rounds on paracetamol and ibuprofen (and a muscle relaxant, sometimes). And a PPI, because I never quite go full retard.
Quite convinced it's somatoform pain. Still waiting for another shrink to make me their problem.
You, me and everyone else who is a net positive tax payer. In theory, I'm not subsidizing the lifestyle of an American with HIV, or even just their life.
But we subsidize a lot of things dawg. Old people. T2DMs hitting the soda fountain while their kidneys spit out sprite. Children with leukemia. Not smokers, since they pay for their sins by saving the taxpayer money by denying themselves old age <3
In the US the tab runs through the public ledger far more than the private one (your healthcare system is deeply in the closet, and claims to be privatized). Medicaid is the single largest payer of HIV care, Medicare second, and the Ryan White program bottoms underneath both as the "payer of last resort," funded at roughly $2.6 billion in FY2024. Domestic federal HIV spending sits around $28 to $33 billion a year, the large majority of it mandatory entitlement money that swells with caseload. Per head, lifetime care runs about $420,000 discounted and north of a million undiscounted, with something like 60 to 68% of it being the antiretrovirals themselves. So yes. It is socialized. I'm not going to pretend otherwise to protect my flank. Or my ass, which is unviolated by anything but NHS negative-ply today.
But you gotta spend money to make money. And in this case, you do make money.
Then the part that should actually interest a cost-conscious person, because it cuts the other way from how you're swinging it through implication. Because U=U holds (UwU) and a virally suppressed person does not transmit, the single most cost-effective prevention tool available is putting positive people on the drugs and keeping them there. Every suppression is an infection that never happens, and every averted infection is another ~$420k to $510k lifetime tab that never opens. The modelling supports this, AFAIK: in the Botswana combination-prevention work each averted infection saved about $9,200 in downstream care and pushed the whole intervention into cost-saving or near-cost-saving territory.
ART buys a lot of QALYs for the treated person, and viral suppression also prevents expensive future infections. At U.S. drug prices, the treatment itself is costly, but interventions that get people diagnosed, treated and suppressed often become cost-saving once avoided transmission is counted.
ART for diagnosed HIV? A fucking bargain at about $21k per QALY.
https://pubmed.ncbi.nlm.nih.gov/23318310/
Well below the usual threshold of $100k per QALY.
ART for prevention? Even better, because you're averting transmissions and secondary QALY/financial losses. HIV is highly contagious (surprising nobody here, I hope, there's a reason it's everywhere and has been for decades).
Finally, ART costs money because people live for decades and keep taking drugs. Duh.
Untreated HIV is not free to the pool. You must consider opportunistic infections, ICU admissions, and onward transmission, all of which cost more than the pills. If your genuine concern is my wallet (doing fine) or yours (can't say) the wallet-minimizing policy is more treatment, started earlier, not less. I'm libertarian-adjacent, and I'd prefer that people pay for themselves really, but if we're going to pool risk and expenses, we might as well do it sensibly. Why yes, I work for the NHS.
If you're trying to pray away the gay, or AIDS, it's not going to work. Things were worse in the 80s and 90s, when the disease was a death sentence. I have little interest in considering "solutions" that involve trying to get rid of gay men being gay men (good luck, even immense social stigma and a near lethal disease couldn't do it), and it's not like most countries don't spend on primary prevention or awareness programs. I'd suggest cutting the budget for expeditions in the ME first, not that anyone listens to me about that. The drugs continue to get cheaper, and I continue to get drunker while the Ritalin wears off.
That is all I have time for, because I'm at a straight pub and I intend to enjoy myself.
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