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PaperclipPerfector  3mo ago (text post)   33985 thread views

Culture War Roundup for the week of February 10, 2025

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NYTimes article that wasn't paywalled for me, with my browser extensions: https://www.nytimes.com/2025/02/06/health/usaid-clinical-trials-funding-trump.html

In more bad-things-happening-due-to-USAID-stop-work-order-news*, it turns out that USAID participated in clinical trials. ("The Times identified more than 30 frozen studies that had volunteers already in the care of researchers...") Interrupting clinical trials is bad:

Asanda Zondi received a startling phone call last Thursday, with orders to make her way to a health clinic in Vulindlela, South Africa, where she was participating in a research study that was testing a new device to prevent pregnancy and H.IV. infection.

The trial was shutting down, a nurse told her. The device, a silicone ring inserted into her vagina, needed to be removed right away.

When Ms. Zondi, 22, arrived at the clinic, she learned why: The U.S. Agency for International Development, which funded the study, had withdrawn financial support and had issued a stop-work order to all organizations around the globe that receive its money. The abrupt move followed an executive order by President Trump freezing all foreign aid for at least 90 days. Since then, the Trump administration has taken steps to dismantle the agency entirely.

Ms. Zondi’s trial is one of dozens that have been abruptly frozen, leaving people around the world with experimental drugs and medical products in their bodies, cut off from the researchers who were monitoring them, and generating waves of suspicion and fear.

The State Department, which now oversees U.S.A.I.D., replied to a request for comment by directing a reporter to USAID.gov, which no longer contains any information except that all permanent employees have been placed on administrative leave. Secretary of State Marco Rubio has said that the agency is wasteful and advances a liberal agenda that is counter to President Trump’s foreign policy.

In interviews, scientists — who are forbidden by the terms of the stop-work order to speak with the news media — described agonizing choices: violate the stop-work orders and continue to care for trial volunteers, or leave them alone to face potential side effects and harm.

The Declaration of Helsinki, a decades-old set of ethical principles for medical research that American institutions and others throughout the world have endorsed, lays out ethical guidelines under which medical research should be conducted, requiring that researchers care for participants throughout a trial, and report the results of their findings to the communities where trials were conducted.

Ms. Zondi said she was baffled and frightened. She talked with other women who had volunteered for the study. “Some people are afraid because we don’t know exactly what was the reason,” she said. “We don’t really know the real reason of pausing the study.”

The stop-work order was so immediate and sweeping that the research staff would be violating it if they helped the women remove the rings. But Dr. Leila Mansoor, a scientist with the Centre for the AIDS Programme of Research in South Africa (known as CAPRISA) and an investigator on the trial, decided she and her team would do so anyway.

“My first thought when I saw this order was, There are rings in people’s bodies and you cannot leave them,” Dr. Mansoor said. “For me ethics and participants come first. There is a line.”

Setting aside that we now won't get the scientific results of these studies, fucking people over like this** seems like counterproductive foreign policy.

*I'm posting this, because I didn't recall clinical trials coming up in the other discussions (I only learned of it this morning), so it's presumably also news to others and I thought it was different in a key way. (see footnote 2)

**I say "fucking people over," because it's not a situation in which receiving something is better than nothing, even if you didn't receive everything you expected/were promised; these test subjects risked their own health on the basis of guarantees from the trials and the USA reneged on its part of the deal. (I.E., if you're too hard-heartened a libertarian to believe in Kantian medical ethics, the USA is still in the wrong, due to not following the terms of contracts it entered.)

So USAid is sponsoring a study that will benefit a foreign drug company and may develop a treatment that at best Americans will have to pay eye watering prices while [that] foreigners get it for free? For a disease that I'd really prefer not a single tax dollar went to treat in the first place. Call me heartless, but I'm strongly in favor of shitting this trial down.

Let's let quarter trillion dollar firms pay for their own medical studies and let's let foreign nations who use monopsony to bid down their fair share of treatment development costs accept that that means fewer treatments get developed.

For a disease that I'd really prefer not a single tax dollar went to treat in the first place.

Yeah, there's been a growing awareness how badly we've been lied to about HIV.

HIV doesn't readily spread from heterosexual sex. There is essentially zero risk from vaginal intercourse the way that 99% of Americans will experience it. In the Western world, it spread in the gay community because of anal sex and extreme promiscuity.

So what happened in South Africa? 1) The common practice of "dry sex" in which women rub abrasives into their vagina 2) Huge rates of child rape.

Those problems might be intractable. Apparently there was a billboard in Eswatini that said "don't rape kids".

HIV doesn't readily spread from heterosexual sex. There is essentially zero risk from vaginal intercourse the way that 99% of Americans will experience it

This is a heck of a non sequitur. Whether you like it or not, a lot of straight men like anal sex - with women. The first Google hit found that in 2013 about a third of heterosexuals in 20 US cities they polled admitted to having had anal sex in the past year. Now, I've never seen the appeal myself, and you're welcome to say it's against nature for all the same reasons as gay sodomy if you want to be all Catholic about it - but it's a thing, massively so. Promiscuous gay men might be a small minority of the American population, but it doesn't follow that the remainder only have wholesome church-approved missionary sex, and you'd have an even harder time trying to change that than trying to walk back gay acceptance.

If you think HIV does spread readily from heterosexual sex, then why hasn't it?

Last time I ran the numbers (several years ago. It might be time for an update), gay men got HIV at >80x the rate of the rest of the population. This was reported like "20x the general population" or something, which neatly hides the fact that people-who-aren't-gay-men get HIV at less than half the rate of the general population.

I don't think your mechanism of action can dismiss such stark differences.

then why hasn't it

It has in Africa and it did to an extent at the height of the HIV pandemic in Russia (mostly intravenous drug fueled, but it spilled over into the straight population for a time) in the late 90s and early 2000s. In almost all cases prostitutes form the reservoir population, such that even though the risk of an individual customers getting infected was very low, there are so many customers that it can still spread.

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