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PaperclipPerfector  2mo ago (text post)   33981 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22, arrived at the clinic, she learned why: The U.S. Agency for International Development, which funded the study, had withdrawn financial support and had issued a stop-work order to all organizations around the globe that receive its money.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.

a study that will benefit a foreign drug company... quarter trillion dollar firms...

Which foreign company is benefiting from this?

Americans will have to pay eye watering prices while foreigners get it for free?

Americans can already get PrEP and it's even covered by Medicare and Medicaid, much to the chagrin of members of this forum who would rather people did not have HIV treatments.

Not to mention that other members of this forum were railing against USAID because they are "propping up" unsustainable populations of Africans. This trial was for a birth control device which would directly reduce the number of future Africans and yet I don't see those members defending this as a worthwhile expenditure. It makes me think that objections founded on population growth aren't really the crux of the objection.

Not to mention that other members of this forum were railing against USAID because they are "propping up" unsustainable populations of Africans. This trial was for a birth control device which would directly reduce the number of future Africans and yet I don't see those members defending this as a worthwhile expenditure.

Presumably I’m one of the posters you have in mind here. For the record, I do think that researching birth control methods (experimental or otherwise) in Africa is a very worthwhile expenditure.

Now, should that expenditure come from USAID specifically? I’m less sure about that. I can see a good argument for it, which is basically: Efforts to drive down Sub-Saharan African fertility cannot be conducted openly and for explicitly eugenic/racialist reasons. Not only would many Africans themselves understandably perceive this as a colonialist affront, but a great many westerners would also be made very uncomfortable by this and would not want their tax dollars employed in such a way. Therefore, laundering this mission through an ostensible charity organization creates the veneer (and, in fairness, also in some sense the reality) of both benevolence on our part and voluntariness on the part of the Africans.

Now, this attitude is directly at odds with the ethos of transparency and legibility which is motivating DOGE’s cuts to things like USAID. They don’t want the government doing things that look like one thing but are actually a totally different thing. They don’t want to continue to countenance the surreptitious laundering of funds for misrepresented ends. This is a respectable motivation, but I do wonder whether it is necessarily at odds with the important work that advanced nations need to be urgently performing in order to find every way imaginable to drive down third world fertility.

Efforts to drive down Sub-Saharan African fertility cannot be conducted openly and for explicitly eugenic/racialist reasons.

They can be and are conducted openly. Yes, they don't openly do this because they think subsaharans are inferior, but that's because they don't and I don't see why that's a bad thing.

Obviously I’m aware of the work the Gates Foundation is doing in this arena, and I applaud it. What I mean is simply that if the Gayes foundation did exactly the same work, but instead of presenting it as a fulfillment of liberal principles of female empowerment they presented it as a work of paternalistic technocratic imposition on a less-developed society for the protection/betterment of a higher civilization, that work would be utterly rejected by both the African populace and the donors. That the Gates Foundation, as far as I’m aware, does sincerely believe in the aforementioned liberal principles is simply the cherry on top.

To be clear, I do absolutely think it’s true that most African women who are currently having six or seven children would prefer to have less than that. (I had a previous post about declining fertility in advanced countries, in which I said that most women simply do not instinctively desire large families, and given the option to have a small number of children, the revealed preference of the average woman is to do so.)

Lowering African fertility is indeed a boon to those women, and to the countries in which they live, which do not have the economic infrastructure to provide gainful and productive employment to their current masses of young people. To the extent that African countries can be made less unstable and less likely to export tens of millions of unemployed and restless young black men to First World countries, the efforts of the Gates Foundation, and of USAID insofar as their efforts have been similar, are a net good for humanity.

However, my hope is that behind the curtain, at the upper echelon of organizations like the Gates Foundation and USAID, there is also a covert understanding of additional eugenic principles and that their work can be targeted, under the guise of charity, to take specific interest in improving the genetic stock of the relevant countries; to not only produce less Africans but also, in the long run, better Africans. Africans who are better equipped to be peer-level participants in the global order as their countries are further integrated into a global political infrastructure.

In patriarchal societies(like most of Africa), women typically desire multiple grown sons. African fertility preferences are genuinely high.

Despite having the highest fertility rate in the world, women and men alike in Niger say they want more children than they actually have – women want an average of nine, while men say they want 11.

—Jill Filipovic, "Why have four children when you could have seven? Family planning in Niger," Guardian, March 2017

Even in that article, the family planning clinic is funded by USAID, huh.

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