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Monkeypox: an expert explains what gay and bisexual men need to know

How it spreads and how to protect yourself.

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Monkeypox is from the same virus family as smallpox. Kateryna Kon/ Shutterstock

Since early May, more than 23,000 cases of monkeypox have been reported worldwide. This is the largest ever global outbreak of the disease.

Cases have now been reported in 78 countries including the UK, Spain, Germany, France, the US and Brazil. Given the scale of the outbreak, the World Health Organization (WHO) has now declared the current monkeypox epidemic a global health emergency.

While anyone can get monkeypox, the current outbreak is overwhelmingly affecting sexually active gay, bisexual and other men who have sex with men. In fact, our recent study which looked at 528 monkeypox infections since the start of the outbreak found that 98% of these infections had occurred in this group. Here’s what these men need to know.

How it spreads

Monkeypox is a disease caused by infection with the human monkeypox virus, which comes from the same virus family as smallpox. In fact, symptoms are quite similar to smallpox and include fever, headache, muscle aches, chills, cold symptoms (such as a cough or sore throat).

Symptoms are also accompanied by a rash that appears in blisters on the face, genitals, the chest and back, and on the hands and feet. Some people also experience very painful sores in the mouth or inside the bottom. For most people, the disease usually resolves within two to three weeks.

Monkeypox spreads through close physical contact with an infected person. Typically this means skin-to-skin contact, especially contact with the rashes and skin lesions caused by the disease. But it can also be spread through large respiratory droplets (such as coughing and sneezing).

It can also spread through contact with bed sheets, towels or other fabrics that have come in contact with the infected person’s sores. We know that the virus can persist on surfaces for a long time – sometimes up to several weeks.

According to our study, 95% of monkeypox infections so far were spread as a result of sexual contact. Around 95% of the people in our study had a rash, mostly occurring on the genitals. Approximately 41% had sores inside the body (including in the anus or mouth).

Our research also revealed that the monkeypox virus was found in more than 90% of the semen samples we tested. However, we don’t yet know whether the virus is infectious in semen.

All this may explain why the virus is primarily spreading through networks of men who have sex with men.

A young man receives a vaccine from a healthcare worker. The worker is wearing white surgical gloves to administer the needle.
Many countries are now offering this at-risk groups vaccines to protect them. Africa Studio/ Shutterstock

It’s worth stressing the virus can spread through any contact with lesions or large respiratory droplets from an infected person. This means that it can spread in households through any close personal contact with an infected person – not just as a result of sexual intimacy. However, during the current outbreak, our study suggests that this kind of non-sexual transmission has so far occurred very rarely, in less than 1% of cases.

Providing protection

Many countries are offering vaccinations to sexually active gay and bisexual men who are at greatest risk of contracting the disease. Used prior to exposure, research suggests the vaccine can provide around 85% protection from infection. If given between four and 14 days after exposure to monkeypox, the vaccine may potentially reduce symptoms of the disease.

The WHO has also recommended that at-risk groups limit how many sexual partners they have and take steps to protect themselves from contact. However, recommending abstinence really doesn’t go far enough, especially given we already have a vaccine which can prevent monkeypox. This is why getting vaccinated (and making sure that everyone has equal access to these vaccines) is of such great importance.

Given that the epidemic at this time is affecting almost exclusively men who have sex with men, directing accurate and relevant public health messages and working together with the community to develop acceptable interventions is what’s needed to help prevent harm and further spread.

One of the difficulties is that gay and bisexual men represent a marginalised community that has already faced stigmatisation and discrimination, particularly during the HIV/Aids pandemic. Nobody wants to repeat that.

But public health messages are most effective when targeted at people who are most at risk of a particular condition. Some even argue that messaging hasn’t been targeted enough during this outbreak.

Although public health agencies such as the WHO, CDC, ECDC and UKHSA have already done a lot to provide clear, non-stigmatising guidance to at-risk groups, it may be important ensure this information is now disseminated in places where they will have the greatest impact – such as on dating apps, for example.

There’s a small window to contain the spread of monkeypox – and it may have already closed. There are already reports of infections in both women and children. But the fact that the disease still seems to primarily be occurring in one group means that, with the right interventions, the course of the outbreak could still be changed and that group protected.

The most important thing now is ensuring all countries have equal access to vaccines and treatment to protect against the further spread of infections. The declaration of a worldwide pandemic by the WHO will hopefully serve to co-ordinate the global response and open up the possibility of mass production of several vaccines with access for all. The question is whether it will be fast enough.

Chloe Orkin receives funding from Gilead Sciences, Viiv Healthcare, Astra Zeneca, Merck Sharpe and Dohme and Janssen for advisory boards, lectureships, travel scholarships and I have also received research grants from the same companies to my institution.

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Steps to building a more patient-centric industry

Lack of access, strict regulations, and demanding schedules have made it extremely difficult for patients to participate in
The post Steps to building…

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Lack of access, strict regulations, and demanding schedules have made it extremely difficult for patients to participate in clinical trials. A 2018 NIH survey found that patients felt clinical trial participation to be inconvenient and burdensome, and nearly half (49.0%) said it disrupted their daily routine. In 2021, a CISCRIP Perceptions and Insights Study reported more disruption to daily routines compared to previous years, citing length of visits, travel, and diagnostic tests as top burdens.

To ease this burden, the life sciences industry has been searching for ways to make clinical trials more accessible for patients and to drive participation numbers, increase participant diversity, and improve overall patient experience. For many patients, this change starts with choice.

A recent survey of clinical trial professionals found that more than two-thirds of respondents (61%) believe giving patients choice will have a positive impact on clinical research, and well over half (58%) said that their organisations plan to give patients the option to choose how they participate in clinical trials moving forward. Some examples of these choices can include video visits, phone visits, and remote monitoring.

As the industry focuses on creating a more holistic, inclusive patient experience, here are key steps to consider in order to help bridge the gap between clinical research and the patient experience.

Build a base in the community

According to the FDA’s 2020 Drug Trials Snapshot Report, only 8% of clinical trial participants are Black or African American, as compared to nearly 14% of the US population. The fact is, many minorities never learn about vital clinical trials in play, or that they’re eligible to participate. Subsequently, they are excluded, creating an evident gap in participants, and subsequently needed data on how treatments respond across different demographics of people.

Creating a broader, more inclusive patient experience starts with building a network of advocates who can help organisers meet patients where they are located and educate them about the availability and value of the trials. Initially, there needs to be a more proactive and sustained nationwide outreach effort to raise clinical trial awareness within minority communities.

It’s also important to partner with trusted people within minority communities, such as religious and government leaders that have the credibility needed to share clinical trial information to counter scepticism. If sponsors can partner with patient-advocacy groups to inform design, recruitment, follow-up, and even data collection (particularly for patient-reported outcomes), it will help to keep patients engaged longer and potentially derive higher quality data sets that can lead to better patient outcomes over the long run.

Embrace technology to expand reach

Technology – especially related to automation and the cloud – can help create a more flexible clinical trial model, thereby making it easier for patients to participate. Digital tools used in decentralised trials, remote enrolment tools, consent forms, wearables, and remote devices, as well as data capture, can help to expand overall access to clinical trials. For example, with remote monitoring, doctors and trial administrators can analyse all the data coming in and, if there’s a problem, they can act more quickly and respond back to the patient through a mobile device such as a smartphone.

Cloud platforms can open two-way communication channels for patients, doctors, and trial administrators to talk and share data, essentially in real-time. Some early examples of these capabilities were part of the US Centers for Disease Control and Prevention’s (CDC) v-safe program, developed by Oracle, which is used to track the effects of the COVID-19 vaccines through voluntary, scheduled survey prompts, and to remind people about boosters. Today, capabilities like this are being extended so that trial data from wearable devices and home-monitoring systems can be communicated directly to trial sites.

A new solution

One significant roadblock to clinical trial inclusion of minority groups has been location and transportation. Many potential participants lack transportation to and from clinical sites, and some trials are only held in large city hospitals, instead of smaller community hospitals that participants can sometimes access more easily. Thanks to decentralised trials and technology that collects data remotely, people from anywhere can participate.

One approach the industry has been exploring is to utilise community retail pharmacies as a central location for people to learn about and participate in clinical trials. By collaborating with pharmacy retailers, sponsors will have more opportunities for patient recruitment because they can offer patients the convenience and comfort of visiting familiar community sites.

For example, CVS and Walgreens have instituted flexible clinical trial models that combine patient insights, technology capabilities, and in-person and virtual-care options to engage broader and more diverse communities. The result is a much more expansive pool of participants and potentially much better information about populations where the drug is effective, and other populations where it might not be effective.

Keep it simple

There’s a notion that because the healthcare and life sciences industries are very complex, the systems that support them have to be equally complex. In fact, the opposite is true. Easier-to-use systems will increase participation rates, and we will have better outcomes as a result. With so many technology advancements at its disposal, the industry must find a way to bridge the divide between patient experience and clinical research. The patient journey must be a positive one, so that they will encourage others to participate.

Imagine, clinical research as an accessible care option to anyone. Technology has given us the opportunity to make this goal a reality. But as an industry, we must innovate to bring new experiences to market and improve the clinical research ecosystem for patients, healthcare professionals, sponsors, and regulators.

About the author

Katherine (Kathy) Vandebelt is global head of clinical innovation at Oracle Health Sciences. With over thirty years of experience in clinical research working in different geographies and across various TA, Kathy has worked with various organisations to advance their clinical operations and business processes to a better operating model. She believes patients are the most important constituent in clinical development and provide the necessary information to assess the safety and efficacy of new medicines. She strives to introduce new experiences and make the clinical research ecosystem better for patients, healthcare professionals, sponsors, and regulators using the power of technology.

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42 Biden Admin Officials Put On Notice By House Republicans

42 Biden Admin Officials Put On Notice By House Republicans

Authored by Jack Phillips via The Epoch Times (emphasis ours),

At least 42 Biden…

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42 Biden Admin Officials Put On Notice By House Republicans

Authored by Jack Phillips via The Epoch Times (emphasis ours),

At least 42 Biden administration officials were sent letters by Republicans on the House Judiciary Committee this month requesting testimony from a variety of White House officials.

Flanked by House Republicans, U.S. Rep. James Comer (R-Ky.) speaks during a news conference at the U.S. Capitol in Washington on Nov. 17, 2022. (Alex Wong/Getty Images)

Those letters primarily dealt with the suspected politicization of the FBI and Department of Justice (DOJ), investigations into U.S. border security, and President Joe Biden’s son Hunter.

A recent letter (pdf) led by Rep. Jim Jordan (R-Ohio) to White House chief of staff Ron Klain requested testimony from Biden administration staffers relating to alleged “misuse of federal criminal and counterterrorism resources to target concerned parents at school board meetings.” Interviews from four White House officials were requested.

Around the same time, another letter (pdf) from Jordan was sent to the Department of Education requesting testimony from three officials, and another letter to the Department of Homeland Security requests interviews from around a dozen administration officials. That includes embattled Homeland Security Secretary Alejandro Mayorkas and U.S. Immigrations and Customs Enforcement chief Tae Johnson.

Even more DOJ and FBI officials were asked to testify during the next Congress, according to two separate letters (pdf, pdf) sent by Jordan and others last week. They’re seeking testimony from Attorney General Merrick Garland, FBI Director Christopher Wray, Deputy Attorney General Lisa Monaco, and dozens of other DOJ and FBI officials, according to a Washington Examiner analysis of the GOP-backed letters.

It’s likely that Republicans will seek to investigate how the FBI and DOJ handled investigations into former President Donald Trump and the raid that targeted Mar-a-Lago in August. Republicans and Trump have long said the two agencies have exhibited a politically motivated animus toward the former president, coming after Garland announced he had appointed a special counsel, Jack Smith, to investigate him.

FBI Director Christopher Wray (R) and Attorney General Merrick Garland speak at a press conference at the Department of Justice in Washington on Oct. 24, 2022. (Kevin Dietsch/Getty Images)

More than a week ago, Garland appointed Smith as special counsel to “oversee two ongoing criminal investigations” into Trump, namely events surrounding the Jan. 6, 2021, Capitol breach and the Mar-a-Lago raid, according to a DOJ statement. Just days before, Trump announced he would be embarking on a third presidential bid in 2024.

Other Investigations

House Majority Leader-elect Steve Scalise (R-La.) revealed that some of the GOP’s priorities for the incoming Congress are probing the origins of COVID-19, the widely criticized U.S. withdrawal from Afghanistan, and allegations surrounding Hunter Biden.

The House Oversight Committee, under its top Republican and likely next chairman, Rep. James Comer (R-Ky.), is “ready to go start looking into a lot of the questions that people have had,” Scalise told Breitbart this weekend.

Whether it’s Hunter Biden’s dealings with all kinds of foreign countries [or] the laptop scandal, which the liberal media tried to dismiss when it came out in 2020,” he added. “It’s been verified.

It turns out there’s a lot of information on that laptop that raises serious questions, and James Comer’s committee’s going to be asking those.

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Tyler Durden Wed, 11/30/2022 - 22:25

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How Inflation Changes Culture

How Inflation Changes Culture

Authored by Jeffrey Tucker via DailyReckoning.com,

The midterm elections are over (no Red Wave), but nothing…

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How Inflation Changes Culture

Authored by Jeffrey Tucker via DailyReckoning.com,

The midterm elections are over (no Red Wave), but nothing has changed. In fact, the Biden regime will probably become even more emboldened to pursue destructive economic policies because it will interpret the lack of a Red Wave as some kind of mandate.

Every day seems to be a day of spin, with every regime apologist assuring the public that inflation is getting better. Just look at the wonderful trend line! They point to the latest inflation numbers, which were down a bit from the month prior.

The regime insists that yes, inflation will vex us for a bit more time but will settle down in a few months. Plus, the president is working to fix this! And we know the American people are on board with him since no Red Wave materialized.

But in the footnotes, you’ll find the truth: it was a tiny drop and mostly for technical reasons and the main reason for the drop has already disappeared from the price trends.

Has any political propaganda on this topic ever been this ineffective? It’s truly a joke.

Where’s the Relief Coming From?

The producer price index that came out recently paints a clearer picture. It’s grim. It reveals no softening at all. In fact, it shows that there are plenty of coming price increases. Here is the index by commodities from 2013 to the present.

Remember how last year many people finally came to the conclusion that we had to learn to live with COVID? That was a smart choice because there was no way that the China-style suppression method could work.

Well, here we are now with a preventable inflation pandemic and the realization that we have to learn to live with inflation. Soon we’ll realize that we have to live with recession at the same time.

But what does this mean?

The impact will be felt not just in terms of economics but in culture. Inflation causes a society-wide shortening of time horizons.

True Prosperity

Let’s review some basics. All societies are born desperately poor, fated to live off foraging and just getting by. Prosperity is built through the construction of capital, which is the institution that embodies forward thinking.

To make capital requires the deferral of consumption: you have to give up some today in order to make tools that enable more consumption tomorrow. This means discipline and a future orientation. And it means, above all, savings that can be invested in productive projects. Only through that path can societies grow rich.

A key component of this concerns the stability of the medium of exchange. And not just stability: a currency that rises in value over time incentivizes saving and thus investing for the long term.

The late 19th century provided a good example of this. Under the gold standard, money grew more valuable over time, thus rewarding long-term thinking and instilling that outlook in the culture at large.

Live for Today

Inflation has the opposite effect. It punishes saving. It forces a penalty on economic behavior that is future-oriented. That means also discouraging investment in long-term projects, which is the whole key to building a complex division of labor and causing wealth to emerge from the muck of the state of nature. Every bit of inflation trims back that future orientation.

Hyperinflation utterly wrecks it.

Living for the day becomes the theme. Taking what you can get now is the method and the theme. Grasping and spending. You might as well because the money is only going down in value and goods are in ever shorter supply.

Better to live hard and short and forget the future. Go into debt if possible. Let the devaluation itself pay the price.

The Seeds of Destruction

Once this attitude becomes instilled in a prosperous society, what we call civilization gradually devolves. If inflation persists, this kind of short-term thinking can wreck everything.

This is why inflation is not just about rising prices. It’s about declining prosperity, the punishing of thrift, the discouragement of financial responsibility, and a culture that gradually falls apart.

Another factor in reducing time horizons is legal instability. This was my first concern when the lockdowns began. Why would anyone start a business if governments can just shut it down on a whim? Why plan for the future when that future can be wrecked by the stroke of a pen?

Many people had assumed that this new path would be short-lived. Surely the politicians would wise up and stop the madness. Surely! Tragically, it got worse and worse. The spending and printing began and ramped up over time. It was a perfect storm of sheer madness, and now we are paying the highest possible price.

The Hinge of History

We need to speak frankly about what’s happening to the global economy. It’s not just about supply chain breakages. Those can be repaired. It’s not just about inflation affecting every country. We are living amidst a fundamental upheaval in the whole world.

The most significant single danger to global prosperity now comes in the form of a devastating and deeply tragic wreckage of the country that was set to lead the world in finance and technology: China.

The WSJ summarizes the current pain:

China in 2021 accounted for 18.1% of global gross domestic product, according to International Monetary Fund data, behind the U.S. at 23.9% but ahead of the 27 members of the European Union at 17.8%. It accounts for almost a third of global manufacturing output, according to United Nations data from 2020. China’s economy expanded modestly at the beginning of the year but data for March and April point to a sharp slowdown.

The trouble there traces to the top. When Xi Jinping locked down Wuhan, the world celebrated him for achieving what no other leader in history had achieved: the eradication of a virus in one country. Even now, he gets accolades for this.

The rest of the world followed, and elites in all countries said that this path was the future.

Going Backwards

Now the virus is on the loose all over the country, and the eradication methods are intensifying. This is crushing economic growth and now threatening genuine economic depression in the country that only a few years ago was seen as the greatest economic engine of the world.

It’s truly the case that Xi Jinping has put his personal pride above the well-being of all people in China. The scientists in the country know that he is wrong about this but no one is in a position to tell him.

We cannot really trust the data coming out of China but officially the rate of infection in that country is one of the lowest in the world. Billions more people need to get the bug and recover in order to have anything close to herd immunity. This means that lockdowns are the way for years to come so long as the present regime remains in power.

American prosperity for decades has relied on: relatively low inflation, fairly stable rules of the game, and widening trade with the world and China in particular. All three are at an end. Yes, it is heartbreaking to watch it all unfold.

I’m not defending China’s human rights abuses. Far from it. But the best way to end these abuses is through engagement, not estrangement.

We all need hope right now but it’s very difficult to find, since we are on a course that is not likely to be fixed for a very long time.

Tyler Durden Wed, 11/30/2022 - 19:05

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