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How Do We Do Public Health Post-Pandemic? – PolicySphere Morning Briefing – March 18, 2024

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#LGBTQ #PublicHealth – Noteworthy for Sen. Rubio to be taking on such a potentially explosive issue… “Rubio questions CDC on use of antibiotic as prophylactic against STIs

Since the Summer of 2020, when we were informed that public health meant you couldn’t leave your house unless you were participating in left-wing protests, we have seen that too much of “public health” is based on a “who/whom” framework rather than sound science or interest in the common good. The next step was “Monkeypox” (which later got a more PC name), a sexually-transmitted disease that clustered in the gay community. After being told that you couldn’t see your grandmother one last time as she lay on her bed of death, we were informed that the gay community couldn’t possibly be expected to eschew orgies for a few weeks in the name of public health. Thankfully the Monkeypox threat was contained because in the meantime the world had built up a significant capacity to produce vaccines on a quick turnaround (thank you, President Trump!).

The impolitic reality is this: as peer-reviewed research shows (it’s all a google search away, knock yourself out) and as every grown-up human who lives in a big city knows, for whatever reasons, risky sexual behavior is very prevalent within the gay community, and this has potential implications for public health, as it can facilitate the emergence or spread of new diseases. Since the 1980s the dogma of the “public health community” has been that, as part of any response to this issue, gays cannot possibly be expected or told that they should in any way alter their behavior, even at the margin. Instead the public health response should be to “work around,” as it were, these behavior traits (free condom dispensers in bathhouses!). In the 1990s, Bill Gates, then a neoliberal centrist simply following the data and getting his feet wet in philanthropy, was booed at an AIDS conference for suggesting that encouraging behavior changes should be part of the public health response to AIDS. And, as Catholics remember, several Popes were accused of encouraging genocide (!) in Africa for promoting the now-accepted “ABC” (“Abstinence, Be faithful, Condoms”) approach to AIDS prevention in Africa.

Again: in the wake of a global pandemic where entire nations were put on house arrest overnight by ukaze (whether justifiably or not), the idea that one community in particular cannot possibly be expected to modify its behavior in response to an emerging public health threat becomes…much less audible.

All of this by way of background to the topic that interests us today: more and more public health agencies are promoting the prophylactic use of antibiotics among the gay community as a way of preventing STI infection. The unsaid, but obvious, implication is that since members of the gay community who like to engage in risky behavior such as stranger sex and orgies and hookups on Grindr cannot possibly be expected to stop or moderate this behavior, public health authorities should work around this behavior by giving them robust antibiotic cocktails to act as a prophylactic.

Apart from an issue of basic fairness (why should one group in particular be immune to requests to modify its behavior, especially behavior which might seem more frivolous than being able to go to work or church or see your elderly family members?), there is an actually-terrifying issue of public health: antibiotic resistance. The overwhelming majority of the public health gains we have made in the last century have come as a result of antibiotics, new antibiotics are few and far-between, and natural selection is causing the emergence of antibiotic-resistant bacteria. (Such as, in the world of STIs, drug-resistant gonorrhea, which also originated in the gay community.)

A short, very strong course of antibiotics can be a useful prophylactic against many infections if taken as a preventative or shortly after infection. If you’ve traveled to sub-Saharan Africa, for example, you will know that Western travelers to such countries are typically given a strong course of daily antibiotics to prevent malaria infection, which they have to continue for a few weeks after returning to the West; this is quite effective for the traveler; it is also causing the rise of drug-resistant strains of malaria.

By the same logic, it seems that promoting antibiotics as prophylactics for gay men who engage in risky sexual behavior, without in any way trying to modify their behavior is…perhaps risky for public health, and certainly involves political questions of public interest and rank-ordering of values.

This is a very sensitive issue, and we have been trying to address it in a sensitive way while remaining true to the facts as we understand them. But it is important that this debate be had, and be had in ways that are sensitive, yes, but mindful of medical science and the public interest.

Given the potential threat of antibiotic resistance, and the disastrous mistakes of the pandemic, we can’t afford to get public heath wrong again.

#PublicHealth #Fentanyl – Speaking of another public health issue that is vitally important and doesn’t get enough attention… Cato: Expand Access to Methadone Treatment

#Environment – Important reminder from The New Atlantis: “We tend to think of natural disasters as natural. But the thing that determines how disastrous they are is mainly what humans do, not what nature does.” Link, via Jesse Walker

More and more Americans–including, anecdotally, conservative Americans–are alive to environmental concerns. As the left’s answer to environmental concerns grows more and more into its eventual final form–full communism–it might be a good idea for the Right to come up with answers that don’t sum up to “No no no no I can’t hear you no no no”

#AmericanManufacturing #Realignment Teamsters support Josh Hawley bill raising tarriffs on Chinese EVs.

#DEI – Very clever from Heritage: what if corporate DEI trainings were actually exercises in the unlicensed practice of psychology?

#EducationThe Surging Growth of K-12 Classical Education (Discovery Institute)

#Immigration #Self-recommending – Christopher Caldwell, the best right-of-center American observer of European politics, reports from the Netherlands in the wake of an election that put “far-right” firebrand Geert Wilders at the top. As we say, self-recommending.

#TaxPolicyCanada’s Tax-Free Savings Accounts Are a Huge Success. U.S. Lawmakers Should Take Note (Tax Foundation)

#VotingRights – New report from Heritage on the voting rights issue. The headlines: “The claim that there is a wave of voter suppression going on across the country that requires expansion of the Voting Rights Act is simply false. Minority voters are registering and turning out to vote in record numbers, and the other factors that showed the need for preclearance have long disappeared. Americans today have an easier time registering and voting securely than at any time in our nation’s history.” Link to the full report.

#Self-recommendingQ&A with RAND Corporation President Jason Matheny on tech, national security, and China. We’ve always appreciated RAND’s work which is relatively non-partisan and most often high quality.

Chart of the Day

Via The New Atlantis

Meme of the Day

Oh, the Bee.

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