Thursday, September 24, 2009

Recent AIDS vaccine trial results - cause for celebration?

I am all in favour of AIDS vaccine trials. It's pretty much clear to me that safe sex (not to talk about abstinence) just isn't happen in sufficient numbers and consistency as to prevent the pandemic from happily continuing on its destructive way. During the last year or two there have been off-the-record discussions among AIDS activists and clinicians about whether HIV preventive vaccine trials should be abandoned altogether, seeing that until now all trials ended up in utter failure. Instead people played with the idea that we should simply get on with large-scale HIV testing and with putting infected people immediately on AIDS medication. The rationale behind this idea is that it turns out to be the case that infected people who are on AIDS medicines become after a short period of time non-infectious (their viral load undetectable). Mathematical modelling suggests that the pandemic could be brought to heel within a generation or two by using this strategy. It turns out to be the case that this test-and-treat strategy is also the most efficient means to keep infected people alive and kicking. On my reading of the literature AIDS would turn from a terminal illness into a serious chronic illness that can be efficiently dealt with by means of medical care. The later you go on treatment the higher your risk to die of AIDS.

Anyhow, this was the world of AIDS until today, at least if you believed the media. As part of the self-fulfilling prophecy (it's just a matter of time till vaccine research will yield results) we're told in today's newspapers and news programs that a vaccine trial conducted in Thailand resulted in a 31% reduction of likelihood of infection. Most people, of course, do not read beyond the headline, and that is unfortunate. The 'successful' vaccine is a combination of two vaccines that crashed and burned previously. There is no mechanism that would explain why a combination of two failed vaccines makes a successful vaccine. The numbers seem to be speaking for themselves - 31%!!! - but do they? I doubt it. Here's the baseline as reported toward the end of the Los Angeles Times article: 'New infections occurred in 51 of the 8,197 given vaccine and in 74 of the 8,198 who received dummy shots. That worked out to a 31 percent lower risk of infection for the vaccine group.' The 23 additional infections in the placebo arm - out of 16400 overall participants - doesn't seem seem to be a figure that's statistically significant by any stretch of the imagination, no matter how hard the study's spin doctors (it cost 105 mio US$ to conduct the study) try to make it look otherwise. There might be good reason to undertake the same study with a much larger number of participants across the world, but until then, I doubt we have anything to celebrate at all.

For starters the number of people infected in both arms is fairly small (roughly 125 out of >16400, 51 in the active agent arm, 74 in the placebo arm - I doubt that is statistically significant, might be just a fluke). Anyhow, the thing is that it could possibly be said that all other things being equal it might have prevented some people from becoming infected. The trouble is, of course, things are not being equal. There's all sorts of behavioural changes among trial participants, with some behaving like they would have anyhow, some increase their risk taking behaviour, others reduce it (overall there's likely a reduction in risk-taking behaviour, but some participants would almost certainly increased their risk-taking behaviour). So it is possible that among the infected people (in both arms) are people who increased their risk-taking behaviour as a result of trial participation.

The whole story is also yet another example of science by press release... the actual study will only be published in late October 2009...

Saturday, September 19, 2009

'Passing as straight'

I thought, there we go again! I talked to a gay male friend the other night, you know, one of those all-over-the-place type chit-chats. Anyhow, at one point he tells me with some pride that one of his closest straight female friends complimented him the other day by saying that he'd 'pass as straight' easily. 'Passing as straight' is a primary preoccupation of many gay (I presume mostly male) folks. Goes also under 'straight acting', and stuff like that. The price is yours if you 'pass as straight', you lose if you fail and people can 'tell' that you're gay.

Now, what is it that makes gay men 'pass' as straight? Well, you guessed it, looking as if they're REAL men (I'm being half tongue in cheek here). What's a real man like? Well, you gotta have a deep voice naturally, you don't flap around too much with your hands, and, if at all possible, you make sexist jokes on the odd occasion (mind you, most drag queens are sadly excelling at that), it also helps to be dressed not too fashionably (mind you, metrosexuals are good at dressing properly these days, too). I suspect you also better have a pint instead of a glass of chardonnay, but I might be off on that one...

It's funny, I have had this 'compliment' more often than I can recall, both from straight and gay folks whom I know/knew. I always thought of it as seriously offensive to be honest. After all, I happen to be gay, and I'd much rather be identified as such if someone sees the need to identify me according to sexual orientation. What's the point of gay men mistaking me for a straight guy? Same is true for straight women... - defeats the purpose, doesn't it? What kind of compliment is it to tell someone who's gay that they don't 'look' gay. I mean, how often have you heard someone telling straight folks that they look 'soooo gay', and that one would have never thought that they might be heterosexual? And of the few who might have heard this 'compliment', how many would have taken pride in this in the same manner that very many gay folks take pride in 'passing' as straight?

What's even more puzzling is that this seemingly innocent 'compliment' also reveals a LOT about people's silly stereotypes. I mean, to be a gay man, does one really have to talk in a high-pitch voice and flap a lot around with one's hands? Isn't that at best a reflection of age-old stereotypical assumptions about gay men being some kind of stereotypical women? And that to be a 'proper' lesbian you got to be REALLY 'butch'. I could go on and on, but I'm sure you get the drift.

Much of this is based on the age-old assumption that gay folks really are the 'other' sex, and that they'd behave like that. I doubt that there's a biological hardwiring that ties this kind of behavior to sexual orientation. Certainly there's no good reason to take pride in 'passing' one way or another. Better to call people out on the prejudices that such 'compliments' reveal.

Stepping off my soap box now :).

Ps: It goes without saying, should you feel like acting it out camp or should you really feel like camp is you, it's REALLY fine, too. None of this matters one way or another!

Wednesday, September 16, 2009

We've got to PAY for news - but how?

You're reading this blog on the web (and no, it's not news!), so I suspect you might be reading much of your news on the web. There's excellent sites serving our insatiable need for news, from the BBC site in the UK to the M&G in South Africa to tbe BMJs health sites, and so on and so forth. This shift from print media to the web has resulted in the death of many venerable newspapers. Many have been household names for a century, and suddenly they were gone. Their sales figures plummeted because people bought paper copies of the newspapers in ever lower numbers, advertising revenue migrated to where people go today for news, a vicious cycle from a newspaper's perspective. Many websites run advertisements to pay for their content. It has become clear by now, however, that large news organisations such as the San Francisco Chronicle, or the Los Angeles Times cannot survive on the advertising revenue derived from their websites. Excellent newspapers tho they are, they're on the brink of extinction.

I have got to be honest, I rarely buy print copies of newspapers these days anymore. Living in Canada, I have difficulty justifying shelling out cash for the local papers, the quality of most of them is plain inferior to what is available free of charge on the web elsewhere. It's also unclear whether they contribute to national debate as much as they used to (after all, web based media are also capable of achieving this feast).

However, when I look carefully at how I interact with internet based news organisations' sites, I notice that, truth be told, essentially I am a free-rider. The superb (to my mind unique in terms of quality) BBC site, for instance is paid for by UK based TV license payers (ie tax payers) who have no choice but to pay their annual fee to support the BBC. While I am grateful to them, truth be told, I should probably pay towards maintaining that great source of high-quality news content that this site is. Equally, I doubt the South Africa based Mail& Guardian makes money from its fairly comprehensive site. There I am, a reasonably well-off developed world dweller, sucking up free news content produced in the developing world (fair enough, South Africa isn't as poor as its townships suggest, but still, you get the drift). Equally, the millions of Jamaican expatriates that read the Jamaican Gleaner newspaper to find out what's going on 'at home' do not pay the paper's proprietor anything for using the news content provided there free of charge to them via the internet. Mind you, the paper sucks so badly that it would probably never succeed if it decided to charge its internet based readers, but who knows...

I can't help but think that sadly Rupert Murdoch is right-on when he tries to get people to pay for news content on the News Corporation's website. As it happens, in my world News Corporation companies do not produce news, they generate reactionary propaganda, so I won't frequent their 'news' websites anymore in the future than I have done in the past. It's bad enough that I can't prevent Fox 'news' flooding into my home thru my cable provider's pre-packaged content delivery. However, if the BBC ever decided to charge a nominal fee for access to its internet news sites, I would almost certainly pay up.

The only disadvantage I see of this is that once the commercial access walls have gone up, there will be so much less news available, because the content will once again become proprietory in nature. Still, to assume that somehow large news sites could survive simply based on advertising revenue seems naive. When - if ever - have you clicked thru to one of the advertisers' sites? I think I may have done so 10 or 20 times over the last decade...

Any views on this anyone? My main concern is not that one would have to pay, as I said, I think we should begin paying for news content currently provided free of charge on the web. No, my main concern is that once we start paying we will ironically also receive access to much less information than we currently have. That surely is a regressive step.

Saturday, September 05, 2009

Brief hiatus

Dear reader:

I haven taken up a Distinguished Visiting Fellowship at my good friend and colleague, Richard Ashcroft's University (Queen Mary, University of London). While I will be commuting forth and back between Canada and the UK (the environment, as usual, be damned ... do-gooders tend to travel at least as much as those who have no qualms about flying our environment into the ground), I have just arrived this week in Britain and I am trying to get my feet on the ground. Please be patient with me. I expect more frequent blog posts to resume this coming week.

Udo Schuklenk