Hacker News new | past | comments | ask | show | jobs | submit login
HIV Is Reported Cured in a Second Patient (nytimes.com)
935 points by aaronbrethorst on Mar 5, 2019 | hide | past | web | favorite | 259 comments

As a kid who grew up in the 1990s, I consider this the biggest technological advance in my lifetime. HIV was a death sentence back then. Arthur Ashe died of it in 1992, and Magic Johnson announced he had it in 1991. It was in our minds right up there with global warming and the hole in the ozone layer as a existential threat to humanity. And now... a 20-something who begins antiretroviral therapy today can expect to live into his or her late 70s. It's a scientific miracle.

As a fellow 90's kid who read almost every book Isaac Asimov wrote, I was shocked to learn he died in 1992 from AIDS acquired previously from a blood transfusion.

The sooner humanity can mostly forget that HIV/AIDS was ever a thing, the better.

Woah, I didn't know about it till this comment! Never even a mention of it in his autobiography either (which is as delightful a book as his fiction)

His family didn't want it to be public for a long time in order to avoid the stigma.

Eventually, hearts changed, and it was decided it would be a powerful statement to come forth with the details surrounding his death.

I didn't know about it either until now. A true tragedy.

I agree with the positive sentiment, but disagree that AIDS should be forgotten. The bigotry and petty vindictiveness in th 90’s was disgusting and in some quarters it lives on. The earlier days were worse as I understand it, and there is a lesson in it all.

Can confirm. My eldest brother died of it via a blood transfusion. This was during the early days when it was little understood and all treatment was experimental.

The "popular" assumption was that catching it proved you were gay and highly promiscuous, or sharing heroin needles, therefore deserved it. Some of my brother's friends never spoke to him again from the moment of finding out. I think he found other's reactions as hard to deal with as the death sentence.

Mother did her utmost to never mention, and made me promise to always say he had cancer.

That bigotry still exists, and is far too common, as seen in some of this thread's comments.

One concern I have is the resurgence of other STDs as a result of curing HIV. The number of sexual partners adults have has been steadily rising and risky so transmission of other "regular" uncurable STDs like HPV and Herpes may spike.

Shouldn't you then question if treating syphilis with penicillin encourages risky habits? Or be concerned about the condom and contraceptive pill? People are always going to want to have sex. Safe sex and condoms aren't foolproof. People get drunk or horny.

The trouble with that apparently innocent concern over the increased risk of other STDs, is the victim blaming it leads to. "Well if only they'd not taken risks", eventually becomes "it's your own fault" and "you shouldn't wear a short skirt".

It was well over a year after my brother died that his widow got the letter admitting liability from the hospital. Until then, I have no doubt that of those who knew he was HIV+ (and that she wasn't) more than a few had doubts. That he had obviously been unfaithful, or was gay and in denial, and had brought it on himself, maybe even deserved it etc. Along with all the extremes of not wanting to breathe the same air, touch, catch it from a seat sat in an hour ago or visit such a dangerous hospital ward.

It was ugly, undeserved and whether gay or not, the popular mood was more of the dark ages than the 20th century. We haven't evolved as far as we like to think.

Safe sex practices have seen a decline in recent years but condoms don't prevent HPV or Herpes Simplex so even people who consistently use condoms because they're concerned about HIV are still risking exposure to HPV & HSV.

People also had the same concern about birth control pills but the social benefits of the pill[1] far outweigh any potential social costs from (alleged) "riskier" behavior. And considering 80% of adults already have HPV and more than 50% carry HSV I think you're concern is largely unwarranted.

[1]https://www.guttmacher.org/sites/default/files/report_pdf/so... [PDF]

Do you have the same concerns about curing smallpox?

They've still not had peer review of their work, but this does seem promising:


>The number of sexual partners adults have has been steadily rising

Got a cite for that? I was under the impression the opposite was true.

And even if it is the case, see the book "More Sex is Safer Sex" by Steven Landsburg:

"You’ve read elsewhere about the sin of promiscuity. Let me tell you about the sin of self-restraint.

Suppose you walk into a bar and find four potential sex partners. Two are highly promiscuous; the others venture out only once a year. The promiscuous ones are, of course, more likely to be HIV-positive. That gives you a 50-50 chance of finding a relatively safe match.

But suppose all once-a-year revelers could be transformed into twice-a-year revelers. Then, on any given night, you’d run into twice as many of them. Those two promiscuous bar patrons would be outnumbered by four of their more cautious rivals. Your odds of a relatively safe match just went up from 50-50 to four out of six."



Given it was a scandal that affected thousands, and the hospital later put it in writing, yes.

She did not want to mention it due to the publicity campaign around AIDS at the time, and the popular presumption I mentioned. To avoid questions like that I guess, whilst he was slowly dying.

The 90s were...an interesting time. I vividly remember two aunts arguing about AIDS research funding vs cancer research funding. "But only the fags get AIDS" vs "Cancer is preventable if you just stop smoking" hopefully give you an idea of the joys of growing up in the midwest.

I was in primary school in the 90s; I remember having to write a topical essay and present it in front of class. For some reason I chose AIDS, and I still remember that one of my key points was that you don't catch it through air or touch. Apparently it was common for people to be afraid of standing near a person with AIDS, or breathing the same air.

That said, "But only the fags get AIDS" vs "Cancer is preventable if you just stop smoking" doesn't seem like a thing of the past - this level of argumentation around AIDS, and about other topics - vaccines, GMOs, artificial sweeteners - is something I hear from most people I meet. I cherish the people in my life capable of deeper thought than that.

> Apparently it was common for people to be afraid of standing near a person with AIDS, or breathing the same air.

There was a catchy phrase wildly in used when and where I grew up (translation doesn't make it justice): "AIDS isn't caught, it's transmitted". Le SIDA ne s'attrape pas, il se transmet.

We had a flight of steps in the backyard that was made from reclaimed bricks from an old grandstand that had a toilet block in it. The neighbours kid wasn’t allowed around once they found this out. Imagine being scared of getting AIDS from a brick.

Wasn’t any better in here in London in the UK.

Two events really stand out in UK history to me

The first was Diana in 87, opening a new hiv/aids unit and shaking the hands of a patient.

The other was a character in a soap (watched by over 1/4 of the population - imagine a show with 90 million viewers in the U.S) becoming HIV, and all the various reactions both of him living with it, then later when the neighbourhood bigots found out, that was in the early 90s

> The other was a character in a soap becoming HIV

I know it wasn't your intention and this is a serious topic, but I did chuckle at the thought of this.

AIDS cannot be forgotten or ignored, even once a cure is discovered and is effective. AIDS wiped out an entire generation of LGBTQ people. It wiped out a generation of artists and creatives. It destroyed so many peoples lives. It would be hugely disrespectful and a dishonor to those people and their memory.

As important as a cure is, and I have a feeling it will happen in our lifetimes, I think the history of what AIDS destroyed is incredibly important. I rarely recommend a TV show, but Pose(on FX) did an incredible job of showing how everyone reacted and dealt with AIDS and death in the early 90's, especially in minority communities. It's truly heartbreaking and as a young LGBTQ person, it's such a stark contrast to how the world views these kinds of things today.

> The bigotry and petty vindictiveness in th 90’s was disgusting and in some quarters it lives on.

I get the sense that HIV/AIDS was very much a part of reducing bigotry. Once it turned out that we all have friends and relatives who are homosexual, it seemed to change the mood about what was acceptable to say about them. I've met an older homosexual couple who've said the same; they had to sort of pretend to be friends for decades until quite rapidly they could just be themselves.

> there is a lesson in it all.

There is, but it does not seem that we learned it. Being a simplistic and tribal species seems to be very deep in our nature, sadly.

These days we have gone too far in the other extreme.

My grandfather needing a blood transfusion in 1990 and was seen as a death sentence because of how little of the blood was tested then in Eastern Europe. It ended up that my father and uncle had to take turns donating blood to try and keep him alive.

When people talk about taking blood from high risk groups and call me a bigot for being absolutely against it I always remember my father fainting three days before my grandfather died because he had given too much blood.

I have read most, but not all of his work but did't know that's how he died.

I wasn't old enough in the 90s to understand HIV/AIDS completely but remember it being a death sentence (I remember a rumor that you could get it by using public toilets)

This is a pretty good time to remember Ryan White, who is a fairly under-appreciated contemporary hero. They called this the "gay plague" at one point, and in a derogatory way. To all of our collective shame, it probably would have killed far fewer if people didn't think it was exclusive to gay communities.


It's shameful that people assumed HIV was exclusive to gay communities, likely due in large part to homophobic prejudice rather than facts.

This is not the only shameful thing that has ever happened in the world, but I'm not sure what your example of a shameful action has to do with the GP's.

That's not shameful. What's shameful is that we decided that it was OK to let AIDS run rampant since it only affected homosexuals.

I didn't think it had to be said, but apparently I was wrong. I know the gp is a flagged/dead now, but I came back to the comment today and wanted to thank you for your succinct and correct summary of my implicit point.

Wasn't it more "only affects people having risky promiscuous sex", it's not like HIV is the only transmissible sexual disease.

Ensuring people can adopt a sexually hedonistic lifestyle without caring about protecting themselves or their partners from disease seems pretty low priority to society?

People (in general, based on my observations) only care about anti-vaxxers because of their effect on others. Isn't it the same? A group choose to do something that exposes them to greater risk of disease; society steps in when the impact on others increases.

As a slight aside: Some consider that the reframing, in USA, of HIV as a general problem -- rather than being transmitted primarily amongst promiscuous male homosexuals -- as a great harm.

> Some consider that the reframing, in USA, of HIV as a general problem -- rather than being transmitted primarily amongst promiscuous male homosexuals -- as a great harm

I don't know what kind of fantasy land you come from but that's preposterous. I come from a city with one of the highest HIV populations in the world and it isn't just gay people who have it. My favorite author died of AIDS from a blood transfusion.

> A group choose to do something that exposes them to greater risk of disease; society steps in when the impact on others increases.

What a disgusting outlook. Everybody didn't decide at the Annual Gay Convention that they wanted to start introducing HIV into their population.

It's great that you think sexual promiscuity is comparable to the anti-vaxxer movement, but that's so far from the truth it's painful.

I care about each individual affected by the anti-vax group, including the involved children, not just those outside the anti-vax group it affects. I'm not only concerned when it starts affecting people I consider to be society's desirables.

I care about each kid involved in this crazy movement to mutilate your children's genitals at a young age to "switch their gender". Even if it doesn't affect me or other people.

I care about each person who has contracted HIV, not just homosexuals. I want them to be able to live happy lives despite living them different from mine.

That's called empathy. Caring for people outside of your immediate circle. It's something you should consider trying.

From what I remember back then it isn't that people assumed only gay people could catch it (otherwise why would absolutely everybody be paranoid about it)...

... but that plenty of people thought it was a convenient way to get rid of gay people. Genocide by omission, if you will.

We don't talk about this era anywhere near as much as we should.


> The correct medical diagnosis was Gay Related Immune Deficiency

The medical “GRID” diagnosis was wrong, while “HIV” was attacking gay men, it was also attacking straight people. They were being ignored because it was eliminating gay people. Hospital staff kicked gay people out as HIV diagnoses came in. My friends held their friends in their arms without medical care as they died because a government and medical association did nothing. If gay people had rights they would have been able to have more successful monogamous relationships. If they had government assistance they could have aided in stopping the spread. For 8 years the government did nothing. Clever trick to call it GRID, then once it blooms in straight populations change the official acronym. “Oh it happens in straight people too?!” Damn right.

> Of course anyone can get AIDS, but men who have sex with men have a much higher risk of contracting than any other group with the exception of IV drug users.

Male to male anal sex is a common and easy method for transmission, so is IV drug use. The greatest rate of new infection is African-American women. Why would you point out some groups and leave others out?


>My friends held their friends in their arms without medical care as they died because a government and medical association did nothing.

Was there any help to be gained from private medical institutions? Or was that also impossible because the government has to allow for treatments?

You’re ignore relative prevalence of the subjects getting infected. Sure, African-American women were infected, but that’s 4,000 out of a population of what? 35M? The rate compared to higher risk populations is still incredibly low.

In the UK, just over half of new infections are in heterosexuals.

The 8 countries with the highest HIV rates all have rates more than twice the rate of homosexuality, so even if every gay and lesbian person had HIV, a majority of people with HIV would not be gay or lesbian.

In the US in particular, new infections are 2:1 homosexual:heterosexual, but the USA isn’t the world.

Reportedly his family didn't publicize the matter at the time, due to the prejudice it would have triggered. His auto biography also does not mention it. It was only made public by his family, several years after his death.

Those tissue paper toilet seat covers only really appeared in public bathrooms in the 90s. I still think about how ridiculous they are in the context of HIV/AIDS, every time I see them.


Yeah, no. Even vigorous bareback anal sex transfers HIV only a minority of the time. Sitting on semen or menstrual fluid, or even rubbing it on your outer sphincter, is not going to give you HIV.

Downvoted for focusing on generating a disgust reaction instead of being aware of any scientific facts.


What do you think is more likely:

1) I like public toilet water splashing up into my anus

2) I want to relay scientific facts about the transmissibility about a disease that has a lot of fear, stigma, and falsehoods spread about it, often in the service of an anti-gay agenda.

To answer what you don't know: no, splashback can't transfer HIV.

I don't know what you're getting at. I just wanted to share a trick.

> I don't know if that can transmit HIV or any other diseases

It's virtually impossible for HIV, you're time would be better spent planning how to spend your big lottery win. The reason anal sex is better at spreading HIV is because anal tearing allows it into the bloodstream, apart from that your anus is no different from your ass checks, you're arm or anywhere else.

>your anus is no different from your ass checks

Doesn't stuff in your intestines get naturally absorbed into your bloodstream by some mechanism? I always figured the danger with putting things in your ass was that you would bypass the safety mechanism that the stomach acids double as.

I'm not a doctor, but consider the size difference between molecules and viruses. Some quick googling puts the size of the aids virus at 0.1 micron and the size of a water molecule at 0.018 microns if I did the conversion right.

Getting from the toilet through the anus and into the intestines is it's own challenge. There's shit, multiple sphincters and bends in the way.

Then you've got the transmissibility of aids itself, which is actually quite low for anything other than blood transfusions: http://www.aidsmap.com/Estimated-risk-per-exposure/page/1324...

Put all that together and there's no chance anyone got aids from toilet splashback.

HN is a relatively sophisticated forum, as forums go. I'm not saying that you need to censor your language, more that a sense of decorum in phrasing could've gone a long way to avoiding downvoting.

Well this has been informative, thanks for sharing.

I am a huge fan of Asimov too. I didn't know he died of AIDS. That's unfortunate.

He and his family kept that fact private, I understand, until years after his passing, because of the enormous stigma around it. That stigma remains one of the most tragic consequences of the disease, as Randy Shilts so devastatingly documented.

I remember chatting with a friend who worked in the biochemical industry in the early 90's - he commented if you had had a blood transfusion in certain countries in the last 10-15 years " you're dead".

I am from East Africa, and I know dozens of people -- including several close relatives -- who have died from it or have the virus. Ours is a generation of orphans, and chances are 90% that an orphan lost their parent[s] to HIV/Aids. Death, in the council estate I grew up in, was a very common occurrence, and it was usually due to HIV/Aids. Even today it is still a threat; it might be less deadly, but people are hit pretty hard, mentally.

So, I hate it. A cure that can be scaled up will be the best thing ever.

(Some might say that our people are careless and whatnot. Maybe. But HIV's spread is also driven by economic and gender factors, ignorance, and sometimes bad healthcare. A high prevalence rate doesn't help either -- because I don't believe that Africans are more sexual than anyone else.)

n=1, but what happened in East Africa was tragic, and was not the fault of careless people. Anyone who says otherwise is not worthy of thought.

I was a kid in the 80s and HIV was terrifying back then. I'm Australian and this ad is burned into the memories of a lot of Australians.


"Stop Aids, love life" in switzerland was (and still is) a kind of funny https://www.lovelife.ch/en/campaign/archive/2004-1987/

Probably similar age as you. I now find this ad mildly amusing

Perhaps these most detailed account of the AIDS epidemic in the US is "And the Band Played On" by Randy Shilts. He too died of it.

My Uncle gave me a hardback copy of The Band Played On in 93 shortly before he died of AIDS. I’ve read it every 5ish years since his death and I cry every time.

Technology is rewriting the future of this virus and I can’t help but to think what might have been different had he contracted HIV in a different time.

You need only look at South Africa to see what could have happened if it came 20 years earlier.

Second recommendation for that book. It really captures the reality of AIDS at the time.

Also recommend the HBO movie version of the book.

And yet some of the brightest analytical minds are regularly drawn to the big dollar signs that comes with optimizing advertising tech at FAANG companies when they could be curing cancer.

I never understood this sentiment. I'm good at JavaScript, not biochemistry. How will I be curing cancer? Trick the cancer cells into calling undefined as a function?

It's not a criticism at your individual specialization. It's fucking hard to get into cancer research at this stage, though if you know the right people, you could maybe help scientists with some simulations or visualizations or whatever other tangential concern that requires JavaScript knowledge.

This is a complaint against the market at large. There is work to be done in things like curing cancer(s) and mitigating climate change, but the jobs are few, far between, and pay peanuts. Meanwhile advertising is a direct social negative (IMO a cancer on human society), but it offers plenty of positions with good wages. The choice thus becomes: take the hard road and a paycut to maybe help some unspecified amount of people you don't know, vs. take the easy road with good wages and hurt an unspecified amount of people you don't know.

This complaint is about the market, and it's essentially the same thing you may say during debugging some algorithm: "I understand the steps it make and they all look good, but the final result is wrong".

Hang in there. Things change. Society as a whole takes it's own sweet time to make hard choices. But we do.

Otherwise the market would still have slave ships running.

Is it possible to speed things up? History says no.

But scaling things fast is a very new thing.

Islam took a few hundred years to spread from Delhi to Lisbon. That was before the invention of the printing press. The Reformation after the printing press, took a hundred years of war before most not all got along with each other.

Today Fortnite or what the Kardashians are upto spreads through the globe in a few months.

This is a new thing. And sooner or later someone will figure out how to infect minds positively at the same rate.

> Otherwise the market would still have slave ships running.

I think the slavery ended mostly because its relative efficiency dropped as technology developed.

You'll see how fast acceptance of animal slaughtering will drop once we can get cheaper, provably healthier lab grown burger.

Slavery dropped due to European Enlightenment values in the inherent dignity of man finally taking root among educated people in power. The cotton gin and the steam engine only made slaves more efficient and ramped up their quotas, not reduced the worth of their labor.

> ... steam engine only made slaves more efficient ...

Yeah, because so many slaves were trained to be steam engine operators.

Slaves are only worthwhile if they do machine job and you don't have a machine and you don't have local population in deep poverty that you could just pay a little bit to do your thing and not care what they eat, where they sleep and whether they die or not. That's why slavery never realy caught on in Europe in industrial times. Europeans were cheper than slaves.

No, enlightenment values were and still are quite good at rationalizing the status quo. It was wealthy religious zealots that ended slavery, to the opposition of the businessmen and economic pragmatists.

I think maybe it's a hockey-stick like graph on the speed...

Think about cigarettes and tobacco. Fairly flat for a while, a few upticks, gradual rising, and then - in the last decade or so, this rapid increase in legislation and other means by consumers against it.

Part of it has to do with attitudes and understanding about harms, and getting the public to understand this. At some point it reaches this breaking point, but that also seems to correlate with technologies to allow for alternatives (witness in the case of tobacco the rise of vaping products, as well as tobacco-free nicotine products becoming OTC and cheaper).

While I think you are right that acceptance of "natural beef" or other similar protein will drop once a viable artificial alternative becomes available, it won't really take off until that alternative can replicate a good portion of the other products out there as well.

That is - for myself - all the artificial ground beef in the world won't get me to switch over and away from a proper well-marbled rib-eye steak, or a BBQ'd brisket or pork shoulder.

But if they could replicate those items as well, and do it at a comparable price, then I'm game for the change (which has been the downside to current analogues on the market - $12-15.00 USD per pound for artificial hamburger is not my idea of a financially sound choice).

I'm much the same for things like electric vehicles - just give me one that is off-road capable, 4WD, that I can lift and put on 30"-plus tires, and still give me a few hundred miles of driving range - and be inexpensive to purchase - then I'll do it.

Heck - even a cheap small 2WD pickup truck would be nice.

Not all of us want a sedan or sports car.

We could use markets to shape humanity based on our collective values but instead we let the markets shape us. Perhaps it’s a failure to coalesce around shared values; too much tribalism. Clearly some political regimes are better able to harness the power of the state to guide the invisible hand to do its work where it’s most needed. By delegating the “guiding” role to market participants themselves, those who control markets by lobbying and legislating, we forfeit our control.

> By delegating the “guiding” role to market participants themselves, those who control markets by lobbying and legislating, we forfeit our control.

This discussion is interesting; I was thinking something similar this morning, with the focus on our collective food choices.

It's an imperfect analogy, but there are many things that we as both a society and thru governments we have banned, or highly regulated, as having too many external negative issues to allow them to continue to be sold openly on the market.

You can think of any number of drugs (including more than a few that used to be OTC not long ago), stuff like "high test peroxide", cigarettes and tobacco products, etc.

For the vast majority of these, though, none have extreme externalities - that is, none cause death in society like certain foods that are easily available.

But those items don't have huge lobbying efforts around them, either.

For instance - we know that HFCS is a great contributor to obesity and heart disease/stroke - yet we don't ban it for commercial food usage. While there have been recent inroads from a consumer standpoint (next time you go shopping for food, note the number of ordinary items that have packaging marked as "contains no HFCS" or similar), it's unknown whether this will continue to be a trend, nor how long it will take to rid the majority of purchased food items of the substance. It is also unknown how long it will take for the effects of its removal to show up in the overall health levels of society.

But there again is a product that we freely allow in our foods that arguably is slowly killing all of us; one could say "well, you are free not to eat those foods" - but one could have argued the same about tobacco and cigarettes not too long back (and they did). There is actually a good parallel between both the tobacco industry and the corn/HFCS industry (the lobbying, hidden and such papers about the dangers, etc) - but even in the case of tobacco, there wasn't an outright ban; it's been more of a slow attrition via consumers and the public...

> Meanwhile advertising is a direct social negative (IMO a cancer on human society)

Wow wow wow you can't just make a claim like that without any basis whatsoever? It might be true or not, but would you mind collaborating on why you think that? I am not even talking about proving it with some science (which is likely very hard), but you just write it off as if everyone else is sharing your view and as if it is self-explanatory or widely accepted. It is not.

Capitalism and the product culture has led to the most technological and in many case, lifestyle, lifespan, and life standard advancements known in history. This way of propelling progress forward requries efficient markets, and markets need to connect products with people who want and can benefit from those products. No advertisement is directly forcing anyone to buy or do anything, they just provide information for people and help locating people who might otherwise not have knowledge of the products they might want.

Assuming your take on the advertisement industry is different, what is that take?

I would think the feeling that marketing as a whole, and advertising as part of it was a large social negative was prevalent enough that one would not have to explain it even if not everyone agrees.

I mean it's common enough that Bill Hicks on the subject is pretty much a meme by this point https://www.youtube.com/watch?v=tHEOGrkhDp0

I'm not saying I necessarily agree, but if someone says advertising is a cancer on society or something like that I would not be like - whoa what particular belief system has led him to conclude this?!? - I would think, huh, they have that set of beliefs regarding advertising and marketing.

So, one more time, care to explain why you think that it is? Or am I to understand this correctly that you think it's "cancer" on society because you have just heard other people say that (like Bill Hicks and perhaps others you respect) and you assume it was prevalent?

It would be interesting to understand your original arguments if it was more clear what you based that assumption on (which is by no means universal).

1. you might notice that it was not me that made the original arguments, I just noted my surprise that you needed understanding of the viewpoint since I've seen it expressed throughout the internet at various levels of lucidity for the last decade at least.

2. one expression might be this https://ioptconsulting.com/online-advertising-is-the-new-dig... if the Bill Hicks expression of it was not to your liking.

3. again, I was not arguing for the correctness of the belief that advertising is a cancer, I just noted that nobody should be surprised at it's existence. Maybe it's like this XKCD https://xkcd.com/1053/ in which case congratulations, I've now given you two links to why people think advertising and marketing are awful awful things.

Again, I do not necessarily see advertising as something that is cancerous, but I am familiar with expressions of the idea so I am not shocked, shocked when I encounter it.

> This way of propelling progress forward requries efficient markets, and markets need to connect products with people who want and can benefit from those products. No advertisement is directly forcing anyone to buy or do anything, they just provide information for people and help locating people who might otherwise not have knowledge of the products they might want.

That's the motte-and-bailey[0] defense of advertising that I particularly dislike. Yes, connecting products & services with people who want them is a crucial ingredient for efficient markets. But that's not what most advertising is about, that's not what the advertising industry is doing, that's not what adtech is working on. Ads as made and experienced today (and for the past 100 years), are all about emotionally manipulating people, about convincing people who know about a product to buy it when they otherwise wouldn't, about brainwashing people with brand associations so that in their moment of weakness they'll default to the advertised brand. The end result is customers making suboptimal purchasing choices, and the externalities are noise and utter destruction of all communications media.

As for "cancer on society" part - the following is an incomplete list of problems brought on us by advertising industry: spam, robocalls, telemarketing - all three having a spectrum from just annoying to outright fraud. Dark UX patterns. Blogspam, content marketing and wholesale flooding of the Internet with free garbage to gather eyeballs. Outrage-inducing news reporting. "Native advertising" (aka. just straight up dishonesty). Leaflets and other advertising material overflowing garbage bins everywhere and spilling on the pavements of every city. Excessive light pollution. Billboards distracting drivers. Social media influencers and other "individual advertisers" directly eroding trust you have in recommendations of people who aren't your immediate family. Having to protect your elderly parents from getting scammed by both criminals and reputable companies alike. Having to protect your kids from Elsagate-style video content. And yes, wholesale tracking and privacy violations too.

I could go on, and on, and on. My belief is that advertising is poisoning society from the inside, while at the same time causing absurd amounts of waste through negative-sum games (when competing for a fixed pie of customers, all your advertising efforts work to cancel out the advertising efforts of your competitors).


[0] - https://rationalwiki.org/wiki/Motte_and_bailey

The root of the problem is how we measure the performance of our economy. Fix that, and all negative effects of ads will go away.

>I'm good at JavaScript, not biochemistry. How will I be curing cancer? Trick the cancer cells into calling undefined as a function?

No, that's how we get cancer in the first place. You need to trick it into calling a defined termination function.

Nobody's gonna cure cancer. We'll be able to prevent some cancers and treat others, but cancer is a large number of distinct diseases with different causes and outcomes and you can't eradicate it.

That said you don't need to be good at biochemistry to help treat cancer. The bottleneck in pharma research right now is essentially finding big enough patient groups for clinical trials, I'm sure Javascript can help with that. (And the "best ad minds" of the generation as well). What about tracking habits that may increase cancer rates? Hmmm, Javascript can help with that. What about mapping out locations that have abnormal occurences of cancer due to possible environmental factors so nobody buys a house somewhere the local plant is dumping waste into the nearby water supply? Well, there again...

Also, you can just study biochemistry and become good at it. I did just that. It's perfectly attainable and does not require extraordinary skill.

Doing software work in support of scientists trying to cure cancer. Scientists aren't curing cancer with a notebook and pen, they have have problems that a software engineer can really help with. Boring internal software, with some public-facing software.

It's not glorious work, and your team is typically understaffed and overworked. There are tradeoffs in the job, it's not for everyone. I work at New York Genome Center, and at the Broad Institute before that, both are nonprofits, and there are plenty of firms with software jobs out there where you can do "just software" and help with something meaningful.

Drop me a note, I'm happy to talk about this more. I missed the monthly jobs thread, but my group is hiring.

You mention you work at a nonprofit. Do you take volunteers as well?

We do not, we're a combination of grant-driven research, production/clinical genome sequencing, and scale computing; the work is hard to structure for ad-hoc volunteer contribution.

You are not good at "javascript" you are good at problem solving and logic.

I am good at programming, but I wasn't bad at chemistry either. I could have chosen to go study that instead, or gone into bioinformatics. I still could. There's plenty of software involved in modeling cell functions, which I imagine is pretty significant for curing cancer. Yet here I am, doing other stuff out of my free will.

I'm happy at my current job, but if I truly wanted to make the world a better place there would be more effective ways to do that (cancer research being one of them).

Many of the hardest problems facing us today in biological research are computational in nature. You could have a lot more of an impact than you think

Bioinfomatics is where a lot of research will be going on. And that's a lot closer to JavaScript than it is to biochemistry most of the time.

Genetics grad here, working in IT.

It’s an understandable sentiment but the salary one would be offered in Biology was basically laughable. Even in the so-called hotbed of biotech where I lived.

I don’t see an easy way to fix that either. Working in a politicized government funded organization would be the most likely outcome and I think most of us would hate it.

The academic model is bankrupt. No wonder a lot of people are dropping out because spending years, if not decades of low paying scholarships (at best) for the possibility of a good paying job later is just not a good proposition.

And then big companies require Masters/PhDs for people to go and do jobs when On The Job training would suffice? Yeah, does not sound good.

> Even in the so-called hotbed of biotech where I lived.

Where was that, if I could ask, and how bad is it? A "hotbed of biotech" is an entry on my list of cities to consider relocating to in the near future.

I was referring to Montreal, as there were a lot of biotech labs at the time.

I recall none of them paid above 35k$ at the time, which was the same as one would be paid handling phone support for telecoms.

This was 15 years back so things may have changed.

Not who you are replying to, but in my mind, the only two "hotbed" cities in the US that I can think of are Boston and San Diego.

Bay area (Emeryville and East Bay are pretty interesting, in addition to South SF), and Research Triangle Park (North Carolina). Seattle a bit.

Minneapolis has one of the largest biotech&medical device sectors in the US as well.

One of the brightest minds who did the same in the previous generation was Bill Gates, who then used his wealth to cure polio and is working on malaria. So maybe making money in tech isn’t actually so bad.

It's not just about money, it's about the "brightest minds" part. Injecting arbitrary amounts of money to some cancer projects won't suddenly make smart people to come back from making ads, especially if such donations are unsustainable. And you can't plan for billionaires; a Bill Gates is one-in-a-billion fluke combination of skill, upbringing, luck and conscience. For all the good Gates family is doing, you can't base humanity's most important projects on whether or not a billionaire wants to help their fellow men, instead of hoarding it all for their estate, or damaging some market in an attempt to turn their fortune into a greater fortune, or just blowing it all on heroin and hookers.

Bill Gates isn't really that much of an outlier within the class of people with that level of wealth. There is a long tradition of it stretching to the likes of Andrew Carnegie, and Gates isn't even the only modern example. Warren Buffet has committed to giving 99% of his wealth to charity. Elon Musk is Elon Musk. Any random billionaire is more likely to have a charitable foundation than not. It's pretty much impossible to spend that amount of money on heroin and hookers in practice.

The problem with relying on billionaires isn't that they won't do it, it's that they don't actually have that much money. Gates with ~$90B is #2 in the world, but spending every cent of it all in the same year would amount to less than one half of one percent of US GDP. His entire fortune is not quite half of what the US spends on just advertising each year.

> Any random billionaire is more likely to have a charitable foundation than not.

something something tax avoidance

Donations to certain charities can be tax deductions, but once you give the money to the charity, it has to be used for charitable purposes or it's not tax avoidance, it's tax fraud. Having it be used for charitable purposes seems like the thing we should want to happen to it.

Moreover, most of the things traditionally thought of as tax avoidance don't involve charities at all and are more along the lines of warehousing wealth in offshore companies where it can collect interest at low/zero tax rates.

Bill Gates has no real ability to cure polio or malaria, other than by throwing money at the problem. Other people have to do the actual work. But if the industry for those kinds of jobs isn't very good, enough people won't go into those careers at the time they need to, which is early: they need to have an interest at a young age, major in the right fields in college, specialize in postdoc, etc.

You can't just throw money at something and expect hordes of highly talented and qualified people to suddenly be available to do it.

This isn't Bill's fault (as much as I'd like to blame him for something after suffering with Windows 9x), it's a product of our society. We don't value that kind of work, we don't demand our government to fund it properly (since the "free market" isn't going to), so we get kids going into college tracks where they can be good at online advertising rather than curing cancer.

> Bill Gates has no real ability to cure polio or malaria, other than by throwing money at the problem.

This is far too simplistic. Throw a bunch of money at advertising and everyone goes to work for FAANG. Shift some of that money to disease research and suddenly people - who might have otherwise become doctors or followed a career path that paid - start realizing its a valid career path that they don’t need to sacrifice quality of life to pursue.

Yes, it’s not something that will happen overnight (it’s not like everyone immediately switched to coding once FAANG started paying a lot), but if the money is there, it will start to happen.

It's very easy to shift from some other programming work (where you have a degree in CS or similar) to working for FAANG.

You can't take a CS degree and start working in disease research, any more than you can get an MBA and start in disease research. The time to get people on that track is when they're coming out of high school.

You can't take doctors and have them work in disease research either. They'll have the necessary undergrad work most likely, but all the med school stuff just isn't useful for it, and they'll have to start over with the postdoc studies to specialize in that research. After they've already invested a fortune in med school, they're not going to do that. Who's going to pay all these people to move away from more lucrative fields into research?

The incentives are not alligned properly. Cancer patients don't pay as good as advertisers. It would help if everybody would have an expensive cancer insurance. But I guess most people don't think about cancer until it's too late. It's more fun to buy stuff after clicking on ads.

Edit: the incentive of an insurance doesn't work either :( . It should be possible to bet money on getting cancer. Everybody who bets against me gets my money in the case that I don't get cancer.

> Everybody who bets against me gets my money in the case that I don't get cancer.

That’s called universal healthcare.

Most cancer researchers aren't working on curing cancer! Rather they're working on fabricating for themselves an impressive history of published papers using p-hacking. RP:CB has been trying to reproduce many landmark cancer studies and found that 1) the majority do not reproduce or only partially reproduce and 2) that the authors of the original papers are generally hostile to attempts to reproduce their work.

I've got a PhD in genetics from Cambridge and I do security development work at Google. I'm far better at the latter, and the skills that I use on a daily basis wouldn't have made me a good fit for the former. These aren't fields where capability in one is equivalent to competence in the other.

Interestingly, I did computer science at Cambridge, and now I'm doing university research in genetics. I very much view what I'm doing as applied computer science, with a not-insignificant amount of software development.

By the way, you gave your supervisor quite a scare when you went off and got a computing job before you had submitted your thesis. I remember him lamenting about it quite clearly.

There's overlap between the fields, just as there is between, say, physics and genetics - but we don't usually end up telling physicists that they should be busy curing cancer rather than fucking about with subatomic particles. Different people have different aptitudes, and there aren't many people I've met in the FAANG space who'd I'd say would be well suited to wet lab work no matter how smart they are.

(And hey, I'd finished my revisions before I got the job, submitting them just ended up being a lower priority than moving to America and getting married…)

It's just as well there are areas of genetics that one can do just sat in front of a computer. I wouldn't trust me in a wet lab.

Does inventing gmail count? Webmail before gmail sucked, now they are essentially clones (or improvements) of gmail.

Many cancer researches use gmail (or other similar webmail) instead of the horrible internal email of the university, with a bad spam filter, small disk quotas, bad browser support (only IE6), etc.

And other researches use gmail (or a similar webmail) too, like to cure tuberculosis, eradicate polio, launch rockets, heart surgery, ...

Sounds like you'd be a fan of http://80000hours.org/

The FAANG companies might end up producing the machine learning algorithms which are key to solving many problems in biochemistry.

Ironically, one of my close colleagues left the tech sector to become an HIV epidemiologist.

I believe they had never been asked whether or not they wanted to be born intelligent and I don’t see why should they be given the burden of fixing the world when the world, quite often, turned their backs on them.

I don’t see how its their responsibility or why it should be.

Whenever you hear old timers tell a story, you know it's going to be good when it starts with, "You gotta remember, this was before AIDS." I wonder if there will be a second sexual revolution once AIDS cures are readily available.

There's still herpes, hepatitis, antiobiotic-resistant chlamidyia, etc. Still very uplifting to know that HIV might soon be behind us.

Interestingly, from what I've read, the social stigma around Herpes type 2 (the genital version) is a fairly modern thing. Before the late 1970's it seems that little distinction was made between the genital and facial variants of the disease and both were socially lumped together without one being given much moral stigma as a venereal disease. It was more in the 70's and 80's that media and pharmaceutical interests basically drew attention to the difference so that a sexual hysteria could be created around the genital variant of the virus, apparently in a way that improved antiviral drug sales.

Herpes may be less of an issue now that Pritelivir/Amenamevir is available to order from Japan. Supposedly it's more efficacious than Valacyclovir, and the effects may be combined.

Exactly, this is why behavior modification should also be emphasized.

HIV is bad but I wouldn't say it was ever a threat to humanity. Condoms and clean needles can protect you from HIV, both very accessible.

That's true if you live in a society where contraception is culturally acceptable. If you don't then condoms aren't readily available, and the spread of HIV is still a problem.

That's a society/culture, not humanity.

Then I guess the culture is the actual threat. Just like the anti-vaccination culture.

Now, slightly off-topic, thinking about this I developed my own conspiracy theory: anti-vax is spread as a way to enforce a kind of natural selection.

Abstinence is also an extremely good way to prevent contracting STDs. Imperfect, of course (there's still the risk of rape, and of bloodborne contagion), but remarkably good.

Abstinence is probably even less culturally acceptable than contraception, pretty much universally.

Chastity (i.e. having sex only with one's spouse) is less reliable than abstinence, since one's spouse may cheat, but it's also a very good way to prevent the spread of STDs. But even chastity is often culturally unacceptable, whether for both sexes (as in the U.S. today) or for men (as in many places, both historically & in the present).

It's sad — STDs could be eliminated, but … people make mistakes.

> But even chastity is often culturally unacceptable, whether for both sexes (as in the U.S. today)

You are saying that in the USA today, that "having sex only with one's spouse" (ie - your definition of "chastity") is "culturally unacceptable" here?

I'm curious on what you base this on?

I am pretty certain that being unfaithful to your spouse, or even "significant other" is still considerably frowned upon in the U.S...?

That is - I don't think it's "accepted" culturally - just tolerated (by the wider secular U.S. society). Maybe that's what you are getting at...?

I think for the most part our culture would rather those who are married to remain honest with each other, to uphold the vows they took when they were married. There is also another smaller part of our culture (of which I am in agreement with) that would say as long as all parties are aware and consenting to it - ie, open marriages - that is ok as well.

But I don't think our culture here in the U.S. completely condones unfaithfulness...?

Maybe I am wrong? Certainly something to think about; which is also why I ask...

Abstinence is as effective as a New Years resolution.

Abstinence isn’t a complete and utter failure because it’s socially unacceptable: it’s a complete and utter failure because people want to have sex. The answer isn’t trying to get people to stop having sex. For most people, that’s like asking them to stop breathing. The answer is better education and free or cheap and easily available contraceptives. And since even the best and easiest of contraceptives will occasionally fail or not be used, continuing research into STD vaccines and providing easily accessible options to women to terminate pregnancy.

Further, promoting abstinence and chastity while not promoting other options, and especially when combined with the often corresponding anti-choice politics, disproportionately and unfairly impacts the poor and uneducated, particularly the women.

I would go so far as to say it’s cruel to continue to promote abstinence today.

Monogamy is also an effective preventative strategy.

Yes, as long as your partner is doing it correctly too.

Many tragic cases involve women being infected by their cheating, promiscuous husbands.

And vice versa. We had a very infamous case of it in my country: https://en.wikipedia.org/wiki/Simon_Mol A few women brought HIV back home catching it from that "activist".

Incredibly disappointing (and predictable, as an "anti-racist, anti-fascist activist") that Mol played the race card when confronted about his HIV status.

He called the Polish people racist, and he called the Polish police racist.

What a monster.

Because only men cheat, right?

Obviously not and I did wonder about phrasing in a more gender neutral way.

However, looking at some data:

https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html - women are at twice the risk of men in heterosexual relationships.

https://ifstudies.org/blog/who-cheats-more-the-demographics-... - men are a bit less than twice as likely to cheat.

So, risk to women would seem to be, say, about three times as much at risk. And that is not counting the additional and heavily lop-sided risk of anal intercourse for women, but I'm not sure how to quantify that.

So my gut feeling that this is something women suffer from more is potentially backed up by evidence, but not to such a disproportionate degree that my original phrasing was accurate. I'm too late to edit, but happy to consider my earlier comment rephrased with these stats.

celibacy is even better!

Wrong on two counts. First because a monogamous couple has a virtually zero chance of contracting the virus and second because celibacy is evolutionarily indistinguishable from death.

Don't delude yourself, even the monogamous couple has to go to the hospital or could, via sheer bad luck, have contracted it from a former partner (I doubt you were talking only about lifelong monogamy).

And the second comment, I don't even know what to make out of it - living also leads to death, where does evolution come into play in this discussion? By your logic, someone who gets infected and later dies from AIDS, but has had a child is better off than someone who never had kids. What kind of mental gymnastics is that?

I was talking about lifelong monogamy. This should be obvious from the "virtually impossible" descriptor. This is just basic logical reasoning.

> someone who gets infected and later dies from AIDS, but has had a child is better off than someone who never had kids. What kind of mental gymnastics is that

It's the kind of "mental gymnastics" where they propagate their genes and a celibate person doesn't. This isn't hard to understand so please don't be willfully obtuse.

Problem with this sort of moral policing is if your spouse is/becomes abusive then you can't leave them and if they die young you can't ever date/marry again.

Lifelong ends with death. And it's not moral policing, I'm not advocating armed men to force people to not be promiscuous. I'm simply stating a fact based on sound scientific reasoning. Because promiscuous people are the reservoir for STDs, not having sex with promiscuous people, which is isomorphic to lifelong monogamy, is a highly effective way to avoid STDs.

The issue is that you might think that you are in a monogamous relationship while you are being cheated on, and this is not that rare.

> celibacy is evolutionarily indistinguishable from death

So? Also, this is not really correct, sperm donations are a thing after all.

> So?

If your solution requires celibacy, the people who ignore you will be 100% of the population after one generation.

(Your “Also” seems to be a separate and valid point)

I was joking man.

Don't forget Freddie Mercury, another victim of this virus.

A victim of Tom Branson if Hollywood is to be believed.

I've almost stopped watching "movies" entirely but my wife really wanted me to watch "Bohemian Rhapsody" with her. Basically a giant pack of lies to fit the story into the "music biopic" narrative arc. Hollywood has fully embraced pandering to the masses, and their demise to the Netflixes of the world couldn't come sooner.

meanwhile a mosquito net will save 10x live as /10 the cost.

Very soon gene drive eliminating all the mosquitos will save many more lives than a mosquito net can save at the fraction of cost and effort.

But we would not be able to find it if we were only spending resources on things that save the maximal number of lives in the short term.

I’m still really alarmed by the idea of the gene drive. Suppose eliminating mosquitos has unintended consequences, such as the loss of species that feed on them, or other species that rely on their existence in some way we don’t understand yet?

But also, gene drive itself is really spooky? What happens when someone truly evil decides to use it to get rid of all the people of the ethnicity they dislike? How are we going to deal with that?

If I understand correctly, gene drives maximise individual reproductive genetic success in a way which eventually makes a species unviable. I think the specific proposal for mosquitoes is to have a female-chromosome-specific gene which forces all offspring to be female and to carry that same gene.

This takes many generations to wipe out a species; only a genocidal maniac who believes The Other are literally another species would consider it; and the capacity to create it is also the capacity to reverse it.

Is eliminating an entire species a good thing?

Much depends on your definition of "good", I expect.

Even setting aside the possibility of unforeseen negative side-effects of the change to ecosystems, etc., it's not clear to me that minimising human sickness is an absolute "good" that outweighs any other effects, and it's not clear how we should evaluate the deliberate extinction of another species.

How many human lives must be saved to justify an extinction? (Of course, those human lives aren't really "saved" in a long-term sense; they're still going to die, just from some other cause. Meanwhile, the extinct species remains permanently extinct.)

How many species can we justify eliminating in order to stop a given disease? One? Tens? Hundreds? Thousands? Does the answer depend on whether they're cute and furry?

Lots of conflicting information here, but the TL;DR - probably, but maybe not.

Perhaps you should compare mosquito nets to condoms.

There's no religious institution prohibiting the use of mosquito nets though.

I've worked in kitchens where hairnets over beards was mandatory though.

maybe too soon to claim victory - this is only the second, and we don't know about any side-effects, short-term or Long-term. This is genetic manipulation after all.

I think the above poster was referring to the advancements in treatment, since HIV is no longer a death sentence even without a full cure.

Just to give some numbers:

Ahead of World AIDS Day, UNAIDS has launched a new report showing that access to treatment has risen significantly. In 2000, just 685 000 people living with HIV had access to antiretroviral therapy. By June 2017, around 20.9 million people had access to the life-saving medicines.


For anyone who doesn’t remember what that period was like, see contemporary works like the movie Philidelphia or the documentary Paris is Burning or the musical Rent. (Those are some that spring to mind anyway after all these years.)

Personally, I wish what would really get attention in the realm of HIV treatments is invention and subsequent spread of "prevention" drugs like PrEP (significantly lowering chances of getting HIV if taken daily) and PEP ("fight off" HIV if possibly exposed to it in the last 72 hours), in addition to amazingly high level of quality that HIV therapies have reached such that if HIV can't be detected - its effectively untransmittable.

Not trying to draw attention away from the potential significance of the article, would just like more of the "widespread", effective treatments get a little light.

Not gonna disagree; the treatments are good and getting better for PLWHs - side effects are nearly nonexistent on the day to day and better than they were in the long run. And PrEP / nPEP are miracles at reducing seroconversions in high risk groups/persons exposed.

We do need a cure. The damage done to the body of an HIV positive person who’s undetectable, on HAART/meds is progressive, permanent, and irreversible. Even on treatment, chronic inflammation of the immune system adds a lot of undue stress to the body. While I’m not at risk for any AIDS defining illnesses/cancers, I’ve still got a very high risk of other cancers compared to someone who’s HIV-negative. I’m grateful for laws protecting people like me with pre existing conditions - which forces my insurance company to fully cover my $6000 US/mo in HAART treatment. (Symtuza/Tivicay if curious)

What’s the amount of money big pharma will make over the course of my life alone? Millions if they can keep this up.

How great could life be without HIV in it for good? I’d like to find out, or at least maybe get my doctor to stop asking me to fill out an advanced care directive.

I’m thankful otherwise that at 32 I’m fit, in perfect health, and undetectable. Someday I hope i’ll change my status to “cured.”

I'm on PrEP. It was astoundingly hard to get on. So many primary care doctors have no idea what it is or why to prescribe it.

in australia at least these days, i’ve gone to arbitrary doctors for my 3mo tests and things and almost always they’ve offered to prescribe me PrEP... i’m already on it, but it seems here it’s being promoted by almost everyone!

PrEP was easy enough to get on with my PCP but I got priced out when my company changed insurance. What use to be a tier 2 drug became tier 4 meaning what used to drop down to a $30 copay after my deductible was met now would cost me $400/mo until I hit my $6K OOP max (which I cannot afford).

What country was this in?


Do you say the same thing to women who are on birth control? Or do you believe that gay men, specifically, should be denied the ability to use a second form of protection?


Condoms break. People enjoy sex. Telling people not to have sex is BS. Monogamy is great if you can find the right person. Many don't, or don't find them for a long time.

There's PEP for condoms breaking.

There's some bastards who go around in clubs and prick people with infected needles. There's a subculture in some communities that believe that everyone should have HIV.

Is it enough of a threat that people take drugs beacause of it?

It seems like wearing a kevlar vest every time you go out to avoid being stabbed and no normal person does that.

Is that covered by insurance? In the UK, some people are expecting the NHS to pay for it.

The NHS absolutely should pay for it.

I disagree. The steps to avoid requiring it are well understood.

If people want to indulge in "risky" behaviour, I have no problem with that. I just don't want to pay for it out of my taxes. It's like someone who makes a habit of jumping out of aeroplanes complaining that the government won't pay for his parachutes.

>If people want to indulge in "risky" behaviour, I have no problem with that. I just don't want to pay for it out of my taxes.

You will pay for it out of your taxes when those people become HIV positive - and it will cost even more than PREP.

> If people want to indulge in "risky" behaviour, I have no problem with that. I just don't want to pay for it out of my taxes.

You do understand that taking PrEP is literally the opposite of "risky behavior"? Just because you are on PrEP does not mean you immediately stop using condoms. Do some people use PrEP as an alternative to condoms? Sure but some women use birth control as the same thing. Please don't lump us all into the same category. Even on PrEP I still used condoms and only had sex with people who were undetectable. I used PrEP to cover all my bases, not to take risks.

According to your logic, people who ride in or drive cars shouldn't get any insured treatment if they have a crash, because they willingly indulged in risky behavior.

Should the government not pay for costs due to pregnancy? The steps to avoid it are well understood, and it does cost a lot of money.

Yeah, not sure you can class promiscuous shagging to bringing a child into the world.

That’s just straight-up homophobia, which is not ok on HN. Most HIV transmission occurs within relationships, and most causal sex (gay or straight) happens indoors and in private.

Your edit doesn't really make sense, as a quite a lot of children are the result of "promiscuous" sex, and the NHS still pays for the relevant care.

You're still ignoring the fact that HIV transmission typically occurs in the context of regular sex with the same person. Having one-off sex with strangers actually isn't a particularly efficient way of becoming HIV positive.

Well, I'd say one was the most important thing most people will do, and evolutionarily their whole reason for existing.

Absent being a sex worker, the other is just hedonism.

Weirdly, you seem to be missing the fact that children happen as a consequence of sex (and not uncommonly as a consequence of promiscuous sex).

Accidentally becoming pregnant can be exactly as "hedonistic" as accidentally becoming HIV positive.

And I think you are going to bring a lot more data to back up the nobility of "bringing a child into the world" because I think that's straight up BS. Ignoring the scores of unplanned pregnancies I think the notion that "bringing a child into the world" is "the most important thing most people will do" is reductionist and frankly disgusting that you think THAT is "the most important thing most people will do". What a sorry state our world is in if that is the case.

Name something most people do that is more important than having a child.

Choosing deliberately to not have a child.

Foldr - updated.

I just wish the financial system around getting it wasn't so complicated. Its a $2000/mo drug - even if you have private insurance, you probably are gonna end up with $1k out of pocket after the manufacturer discount. If you're broke and have a high deductible, you have to pay through the whole deductible every January to get your refill.

If you change providers and its not timed perfectly, you're out the $1k out of pocket cost until you can snail-mail in the form and get reimbursed. It ends up that only the more financially stable, or medicare-eligible people can afford it, and even then its a significant hassle. I'd consider it very worth the piece of mind but its a financial landmine.

Not to be negative on it. If you're thinking you should be on it, you probably should. Be prepared to jump through a few hoops though.

This is using a stem cell transplant again like the first person which carries a high risk of lifelong complications and death. While awesome, this is not a realistic or great option for patients without another issue needing a stem cell transplant. With modern HAART therapy one is expected to live as long as the average non-HIV infected patient in the US.

The article says as much. The takeaway isn't that bone-marrow transplants should replace today's standard courses of treatment, but rather the fact that there's been a second instance of such a cure means that there's hopefully some signal here that can eventually be leveraged in finding a more workable cure

And specifically this time it did not need to nearly kill the patient.

[1] suggests he still got the fun host-versus-graft-disease, so it seems like he might still have had that nasty rollercoaster, unless you meant some other nearly-killed-the-patient.

[1] - https://www.theguardian.com/society/2019/mar/05/london-patie...

Does destroying all the possible reservoir cells really point to incremental possibilities?

I think so. I'm cynical, and might wonder whether it's truly possible to eradicate such a reservoir. Seeing a couple examples that prove my intuition wrong is very powerful.

We may see iterative improvements from here-on though.

HIV is still transmissible even with HAART therapy, so I'm not sure how it's relevant to the discussion of a cure.

HIV transmissibility relates to whether someone has been on HAART therapy and in compliance with that therapy long enough so that their measured viral load as been assessed and has dropped below a particular threshold.

Transmissibility also relates to transmission vectors: eg vaginal or anal intercourse, sharing needles with intravenous drugs, and infected-mother-to-child routes (eg placental and/or breastfeeding).

In particular the "Undetectable = Untransmissible" claim is (as I understand it) a claim specifically about transmission through vaginal and anal intercourse.

HIV isn’t actually that contagious unless you’re the receptive partner in anal sex or have direct blood borne infection as with sharing infected needles so reducing the viral load to less than 1/10,000th of normal should make getting infected a risk on par with getting hit by lightning.

> Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis

> Results: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19–1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person- years, and 0.16 (95% CI 0.02–1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse.

> Conclusion: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART.


> Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda

> RESULTS The mean frequency of intercourse was 8.9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0.0011 (95% CI 0.0008-0.0015). Transmission probabilities increased from 0.0001 per act at viral loads of less than 1700 copies/mL to 0.0023 per act at 38 500 copies/mL or more (p=0.002), and were 0.0041 with genital ulceration versus 0.0011 without (p=0.02). Transmission probabilities per act did not differ significantly by HIV-1 subtypes A and D, sex, STDs, or symptoms of discharge or dysuria in the HIV-1-positive partner. INTERPRETATION Higher viral load and genital ulceration are the main determinants of HIV-1 transmission per coital act in this Ugandan population.

Undetectable also means non transmissible.

Bold claim. How recent are HPV tests?

Edit: While my comment came from caution due to historical human hubris, it appears I am wrong:

“According to the Centers for Disease Control and Prevention (CDC), a person with an undetectable viral load has “effectively no risk” of sexually transmitting HIV. In 2016, the Prevention Access Campaign launched the U=U, or Undetectable = Untransmittable, campaign.”

That claim isn't a bold assessment of the medical literature at all, it's actually widely held to by the medical organizations responsible for HIV treatment and prevention.

Here [1] is for instance an article referencing this claim, describing it as "based on strong scientific evidence" that was peer reviewed published by the journal of the American Medical Association. (EDIT: it's important to add the caveat, which is that this claim is about sexual transmission only, and does not cover pregnant-mother-to-child transmission or intravenous needle sharing).

Also your comment now refers to "HPV" which is the name of a different disease.

[1] https://jamanetwork.com/journals/jama/article-abstract/27209...

I refer to HPV as a case study in humans not having tests available for a communicable disease (no HPV test exists for men) and underestimating it’s communicability (not to mention it’s role in causing several types of cancer). Apologies if you thought I was confusing HPV and HIV.

Too often we think we’re smarter than we are, and the consequences can be damning. Hence why I said its a bold claim that undetectable means it can’t be transmitted. Are we absolutely sure? Because if we’re not, someone could acquire a life long chronic disease that would otherwise have been preventable. But the CDC says undetectable says no transmission; I hope they’re right in 100% of transmission scenarios.

Being on HAART does not guarantee an undetectable viral load.

I assume it's the same method they've successfully used to eliminate Multiple Sclerosis.


How are we not pumping billions more into stem cell research?!?

I've had MS for 20 years.

The procedure for MS is HSCT. It's erroneously called "transplant," as it actually is stem-cell rescue. The basic idea is to extract your own stem cells, kill of most (not all) of your existing immune system, and then re-infuse your stem cells to "reinstall" your immune system. Hopefully before you get an infection while you don't have any defenses.

This treatment has been shown to be effective for the most mild form of MS, Relapsing Remitting (RRMS), and only in the early stages of the disease. It's relatively risky, and if we were to do the procedure for everyone diagnosed with RRMS today, hundreds (if not thousands) of people would die from the treatment. Either from complications from the procedure, or from increased instances of cancer years down the road, since the poison part of the treatment is known to be carcinogenic.

Meanwhile, there is Rituximab, which is a monoclonal antibody targeting the CD20 protein that has had its patent recently expire. This means it can be manufactured as a generic. Clinical trials recently run in England have shown that not only is it extremely effective at controlling the disease in the most mild form (RRMS), but CD20-targeting monoclonal antibodies are the only drugs known to be in any (meaningful) way effective for the more serious forms of the disease, Secondary Progressive (SPMS) and Primary Progressive (PPMS).

Given the choice between HSCT or Rituximab, in terms of effectiveness, safety and cost, Rituximab wins as a treatment for MS, hands-down.

For those stuck in the United States, the FDA will let you get Ocrelizumab (Ocrevus), which is basically Rituximab tweaked enough so that Genentech could get patent protection for it. With that patent protection, they got the financial incentive to run it through the FDA approval process so they can now sell it to you for the bargain price of about $80,000 per year. It's just about as effective as Rituximab and maybe only a little more dangerous.

And for those wondering, in the UK Rituximab costs the NHS £349.50 for a course. https://bnf.nice.org.uk/medicinal-forms/rituximab.html

That link only works if you are in the UK.


> In the United Kingdom this amount cost the NHS approximately £182 in 2015.[9] The average wholesale price in the United States of a typical treatment for rheumatoid arthritis (1,000 mg IV dose, 2 weeks apart) would have been $14,100 a month in 2014 ($705 per 100 mg)[10] but the patent expired in 2016.[

You’re clearly wrong. It’s only America where people are cured. The NHS has death panels to get rid of people they don’t like.


> For those stuck in the United States, the FDA will let you get Ocrelizumab, which is basically Rituximab tweaked enough so that Genentech could get patent protection for it.

So Rituximab was never approved by the FDA? I assume it too had once been under patent, and its manufacturer would have tried to get it approved.

In the U.S., the FDA approves a drug for a particular use. Rituximab would have to undergo a complete set of clinical trials to show its safety and efficacy for MS in particular. Otherwise doctors can only prescribe it off-label, and the system (i.e., liability) is set up to dissuade doctors from prescribing drugs off-label if there exists a drug approved by the FDA for the particular purpose.

It sounds like the more complicated version of the aggressive bone marrow translpants for cancer back in the 80s, and like those, causes increased risk for cancer down the line due to the carcinogens used.

I've been looking into MS drugs recently for someone I know, and Rituximab definitely sounds like the better option.

Perhaps because it's controversial on religious grounds.

W. vetoed multiple embryonic stem cell research bills during his administration, the Catholic Church still formally opposes it[0], as well as the Southern Baptist Convention.

[0]: http://www.usccb.org/issues-and-action/human-life-and-dignit...

My understanding is that embryonic stem cells are no longer needed for today’s stem cell research. If a domain expert sees this, call me out if I’m wrong.

https://www.scientificamerican.com/article/human-stem-cells-... (Human Stem Cell Breakthrough: No Embryos Required, 2007)

This treatment was actually done with stem cells from an adult donor.[1] (Stem cell research is a bit of a black eye for liberals in my opinion. W. Bush's restrictions on embryonic stem cell research were not particularly draconian. It was limited to use of federal funds, and even then only restricted creating new embryonic stem cell lines. And the left was just wrong on how much could be done with adult stem cells. That is not to say that adult stem cells are an alternative in every case, but rather that a lot of the folks calling Republicans anti-science were themselves wrong on the science of how promising adult stem cell research was.)

[1] I'll also add: the question of whether destroying embryos for research is moral is not a religious one, but rather a political issue on which religions have strong opinions. So long as the government makes it illegal to kill people, it must as a purely political question define what a "person" is and what the exceptions are to that rule. Thus, the death penalty is a political issue rather than a religious issue, even though e.g. the Catholic church and several protestant denominations officially condemn it.

That seems like a post-hoc rationalization. Because in hindsight it turned out that — at least as they're understood today — embryonic stem cells were not the holy grail some thought they would be, it was therefore perfectly fine for Bush, for obviously religious (not secular political) reasons, to restrict use of federal funds in certain ways relating to embryonic stem cells?

The rationalization against embryonic stem-cell research, or against first-term abortion as commonly expressed, is in almost every case drawn from religious motivation. I don't know why you're claiming they're primarily political. They're political in that people of faith will export religious dogma into the political sphere, but that doesn't make it primarily a political issue like you suggest.

It's possible to make a (tenuous) secular argument against abortion (though it's pretty rough going and is easy to demolish), but... can you put forward any plausible secular argument against embryonic stem cell research, except by assuming the conclusion you want — which is that embryonic stem cells are largely problematic, and adult stem cells can be made to work pretty well, for most things?

I don’t think it’s a hindsight issue. People discounted the potential of adult stem cell research because they needed to in order to be consistent with their political objectives.

As to the secular argument against embryonic stem cell research: embryos are both human, and alive. Both facts are undisputedly true as a matter of biology. So the general rule against killing humans should apply unless some other exception is implicated. What those exceptions are is a political issue, even if it happens to also be a religious issue.

Note also that the secular justification for abortion doesn’t carry over to stem cell research. With abortion, there is the argument that, whatever the nature of the embryo happens to be, it doesn’t outweigh the mother’s right to bodily autonomy. But these embryos are already removed and frozen. Destroying them for research requires a different justification than destroying them for purposes of abortion

Tumors are genetically human and biologically alive at a cellular level. Does God want us to stop doing cancer surgery? Do tumors have souls? Embryonic stem cells tend to create tumors, not humans, if attached to existing human tissue. Do some tumors have souls while others don't? Where did the soul go for an embryonic stem cell tumor if it doesn't have one?

The pain and suffering argument (not that you've raised it) is nonsense as well, since pain and suffering during the murder of other animals in socially acceptable contexts is not regarded as very serious, except (sort of) by the Jains. And those animals, even insects, have more cognitive/sensory capacity than a human embryo (which has zero).

The only foothold the religious argument can rely on, without falling to oblivion, is the notion of future potential of a human embryo. But that raises other issues. The embryo won't get there on its own. It requires 9 months of symbiosis with another human with her own interests, or perhaps in the future there will be some option of 9 months of extremely expensive artificial incubation.

When you descend into the insanity of judging based on (uncertain) future potential, it's unclear why, as a matter of religious doctrine, destroying/wasting embryos/zygotes is forbidden, but wasting gametes is perfectly acceptable. If a woman's interests, ability to support a child, and relationship with (potentially) a spouse (who will co-raise and co-support the child) are not relevant in the determination of whether a future child is worth seeing through, why then would you stop at banning abortion? Why stop at banning contraception, even? Women, if maximizing potential future children is paramount, should never ever be allowed to say no, to anyone, ever, should they?

Of course, the reason for that difference in treatment is the (convenient) concept that the soul enters upon formation of a zygote, but that is a purely religious concept, and now we're back in religious la-la land, not in secular-argument land like you claimed. So about those tumors with souls...

Regarding the motive for the embryonic stem cell ban — it's not clear that the actual religious objection is primarily concerned with preventing destruction. Research involves splitting and growing the cell lines, which results in branches of the cell line being experimented on and then killed. If each of these isolated cell clusters has a soul, isn't ongoing experimentation just as bad, and actually worse, than simply killing the single master cell line? The latter would result in one death. Ongoing experimentation results in potentially unlimited deaths.

It seems like the real intent behind the federal funding ban for research involving new embryonic stem cell lines is to prevent their creation in the first place, knowing that once created all the options are bad (according to religious dogma) and result in the destruction of one or many soul-vessels. But to be ideological consistent, wouldn't you want to prevent the creation of never-to-be-gestated soul-vessels by splitting, too, in addition to preventing their initial creation? If so, W's ban makes no sense.

If you agree that identical twins have separate souls and tumors don't have souls, I don't know what you (or anyone against embryonic stem cell research or IVF which has similar issues) are doing, other than grasping at biological partial-realities trying to defend your religious dogma.

Federal funds are an enormous proportion of the money available for biomedical research. There was also a lot of uncertainty over how broadly this prohibition was going to be interpreted: could new lines be analyzed using equipment bought with federal money? Could you even keep them in a federally-funded fridge? I worked in a lab that was making all sorts of weird contingency plans in case we wanted to handle covered embryonic stem cells. Some of this is undoubtedly the university’s fault, but it was still annoying.

I don't think anybody knew at the time how useful adult stem cells would be. I'm glad that they are, though.

Because certain subsets of society have issues with it, sadly. They view it as killing babies, and Baby Bush put a ban on stem cell research funding in the US.

looking at this response, https://news.ycombinator.com/item?id=19307693

it seems to use your own stem cells, and is not used because of its risk factor

This is wrong on multiple fronts, as well explained in another comment[0] under the parent.

[0] https://news.ycombinator.com/item?id=19307854

While this treatment course doesn't appear to be without serious side effects or scale well let's not lose sight of the real win here. Reinforcing that a cure is possible.

"The surprise success now confirms that a cure for H.I.V. infection is possible, if difficult, researchers said."

^ So much this. For everyone of us who know and care about someone who has HIV, and for everyone who has it, it's basically a sunbeam of hope -- regardless of how effective or not it turns out to be in practice.

Especially people who both parents died of age like my siblings. It gives you hope for a future where that won't be the outcome.

The existing research of the berlin patient (https://en.wikipedia.org/wiki/Timothy_Ray_Brown) indicates the likely elimination of HIV was graft vs. host disease (https://en.wikipedia.org/wiki/Graft-versus-host_disease#HIV_...).

The NY Times doesn't mention graft vs. host, but the doctor treating the berlin patient says no one else was cured undergoing the treatment the berlin patient underwent. According to records, 6 additional people were thought to be cured. I couldn't find any follow-up on them. (https://www.newscientist.com/article/mg23431244-400-immune-w...)

[1] suggests this was also true here, but AFAICT the other patients they've tried this on to see if it was just graft versus host all wound up relapsing (I swear there was another study of this negative outcome with n>2, but I'm not turning it up, so maybe I'm full of it). [2]

Though [3] claims another set of experiments with this resulted in 5 cured/undetectable patients and one remission who was allegedly an odd duck out in terms of treatment (cord blood versus bone marrow),

[1] - https://www.theguardian.com/society/2019/mar/05/london-patie...

[2] - https://www.nature.com/news/hopes-of-hiv-cure-in-boston-pati...

[3] - https://annals.org/aim/article-abstract/2707334/mechanisms-c...

Feels a bit like correlation vs causation. It's unclear what the mechanism of action in GvH would be and it's also clear in this case that GvH was not necessary.

Bone marrow transplants are a very high risk procedure. Something like 50 percent work, while the rest die shortly after. I knew a guy with cancer that did it as a last resort treatment. They killed all the marrow (whatever kind of cells, I'm not a doctor) and reintroduced some to take over. It took. And then they found the sample they reintroduced (they used his own) was tainted with cancer. He died shortly after. Had it not been tainted he would have been cured. Taking the cells from someone else means getting it cancer-free but also means higher risk it won't work. It also provides the opportunity to give the person an AIDS-proof immune system (which some people have). This is not a generally usable cure, but it is cool AF when it works.

Is that why people freeze and save their stem cells? Would it help in this case?

I think that's the type of scenario they think might be possible some day. I'm not sure if there are any actual treatments that rely on frozen stem cells. Turns out you can convert some cells to stem cells, and there are some other sources.

This was only the second cure of several dozen similar marrow transplant procedures ech costing on the order of six figures. And with 50 million around the world infected and 40 years of searching for a reliable cure.

Its far more likely that a million were saved by having a rare mutation (1% population) that prevents HIV infection. The recently disgraced Chinese scientist used CRSPER/CAS9 genetic engineering on human embryros to induce this immunity into people who lacked it. The experiment was conducted in a totally unethical way with the scientist under criminal investigation. But the goal was noble.

CCR5 is the protein that He Jiankui Mengele, a scientist in China, claimed to have modified with gene editing in at least two children

Related: whatever happened to The Immunity Project, the AIDS vaccine funded by Y Combinator in 2014? http://www.immunityproject.org

Check out the linkedin profiles for people on this page


Seems like some of them have left, otherwise still active?

The website has not had any new updates since 2016 though which is worrying.

Caveat: one kind of HIV.

>> "This is only going to work if someone has a virus that really only uses CCR5 for entry — and that’s actually probably about 50 percent of the people who are living with H.I.V., if not less"

Yes, but an actual cure for up to half of people with HIV would still be a huge positive.

Standby for insulin pricing!

Which is completely irrelevant to this because insulin isn’t a cure and has been around for nearly a century.

Insulin pricing would still be a lot cheaper than the anti-retrovirals are today I think.

> But rearming the body with immune cells similarly modified to resist H.I.V. might well succeed as a practical treatment, experts said.

Do people know what is the existing literature on injecting or transplanting different or modified immune cells into someone as a general class of cures? Seems like this could generalize into something of an alternative to vaccine (or a different class of cures).

There’s a massive arm of cancer research devoted to exactly this, called immunotherapy. It’s where many of the best new treatments are being discovered lately. People are calling it the new chemo.

It’s particular promising in leukemia, for example.

Typically involves injecting a growth factor and then harvesting stem cells from peripheral blood (as supposed to having to go into the marrow directly), then processing the cells in some way to make them more antagonistic to the cancerous mutations.

In some cases the cancerous cells will be tagged with some marker that can then be used as a target site the extracted cells can be trained on.

Then the patient’s own stem-cells are transplanted back into their body to do their work.

Sometimes the patient gets ablated before reintoducing the new cells. That’s called an autologous (“auto”) stem-cell transplant.

The infection with the HIV virus leads to the AIDS decease.

It is sad to see that even the NYT can't get things straight when it comes to science.

I am very curious about the paper/data. For now, the typical newspaper headline does not mean a thing to me.

Assuming you meant "disease" instead of "decease", that's literally what the very first line in the article says. I'm in HIV research, and I have only the most minor nitpicks with the article's science.

Indeed, I meant disease.

I meant the title, not the article itself.

So much for making quick and precise comments on HN.


My first thought is to short condom manufacturers but when I think about it most of them are one of many many brands of a conglomerate.

Perhaps the bone marrow was from one of the rare occurences of people who are immune to HIV

entirely implausible, if the virus rewrites the host dna via rna...a rootkit in biology

Didn't Asimov died of HIV from wrongly transplant

Guidelines | FAQ | Support | API | Security | Lists | Bookmarklet | Legal | Apply to YC | Contact