Is HIV Prevention and Treatment "Gender-Affirming Care"?
The Wild Borderlands Between Fact and Fiction
When the going gets weird, the weird start asking different questions.
RFK Jr released public guidance yesterday that asserts a person’s sex is “unchangeable” and launching a website that promotes orders aimed at transgender people.
His action marks (another) head-snapping shift in the government’s operating philosophy, this one on transgender and nonbinary issues, rejecting the idea that Americans can identify with a gender other than their sex at birth. The new messaging aligns with President Donald Trump’s executive orders on the subject.
And in a campaign-style speech at the Department of Health and Human Services on Tuesday, Kennedy told thousands of HHS employees he plans to investigate the childhood vaccine schedule that prevents measles, polio and other dangerous diseases.
[Note One: More than 15 states are now pushing for policy change to allow more vaccine exemptions, establish state-level vaccine injury databases or change laws that dictate what providers must tell patients about the shots.]
[Note Two: A Centers for Disease Control and Prevention vaccine advisory committee meeting scheduled for next week — the first since Health and Human Services Secretary Robert F. Kennedy Jr. was sworn in — has been postponed, reports NBC News. The discussion included a presentation and vote on the use of the British drugmaker GSK’s meningococcal vaccine.]
[Note Three: Amid a measles outbreak in west Texas, state legislators are debating new laws to relax vaccine rules, urged on by Texans for Vaccine Choice. On February 18th activists in “Come and Make Me” shirts took to the Capitol to lobby for "medical freedom . As many as 45 vaccine-related bills have been introduced in the first month of the legislative session; 37 of them are anti-vaccine.Two especially worry public-health experts: one would make it easier for parents to exempt their children from school mandates; the other would give politicians, rather than health officials, control over which are required.]
“Nothing is going to be off limits,” Kennedy said, adding that pesticides, food additives, microplastics, antidepressants and the electromagnetic waves emitted by cellphones and microwaves also would be studied.
Here’s the basic tipping point for the perplexed:
Assuming stability is one of the ways ruins -- government, industry, market, business, career -- get made. Resilience accommodates the unexpected.
Few CEOs know the double-edged nature of dealing with US President Donald Trump as viscerally as Pfizer’s Albert Bourla, writes Andrew Edgecliffe-Johnson in a recent piece for The CEO Signal (Pfizer’s Albert Bourla on Trump 2.0: ‘The status quo will collapse’). In his first term, Trump championed the $18 billion Operation Warp Speed program that helped the US drugmaker develop its COVID-19 vaccines. He also pushed conspiracy theories that made Bourla a target.
“If Bourla feels aggrieved, he isn’t showing it. Instead, after Trump was reelected, he booked a Pfizer management meeting at Mar-a-Lago. Two days before Semafor met him in Davos, he was at Trump’s inauguration.
“People were thinking that because it is Trump, [who] is a little bit more controversial leader than the mainstream political leaders, we will change the way that we engage,” the Greek-American doctor of veterinary medicine says. “No. We engaged with him in the first administration, and we will engage with him now.” Even if he sees the other edge of Trump again, he says, “I’m very resilient, so I will never disengage.”
Trump understands that business “has a dynamism that can overcome mountains,” Bourla says. “He said, ‘I’ll put my money on you, Albert’ — and that means on the private sector, not on me particularly.”
Such enthusiasm for the new administration was widespread in Davos this week. Even so, Bourla does not understate the upheaval Trump represents: “It’s clear that with the radical change that is coming, there will be risks and there will be opportunities. The status quo will collapse.”
I would suggest the status quo has already collapsed. It is not a future state but a current one. And it has happened with head-snapping speed, ‘flooding the zone’ with big system change, a velocity of structural breaks with the Old Order that is putting critics on their back feet, leaving entire economic systems — countries, industries, markets — gobsmacked and gasping for air, thinking the unthinkable. Look no further than the loud chorus of boos Bourla received yesterday the moment Trump said he wanted to "thank" Pfizer's CEO during a reception in the White House's East Room for Black History Month.
“We only know one speed,” White House deputy chief of staff Taylor Budowich told the Wall Street Journal last week (Trump Steamrolls Critics With Flood-the-Zone Strategy). “That’s a stark contrast to the last four years.”
Gripped by The Big Fear
The function of strategy is a cool head in a bad hour, fresh vision and thinking to bring order out of chaos, a tall order even when the chaos is static, and a superhuman task when chaos is multiplying. But leaders risk more to prevent losses than to achieve gains.
“A decade ago, Germany was the model nation.
Its economy hadn’t just withstood the ascendance of China; it was thriving in its wake. Its balanced public finances stood out in a world of huge government debt. And while British and U.S. lawmakers were caught up in the culture wars, German politicians continued to practice the art of compromise.
Today, Germany has gone from paragon to pariah. Its "business model is gone", its self-confidence shattered and its political landscape fractured.
There are external causes for this malaise, from the war in Ukraine to U.S. protectionism and China’s economic slowdown. Yet some analysts, economists and historians think Berlin mismanaged its response. The reason: conservatism — defined not as the political ideology but as the preference for the status quo over change, for reaction over action and for caution over risk.”
-- "Why Germany’s Confidence Is Shattered and Its Economy Is Kaput: Historians and economists say risk-averse leadership is holding back Europe’s largest economy" via the Wall Street Journal this morning.
Hunter S. Thompson died 20 years ago today.
Thompson gave the phrase “fear and loathing” its cultural relevancy, writing the darkly comic altered-states novel Fear and Loathing in Las Vegas and the maniacal political reportage of Fear and Loathing: On the Campaign Trail ’72. From his obituary in Rolling Stone:
A friend called his style “totally gonzo”. The name stuck, though, as he confessed, nobody knew what the hell it meant. For the literary, he could explain that it followed William Faulkner's dictum that “the best fiction is more true than any kind of journalism.” Mr Thompson stalked, rifle in hand, cigarette (in holder) dangling, on the wild borderlands between fact and fiction, leaving readers to decide what was true and what was not.
If he feared anything, Thompson knew how to hide it well. “I hate to advocate drugs, alcohol, violence or insanity to anyone,” he once said, “but they’ve always worked for me.”
For the galaxy of brands, products and vendors trying to make a go of things in the current configuration of the healthcare industrial complex, business and commercial models all trying to forecast and find product-market fit to mushrooming chaos, common sense would suggest it's time to stop riding the dead horse of the past.
And that dismount starts by asking weird questions:
What would happen if RFK Jr. were to ban DTC advertising?
How stable is the $20 billion market in drug products for depression?
How stable is the $46 billion market in products for HIV prevention and treatment?
How confident should you be in the $80 billion market for vaccines?
How confident should you be in the $470 billion forecast for GLP-1s?
How can you position yourself/your business in a new peer group?
How can you reshape your operating environment?
How do you invent leverage?
How can you make history?
’I’ve written elsewhere: When it comes to pharmaceutical brand, business and industry leadership reading the room accurately: The elephant in the room is the room itself, an approach to business and product marketing unchanged since the “modern pharmaceutical industry” began around 1849, when Pfizer was founded in Brooklyn.
A modern strategy starts by sweeping the old concepts out of the saddle. That comfortable mental furniture used as the centerpiece of product management — principles of branding, positioning, message and even “strategy” itself — are coming apart at the seams, unable to accommodate the seismic instability happening the world over. Existential crises abound and confound.
The massive grapple ahead is negotiating big system change.
/ jgs
John G. Singer is Executive Director of Blue Spoon, the global leader in positioning strategy and innovation at a system level. To engage with weird: john@bluespoonconsulting.com