10-sketch explanation

Choosing Tasks

Bringing News

carrying out 1:1s

providing critique

Managing Turbulence

Steve Jobs' initial mission at Apple in 1997 was to destroy. He killed the Newton PDA and Macintosh clones. Apple stopped trying to please everyone under Jobs.

Afterward, there were few highly targeted moves. First, the pink iMac. Modest success. The iPod, iPhone, and iPad made Apple the world's most valuable firm. Each maneuver changed the company's center of gravity and won.

That's the idea behind Schwerpunkt, a German military term meaning "focus." Jobs didn't need to win everywhere, just where it mattered, so he focused Apple's resources on a few key goods. Finding your Schwerpunkt is more important than charts and analysis for excellent strategy.

Comparison of Relative Strength and Relative Weakness

The iPod, Apple's first major hit after Jobs' return, didn't damage Microsoft and the PC, but instead focused Apple's emphasis on a fledgling, fragmented market that generated "sucky" products. Apple couldn't have taken on the computer titans at this stage, yet it beat them.

The move into music players used Apple's particular capabilities, especially its ability to build simple, easy-to-use interfaces. Jobs' charisma and stature, along his understanding of intellectual property rights from Pixar, helped him build up iTunes store, which was a quagmire at the time.

In Good Strategy | Bad Strategy, management researcher Richard Rumelt argues that good strategy uses relative strength to counter relative weakness. To discover your main point, determine your abilities and where to effectively use them.

Steve Jobs did that at Apple. Microsoft and Dell, who controlled the computer sector at the time, couldn't enter the music player business. Both sought to produce iPod competitors but failed. Apple's iPod was nobody else's focus.

Finding The Center of Attention

In a military engagement, leaders decide where to focus their efforts by assessing commanders intent, the situation on the ground, the topography, and the enemy's posture on that terrain. Officers spend their careers learning about schwerpunkt.

Business executives must assess internal strengths including personnel, technology, and information, market context, competitive environment, and external partner ecosystems. Steve Jobs was a master at analyzing forces when he returned to Apple.

He believed Apple could integrate technology and design for the iPod and that the digital music player industry sucked. By analyzing competitors' products, he was convinced he could produce a smash by putting 1000 tunes in my pocket.

The only difficulty was there wasn't the necessary technology. External ecosystems were needed. On a trip to Japan to meet with suppliers, a Toshiba engineer claimed the company had produced a tiny memory drive approximately the size of a silver dollar.

Jobs knew the memory drive was his focus. He wrote a $10 million cheque and acquired exclusive technical rights. For a time, none of his competitors would be able to recreate his iPod with the 1000 songs in my pocket.

How to Enter the OODA Loop

John Boyd invented the OODA loop as a pilot to better his own decision-making. First OBSERVE your surroundings, then ORIENT that information using previous knowledge and experiences. Then you DECIDE and ACT, which changes the circumstance you must observe, orient, decide, and act on.

Steve Jobs used the OODA loop to decide to give Toshiba $10 million for a technology it had no use for. He compared the new information with earlier observations about the digital music market.

Then something much more interesting happened. The iPod was an instant hit, changing competition. Other computer businesses that competed in laptops, desktops, and servers created digital music players. Microsoft's Zune came out in 2006, Dell's Digital Jukebox in 2004. Both flopped.

By then, Apple was poised to unveil the iPhone, which would cause its competitors to Observe, Orient, Decide, and Act. Boyd named this OODA Loop infiltration. They couldn't gain the initiative by constantly reacting to Apple.

Microsoft and Dell were titans back then, but it's hard to recall. Apple went from near bankruptcy to crushing its competition via Schwerpunkt.

Rather than a destination, it is a journey

Trying to win everywhere is a strategic blunder. Win significant fights, not trivial skirmishes. Identifying a focal point to direct resources and efforts is the essence of Schwerpunkt.

When Steve Jobs returned to Apple, PC firms were competing, but he focused on digital music players, and the iPod made Apple a player. He launched the iPhone when his competitors were still reacting. When Steve Jobs said, "One more thing," at the end of a product presentation, he had a new focus.

Schwerpunkt isn't static; it's dynamic. Jobs' ability to observe, refocus, and modify the competitive backdrop allowed Apple to innovate consistently. His strategy was tailored to Apple's capabilities, customers, and ecosystem. Microsoft or Dell, better suited for the enterprise sector, couldn't succeed with a comparable approach.

There is no optimal strategy, only ones suited to a given environment, when relative strength might be used against relative weakness. Discovering the center of gravity where you can break through is more of a journey than a destination; it will become evident after you reach.

Great technology opens up an universe of possibilities.

Need a friend? WhatsApp, Telegram, Slack, etc.

Traveling? AirBnB, Expedia, Google Flights, etc.

Money transfer? Use digital banking, e-wallet, or crypto applications

Products inspire us. How do we become great?

I asked product managers in my network:

What does it take to be a great product manager?

52 product managers from 40+ prominent IT businesses in Southeast Asia responded passionately. Many of the PMs I've worked with have built fantastic products, from unicorns (Lazada, Tokopedia, Ovo) to incumbents (Google, PayPal, Experian, WarnerMedia) to growing (etaily, Nium, Shipper).

TL;DR:

• Soft talents are more important than hard skills. Technical expertise was hardly ever stressed by product managers, and empathy was mentioned more than ten times. Janani from Xendit expertly recorded the moment. A superb PM must comprehend that their empathy for the feelings of their users must surpass all logic and data.

• Constant attention to the needs of the user. Many people concur that the closer a PM gets to their customer/user, the more likely it is that the conclusion will be better. There were almost 30 references to customers and users. Focusing on customers has the advantage because it is hard to overshoot, as Rajesh from Lazada puts it best.

• Setting priorities is invaluable. Prioritization is essential because there are so many problems that a PM must deal with every day. My favorite quotation on this is from Rakuten user Yee Jie. Viki, A competent product manager extinguishes fires. A good product manager lets things burn and then prioritizes.

This summary isn't enough to capture what excellent PMs claim it requires. Read below!

What qualities make a successful product manager?

Themed quotes are alphabetized by author.

Embrace your user/customer

Aeriel Dela Paz, Rainmaking Venture Architect, ex-GCash Product Head

Great PMs know what customers need even when they don’t say it directly. It’s about reading between the lines and going through the numbers to address that need.

Anders Nordahl, OrkestraSCS's Product Manager

Understanding the vision of your customer is as important as to get the customer to buy your vision

Angel Mendoza, MetaverseGo's Product Head

Most people think that to be a great product manager, you must have technical know-how. It’s textbook and I do think it is helpful to some extent, but for me the secret sauce is EMPATHY — the ability to see and feel things from someone else’s perspective. You can’t create a solution without deeply understanding the problem.

Senior Product Manager, Tokopedia

Focus on delivering value and helping people (consumer as well as colleague) and everything else will follow

Darren Lau, Deloitte Digital's Head of Customer Experience

Start with the users, and work backwards. Don’t have a solution looking for a problem

Darryl Tan, Grab Product Manager

I would say that a great product manager is able to identify the crucial problems to solve through strong user empathy and synthesis of insights

Diego Perdana, Kitalulus Senior Product Manager

I think to be a great product manager you need to be obsessed with customer problems and most important is solve the right problem with the right solution

Senior Product Manager, AirAsia

Lot of common sense + Customer Obsession. The most important role of a Product manager is to bring clarity of a solution. Your product is good if it solves customer problems. Your product is great if it solves an eco-system problem and disrupts the business in a positive way.

Edward Xie, Mastercard Managing Consultant, ex-Shopee Product Manager

Perfect your product, but be prepared to compromise for right users

AVP Product, Shipper

For me, a great product manager need to be rational enough to find the business opportunities while obsessing the customers.

Janani Gopalakrishnan is a senior product manager of a stealth firm.

While as a good PM it’s important to be data-driven, to be a great PM one needs to understand that their empathy for their users’ emotions must exceed all logic and data. Great PMs also make these product discussions thrive within the team by intently listening to all the members thoughts and influence the team’s skin in the game positively.

Director, Product Management, Indeed

Great product managers put their users first. They discover problems that matter most to their users and inspire their team to find creative solutions.

Grab's Senior Product Manager Lakshay Kalra

Product management is all about finding and solving most important user problems

Quipper's Mega Puji Saraswati

First of all, always remember the value of “user first” to solve what user really needs (the main problem) for guidance to arrange the task priority and develop new ideas. Second, ownership. Treat the product as your “2nd baby”, and the team as your “2nd family”. Third, maintain a good communication, both horizontally and vertically. But on top of those, always remember to have a work — life balance, and know exactly the priority in life :)

Senior Product Manager, Prosa.AI Miswanto Miswanto

A great Product Manager is someone who can be the link between customer needs with the readiness and flexibility of the team. So that it can provide, build, and produce a product that is useful and helps the community to carry out their daily activities. And He/She can improve product quality ongoing basis or continuous to help provide solutions for users or our customer.

Lead Product Manager, Tokopedia, Oriza Wahyu Utami

Be a great listener, be curious and be determined. every great product manager have the ability to listen the pain points and understand the problems, they are always curious on the users feedback, and they also very determined to look for the solutions that benefited users and the business.

99 Group CPO Rajesh Sangati

The advantage of focusing on customers: it’s impossible to overshoot

Ray Jang, founder of Scenius, formerly of ByteDance

The difference between good and great product managers is that great product managers are willing to go the unsexy and unglamorous extra mile by rolling up their sleeves and ironing out all minutiae details of the product such that when the user uses the product, they can’t help but say “This was made for me.”

BCG Digital Ventures' Sid Narayanan

Great product managers ensure that what gets built and shipped is at the intersection of what creates value for the customer and for the business that’s building the product…often times, especially in today’s highly liquid funding environment, the unit economics, aka ensuring that what gets shipped creates value for the business and is sustainable, gets overlooked

Stephanie Brownlee, BCG Digital Ventures Product Manager

There is software in the world that does more harm than good to people and society. Great Product Managers build products that solve problems not create problems

Experiment constantly

Delivery Hero's Abhishek Muralidharan

Embracing your failure is the key to become a great Product Manager

DeliveryHero's Anuraag Burman

Product Managers should be thick skinned to deal with criticism and the stomach to take risk and face failures.

DataSpark Product Head Apurva Lawale

Great product managers enjoy the creative process with their team to deliver intuitive user experiences to benefit users.

Dexter Zhuang, Xendit Product Manager

The key to creating winning products is building what customers want as quickly as you can — testing and learning along the way.

PayPal's Jay Ko

To me, great product managers always remain relentlessly curious. They are empathetic leaders and problem solvers that glean customer insights into building impactful products

Home Credit Philippines' Jedd Flores

Great Product Managers are the best dreamers; they think of what can be possible for the customers, for the company and the positive impact that it will have in the industry that they’re part of

Set priorities first, foremost, foremost.

HBO Go Product Manager Akshay Ishwar

Good product managers strive to balance the signal to noise ratio, Great product managers know when to turn the dials for each up exactly

Zuellig Pharma's Guojie Su

Have the courage to say no. Managing egos and request is never easy and rejecting them makes it harder but necessary to deliver the best value for the customers.

Ninja Van's John Prawira

(1) PMs should be able to ruthlessly prioritize. In order to be effective, PMs should anchor their product development process with their north stars (success metrics) and always communicate with a purpose. (2) User-first when validating assumptions. PMs should validate assumptions early and often to manage risk when leading initiatives with a focus on generating the highest impact to solving a particular user pain-point. We can’t expect a product/feature launch to be perfect (there might be bugs or we might not achieve our success metric — which is where iteration comes in), but we should try our best to optimize on user-experience earlier on.

Nium Product Manager Keika Sugiyama

I’d say a great PM holds the ability to balance ruthlessness and empathy at the same time. It’s easier said than done for sure!

ShopBack product manager Li Cai

Great product managers are like great Directors of movies. They do not create great products/movies by themselves. They deliver it by Defining, Prioritising, Energising the team to deliver what customers love.

Quincus' Michael Lim

A great product manager, keeps a pulse on the company’s big picture, identifies key problems, and discerns its rightful prioritization, is able to switch between the macro perspective to micro specifics, and communicates concisely with humility that influences naturally for execution

Mathieu François-Barseghian, SVP, Citi Ventures

“You ship your org chart”. This is Conway’s Law short version (1967!): the fundamental socio-technical driver behind innovation successes (Netflix) and failures (your typical bank). The hype behind micro-services is just another reflection of Conway’s Law

Mastercard's Regional Product Manager Nikhil Moorthy

A great PM should always look to build products which are scalable & viable , always keep the end consumer journey in mind. Keeping things simple & having a MVP based approach helps roll out products faster. One has to test & learn & then accordingly enhance / adapt, these are key to success

Rendy Andi, Tokopedia Product Manager

Articulate a clear vision and the path to get there, Create a process that delivers the best results and Be serious about customers.

Senior Product Manager, DANA Indonesia

Own the problem, not the solution — Great PMs are outstanding problem preventers. Great PMs are discerning about which problems to prevent, which problems to solve, and which problems not to solve

Tat Leong Seah, LionsBot International Senior UX Engineer, ex-ViSenze Product Manager

Prioritize outcomes for your users, not outputs of your system” or more succinctly “be agile in delivering value; not features”

Senior Product Manager, Rakuten Viki

A good product manager puts out fires. A great product manager lets fires burn and prioritize from there

acquire fundamental soft skills

Oracle NetSuite's Astrid April Dominguez

Personally, i believe that it takes grit, empathy, and optimistic mindset to become a great PM

Ovo Lead Product Manager Boy Al Idrus

Contrary to popular beliefs, being a great product manager doesn’t have anything to do with technicals, it sure plays a part but most important weapons are: understanding pain points of users, project management, sympathy in leadership and business critical skills; these 4 aspects would definitely help you to become a great product manager.

PwC Product Manager Eric Koh

Product managers need to be courageous to be successful. Courage is required to dive deep, solving big problems at its root and also to think far and dream big to achieve bold visions for your product

Ninja Van's Product Director

In my opinion the two most important ingredients to become a successful product manager is: 1. Strong critical thinking 2. Strong passion for the work. As product managers, we typically need to solve very complex problems where the answers are often very ambiguous. The work is tough and at times can be really frustrating. The 2 ingredients I mentioned earlier will be critical towards helping you to slowly discover the solution that may become a game changer.

PayPal's Lead Product Manager

A great PM has an eye of a designer, the brain of an engineer and the tongue of a diplomat

Product Manager Irene Chan

A great Product Manager is able to think like a CEO of the company. Visionary with Agile Execution in mind

Isabella Yamin, Rakuten Viki Product Manager

There is no one model of being a great product person but what I’ve observed from people I’ve had the privilege working with is an overflowing passion for the user problem, sprinkled with a knack for data and negotiation

Google product manager Jachin Cheng

Great product managers start with abundant intellectual curiosity and grow into a classic T-shape. Horizontally: generalists who range widely, communicate fluidly and collaborate easily cross-functionally, connect unexpected dots, and have the pulse both internally and externally across users, stakeholders, and ecosystem players. Vertically: deep product craftsmanship comes from connecting relentless user obsession with storytelling, business strategy with detailed features and execution, inspiring leadership with risk mitigation, and applying the most relevant tools to solving the right problems.

Jene Lim, Experian's Product Manager

3 Cs and 3 Rs. Critical thinking , Customer empathy, Creativity. Resourcefulness, Resilience, Results orientation.

Nirenj George, Envision Digital's Security Product Manager

A great product manager is someone who can lead, collaborate and influence different stakeholders around the product vision, and should be able to execute the product strategy based on customer insights, as well as take ownership of the product roadmap to create a greater impact on customers.

Grab's Lead Product Manager

Product Management is a multi-dimensional role that looks very different across each product team so each product manager has different challenges to deal with but what I have found common among great product managers is ability to create leverage through their efforts to drive outsized impacts for their products. This leverage is built using data with intuition, building consensus with stakeholders, empowering their teams and focussed efforts on needle moving work.

NCS Product Manager Umar Masagos

To be a great product manager, one must master both the science and art of Product Management. On one hand, you need have a strong understanding of the tools, metrics and data you need to drive your product. On the other hand, you need an in-depth understanding of your organization, your target market and target users, which is often the more challenging aspect to master.

M1 product manager Wei Jiao Keong

A great product manager is multi-faceted. First, you need to have the ability to see the bigger picture, yet have a keen eye for detail. Secondly, you are empathetic and is able to deliver products with exceptional user experience while being analytical enough to achieve business outcomes. Lastly, you are highly resourceful and independent yet comfortable working cross-functionally.

Yudha Utomo, ex-Senior Product Manager, Tokopedia

A great Product Manager is essentially an effective note-taker. In order to achieve the product goals, It is PM’s job to ensure objective has been clearly conveyed, efforts are assessed, and tasks are properly tracked and managed. PM can do this by having top-notch documentation skills.

or, how I spread monkeypox and got it myself.

This story contains nsfw (not safe for wife) stuff and shouldn't be read if you're under 18 or think I'm a newborn angel. After the opening, it's broken into three sections: a chronological explanation of my disease course, my ideas, and what I plan to do next.

Your journey awaits.

As early as mid-may, I was waltzing around the lab talking about monkeypox, a rare tropical disease with an inaccurate name. Monkeys are not its primary animal reservoir. It caused an outbreak among men who have sex with men across Europe, with unprecedented levels of person-to-person transmission. European health authorities speculated that the virus spread at raves and parties and was easily transferred through intimate, mainly sexual, contact. I had already read the nejm article about the first confirmed monkeypox patient in the u.s. and shared the photos on social media so people knew what to look for. The cdc information page only included 4 photographs of monkeypox lesions that looked like they were captured on a motorola razr.

I warned my ex-boyfriend about monkeypox. Monkeypox? responded.

Mom, I'm afraid about monkeypox. What's monkeypox?

My therapist is scared about monkeypox. What's monkeypox?

Was I alone? A few science gays on Twitter didn't make me feel overreacting.

This information got my gay head turning. The incubation period for the sickness is weeks. Many of my social media contacts are traveling to Europe this summer. What is pride? Travel, parties, and sex. Many people may become infected before attending these activities. Monkeypox will affect the lgbtq+ community.

Being right always stinks. My young scientist brain was right, though. Someone who saw this coming is one of the early victims. I'll talk about my feelings publicly, and trust me, I have many concerning what's occurring.

Part 1 is the specifics.

Wednesday nights are never smart but always entertaining. I didn't wake up until noon on june 23 and saw gay twitter blazing. Without warning, the nyc department of health announced a pop-up monkeypox immunization station in chelsea. Some days would be 11am-7pm. Walk-ins were welcome, however appointments were preferred. I tried to arrange an appointment after rubbing my eyes, but they were all taken. I got out of bed, washed my face, brushed my teeth, and put on short shorts because I wanted to get a walk-in dose and show off my legs. I got a 20-oz. cold brew on the way to the train and texted a chelsea-based acquaintance for help.

Clinic closed at 2pm. No more doses. Hundreds queued up. The government initially gave them only 1,000 dosages. For a city with 500,000 LGBT people, c'mon. What more could I do? I was upset by how things were handled. The evidence speaks for itself.

I decided to seek an appointment when additional doses were available and continued my weekend. I was celebrating nyc pride with pals. Fun! sex! * ‍

On tuesday after that, I felt a little burn. This wasn't surprising because I'd been sexually active throughout the weekend, so I got a sti panel the next day. I expected to get results in a few days, take antibiotics, and move on.

Emerging germs had other intentions. Wednesday night, I felt sore, and thursday morning, I had a blazing temperature and had sweat through my bedding. I had fever, chills, and body-wide aches and pains for three days. I reached 102 degrees. I believed I had covid over pride weekend, but I tested negative for three days straight.

STDs don't induce fevers or other systemic symptoms. If lymphogranuloma venereum advances, it can cause flu-like symptoms and swollen lymph nodes. I was suspicious and desperate for answers, so I researched monkeypox on the cdc website (for healthcare professionals). Much of what I saw on screen about monkeypox prodrome matched my symptoms. Multiple-day fever, headache, muscle aches, chills, tiredness, enlarged lymph nodes. Pox were lacking.

I told my doctor my concerns pre-medically. I'm occasionally annoying.

On saturday night, my fever broke and I felt better. Still burning, I was optimistic till sunday, when I woke up with five red splotches on my arms and fingertips.

As spots formed, burning became pain. I observed as spots developed on my body throughout the day. I had more than a dozen by the end of the day, and the early spots were pustular. I had monkeypox, as feared.

Fourth of July weekend limited my options. I'm well-connected in my school's infectious disease academic community, so I texted a coworker for advice. He agreed it was likely monkeypox and scheduled me for testing on tuesday.

nyc health could only perform 10 monkeypox tests every day. Before doctors could take swabs and send them in, each test had to be approved by the department. Some commercial labs can now perform monkeypox testing, but the backlog is huge. I still don't have a positive orthopoxvirus test five days after my test. *My 12-day-old case may not be included in the official monkeypox tally. This outbreak is far wider than we first thought, therefore I'm attempting to spread the information and help contain it.

*Update, 7/11: I have orthopoxvirus.

I spent all day in the bathtub because of the agony. Warm lavender epsom salts helped me feel better. I can't stand lavender anymore. I brought my laptop into the bathroom and viewed everything everywhere at once (2022). If my ex and I hadn't recently broken up, I wouldn't have monkeypox. All of these things made me cry, and I sat in the bathtub on the 4th of July sobbing. I thought, Is this it? I felt like Bridesmaids' Kristen Wiig (2011). I'm a flop. From here, things can only improve.

Later that night, I wore a mask and went to my roof to see the fireworks. Even though I don't like fireworks, there was something wonderful about them this year: the colors, how they illuminated the black surfaces around me, and their transient beauty. Joyful moments rarely linger long in our life. We must enjoy them now.

Several roofs away, my neighbors gathered. Happy 4th! I heard a woman yell. Why is this godforsaken country so happy? Instead of being rude, I replied. I didn't tell them I had monkeypox. I thought that would kill the mood.

By the time I went to the hospital the next day to get my lesions swabbed, wearing long sleeves, pants, and a mask, they looked like this:

I had 30 lesions on my arms, hands, stomach, back, legs, buttcheeks, face, scalp, and right eyebrow. I had some in my mouth, gums, and throat. Current medical thought is that lesions on mucous membranes cause discomfort in sensitive places. Internal lesions are a new feature of this outbreak of monkeypox. Despite being unattractive, the other sores weren't unpleasant or bothersome.

I had a bacterial sti with the pox. Who knows if that would've created symptoms (often it doesn't), but different infections can happen at once. My care team remembered that having a sti doesn't exclude out monkeypox. doxycycline rocks!

The coworker who introduced me to testing also offered me his home. We share a restroom, and monkeypox can be spread through surfaces. (Being a dna virus gives it environmental hardiness that rna viruses like sars-cov-2 lack.) I disinfected our bathroom after every usage, but I was apprehensive. My friend's place has a guest room and second bathroom, so no cross-contamination. It was the ideal monkeypox isolation environment, so I accepted his offer and am writing this piece there. I don't know what I would have done without his hospitality and attention.

The next day, I started tecovirimat, or tpoxx, for 14 days. Smallpox has been eradicated worldwide since the 1980s but remains a bioterrorism concern. Tecovirimat has a unique, orthopoxvirus-specific method of action, which reduces side effects to headache and nausea. It hasn't been used in many people, therefore the cdc is encouraging patients who take it for monkeypox to track their disease and symptoms.

Tpoxx's oral absorption requires a fatty meal. The hospital ordered me to take the medication after a 600-calorie, 25-gram-fat meal every 12 hours. The coordinator joked, "Don't diet for the next two weeks." I wanted to get peanut butter delivered, but jif is recalling their supply due to salmonella. Please give pathogens a break. I got almond butter.

Tpoxx study enrollment was documented. After signing consent documents, my lesions were photographed and measured during a complete physical exam. I got bloodwork to assess my health. My medication delivery was precise; every step must be accounted for. I got a two-week supply and started taking it that night. I rewarded myself with McDonald's. I'd been hungry for a week. I was also prescribed ketorolac (aka toradol), a stronger ibuprofen, for my discomfort.

I thought tpoxx was a wonder medicine by day two of treatment. Early lesions looked like this.

however, They vanished. The three largest lesions on my back flattened and practically disappeared into my skin. Some pustular lesions were diminishing. Tpoxx+toradol has helped me sleep, focus, and feel human again. I'm down to twice-daily baths and feeling hungrier than ever in this illness. On day five of tpoxx, some of the lesions look like this:

I have a ways to go. We must believe I'll be contagious until the last of my patches scabs over, falls off, and sprouts new skin. There's no way to tell. After a week and a half of tremendous pain and psychological stress, any news is good news. I'm grateful for my slow but steady development.

Part 2 of the rant.

Being close to yet not in the medical world is interesting. It lets me know a lot about it without being persuaded by my involvement. Doctors identify and treat patients using a tool called differential diagnosis.

A doctor interviews a patient to learn about them and their symptoms. More is better. Doctors may ask, "Have you traveled recently?" sex life? Have pets? preferred streaming service? (No, really. (Hbomax is right.) After the inquisition, the doctor will complete a body exam ranging from looking in your eyes, ears, and throat to a thorough physical.

After collecting data, the doctor makes a mental (or physical) inventory of all the conceivable illnesses that could cause or explain the patient's symptoms. Differential diagnosis list. After establishing the differential, the clinician can eliminate options. The doctor will usually conduct nucleic acid tests on swab samples or bloodwork to learn more. This helps eliminate conditions from the differential or boosts a condition's likelihood. In an ideal circumstance, the doctor can eliminate all but one reason of your symptoms, leaving your formal diagnosis. Once diagnosed, treatment can begin. yay! Love medicine.

My symptoms two weeks ago did not suggest monkeypox. Fever, pains, weariness, and swollen lymph nodes are caused by several things. My scandalous symptoms weren't linked to common ones. My instance shows the importance of diversity and representation in healthcare. My doctor isn't gay, but he provides culturally sensitive care. I'd heard about monkeypox as a gay man in New York. I was hyper-aware of it and had heard of friends of friends who had contracted it the week before, even though the official case count in the US was 40. My physicians weren't concerned, but I was. How would it appear on his mental differential if it wasn't on his radar? Mental differential rhymes! I'll trademark it to prevent theft. differential!

I was in a rare position to recognize my condition and advocate for myself. I study infections. I'd spent months researching monkeypox. I work at a university where I rub shoulders with some of the country's greatest doctors. I'm a gay dude who follows nyc queer social networks online. All of these variables positioned me to think, "Maybe this is monkeypox," and to explain why.

This outbreak is another example of privilege at work. The brokenness of our healthcare system is once again exposed by the inequities produced by the vaccination rollout and the existence of people like myself who can pull strings owing to their line of work. I can't cure this situation on my own, but I can be a strong voice demanding the government do a better job addressing the outbreak and giving resources and advice to everyone I can.

lgbtqia+ community members' support has always impressed me in new york. The queer community has watched out for me and supported me in ways I never dreamed were possible.

Queer individuals are there for each other when societal structures fail. People went to the internet on the first day of the vaccine rollout to share appointment information and the vaccine clinic's message. Twitter timelines were more effective than marketing campaigns. Contrary to widespread anti-vaccine sentiment, the LGBT community was eager to protect themselves. Smallpox vaccination? sure. gimme. whether I'm safe. I credit the community's sex positivity. Many people are used to talking about STDs, so there's a reduced barrier to saying, "I think I have something, you should be on the watch too," and taking steps to protect our health.

Once I got monkeypox, I posted on Twitter and Instagram. Besides fueling my main character syndrome, I felt like I wasn't alone. My dc-based friend had monkeypox within hours. He told me about his experience and gave me ideas for managing the discomfort. I can't imagine life without him.

My buddy and colleague organized my medical care and let me remain in his home. His and his husband's friendliness and attention made a world of difference in my recovery. All of my friends and family who helped me, whether by venmo, doordash, or moral support, made me feel cared about. I don't deserve the amazing people in my life.

Finally, I think of everyone who commented on my social media posts regarding my trip. Friends from all sectors of my life and all sexualities have written me well wishes and complimented me for my vulnerability, but I feel the most gravitas from fellow lgbtq+ persons. They're learning to spot. They're learning where to go ill. They're learning self-advocacy. I'm another link in our network of caretaking. I've been cared for, therefore I want to do the same. Community and knowledge are powerful.

You're probably wondering where the diatribe is. You may believe he's gushing about his loved ones, and you'd be right. I say that just because the queer community can take care of itself doesn't mean we should.

Even when caused by the same pathogen, comparing health crises is risky. Aids is unlike covid-19 or monkeypox, yet all were caused by poorly understood viruses. The lgbtq+ community has a history of self-medicating. Queer people (and their supporters) have led the charge to protect themselves throughout history when the government refused. Surreal to experience this in real time.

First, vaccination access is a government failure. The strategic national stockpile contains tens of thousands of doses of jynneos, the newest fda-approved smallpox vaccine, and millions of doses of acam2000, an older vaccine for immunocompetent populations. Despite being a monkeypox hotspot and international crossroads, new york has only received 7,000 doses of the jynneos vaccine. Vaccine appointments are booked within minutes. It's showing Hunger Games, which bothers me.

Second, I think the government failed to recognize the severity of the european monkeypox outbreak. We saw abroad reports in may, but the first vaccines weren't available until june. Why was I a 26-year-old pharmacology grad student, able to see a monkeypox problem in europe but not the u.s. public health agency? Or was there too much bureaucracy and politicking, delaying action?

Lack of testing infrastructure for a known virus with vaccinations and therapies is appalling. More testing would have helped understand the problem's breadth. Many homosexual guys, including myself, didn't behave like monkeypox was a significant threat because there were only a dozen instances across the country. Our underestimating of the issue, spurred by a story of few infections, was huge.

Public health officials' response to infectious diseases frustrates me. A wait-and-see approach to infectious diseases is unsatisfactory. Before a sick person is recognized, they've exposed and maybe contaminated numerous others. Vaccinating susceptible populations before a disease becomes entrenched prevents disease. CDC might operate this way. When it was easier, they didn't control or prevent monkeypox. We'll learn when. Sometimes I fear never. Emerging viral infections are a menace in the era of climate change and globalization, and I fear our government will repeat the same mistakes. I don't work at the cdc, thus I have no idea what they do. As a scientist, a homosexual guy, and a citizen of this country, I feel confident declaring that the cdc has not done enough about monkeypox. Will they do enough about monkeypox? The strategic national stockpile can respond to a bioterrorism disaster in 12 hours. I'm skeptical following this outbreak.

It's simple to criticize the cdc, but they're not to blame. Underfunding public health services, especially the cdc, is another way our government fails to safeguard its citizens. I may gripe about the vaccination rollout all I want, but local health departments are doing their best with limited resources. They may not have enough workers to keep up with demand and run a contact-tracing program. Since my orthopoxvirus test is still negative, the doh hasn't asked about my close contacts. By then, my illness will be two weeks old, too long to do anything productive. Not their fault. They're functioning in a broken system that's underfunded for the work it does.

*Update, 7/11: I have orthopoxvirus.

Monkeypox is slow, so i've had time to contemplate. Now that I'm better, I'm angry. furious and sad I want to help. I wish to spare others my pain. This was preventable and solvable, I hope. HOW?

Third, the duty.

Family, especially selected family, helps each other. So many people have helped me throughout this difficult time. How can I give back? I have ideas.

1. Education. I've already started doing this by writing incredibly detailed posts on Instagram about my physical sickness and my thoughts on the entire scandal. via tweets. by producing this essay. I'll keep doing it even if people start to resent me! It's crucial! On my Instagram profile (@kyleplanckton), you may discover a story highlight with links to all of my bizarre yet educational posts.

2. Resources. I've forwarded the contact information for my institution's infectious diseases clinic to several folks who will hopefully be able to get tpoxx under the expanded use policy. Through my social networks, I've learned of similar institutions. I've also shared crowdsourced resources about symptom relief and vaccine appointment availability on social media. DM me or see my Instagram highlight for more.

3. Community action. During my illness, my friends' willingness to aid me has meant the most. It was nice to know I had folks on my side. One of my pals (thanks, kenny) snagged me a mcgriddle this morning when seamless canceled my order. This scenario has me thinking about methods to help people with monkeypox isolation. A two-week isolation period is financially damaging for many hourly workers. Certain governments required paid sick leave for covid-19 to allow employees to recover and prevent spread. No comparable program exists for monkeypox, and none seems to be planned shortly.

I want to aid monkeypox patients in severe financial conditions. I'm willing to pick up and bring groceries or fund meals/expenses for sick neighbors. I've seen several GoFundMe accounts, but I wish there was a centralized mechanism to link those in need with those who can help. Please contact me if you have expertise with mutual aid organizations. I hope we can start this shortly.

4. lobbying. Personal narratives are powerful. My narrative is only one, but I think it's compelling. Over the next day or so, i'll write to local, state, and federal officials about monkeypox. I wanted a vaccine but couldn't acquire one, and I feel tpoxx helped my disease. As a pharmacologist-in-training, I believe collecting data on a novel medicine is important, and there are ethical problems when making a drug with limited patient data broadly available. Many folks I know can't receive tpoxx due of red tape and a lack of contacts. People shouldn't have to go to an ivy league hospital to obtain the greatest care. Based on my experience and other people's tales, I believe tpoxx can drastically lessen monkeypox patients' pain and potentially curb transmission chains if administered early enough. This outbreak is manageable. It's not too late if we use all the instruments we have (diagnostic, vaccine, treatment).

*UPDATE 7/15: I submitted the following letter to Chuck Schumer and Kirsten Gillibrand. I've addressed identical letters to local, state, and federal officials, including the CDC and HHS.

I hope to join RESPND-MI, an LGBTQ+ community-led assessment of monkeypox symptoms and networks in NYC. Visit their website to learn more and give to this community-based charity.

How I got monkeypox is a mystery. I received it through a pride physical interaction, but i'm not sure which one. This outbreak will expand unless leaders act quickly. Until then, I'll keep educating and connecting people to care in my neighborhood.

Despite my misgivings, I see some optimism. Health department social media efforts are underway. During the outbreak, the CDC provided nonjudgmental suggestions for safer social and sexual activity. There's additional information regarding the disease course online, including how to request tpoxx for sufferers. These materials can help people advocate for themselves if they're sick. Importantly, homosexual guys are listening when they discuss about monkeypox online and irl. Learners They're serious.

The government has a terrible track record with lgtbq+ health issues, and they're not off to a good start this time. I hope this time will be better. If I can aid even one individual, I'll do so.

Thanks for reading, supporting me, and spreading awareness about the 2022 monkeypox outbreak. My dms are accessible if you want info, resources, queries, or to chat.

y'all well

kyle

This report from Mark Gurman has stuck with me:

In the News and Stocks apps, the display ads are no different than what you might get on an ad-supported website. In the App Store, the ads are for actual apps, which are probably more useful for Apple users than mortgage rates. Some people may resent Apple putting ads in the News and Stocks apps. After all, the iPhone is supposed to be a premium device. Let’s say you shelled out $1,000 or more to buy one, do you want to feel like Apple is squeezing more money out of you just to use its standard features? Now, a portion of ad revenue from the News app’s Today tab goes to publishers, but it’s not clear how much. Apple also lets publishers advertise within their stories and keep the vast majority of that money. Surprisingly, Today ads also appear if you subscribe to News+ for $10 per month (though it’s a smaller number).

I use Apple News often. It's a good general news catch-up tool, like Twitter without the BS. Customized notifications are helpful. Fast and lovely. Except for advertisements. I have Apple One, which includes News+, and while I understand why the magazines still have brand ads, it's ridiculous to me that Apple enables web publishers to introduce awful ads into this experience. Apple's junky commercials are ridiculous.

We know publishers want and probably requested this. Let's keep Apple News ad-free for the much smaller percentage of paid users, and here's your portion. (Same with Stocks, which is more sillier.)

Paid app placement in the App Store is a wonderful approach for developers to find new users (though far too many of those ads are trying to trick users, in my opinion).

Apple is also planning to increase ads in its Maps app. This sounds like Google Maps, and I don't like it. I never find these relevant, and they clutter up the user experience. Apple Maps now has a UI advantage (though not a data/search one, which matters more).

Apple is nickel-and-diming its customers. We spend thousands for their products and premium services like Apple One. We all know why: income must rise, and new firms are needed to scale. This will eventually backfire.