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Netflix has spent big in recent years on flashy, blockbuster-style action movies like “The Gray Man” and “Red Notice,” which ran the company $200 million each.
Meanwhile it’s found success in the horror genre, which traditionally comes with much lower budgets.
Part of the scrutiny on Netflix’s content spend stems from the lack of clear metrics around the financial performance of streaming-first shows and movies.

A button for launching the Netflix application is seen on a remote control in this photo illustration in Warsaw, Poland on April 25, 2019.
Jaap Arriens | NurPhoto | Getty Images

There’s a big money question haunting Netflix.
In recent years, the streamer has spent big on flashy, blockbuster-style action movies like “The Gray Man” and “Red Notice,” which ran the company $200 million each. The films are the first steps in bids to spark event-level franchises. But they’re costly, and it’s unclear how impactful they have been for Netflix’s bottom line.

Meanwhile, the platform’s smash hit “Stranger Things,” a supernatural thriller with horror undertones, has become a clear cultural touchstone. The series, which just released its fourth season, has inspired Halloween costumes and videogame versions of the monster-filled alternative universe.
While the show has a similar budget to these high-octane action flicks — around $30 million per episode, or more than $200 million per season — its success has led some in the industry to question whether high-budget features are worth Netflix’s investment.
Netflix’s streaming rivals have begun to shift their own content strategies in order to spend less on direct-to-streaming film content. Warner Bros. Discovery CEO David Zaslav said Thursday his company has been unable to find an “economic value” in producing big-budget films for its streaming services.
“We’ve seen, luckily, by having access now to all the data, how direct-to-streaming movies perform,” Zaslav said during the company’s second-quarter earnings call. “And our conclusion is that expensive direct-to-streaming movies … is no comparison to what happens when you launch a film in the motion picture, in the theaters.”
Netflix doesn’t often release films in theaters, unless it’s seeking Academy Award eligibility, so it budgets for movies knowing that its only option for recouping spend is through subscription growth.

That’s why analysts have pointed to the horror genre as a potential avenue for Netflix.
The horror genre, in particular, typically comes with lower production costs, making these kinds of films ideal for the box office as they often rake in significantly more in ticket sales than they cost to make.
Blumhouse and Universal’s “Get Out” cost just $4.5 million to produce and went on to generate more than $250 million at the global box office.
And while “The Gray Man” is set to be developed into a franchise, Peter Csathy, founder and chairman of advisory firm Creative Media, suggested Netflix is overlooking franchise opportunities in horror that could save the company hundreds of millions per film.
“Scream,” “Insidious,” “Halloween” and other horror film series have won over fans of the genre, as low-budget alternatives to more expensive franchise endeavors like Fast and Furious, Star Wars, Marvel or Lord of the Rings.
“The production costs are a sliver, a fraction, a small fraction of what it is for these huge bets that are made,” he said. “And why not go for an inexpensive sure thing that hits your targeted demo? Why not put your money there, rather than doing these big prestige plays?”
Plus, Csathy added, the target audience for the horror genre also happens to be young — the demographic advertisers and streamers want to tap into.
Netflix has seen success from past horror releases including its “Fear Street” trilogy and has a number of Netflix Original releases in the genre including “No One Gets Out Alive” and “There’s Someone Inside Your House.”
Michael Pachter, an analyst at Wedbush, suggested Netflix could get more for its money by sticking with a lineup of horror and rom-com projects, both of which tend to be relatively low-budget. With more modest budgets, missteps aren’t as big of a deal.
“The cool thing about low budget is you can make mistakes,” he said. “Big budget, you just can’t make any. If you screw up, you’re screwed. So which is riskier, a $150 million movie or three $50 million movies?”

Missing metrics

Part of the scrutiny on Netflix’s content spend stems from the lack of clear metrics around the financial performance of streaming-first shows and movies.
Box office tallies for theater releases and TV ad revenue are tried-and-true metrics. With streaming-only platforms, viewership data varies from service to service and paints an incomplete picture for analysts trying to determine how a film or television show has actually performed.
A bill upwards of $200 million for a film like “The Gray Man” is harder to explain when there’s no visible financial gain at the end of production, like studios see in box office ticket sales. Streaming subscribers pay flat monthly or annual fees to access all available content. Netflix argues its content keeps users on the platform and handing over subscriber fees.
For Netflix, the push into big-budget movies is a way to burnish its image and quiet criticisms that it churns out mediocre content. The company has shored up its balance sheet, is cash flow positive and has a three-year window before a significant portion of its debt matures, giving it some wiggle room to spend.
It’s unclear how much Netflix spent per film for its “Fear Street” trilogy, and there’s limited data around its performance on the platform. But Nielsen ratings estimated that “Fear Street 1994” generated 284 million viewing minutes during its first week on the service and “Fear Street 1978” tallied 229 million minutes. It is unclear how the third film, “Fear Street 1666” performed.
What’s more, the fourth season of “Stranger Things” has become just the second Netflix series to cross 1 billion hours viewed within the first 28 days of availability. Of course, comparing Netflix’s films to its television series is a bit like comparing apples to oranges, but it’s the best data analysts have access to as long as the company keeps quiet about content spend and success.

Many entertainment experts have tried to crunch the numbers on how streaming hours translate to revenue, retention and, ultimately, the strength of Netflix’s business. But much of how Netflix decides what to greenlight and what to cancel remains a mystery to analysts.
Based on Netflix’s own data, “The Gray Man” amassed more than 88 million hours in worldwide viewing during its opening weekend on the service, 60 million fewer hours than “Red Notice” pulled during the same period last November. “Red Notice” stayed in the top spot of Netflix’s top 10 list for 12 days, while “The Gray Man” was usurped after just eight days.
As of Friday, the film holds the fourth spot on the list behind “Purple Hearts,” “Tower Heist” and “Age of Adaline.”
So, was “The Gray Man” worth its $200 million price tag? It appears to have have hit some behind-the-curtain metric for Netflix, which is moving forward with a sequel and a spinoff.
“Netflix, obviously has the data and the methodology that they believe is accurate, to determine what is this success at Netflix and what isn’t,” said Dan Rayburn, a media and streaming analyst. “If [‘The Gray Man’] had bombed by their definition of bombing, whatever that is, we don’t know, they would not have announced an expanded deal.”
As for how Netflix makes its content choices, Rayburn says that while data is not currently widely available, that could change once the streamer enters the ad market.
“Whether they want to give us data or not, we’re gonna get more data as the years go on, because the advertising side,” he said. “That’s gonna help us better understand content.”
Disclosure: Comcast is the parent company of NBCUniversal and CNBC. Universal is the distributor of the Halloween franchise and “Get Out.”

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Eli Lilly, one of the biggest employers in Indiana, said that the state’s newly passed restrictions on abortions will cause it to grow away from its home turf.
Cummins, which employs about 10,000 people in Indiana, spoke out over the weekend against the new law as well.
Indiana’s Legislature on Friday became the first in the nation to pass new legislation restricting access to abortions since the U.S. Supreme Court overturned Roe v. Wade.

An Eli Lilly and Company pharmaceutical manufacturing plant is pictured at 50 ImClone Drive in Branchburg, New Jersey, March 5, 2021.
Mike Segar | Reuters

Drugmaker Eli Lilly, one of the biggest employers in Indiana, said that the state’s newly passed law restricting abortions will cause the company to grow away from its home turf.
Lilly said in a statement on Saturday that it recognizes abortion as a “divisive and deeply personal issue with no clear consensus among the citizens of Indiana.”

“Despite this lack of agreement, Indiana has opted to quickly adopt one of the most restrictive anti-abortion laws in the United States,” Eli Lilly said. “We are concerned that this law will hinder Lilly’s — and Indiana’s — ability to attract diverse scientific, engineering and business talent from around the world. Given this new law, we will be forced to plan for more employment growth outside our home state.”
Indiana’s Legislature on Friday became the first in the nation to pass new legislation restricting access to abortions since the U.S. Supreme Court overturned Roe v. Wade. The state was among the earliest Republican-run state legislatures to debate tighter abortion laws after the Supreme Court ruling in June that removed constitutional protections for the procedure.
Lilly employs about 10,000 people in Indiana, where it has been headquartered in Indianapolis for more than 145 years.
Cummins, an engine manufacturing company that also employs about 10,000 people in Indiana, spoke out over the weekend against the new law as well.
“The right to make decisions regarding reproductive health ensures that women have the same opportunity as others to participate fully in our workforce and that our workforce is diverse,” a company spokesman said in a statement.

“There are provisions in the law that conflict with this, impact our people, impede our ability to attract and retain top talent and influence our decisions as we continue to grow our footprint with a focus on selecting welcoming and inclusive environments,” the Cummins spokesman said.
The two businesses join a growing list of companies, including tech giant Apple and denim retailer Levi Strauss, which are offering their employees resources for reproductive care in states where restrictions have been put into place.
Eli Lilly noted Saturday that although the pharmaceutical company has expanded its employee health plan coverage to include travel for reproductive services, “that may not be enough for some current and potential employees.”
Indiana’s abortion ban is expected to go into effect on Sept. 15. It comes with some exceptions, including for cases of rape or incest, and for protecting the mother’s life.
President Joe Biden’s administration has also condemned Indiana’s decision. White House Press Secretary Karine Jean-Pierre called it a “devastating step.”
“And, it’s another radical step by Republican legislators to take away women’s reproductive rights and freedom, and put personal health-care decisions in the hands of politicians rather than women and their doctors,” she said in a statement.

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President Joe Biden tested negative for Covid-19 on Saturday from an antigen test.
He will continue to isolate in an abundance of caution, said the White House physician.

Jim Watson | Afp | Getty Images

President Joe Biden tested negative for Covid-19 but will continue to isolate, according to the White House.
Biden “continues to feel very well,” White House physician Kevin O’Connor said in a memorandum on Saturday. Despite his negative antigen test, “in an abundance of caution, the president will continue his strict isolation measures pending a second negative test,” O’Connor said.

Biden, who is fully vaccinated and received two booster shots, first tested positive for Covid on July 21 and then tested positive for the second time in a “rebound” case one week ago.
O’Connor had previously warned of the potential for a rebound in positive test results, a phenomenon among a small percentage of patients who, like Biden, used the antiviral medication Paxlovid as part of their treatment.
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I never was the entrepreneurial type. But after losing my job as an audio engineer in 2009, I had to get creative to make ends meet.
Thirteen years later, at age 39, I’ve built two online businesses that earns me a combined $160,000 a month in passive income. I also recently published a book, “How to Get Paid for What You Know.”

The first business I started was The Recording Revolution, a music and education blog that sells music production courses. The second, which I started in 2018, teaches people how to make money off their passions, like I did. It’s the most lucrative business, thanks to online course and coaching program sales, as well as affiliate commissions.

Graham Cochrane started his first business in 2009. Since then, he’s scaled two online companies and now grosses about $120,000 per month.
Photo: John Olson for CNBC Make It

Around 2,800 people use my products, and my goal is to help more entrepreneurs grow their online businesses while working fewer hours.
My top priorities are spending time with family and being able to give back, so I’ve set up my work and personal life to be able to focus on those key values.
Here’s what my typical day looks like:

Mornings start slow and easy

I usually wake up at 5 a.m. — before the kids — because I always want an hour to myself. I’ll start with coffee and my Bible.

After some reading, praying and journaling, I’ll make breakfast with my wife and wake the kids. We’ll spend 20 to 30 minutes eating together in the kitchen before I drop them off at school by 7:30 a.m.
Then I head back to my home office, or do a quick gym session if I’m in the mood.

Graham and his wife have breakfast with their kids in the morning before talking through their schedule.
Photo: John Olson for CNBC Make It

I work just five hours a week — Mondays and Wednesdays

On Mondays, I plan and create YouTube videos and podcast episodes. Potential customers usually find me through this free online content. If they like it, they can sign up for my newsletter and get emails about free resources and premium online courses.
I make a chunk of passive income from these courses. I’ve designed my business system to automatically send emails, so the bulk of my work is just to maintain a steady flow of new, free content.
Recording videos and podcasts takes about two hours. I also have someone who edits and uploads the content. My remaining hour on Mondays is dedicated to answering emails or giving advice to members of my Six-Figure Coaching Community.
On Wednesdays, I spend time on community interaction, then host a 90-minute live call with my advanced business coaching students.

Graham spend about five hours a week creating content and managing his businesses.
Photo: John Olson for CNBC Make It

Once a month, I film an exclusive training for members of my paid community which adds about two extra hours of work per month to my schedule.
I’ve never been a fan of the hustle culture; I don’t believe it’s healthy or wise. If you can find a way to build systems into your business so that it mostly runs on its own, you don’t need to waste time doing constant upkeep.
After all, what’s the point of “being your own boss” if you’re working all the time?

Family time is my No. 1 priority

People often ask me what I do with all the extra time in my week, and my answer isn’t the most exciting. I run errands, hit the gym, go to the car wash, have coffee or lunch with a friend, or dive into a good book. Right now, I’m reading “Living Fearless” by Jamie Winship.
But most importantly, I spend time with my family. Fridays are considered as “date day” with my wife. We work out, go out to lunch, catch up on life, talk about the kids, and meet with our marriage counselor.
Lately, we’ve been focusing on how to communicate better when we have disagreements. No marriage is perfect, and the work I’ve put into our relationship has has made me a better husband and father.
My wife and I never compromise on picking up the kids from school together. We want to be home when they are. Our other non-negotiable is family dinner. We sit down to a tech-free dinner every night. Most evenings, my wife cooks and I do the dishes. But we also eat out a few times a week.

“My schedule has two non-negotiables,” says Graham: “I pick my daughters up from school every day, and our family eats dinner together every night.”
Photo: John Olson for CNBC Make It

We love going out for walks, swimming in the pool, watching movies or playing Nintendo Switch with the kids. By spending time together, we hope to teach them essential life skills like how to share feelings and be kind to each other. I also want them to feel like valuable, included members of the family.
We’re big on traveling, too — both locally in Florida and around the world. A few summers ago, we spent a month in the South of France. And just this spring, we stayed in Puerto Rico for three weeks. Having the time and flexibility to make these kinds of memories together is priceless.

Radical generosity a core value

We attend church every Sunday, and often do volunteer work with local organizations that help the unhoused population in our city.
My philosophy is that I make this money so that I can give most of my profits away to charities and my local church, groups that are doing a lot of good in the world.
Right now, my wife and I donate 30% of our income, but we are hoping to eventually give away 50%.
Graham Cochrane is founder of The Recording Revolution, author of “How to Get Paid for What You Know″ and is a business coach to over 2,800 customers worldwide. Follow him on Instagram and Twitter.
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SMALL BUSINESS PLAYBOOK 2022
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Walmart and Target inventory management failed to keep up with swift changes in consumer spending and the impact of inflation and Covid.
The big box retailers had to resort to big markdowns to move products.
Small business experts say there is an advantage to being smaller and closer to your suppliers and customers, whether B2B or B2C, and Main Street should take advantage.

Filip Radwanski | Lightrocket | Getty Images

The retail battle narrative over the past few decades has cited one of two wars: Amazon and e-commerce against the big bricks-and-mortar retailers, and everybody big against small Main Street entrepreneurs. But in the current confusing economic environment — marked by inflation, supply chain bottlenecks and a volatile consumer changing spending patterns due to the high prices which followed Covid — small business experts say that Main Street should be more optimistic about the advantages of being small.
The inventory builds and subsequent markdowns from the biggest retailers, including Walmart and Target, show that even the best can get this consumer economy wrong. In fact, small business owners, being closer to relationships on both the supply and customer ends, may be able to more nimbly manage a fast-changing environment.

That’s the advice from Nada Sanders, Northeastern University distinguished professor of supply chain management. She told CNBC’s Small Business Playbook virtual summit on Wednesday that she has been “gloom and doom” in the past, but is now optimistic about Main Street’s chances in the current economy.
“I actually see this as a tremendous opportunity. I really do. Especially for small businesses,” Sanders said.
She cites three areas where entrepreneurs should be focused, and the first is directly related to the big box retailer woes: forecasting.
“The big companies are really struggling with that,” Sanders, who is an academic expert on forecasting, said. “We see it, obviously, with the retailers. Walmart, Target.”
Talk directly to customers to understand shifting consumer demand
Her opinion is that the biggest companies have become too reliant on inventory algorithms to forecast data, but in the current economy, which has defied many historical patterns, “historical data in this space right now isn’t really good data. It’s not clean data, it doesn’t indicate the future that is very volatile,” she said.

This gives small business owners who can connect directly with customers, to understand what their needs are, a potential advantage that can’t be calculated by an algorithm.
Whether a small business is B2B or B2C, Sanders said direct communication is a “real answer” for them right now in dealing with changing consumer behavior.
“What I’m seeing with the big companies, they’re trying to hire futurists and trying to figure out ways to actually predict demand. But every time we look at the numbers, the Consumer Price Index, all of it, we’re looking backwards,” Sanders said. “The fact of the matter is, we’re in a very quickly changing landscape and I think we have to look forward. Small business owners really need to connect and use judgment to forecast and to understand what their customers need.”
“As a small business owner on a tight budget … you don’t even need the really heavy duty AI, which I think a lot of small business owners, they get a little bit nervous. … You can actually make a lot of gains with really simple solutions,” Sanders said, “When you’re a small business, you have an end-to-end control that a large business doesn’t have. I see this as a really big opportunity,” she added.
Main Street already thinks it’s operating in a recession
It will be a leap for many entrepreneurs to come around to this view. Data shows that the current sentiment on Main Street is pessimistic. The latest CNBC|SurveyMonkey Small Business Survey for Q3 2022 showed that small business confidence hit an all-time low, with the largest percentage of small businesses citing inflation as their biggest risk.

In the Q3 survey, an increasing percentage of small businesses forecast a sales decline over the next 12 months as the economy, in their view, is already in a recession. The downbeat sales outlook was the biggest contributor to the all-time low in confidence being hit. And as small businesses face higher costs in inputs, labor, transportation and energy, few (only 13%) say now is a good time to pass along price increases to customers, according to the survey.
How to set pricing during inflation
But pricing is also an area where small businesses can effectively, and directly, communicate with their customers and find solutions.
Jeffrey Robinson, Rutgers Business School provost and executive vice-chancellor, and co-founder of the Center for Urban Entrepreneurship and Economic Development, said at the Small Business Playbook virtual summit that one big mistake business owners make is to not figure out pricing on new products until it is too late. At a time of high inflation, entrepreneurs need to be basing any pricing of new items on a detailed analysis of the costs that go into producing it. A traditional way that businesses set pricing — decide on the product and then once it is available look at what competitors are charging — is not the way to operate in this economy. Inflation requires that small business owners set price by, first and foremost, understanding their costs.
“All those prices along the supply chain have gone up,” Robinson said. “The shipping costs … anything that has any component of transportation involved, those costs have gone up. So assessing and valuing your product or service that you’re providing along those costs, before you set the price, allows you to set the price at the right level,” he said.
And then comes the hard part: explaining it to the customer. Robinson says the direct relationship that small businesses have with their customers should be seen as an advantage, too.
“We have relationships. Talk,” he said. “Explore. You’ve got to explain to them that the costs have gone up for these components. ‘In order for me to do this, I have to change some pricing,'” he said.
Helping customers understand the situation that a business is in related to supply chain inflation is going to help set prices in an appropriate way, he said. In the end, Robinson said it is really no different than a restaurant that has always shown the price of a fish on the menu to be “market price.” That may be a simplified example, but it has reverberated in the current situation.
Some restaurants have put signs out front during the current inflationary period to be transparent with customers about pricing changes. Robinson didn’t weigh in on that method specifically, but did say every business needs to have some form of conversation with customers and potential customers about the fact that the prices of two years ago are not going to be the prices of today. While the survey data shows that small business owners are wary of this conversation, Robinson said they shouldn’t be.
“I believe a lot of consumers understand that, especially if you’re a business-to-consumer type of business,” he said. “It’s about being transparent … helping people understand that pricing is changing.”
Map out the supply chain with key vendors
The conversation with suppliers is no less important, and Sanders said the data shows that, on average, 80% of a company’s spend goes towards about 6% of their suppliers. Those are the business partners to focus on, and where to pick up the phone and call and build a relationship. “As a small company, this is really what it’s going to be about,” Sanders said. “What I think you need to do as a small company is really be able to map your supply chain for your key items, talk to your vendors, really build partnerships,” she said.
Most big companies don’t have great visibility below their tier one suppliers, according to Sanders, so many items become harder to track that are far back in the supply chain, “tier four, tier five,” she said.
A small business can map out its supply chain and work with partners to visualize the entire chain and identify the risks. Right now, the inventory issues in retail might make small business owners more reluctant to stock up — even though it is the start of peak shopping season, with back-to-school and then the holidays. Sanders said she is firm believer in running a “lean” operation, but in the current economy, “we need to implement some caveats to the meaning of lean.”
In certain cases, small businesses are going to have to store extra items, critical items with longer lead times, and where there are expected price increases. All businesses should also be taking a look at their production processes and whether alternatives exist that could lead to more cost-effective operations. Carrying extra inventories “flies in the face of lean,” she said, but she added, “the advantage for a small business is really being able to manage at the same time, upstream and downstream, and coordinate those.”
The biggest problem in the current economy is the mismatch between demand supply, and that’s where Sanders comes back to the issues Walmart and Target have faced and why small businesses should take an opportunistic view of the situation, and be proactive about conversations on both the supply side and end customer side of their operations.
“Large companies are dinosaurs. … They’re very heavy, bureaucratic. As a small business, you’re very limber,” she said.
The key for small business owners is to not only look one way, either downstream (customer) or upstream (supplier). “But look at those at the same time, really marry those, watch them, and connect with customers, connect with all the vendors,” Sanders said. “Large companies can’t do that. They’re stuck because they have huge silos. As a small business, you don’t have that, so leverage that right now.” 
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Sexual health clinics are facing a surge of patients seeking testing, vaccines and treatment for monkeypox.
Sexual health has been underfunded in the U.S., and physicians at clinics said they’re struggling to keep up with patient volume, which could hamper efforts to contain the virus.
More than 100 members of Congress told President Joe Biden in a letter late last month that the administration needs to do more to support sexual health clinics.

Dr. Emily Drwiega from the University of Illinois Health and Maggie Butler, a registered nurse, prepare monkeypox vaccines at the Test Positive Aware Network nonprofit clinic in Chicago, Illinois, July 25, 2022.
Eric Cox | Reuters

Dr. Ward Carpenter, co-director of health services at the Los Angeles LGBT Center, said the monkeypox outbreak across the U.S. is worse than imagined.
“We’re just as busy, just as stressed out and living in just as much chaos as at the beginning of Covid,” he said.

The Los Angeles LGBT Center has had to shift so much of its staff to respond to the outbreak that it no longer has the capacity for urgent and walk-in care for its patients, Carpenter said. The center is providing monkeypox vaccinations, testing and treatment on top of its normal services, which include primary care, HIV care, sexual health, women’s health and mental health.
“We’ve got people who have nothing to do with this sort of work who have stopped doing their normal jobs and have started working on this response,” Carpenter said.
U.S. health officials designated monkeypox as a national health emergency on Thursday as cases surge and clinics struggle. STD clinics in major cities across the country are serving as the first line of defense in trying to contain the virus in the U.S., offering care and guidance to gay and bisexual men who currently face the greatest threat from the disease.

Clinics struggle

A surge of patients who need vaccines, testing and treatment for the disease as infections rise are putting pressure on a system already strapped for resources after years of underfunding, physicians say.
Monkeypox is spreading primarily through skin-to-skin contact during sex. Since the United Kingdom first alerted the world to the presence of the virus in May, sexual health clinics across the world have been the eyes and ears of national public health systems, identifying unusual symptoms that diverge from the usual description of the disease in medical literature.

Physicians at clinics in Los Angeles and Chicago, major centers of the current outbreak in the U.S., say they are struggling to keep up with the demand for vaccines, testing and treatment from the communities they serve and are in need of financial support to respond to the outbreak.
The U.S. has reported more than 7,000 cases of monkeypox across 48 states, Washington, D.C., and Puerto Rico, according to the Centers for Disease Control and Prevention. The outbreak has spread swiftly since health authorities in Boston confirmed the first U.S. case in May.
Monkeypox is rarely fatal, and no deaths have been reported in the U.S. But some patients suffer pain so excruciating from the rash, which often develops on the genitals or anus, that they require hospitalization.

‘Pain for weeks’

“Unless you potentially experienced pain in these sensitive areas, it’s hard to maybe conceptualize what this is, but this is not something that’s cleared up with some antibiotics in a matter of days. People are living with this pain for weeks” said Dr. Anu Hazra, a physician and infectious disease expert at Howard Brown Health in Chicago.
Though gay and bisexual men are currently at the highest risk, public health officials have repeatedly emphasized that anyone can catch monkeypox through physical contact with someone infected with the virus or via contaminated materials such as towels and bedsheets.
“Monkeypox doesn’t care if you’re gay. It doesn’t care what kind of sex you have,” Hazra said. “Monkeypox only cares if you were in close contact with another person that has monkeypox.”
Carpenter said the U.S. has the opportunity to contain the outbreak while it is still mostly limited within a close-knit community of gay and bisexual men, but as infections rise, the risk grows that the virus will start spreading more broadly.
“We’ve now had two in a row, outbreaks that were not managed in a way that allowed them to be contained,” Carpenter said. “This is going to take a coordinated and committed and comprehensive public health strategy that goes from top to bottom and treats it just as seriously as Covid was,” he said.

Surge of patients

The Los Angeles LGBT Center knew in early May that monkeypox was going to become a major health issue for the communities it serves after cases reported in Europe indicated transmission was occurring in sexual networks of gay and bisexual men, according to Carpenter.
Staff at the center had never dealt with monkeypox before, so they started educating themselves about the virus. But patients had symptoms that weren’t described in the medical literature, such as single lesions in the genital and anal areas. They didn’t know their first patient had monkeypox until the results came back because the symptoms didn’t fit the textbook description.
“We knew from very early on that this was not going to be behaving like the book,” Carpenter said. “We’re learning not only from the books, but as we go and seeing clients, we’re actually learning what this new outbreak is looking like and how it differs.”
More and more patients started coming in for screenings in late June as Pride month wrapped up, Carpenter said. The center is testing up to 15 people a day, and patients who have sexually transmitted infections now need a full skin exam to see if they might have monkeypox as well.
Hazra said the number of people coming in for monkeypox screenings at Howard Brown Health in Chicago has increased exponentially since May.

Calls for federal support

Some U.S. lawmakers and local communities have criticized the pace of the federal government’s response, but Health Secretary Xavier Becerra said last week the Biden administration has done everything it can to ramp up the availability of vaccines, testing and treatment to fight the outbreak.
More than 100 members of Congress told President Joe Biden in a letter late last month that the administration needs to do more to support sexual health clinics on the front lines. They called on Biden, Becerra and CDC Director Rochelle Walensky to devote at least $30 million in funding for clinics that are battling the outbreak through the CDC’s division of STD prevention.
“If we do not provide sufficient funding for our nation’s STI clinics now, it will become significantly more challenging to eradicate monkeypox in the months ahead,” wrote Reps. Jerrold Nadler, D-NY, and David Cicilline, D-RI in the letter.
Hazra at Howard Brown in Chicago said Covid showed that public health in general is chronically underfunded. Sexual health is even more ignored, he said. Federal funding for STD prevention has declined 41% since 2003 when adjusted for inflation, according to the National Coalition of STD Directors, a national association of state health officials that work in sexual health.
Though monkeypox is not classified as an STD, sexual health clinics are the primary point of care for many people who have the virus, which causes a rash that can be confused with sexually transmitted infections. A survey of 80 clinics in late July found 40% had unanticipated costs for supplies and personnel due to the monkeypox outbreak, while 65% stopped taking walk-in patients and shifted to appointment only due to capacity issues, according to the coalition.
“There’s absolutely not enough funding,” Carpenter said. “Local health centers like ours play a really important role in responses like this, but we don’t have the capacity to turn on a dime, shift and double our capacity to be able to handle whoever needs it.”

Vaccines still limited

Carpenter said the demand for monkeypox vaccines is enormous and is still outstripping supply. Staff spent all day, every day vaccinating people last week, he said. They have administered 1,500 doses of the vaccine so far.
The center recently told patients to book appointments for the shots after receiving more supply. Half the appointments were filled in two hours and all the slots were booked by the end of the day, Carpenter said. Los Angeles has received about 24,000 doses from the federal government, according to the county health department.
CDC Director Dr. Rochelle Walensky acknowledged last month demand that supply of the two-dose monkeypox vaccine, Jynneos, is limited, which has led to lines outside clinics and protests in some cities. The Health and Human Services Department has ramped up shipments to state and local health departments, with more than 600,000 doses delivered since May.
HHS made 786,000 doses available to state and local health departments last Friday. The city of Chicago received an additional 15,000 doses of the vaccine last weekend in addition to 7,000 delivered in July. But Hazra said that’s still not enough to meet the demand of at-risk men who have sex with men estimated at between 40,000 to 50,000 people in the city.
“We are currently scheduled out three weeks in advance in terms of a vaccine appointments,” Hazra said. Howard Brown Health has administered 2,800 doses to date.
The governors of California, Illinois and New York have all declared emergencies in response to the outbreak, in part to support the vaccination effort. But Carpenter said the vaccination campaign needs to expand so anyone who thinks they’re at risk for monkeypox can get the shots.
In Los Angeles, the vaccination campaign is focused on people who are taking medicine, called PrEP, that reduces their chance of contracting HIV and individuals who have had a gonorrhea or syphilis in the past year, according to Carpenter. This information is used as a way to identify people who are considered at high risk of contracting monkeypox.
Walensky said this week there are 1.7 million gay and bisexual men in the U.S. who are considered at highest risk for monkeypox because they are either HIV positive or taking PrEP. People with weakened immune systems, such as individuals with HIV, can suffer more severe symptoms from monkeypox.
The approach is far from perfect, Carpenter said, because there are many people who haven’t caught an STD in the past year who are also at risk for monkeypox.
“What we really want to do is get to the point where we can vaccinate everyone who wants it,” he said. “We’re still not anywhere close to that. We are really trying to focus on the people who are most at need, most at risk. But that’s not a successful public health strategy.”

Increase in testing, treatment

While vaccine access remains limited, Hazra and Carpenter said the federal response has significantly improved access to testing and antiviral treatments in recent weeks.
Testing has become significantly easier since the beginning of the outbreak after the CDC brought commercial labs on board, increasing weekly capacity around the U.S. to 80,000 tests per week.
“We are nowhere near that capacity right now,” Hazra said. “The testing bottleneck has loosened which is helpful.”
But even with increased testing, the U.S. still is likely not capturing the true extent of the outbreak. Clinicians swab the rash caused by monkeypox to collect the specimen for the test. But the rash in some cases can take weeks to develop after the initial exposure to the virus. This means there are people who are infected but can’t get tested because they don’t yet have a rash.
Carpenter said the CDC has also made it significantly easier to prescribe the antiviral tecovirimat to patients who have monkeypox. Tecovirimat is only approved by the Food and Drug Administration for smallpox, so prescribing the drug to treat monkeypox comes with an additional layer of bureaucracy.
Initially, physicians had to fill out a 120-page document for every patient who need the antiviral, Carpenter said. The CDC has significantly slashed the bureaucratic burden through an online form that autopopulates, making the process much easier, he said.
Hazra and Carpenter said they haven’t experienced issues with getting supplies of tecovirimat. The U.S. has 1.7 million courses in the strategic national stockpile, according to HHS.
Hazra said the White House has been responding to the outbreak, but he said more resources and outreach should have been available before now. He said Pride month could have better leveraged to vaccinate people and educate those at risk of infection.
“I think there was a lot of time that went by that was unfortunately wasted,” he said.

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Fast-food value menus are shrinking and becoming more expensive amid the current inflationary environment.
To protect their margins, fast-food companies are using deals to get people to sign up for mobile apps and rewards programs.

A customer waits to order food at a McDonalds fast food restaurant on July 26, 2022 in Miami, Florida.
Joe Raedle | Getty Images

Fast-food chains are playing up the value of their burgers, pizzas and tacos as inflation squeezes budgets — but expect higher prices, skimpier portions and more deals enticing people to sign up for rewards programs as companies rethink their value strategies.
Citing rising costs, Domino’s Pizza earlier this year raised the price of its Mix & Match delivery deal from $5.99 to $6.99, and made its $7.99 national carry-out offer available only for digital orders. Burger King removed the Whopper from its value menu and trimmed its 10-piece nuggets to eight pieces. For the first time, Yelp said customers are mentioning “shrinkflation” in their restaurant reviews, most commonly at places serving affordable offerings like hot dogs, hamburgers and pizzas.

“We’ve seen companies tweaking their value menus across the board,” said Michael Schaefer, the global lead for food and beverage at market researcher Euromonitor International. “We’re seeing fewer items total, limited price increases, smaller items.”
The changes signal the latest chapter in the ongoing evolution of the traditional value deals that have become a hallmark at many fast-food chains. In the years since McDonald’s dropped its popular Dollar Menu and Subway hit the brakes on its $5 Footlong campaign, experts say the industry has been trying to lessen its reliance on such promotions that eat into profit margins.
And as companies face surging costs for ingredients and labor, the push to rethink value strategies is taking on new urgency.
Even as they quietly raise prices or change menu items, experts say fast-food companies are increasingly focusing value strategies around mobile apps and rewards programs that would let them offer personalized deals, while making more money off each customer.
At McDonald’s, for instance, customers can get a free order of large fries and 1,500 bonus points for downloading its app and signing up for its rewards program.

In an earnings call last month, McDonald’s executives said the program gets customers to visit more frequently and noted another benefit it could bring — the ability to eventually offer more personalized deals.
National promotions, by contrast, give discounts even to people who would’ve paid more, said McDonald’s CEO Chris Kempczinski.
“There’s a lot of waste in that,” he said.
Among the chains offering rewards programs are Chipotle, Chik-fil-A, Dunkin’ Donuts, Papa Johns, Wendy’s and Burger King, which lets members earn “crowns” with purchases that can be redeemed for menu items.
Personalized offers can be a win-win by giving customers discounts on the items they actually want, while also letting companies maintain profit margins, said Francois Acerra, director of research and consumer analytics for Revenue Management Solutions, a restaurant data analysis company.
“Brands can say ‘Oh, it’s due to the inflation,’ but I think brands have been trying to move away from those lower price points for quite a while,” Acerra said. “Brands are willing to provide value to consumers for so long as they can leverage guests’ purchase history to maximize customer lifetime value in the long run.”
Apps help companies do just that. Given how frequently people check their phones, an app on a person’s home screen is “like the billboard ad that keeps giving,” said Adam Blacker, director of content and communications for Apptopia, a data analytics company.
“The rate at which we look at it, the importance that it holds within you, just seeing that logo every day can have an effect,” he said.  
Apps can also provide information on what and when customers are ordering and which promotions they respond to, helping companies refine strategies on push notifications for deals.
Still, rewards programs remain a relatively new and developing area for many companies. In the meantime, one way companies are offering more targeted deals is to give local operators flexibility.
McDonald’s executives said the chain will run national promotions, such as its $1, $2, $3 menu, but that regions can select which products to offer. Papa John’s executives also noted the leeway their restaurants have to adjust deals.
“A discount in San Francisco is different than a discount in Atlanta and Ohio,” said CEO Rob Lynch said during the company’s earnings call.
But even as they become more targeted in coming years, experts say fast-food chains will still need to keep offering eye-catching deals to draw certain customers.
“They may look a bit different than in years past, but there will always be a place for high-visibility, low-priced items, which drive traffic and higher-margin add-ons,” said Schaefer of Euromonitor.

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Netflix plans to expand its video game catalog from 24 to 50 by year-end, marking a significant investment.
Netflix’s mobile games have been downloaded 23.3 million globally, according to Apptopia.
The app tracker estimates an average of 1.7 million people are engaging with the games daily, less than 1% of Netflix’s 221 million subscribers.

Dado Ruvic | Reuters

Netflix is accelerating its push into video games with plans to double its catalog of offerings by the end of the year, but for now, few of the streaming giant’s subscribers are playing.
Since last November, the company has been rolling out the games as a way to keep users engaged between show releases. The games are accessible only to subscribers, but have to be downloaded as separate apps.

The games have been downloaded a total of 23.3 million times and average 1.7 million daily users, according to Apptopia, an app analytics company. That’s less than 1% of Netflix’s 221 million subscribers.
The importance of games to Netflix’s overall strategy has arguably increased in recent months as the company faces intensifying competition for user attention. In the second quarter, Netflix lost nearly a million subscribers, after losing 200,000 subscribers during the first quarter — its first subscriber declines in more than a decade.
In a letter to shareholders last year, Netflix named Epic Games and TikTok as among its biggest rivals for people’s time.
“One of the many advantages to Netflix in pursuing the strategy is the ability to drive engagement beyond when the show first comes out on the platform,” Prosek Partners analyst Tom Forte said.
Still, Netflix Chief Operating Officer Greg Peters said last year the company was “many months and really, frankly, years” into learning how games can keep customers on the service.

“We’re going to be experimental and try a bunch of things,” Peters said during the company’s fourth-quarter earnings conference call. “But I would say the eyes that we have on the long-term prize really center more around our ability to create properties that are connected to the universes, the characters, the stories that we’re building.”
The company’s current catalog of 24 game apps covers a variety of genres and Netflix shows, such as “Stranger Things: 1984.” Several are modeled after popular card games, such as “Mahjong Solitaire” and “Exploding Kittens.”
The catalog will grow to 50 games by the end of the year, including “Queen’s Gambit Chess,” based on the hit Netflix series, according a company representative.

Intentionally vague

Netflix has been cagey about how it plans to make video gaming a core part of the company’s strategy, rather than merely a side hobby.
“We’re still intentionally keeping things a little bit quiet because we’re still learning and experimenting and trying to figure out what things are going to actually resonate with our members, what games people want to play,” Leanne Loombe, Netflix’s head of external games, said during a panel at the Tribeca Film Festival in June.
Netflix hinted earlier this year that it will license popular intellectual property for its new gaming additions.
“We’re open to licensing, accessing large game IP that people will recognize,” Peters said in January. “And I think you will see some of that happen over the year to come.”
Netflix tapped outside developers for its current catalog, but has acquired three video game developers in the past year.
All of that adds up to growing investment. Netflix hasn’t disclosed how much it’s spending to develop its video game segment, but the efforts are capital-intensive. Netflix’s acquisition of Finnish developer Next Games cost the streamer about $72 million.
Forrester analyst Mike Proulx noted that Netflix has been investing in gaming slowly, and that it still appears to be what he would consider “more of a test and experiment at this stage.” He noted that most people don’t associate Netflix with games.
So far, download figures for Netflix games fall far short of the leading mobile games — Subway Surfers, Roblox and Among Us, for a few — which each have more than 100 million downloads, according to Apptopia. Still, downloads have slowly climbed since May, after a downward trend that started in December.
“We’ve got to please our members by having the absolute best in the category,” Netflix co-CEO and co-founder Reed Hastings said in January. “We have to be differentially great at it. There’s no point of just being in it.”

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