The end of the end of polio?

May 27, 2011 1:18 PM

With the help of Bill Gates, the World's efforts to eradicate polio (PDF) have over the last few years gained a great deal of new hope (TED)

However, as the scientific community's most influential critic of the rapidly growing amount of money to prevent a dwindling number of cases changes his mind about the possibility of eradication, new constitutional reforms in Pakistan threaten to derail efforts leading to new global outbreaks.

posted by Blasdelb (66 comments total)

From the O.P nyt link: And Arthur L. Caplan, director of the University of Pennsylvania’s bioethics center, who himself spent nine months in a hospital with polio as a child, said in an interview, “We ought to admit that the best we can achieve is control.” Those arguments infuriate Mr. Gates.

I'll bet that they do. It must be infuriating to want to be known as the man who took polio out of the world <sub>take that Dr. Jonas Salk rather then brought Vista into it.

All kidding aside, it's great that wealthy people who fucked over the world (Andrew Carnegie, Bill Gates, John Rockefeller) want to leave a legacy of niceness behind by donating some small fraction of their net worth to building a college or a library or eradicating polio from the world by throwing gobs of money at it. That's just super, really - thank you robber barons! But the NYT article points out some real problems in that Gate's obsession is taking away the focus from other disease eradication programs that have a much better chance of completion then the polio program.</sub>
posted by Poet_Lariat at 1:45 PM on May 27, 2011 [2 favorites]

Just because people don't use Linux doesn't mean Gates fucked over the world.
posted by smackfu at 1:48 PM on May 27, 2011 [15 favorites]

I would be curious to know if there were any criticisms from The Lancet's David McCoy that the BMGF internalized and learned from. It sounds like Gates still thinks his narrowly focused efforts are preferred to more broader health concerns, for example:

In The Lancet today, David McCoy and colleagues extend these findings by evaluating the grants allocated by the Gates Foundation from 1998–2007. Their study shows even more robustly that the grants made by the Foundation do not reflect the burden of disease endured by those in deepest poverty... The concern expressed to us by many scientists who have long worked in low-income settings is that important health programmes are being distorted by large grants from the Gates Foundation. For example, a focus on malaria in areas where other diseases cause more human harm creates damaging perverse incentives for politicians, policy makers, and health workers. In some countries, the valuable resources of the Foundation are being wasted and diverted from more urgent needs.

Has the foundation made any headway in considering the following ideas?

We have five modest proposals for the Gates Foundation. First, improve your governance. Visibly involve diverse leaders with experience in global health in your strategic and operational stewardship. Second, be more transparent and accountable in your decision making. Explain your strategy openly and change it in the light of advice and evidence. Third, devise a grant award plan that more accurately reflects the global burden of disease, aligning yourself more with the needs of those in greatest suffering. Fourth, do more to invest in health systems and research capacity in low-income countries, leaving a sustainable footprint of your commitment. Finally, listen and be prepared to engage with your friends.

What has been the larger cost of focusing on one or two diseases, at the expense of a broader vision that could, perhaps, help greater numbers of people?
posted by Blazecock Pileon at 1:49 PM on May 27, 2011 [3 favorites]

it's great that wealthy people who fucked over the world...Bill Gates...

[cite needed]
posted by eyeballkid at 1:49 PM on May 27, 2011 [1 favorite]

And it will take just one Jenny McCarthy to undo all of this progress.
posted by MattMangels at 1:57 PM on May 27, 2011 [2 favorites]

Just because people don't use Linux doesn't mean Gates fucked over the world.

I was thinking more of the monopolistic anti-competitive practices that drove so many other hardware and software manufacturers out of business over his 15 or 20 year reign. You know, the ones that the DOJ eventually brought Microsoft up on charges for and for which MS got a hand slapping after much political contributions during the Clinton administration.

During the 90's Microsoft did more to stifle innovation and growth (outside of Microsoft) in the computer industry than any other force I can recall.
posted by Poet_Lariat at 1:58 PM on May 27, 2011 [2 favorites]

All kidding aside, it's great that wealthy people who fucked over the world (Andrew Carnegie, Bill Gates, John Rockefeller) want to leave a legacy of niceness behind by donating some small fraction of their net worth to building a college or a library or eradicating polio from the world by throwing gobs of money at it.

In 2007 Bill Gates had already given away half of his money. In 2010, Gates, Warren Buffett and Mark Zuckerberg signed a promise to donate to charity at least half of their wealth over the course of time.

Most people who do good things do so as part of a group working towards a common goal. Their actions are supported and funded by the group. I hold the opinion that these very rich people who unilaterally and voluntarily give away most of their money do more good as an individual than anyone else in history.

But yeah, Vista was kind of annoying.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 1:58 PM on May 27, 2011 [5 favorites]

(1) It's arguably legitimate to say that Bill Gates screwed up the world. He deliberately (and illegally) used monopoly power to destroy promising technology, especially in browsers, that threatened his monopoly. Your computer works worse today as a result. Since the internet does lots of wonderful and important things (including for scientific researchers, food productivity, education, the kinds of things the Gates Foundation works on), it's worth carrying a serious grudge. I've ranted about this before at greater length.

(2) That said, whether Bill Gates screwed up our computers is the least interesting part of this story. Anyone know anything about polio eradication?
posted by jhc at 2:02 PM on May 27, 2011

...and more to do with Ballmer than Gates.
posted by Artw at 2:02 PM on May 27, 2011

During the 90's Microsoft did more to stifle innovation and growth (outside of Microsoft) in the computer industry than any other force I can recall.

And looking back, it doesn't really seem to have mattered that much. It seems like hardware drove technology advances much more than software.
posted by smackfu at 2:03 PM on May 27, 2011

But as others have said, this all off-topic. I was just trying to fight back against the first post shit in the bowl.
posted by smackfu at 2:04 PM on May 27, 2011

It's arguably legitimate to say that Bill Gates screwed up the world. He deliberately (and illegally) used monopoly power to destroy promising technology, especially in browsers, that threatened his monopoly. Your computer works worse today as a result.

...could I get some specific examples of how my computer works worse today as a result, and how these consequences are so dire as to justify the use of the phrase "screwed up the world"?
posted by IjonTichy at 2:04 PM on May 27, 2011 [1 favorite]

In 2010, Gates, Warren Buffett and Mark Zuckerberg signed a promise to donate to charity at least half of their wealth over the course of time.

Great press. I do wonder about the execution though.

I recall a newspaper article from within the past five years that indicated that Gate's foundation had in fact made huge low coast loans to other very wealthy people. Kind of shifting the money around. I can not find that article immediately (too much google-turfing out there) but I'll bet I can with just a bit more time.

People, as a rule, don't get that wealthy because they care about you. The robber barons (heinous industrialists who killed hundreds to thousands of workers- google Pinkerton riots for a start - to make a dishonest buck) spent the last decades of their lives building libraries , colleges and foundations so people like you would not remember that their families killed families like yours to make a buck and we would not revile their son's and daughter's wealth.

This is all harsh and cynical sounding I know but it is reality. I put Gates into the same category.
posted by Poet_Lariat at 2:08 PM on May 27, 2011

heinous industrialists who killed hundreds to thousands of workers

I put Gates into the same category

...this sounds like a pretty wide category.
posted by IjonTichy at 2:10 PM on May 27, 2011 [2 favorites]

it's great that wealthy people who fucked over the world (Andrew Carnegie, Bill Gates, John Rockefeller)

I remember when Gates ordered his mercenaries to open fire on striking employees and their family. Oh wait.
posted by atrazine at 2:10 PM on May 27, 2011 [4 favorites]

Can you guys take it to Metatalk, or at least RTFA? Thanks.
posted by Blazecock Pileon at 2:11 PM on May 27, 2011 [4 favorites]

Poet_Lariat: " In 2010, Gates, Warren Buffett and Mark Zuckerberg signed a promise to donate to charity at least half of their wealth over the course of time."

"Great press."

I dare you to make the same commitment to charity!

"This is all harsh and cynical sounding I know but it is reality. I put Gates into the same category."

Watch his several TED talks. I don't think he's playing us for rubes. He cares about the future and is doing what he can to make it better. And please keep searching for your cites; I'm genuinely interested if what you say is true.
posted by gilrain at 2:13 PM on May 27, 2011

I think it's so remarkable that we have the power to get rid of diseases forever. What a great day it will be when we can seriously discuss destroying the last stocks of Polio, the way we do with smallpox now.
posted by atrazine at 2:15 PM on May 27, 2011 [2 favorites]

Dittoing IjonTichy.

Good god, I think Bill Gates' net positive impact on the world (I'm not saying there aren't negatives) will probably outweigh what 99% of the "fuck Bill Gates forever and ever" crowd will ever do. I find Poet-Lariat's level of hysteria to be hysterical.


I recall a newspaper article from within the past five years that indicated that Gate's foundation had in fact made huge low coast loans to other very wealthy people. Kind of shifting the money around. I can not find that article immediately (too much google-turfing out there) but I'll bet I can with just a bit more time.

Yes, please find this.
posted by The ____ of Justice at 2:16 PM on May 27, 2011

Far from fucking over the world, I say Microsoft eventually including TCP/IP in windows did more to make the world the way it is today than almost any other tech company. On second thought , I guess you can say he fucked over the world.

If my Microsoft tax went to eradicate disease, so be it.
posted by Ad hominem at 2:18 PM on May 27, 2011

Can you guys take it to Metatalk

I suppose you're right - thanks :)
Last word from me - here's an alternative peek at some of the things that Gates Foundation is doing.
posted by Poet_Lariat at 2:18 PM on May 27, 2011

That article is basically just complaining about this:

At the Gates Foundation, blind-eye investing has been enforced by a firewall it has erected between its grant-making side and its investing side. The goals of the former are not allowed to interfere with the investments of the latter.

posted by smackfu at 2:21 PM on May 27, 2011

It might be wiser to complain about the millions of people who invest amorally and give almost nothing to charity, instead of those who invest amorally and give half to charity.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 2:32 PM on May 27, 2011 [2 favorites]

Metafilter: I've ranted about this before at greater length.
posted by rkent at 2:41 PM on May 27, 2011 [4 favorites]

Poet_Lariat, way to shit first and leave a steaming pile!

In any case:

The push to make polio the second human pathogen after smallpox to be eradicated began in 1988. That year, an estimated 350,000 people developed poliomyelitis, an insidious infection that attacks the nervous system and can render patients paralysed within hours...

...By the mid-2000s, fewer than 2,000 people worldwide contracted polio each year, with the vast majority of cases occurring in Nigeria and India, where the campaign faced obstacles including vaccine boycotts.

This is quite a historic feat. 350,000 to 2000?!? Kudos to the men and women accountable for this drop.

The article says decentralizing Pakistan's health care will make the final stages of eradication more costly and time-consuming for Pakistan. I would hope the local organizations that are set up in place would make Polio a priority.
posted by The ____ of Justice at 2:46 PM on May 27, 2011 [1 favorite]

In some countries, the valuable resources of the Foundation are being wasted and diverted from more urgent needs.

Um, excweeze me? The resources of the Gates Foundation belong to the Gates Foundation. We're all entitled to opinions on where his efforts should go, just as I'm entitled to an opinion on who the Red Sox should send to the mount first on the next game day. But I'm not the Red Sox manager, and these people are not the board of the Gates Foundation, and they might want to watch their semantics if they want to be taken seriously.

As to Polio, the WHO almost achieved victory in 1998. I think it's worth a shot trying it again, because if it succeeds, it will be a case of money spent in one generation to solve a problem for all generations thereafter. That's one hell of a long eternal recurring dividend on that investment.
posted by ocschwar at 2:54 PM on May 27, 2011

And Arthur L. Caplan, director of the University of Pennsylvania’s bioethics center, who himself spent nine months in a hospital with polio as a child, said in an interview, “We ought to admit that the best we can achieve is control.” Those arguments infuriate Mr. Gates.

I'm with Gates on this one. The history of Polio eradication is truly fascinating but, more than that, it's heartbreaking. We got so close to wiping the disease off the planet: The WHO's best data confirmed it as eradicated from the Americas, Europe, Australasia, Asia and most of Africa. Really, we were down to endemic* status in one or two countries, with occasional outbreaks in a couple of others being mopped up by flying treatment centres out to the affected areas.

Now, these outbreaks were occurring because not everyone was vaccinated. The polio vaccine was relatively expensive (at the start of the campaign, they were using a weakened live virus which needed to be purified and then refrigerated, which is a huge logistical and therefore cost issue) and had associated risks: something like 1/1,000,000 recipients is expected to succumb to this weakened virus and develop serious complications, up to up to and including lethality.** So vaccinating everyone, as well as being impractical, is not desirable. Instead, you try to break the chain of transmission: isolate (suspected) cases and vaccinate the people near them, putting a sort of firebreak between the virus and its next set of hosts. And it was working.

Then The Stupid kicked in. My memories of the details are hazy (this is from an undergrad lecture a depressing number of years ago), but IIRC political issues -- persuading governments to let all these huge teams of medics come into their borders and interfere with their populations -- combined with natural paranoia, which led to rumours that the vaccine was actually part of some Western/US plot to poison, sterilise or do other evil things to Africans. So that last handful of smallish countries stayed there as an incubator for the virus. As money and momentum behind the campaign died, people travelling from those last countries unwittingly started outbreaks in their previously clean neighbours. Those outbreaks weren't contained, so re-established endemic infections in those areas, then spread further and further out again. Now the virus is back to being an endemic problem over half the fucking continent, and seems likely to spread around the world again as travel to and from the infected parts of Africa becomes cheaper and more frequent.

And all because of those stupid, fearful, ignorant proto-anti-vaxxers. I'm sure that a decent sociologist would point out that their point of view was reasonable and that the failure was on the side of the medical officials who didn't manage to communicate with them in quite the same way. Maybe they're right. Still though, I can't help but hate them a little, and I think of that chain of events and how close we came every time I hear some willfully ignorant parent proclaiming the dangers of vaccines today, and die a little inside when reading the latest stats on rising measels, mumps and rubella cases in so-called first world countries. This stuff really does matter, and it's exactly the thinking that's allowing Polio to end and ruin lives right now, instead of having been snuffed out decades ago.

The vaccine we have today is much better logistically (doesn't involve live virus, so no need to refrigerate and much safer), and works beautifully. Eradicating Polio is not a biological problem, it's a political one. One that we came so very, very close to achieving before and that, just maybe, throwing money at actually has a big chance of helping with.

On a somewhat less polemical note, there are relatively few candidates for worldwide eradication. The shopping list goes something like:

- An effective vaccine exists at a reasonable cost and safety (we're getting dramatically better at this as we get better at vaccines made from artificially grown disease fragments, rather than from the complete disease organisms themselves)
- Unpleasant enough that governments will actually want to put the effort in
- Easy to diagnose cases early in the infectivity window (so you can isolate people before they've infected their entire town)
- Unstable in the environment (no outbreaks caused by a weeks-old stain on someone's clothes)
- No "reservoir" of disease in animals, e.g. as there is with rabies (otherwise we need to vaccinate all the animals as well as all the people, which is an additional nightmare)

Polio was always going to be harder than Smallpox, as it doesn't fit those criteria quite so well. It's definitely achievable though, we just need to get our species' collective head out of our planet-sized arse and work together for once. And if Gates thinks he can buy, manipulate and bully his way into achieving that, I'm all for it.

*There are more precise definitions, but roughly endemic == steady rate of cases throughout the population, epidemic == rapid spread of increased rate of cases through a population, pandemic == epidemic covering the whole world

**This is always the big debate in vaccine deployment, and in population-wide medicine generally: can we be sure that the harm (because virtually everything efficacious enough to bother with has some potential for harm) is worth the payoff? The polio eradication campaign was, with statistical certainty, directly responsible for numerous deaths and disabilities. But it prevented many more, by orders of magnitude, so it was worth it. There's a related side-debate about the cervical cancer vaccines, which I'll write about if you ask me. It's fun stuff to discuss if you like medical ethics, and it's the stuff that makes epidemiologists and vaccination programme designers wake up in the middle of the night screaming and praying that they've made the right decision.
posted by metaBugs at 3:19 PM on May 27, 2011 [9 favorites]

Gates undoubtedly does care about world health in a genuine way. Of course, being a unilateral anti-democratic kind of guy, he's takes action about it with no accountability to the larger international health community. He and his anti-abortion wife Melinda (and his father) have enormous control over how billions of health dollars are spent around the world. They - not the World Health Organization - are the de facto deciders of international health policy. Watch the Gates Foundation representative at an international health conference sometime. The crowds buzz around them like flies to a stinking pile of garbage.

Gates' foundation has been criticized by well-respected leaders in world health (as cited above), but mostly people keep their mouths shut for fear of losing access to what is now one of the only major sources of money. The foundation itself refuses to divest from corporations that actively worsen health.

Sure, Gates should have the right to do what he wants with his money. Very simple issue, right? But he has more say over the health of the entire world than any other single person on this planet. And none of us get a vote in how he's shaping world health. In a society where money = power, I don't think we can afford to let some rich guy with no medical background decide the direction of all of our health efforts.
posted by serazin at 3:21 PM on May 27, 2011 [2 favorites]

Of course, being a unilateral anti-democratic kind of guy, he's takes action about it with no accountability to the larger international health community.

Anti-democratic? What in tarnation?

They - not the World Health Organization - are the de facto deciders of international health policy.

Do you have any evidence that the Gates Foundation undermines and damages international health organizations, rather than complementing them? Are you suggesting that a world without Bill Gates' billions of dollars in medical research and aid would have superior medical research and aid?

In a society where money = power, I don't think we can afford to let some rich guy with no medical background decide the direction of all of our health efforts.

The solution is to increase government investment in health research, not to discourage private investment in health research. This is asinine. If Bill Gates could heal the lame, you people would accuse him of trying to sell more Kinects.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 3:54 PM on May 27, 2011 [6 favorites]

He and his anti-abortion wife Melinda

That allegation is unsupported by your link. Note that unlike the Bush administration, the Gates Foundation has never refused to fund organisations that carry out abortions, they just don't fund them directly. Considering that people other than the Gates' put large amounts of money into the foundation, they may just not want to cause problems with other donors.

By that logic, anyone not directly providing funding for abortions is anti-choice.

I also don't recall voting for the people running the WHO, so I'm not sure that's anymore democratic (not in my opinion a very important criterion in this case anyway)
posted by atrazine at 4:34 PM on May 27, 2011 [1 favorite]

He and his anti-abortion wife Melinda...

That article doesn't say that Melinda is anti-abortion at all, merely that their organization doesn't fund them. And they do fund reproductive health programs. They also support Planned Parenthood.
posted by shoesietart at 4:36 PM on May 27, 2011 [2 favorites]

With the help of Bill Gates, the World's efforts to eradicate Robber Barons have over the last few years been completely crushed.

Just think what governments, corporations, and individuals would have done with the billions of dollars BillG's monopoly forced them to overpay and lose.
posted by charlie don't surf at 5:14 PM on May 27, 2011

In 2007 Bill Gates had already given away half of his money.

Ah, that old talking point. No, BillG didn't give away a damn red cent. He merely transferred much of his holdings into a foundation that he controls exclusively. He took money out of one of his wallets and bought a new wallet to put it in. The Bill and Mel G Foundation is, like almost all Robber Baron foundations, a tax dodge to allow the Baron to enjoy the use of his money for his own goals, while technically not having possession of the money.
posted by charlie don't surf at 5:19 PM on May 27, 2011 [3 favorites]

thanks metaBugs for your thoughtful and informative commentary. Polio is a terrible disease and it really is a shame that we were SO CLOSE to eradicating it and then failed, for political and not scientific reasons. It is an achievable goal, and that's partly why I think it's so attractive to the Gates Foundation.

As an aside, I'm a research microbiologist working on a project funded by the Gates Foundation that focuses on childhood pneumonia. Pneumonia is the leading killer of children under the age of five worldwide. I kind of wish everyone in this thread would shut up about Bill and talk about science and public health instead.
posted by emd3737 at 5:42 PM on May 27, 2011 [2 favorites]

In some areas of the U.S., childhood polio vaccination rates are dropping below 90%, which could pave the way for outbreaks, as happened in Tajikistan in 2010, where vaccination rates had dropped to about 87%. The major dangers in vaccination programs stem from the use of oral vaccines, which are much more subject to mutation into live, transmissible polio virus, such as seem to have been the origin of the outbreaks in Haiti and the Dominican Republic in 1999 and 2000. In the U.S., oral vaccines have been replaced by IPV for years, and IPV doesn't provide the gut bacteria chromosome exchange vectors that apparently allowed the vaccination program oral vaccine in Haiti and the Dominican Republic to become re-virulent. But improved bi-valent oral vaccines (OPV) are still used as primary vaccines in many developing countries, because of their ease of administration, and the lack of trained health care workers who can deliver injectable polio vaccine (IPV).

Thus, both wild polio virus, and vaccine-derived poliovirus (VDPV) remain threats to populations of developed "polio free" countries and regions. And the real cost of failing to achieve worldwide eradication is the need to continue effective vaccination programs for millions of children, worldwide, each year. Beyond the considerable continuing financial costs of such vaccination programs, is the moral cost that comes with knowledge that vaccination programs which must be continued in the face of failure to eradicate, which rely on OPV, will cause some 200+ cases of VPDV polio each year, and continue to be a threat to children who remain unvaccinated in "polio free" countries and regions, due to religious reasons, parental objections, or other reasons for failure to vaccinate.
posted by paulsc at 5:48 PM on May 27, 2011

The Bill and Mel G Foundation is, like almost all Robber Baron foundations, a tax dodge to allow the Baron to enjoy the use of his money for his own goals, while technically not having possession of the money.

Absolutely. It's just that those goals include things like eradicating polio.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 5:57 PM on May 27, 2011 [3 favorites]

Just think what governments, corporations, and individuals would have done with the billions of dollars BillG's monopoly forced them to overpay and lose.

Yes, they could have paid to go on Linux training courses. The threadshitting and whining in response to something involving Bill Gates is just unreal. And no, I don't own any Microsoft stock.
posted by anigbrowl at 6:17 PM on May 27, 2011

Absolutely. It's just that those goals include things like eradicating polio.

Maybe the CDC could eradicate polio if BillG would pay taxes on that money. Maybe the CDC and the WHO have higher priorities. Why should BillG be entitled to reshape the world according to his whims?

It should be noted that BillG has spent the last decade or so acquiring a large stock portfolio in Big Pharma. Getting third world countries hooked on Big Pharma is more profitable than a monopoly on operating systems. It should also be noted that BillG holds large amounts of stock in companies like BP that are despoiling the world and causing health problems in the same third world countries he claims to be working to help eradicate polio. The world takes a net loss while BillG gets the benefits of a phony image as "The World's Greatest Philanthropist" instead of "The World's Greatest Robber Baron."

Sorry emd3737, this issue is inseparable from BillG's foundation. You're looking through a microscope and not seeing the bigger picture. No anigbrowl, this isn't threadshitting, it's a legitimate issue. No I don't care about linux.
posted by charlie don't surf at 6:26 PM on May 27, 2011 [1 favorite]

What is frustrating to me about the BGF is that it isn't trying to change the system when it is one of the few entities in a good place to do so. I tend to think the vast majority of their efforts should go towards propaganda in 1st world countries exposing how those countries manipulate and control third world countries for the benefit of private corporations and work counter to the interests of human decency and generally accepted morality.

Fighting malaria or polio is transient and not particularly helpful when the real problem is a systemic selling out of your and your children's future to foreign interests. Make it untenable to exploit the poor, and the other problems will swiftly sort themselves out. 35 billion dollars can go a long way towards enlightening the voting public of powerful nations about the true cost of externalities, the living conditions of overseas workers, the political infrastructure that allows for the buying and selling of laws to benefit corrupt, evil, massive corporations, how their choices as consumers and their elected representatives' choices as lawmakers can and do shape the future, and the commonalities of the exploited working class in all countries, including the first world.

Everything important (disease, hunger, shelter, illiteracy) is a solved problem, except for the very common dark heart of "I got mine" that guides state and corporate actors. Solving that problem is where the money is needed, and yet I am not aware of the foundation spending a single cent in addressing that problem.
posted by jsturgill at 6:53 PM on May 27, 2011

Maybe the CDC could eradicate polio if BillG would pay taxes on that money.
Maybe the CDC and the WHO have higher priorities. Why should BillG be entitled to reshape the world according to his whims?

So he should just write a check to the WHO and forget about it? Do you not think that maybe, just maybe, Bill Gates's money will achieve more if he pays attention to how it's used and what results it gets? That maybe the WHO is less likely to waste it if they know it would cause Gates to divert it to a different public health related NGO ?

I never thought I'd say this, but as far as Bill Gates is concerned, MetaFilter can be dumber than Slashdot.
posted by ocschwar at 7:06 PM on May 27, 2011 [5 favorites]

What is frustrating to me about the BGF is that it isn't trying to change the system when it is one of the few entities in a good place to do so.

So Gates cares more about eradicating polio than about catering to your simplistic and blindered worldview. Makes me want to buy the guy a latte, really.
posted by ocschwar at 7:08 PM on May 27, 2011 [2 favorites]

The push to make polio the second human pathogen after smallpox to be eradicated began in 1988. That year, an estimated 350,000 people developed poliomyelitis, an insidious infection that attacks the nervous system and can render patients paralysed within hours...

...By the mid-2000s, fewer than 2,000 people worldwide contracted polio each year, with the vast majority of cases occurring in Nigeria and India, where the campaign faced obstacles including vaccine boycotts.

This is quite a historic feat. 350,000 to 2000?!? Kudos to the men and women accountable for this drop.

Yes indeed. That's an excellent outcome, and I applaud the efforts of everyone who contributed.

As an interesting point of comparison:

Cases of Guinea Worm Disease Reported January to December 2010: 1,797

The provisional total number of Guinea worm cases reported for all of 2010 was 1,797 - a 44 percent reduction over 2009 (3,190). ...

When The Carter Center began leading the campaign to eradicate Guinea worm in 1986, there were an estimated 3.5 million cases of the disease in 20 countries in Africa and Asia. Today, cases have been reduced by more than 99 percent, making Guinea worm poised to be the next disease after smallpox to be eradicated.

From The Carter Center's website - emphasis mine.

The Carter Center is an organization lots of people have never heard of, yet it's helped millions of people live a life free from a horrible disease. It was founded by a couple with considerable name recognition but a net worth of only $7,000,000; the Carters previously faced bankruptcy. Much of that $7 million came from royalties on the books Carter wrote.

Like the Gates Foundation, the Carter Center is involved in a number of programs to help make the world a better place: health programs are fighting not just guinea worm disease but also malaria, trachoma, schistosomiasis, and mental illness, and peace and justice programs include election monitoring and helping increase citizen oversight.

They're obviously two very different organizations: the Gates Foundation is a private family foundation, while the Carter Center is a registered non-profit. The Gates Foundation distributed $3.6 billion in grants in 2009; the Carter Center distributed $11.7 million, so the Gates Foundation is clearly putting more money out into the world, and it's pretty much all coming from the Gates and Warren Buffett, as far as I know. Tax statements say Bill spends about 25 hours a week on the foundation, and Melinda about 30 hours a week, while each of the Carters puts in about 40 hours a week. At the Gates Foundation, the 2 highest paid employees got $700,000 and $650,000 each; the next 3 highest-paid got more than $500,000 each. They also spent $24 million with Accenture for software system implementation. At the Carter Center, there are 7 highly paid employees; the top-paid got about $350,000 in total compensation, and the other 6 got $150,000-$200,000.

I'm sure everyone who wants to put money toward making the world a better place has to weigh a lot of factors in deciding where that money will make the greatest difference. I certainly do, and I only have a tiny amount of money to give, compared to the Gateses.

I'm glad whenever anyone gives time or money toward helping someone else, and I'm particularly impressed with all that the Carter Center has managed to achieve, even with so much less publicity than the better-known, private Gates Foundation.
posted by kristi at 7:25 PM on May 27, 2011 [2 favorites]

Melinda Gates is honest about her anti-abortion position. The Foundation officially states: "...the foundation does not fund abortion ... "

The reality is they do fund IPPF which does indirectly fund abortion, increasingly so with the addition of the Buffet money (he has always been a big family planning and abortion funder) - however - they are certainly not leaders in safe abortion care. To my knowledge, they do not fund any organizations that are primarily working on abortion, such as Ipas. This matters because the people who get the Gates money get to do the work. If you've worked for nonprofits you know the way we too often end up bending our mission to chase the available money. You may have also seen the phenomenon where Gates money attracts other money. It's not a good thing, but it's reality.

The Gates Foundation stepped into a world steeped in it's various problems, imperfections, and controversies. And they chose sides in the form of large amounts of cash. Their side is basically represented by technological fixes, and much less on say, lessening poverty in general which many in the international health community view as the root cause of poor health. This has been critiqued by numerous experts who have dedicated their lives to these issues. Targeting funding to only specific health problems, rather than to strengthening health systems overall (as this eradication program proposes), has very real and deathly consequences.

The Lancet study linked previously points out that the vast majority of their international health funds go not to community based organizations, but to a few large organizations, mostly US based. These giant funds are, at least in one case, being massively misspent. The Lancet study also critiques the policy control exerted by the foundation: "All the key contributors to global health have an association with the Gates Foundation through some sort of funding arrangement. Coupled with the large amount of money involved, these relations give the foundation a great degree of influence over both the architecture and policy agenda of global health... and ...establishes some leverage over the voice of civil society. These observations are pertinent because the Gates Foundation is not a passive donor. The foundation actively engages in policy making and agenda setting activities."

Other, not-directly-related problems with the foundation include their in house spending and the issue of their stock portfolio that funds Monsanto, oil companies including BP, etc. I've also personally watched them dismantle my city's struggling school system (and others take issue with that as well.)


Did I say the world is net worse off with Bill's money? No. Do I think someone with this degree of power should be accountable to the world health community not to mention to the largely voiceless communities he aims to serve? Yes I do.
posted by serazin at 7:51 PM on May 27, 2011 [3 favorites]

I bought another copy of Windows 7 just to irritate you. Just right now. It's installing as we speak.

Think of the hundreds of thousands that will die to feed the engine of my commerce!

Mhahaha!
posted by kbanas at 7:55 PM on May 27, 2011

Bill Gates's money will achieve more if he pays attention to how it's used and what results it gets

This is a false argument. Of course he should be involved. But he could, for example, enact decision making strategies that ensure meaningful input from a range of community health experts from different parts of the world. He could respond meaningfully to critics (for example on the investments issue where the Foundation initially promised to make a change and then back peddled when the press backed off.) There is something else besides all or nothing.
posted by serazin at 7:56 PM on May 27, 2011

Another note on the Carter Center: they specifically enlist, and pay, local health workers to carry out their work. Their money enriches the communities where they work.
posted by serazin at 7:58 PM on May 27, 2011

Jesus, is anybody as "OMG, WTF" at the Bill Gates hate in this thread?

Some of you people have lost serious perspective.

For one thing, how the bloody fuck is Melinda Gates "honest about her anti-abortion position?" Deciding not to fund abortion-related services isn't being AGAINST abortion. They quote her in the article as saying "We don't want to be part of the controversy."

Yeah, no shit. I'm sure a good chunk of their donors would stop giving them money, and also the fact that abortion is considered a crime in certain religions (not just Christian) might make things complicated for the work they do in certain non-Western countries.

So for fuck's sakes, that's not being "AGAINST" abortion. You might say the reluctance of the foundation to fund abortions is uncool to you, but it doesn't mean they are "AGAINST" them. Serious doublespeak there, serazin.

Well, fuck it, guess I'm a fool for arguing with morons.

Goodbye thread, I don't have time for this shit. Honestly, I tried. I'm out.
posted by The ____ of Justice at 11:07 PM on May 27, 2011 [3 favorites]

We'll be hearing about how polio should have rights and Gates is oppressing it next.
posted by Artw at 11:17 PM on May 27, 2011

Jesus, is anybody as "OMG, WTF" at the Bill Gates hate in this thread?

I am on the verge of uninstalling my Linux boxes with embarrasment at the cretinous idiocy on display from a bunch of brain-damaged neds with a perspective so myopic it barely makes it past the rims of their fedoras. What a fucking embarrasment.

Do I think someone with this degree of power should be accountable to the world health community

Who is the "world health community"? To whom are they accountable? Becuase if it's the same countries that get together to vote down gay and reproductive rights at the UN because they're run by religious loons, I'd rather the Gateses go their own sweet way, thanks.
posted by rodgerd at 12:50 AM on May 28, 2011 [6 favorites]

If polio is eradicated then it will save lives every year, year after year, forever - lives lots due to polio, lives lost due to side-effects of vaccines, lives lost due to the fact that medical care in third-world countries is dangerous. So yes, there are very likely more pressing healthcare issues right now, but the only reason they're more pressing is that we're keeping a lid on polio, and they're mostly not problems that can be solved forever and ever amen. In contrast, if we eradicate polio then it's gone for good - no more summer epidemics, no more people with post-polio syndrome, no fear that a war or civil disaster will unleash the demon again. It's really, really worth doing.
posted by Joe in Australia at 2:29 AM on May 28, 2011 [1 favorite]

To turn the discussion back to polio a bit, here's Staff Benda Bilili performing a song about it.

Oddly, the lyrics do not seem to mention Bill Gates.
posted by klausness at 4:00 AM on May 28, 2011

Wow. I thought I was a Bill hating guy. I used [e-mail] as my spam bait address every time since 1994, I pirated every windows OS and office program and did my best to promote microsoft piracy. But really. A lot of the comments in this thread are disgusting.
Bill Gates has decided to toss a huge chunk of money at programs that will pay recurring dividends to humanity. Sure, feeding a man today is important, but he has decided to teach a man to fish metaphorically, and target stuff that if is successful will have an ongoing dividend to the world.
I don't understand this thread at all. Eradicating smallpox was an astonishing achievement. If we can eradicate polio thanks to gates/buffet money, well, that is probably much more than we would have had as a people than if microsoft had been less anti-competitive and if every consumer had an extra $50 to spend on Doritos.
Where is the line for hating MS business practices, but being 100% behind Bill Gates approach to philanthropy?
posted by bystander at 7:50 AM on May 28, 2011 [3 favorites]

The ____ of Justice writes "For one thing, how the bloody fuck is Melinda Gates 'honest about her anti-abortion position?' Deciding not to fund abortion-related services isn't being AGAINST abortion. They quote her in the article as saying 'We don't want to be part of the controversy.' "

By explicitly not funding abortions as a point of policy they are part of the controversy.
posted by Mitheral at 8:15 AM on May 28, 2011

Do you not think that maybe, just maybe, Bill Gates's money will achieve more if he pays attention to how it's used and what results it gets?

Right, BillG generally requires that he receives a board membership on any organization he funds. It is said that BillG doesn't donate to charities, he assimilates them. I didn't think it was possible to acquire a monopoly on philanthropy, but with Buffet, he essentially has. It is well known within the health research world that competing but potentially successful research gets defunded if it does not conform to BillG's goals.

I never thought it was possible, but an old joke is coming true. Back on the old Daily Show with Craig Kilborn, he once said, "Bill Gates has announced his initiative to eradicate the AIDS virus. He plans to buy up all competing viruses, and use his power of monopoly to drive AIDS to extinction."
posted by charlie don't surf at 8:19 AM on May 28, 2011

Meanwhile Paul Allen has built a really ugly building and written a snarky book.
posted by Artw at 8:32 AM on May 28, 2011

Generally when people start calling me names (brain damaged, moron) I presume they've run out of rational arguments.

Bill Gates gives away a lot of money. As I said several times, I'm all for that. I just believe that his giving away a lot of money should not shield him from critique. And a number of non-morons from organizations like Johns Hopkins, the World Health Organization, etc, quoted in the articles I linked, agree with me on that. "The international health community" is a massive network of NGO, university, and government workers who decide health policy. They work for places like UNICEF, Medicines Sans Fronteras, the Carter Center, WHO, and countless small, community based in-country organizations that provide health infrastructure in places where the government and corporations do not. They have nothing down with "voting down gay rights". Among those who work in international health, Melinda Gates is widely-known to be anti-abortion. I can't give you proof of that, but as my first link shows, I'm not the only person repeating that and Melinda has never publicly disputed it. If you disagree with me, that's cool. If you think I'm a moron, well, I guess at least I'm in good company.
posted by serazin at 8:34 AM on May 28, 2011 [1 favorite]

It's time for Bill Gates to come back to Microsoft.
posted by Artw at 8:54 AM on May 28, 2011

"Though he lacks Angelina Jolie’s pneumatic allure, his lingering “world’s richest man” cologne is just as aphrodisiacal to TV cameras."

This from the NYTimes article. This kind of writing is one reason I no longer read the NYTimes.
posted by IndigoJones at 10:15 AM on May 28, 2011

In my previous comment I wrote a little bit about the considerations of risk/benefit with regard to the polio vaccine, and mentioned that there's a related debate about the cervical cancer vaccine. Ac couple of people have asked me to expand on that.

First and most importantly, I'm a biologist but I'm not a medical doctor. Please don't construe the ramblings of internet strangers as worthwhile medical advice; talk to a proper doctor, in real life, about your health concerns. If they contradict me, you should almost certainly believe them, not me.

So, the debate about the cervical cancer vaccine (really, it's a vaccine against specific strains of Human Papilloma Virus (HPV) that cause warts that can become cancerous if left for long enough) is not one that's based around its safety. This vaccine is NOT one that contains live virus; instead it's a handful of proteins copied from the virus, manufactured in a lab (probably grown inside a harmless strain of bacteria, then carefully purified), delivered along with something to help attract the immune system's attention. Really, so many hundreds of millions of people have had this kind of vaccination over the past few decades that it's a very well-understood technique. Every vaccine is going to be slightly different because biology is complex, but it'd be a gargantuan surprise if anything new came up. I can't claim to have read the recent trial data, but I attended a talk given after the early, smaller human trials and nothing out of the ordinary had been seen. So, for the patient, this vaccine should be at least as safe as any other. Which is to say: very, very safe. Definitely safer than the most recent car journey you took, for example.

Instead, the issue that was under debate is a slightly more subtle epidemiological one. Cervical cancer is one of the big success stories of our time, almost entirely due to the huge screening programmes that allow and encourage women to get themselves checked at regular intervals. Early detection lets us treat early, which keeps the long-term survival rates comfortably north of 98% (old data; the rate might be better now).

Now, the vaccine will not prevent all cases of cervical cancer: it will not protect all treated people from the viruses, and not all cervical cancers are caused by those viruses anyway. So some (much smaller) number of women will still develop cancers that still need to be caught early to keep the excellent survival rates up where they should be.

The worry is that by vaccinating a high proportion of the population, we'll create a generation of women who don't think it's necessary to ever get screened. If this happens, although far fewer women will develop cervical cancer, the ones who do will be more likely to die than if they'd had regular screening like the current generation does.

It sounds terribly callous but, while tragic, this is not a deal breaker in itself. We're struggling to achieve the greatest net benefit across the population. So, is the number of lives saved by the vaccine greater than the number of lives lost due to falling attendance at screenings? Should we introduce a safe-but-imperfect vaccine at the risk of destroying our excellent, life-saving screening programme?

In principle, we just do some sums and choose whichever option gives us the most healthy, happy people at the end. We just need data to plug into the formulae. We have a solid idea of how effective the vaccine will be (and an idea of how wrong that prediction is likely to be), good data on non-viral cancers, etc. and lots of other factors to plug into the statistical models. But to estimate numbers for how many vaccinated women will still turn up for screening, we have to wade into the muddy waters of predicting patient psychology and public attitudes, which is hellishly difficult to do. And tiny changes in the numbers you choose for this to plug into your model will wildly swing your results one way or another. So even though they agree that the vaccine is safe at an individual level, epidemiologists end up arguing over the costs and benefits at a population level.

To summarise:
On an individual level the vaccine itself is appears to be as close to "perfectly safe" as any medical intervention can be. More Data Is (always) Needed, but it has passed trials with flying colours and is one more implementation of a well-understood technique. I know that if it ever becomes available for my demographic I'll go for it.*

On a population level, the epidemiologists'/policy advisors' usual problems of weighing efficacy, safety and costs is made more complex by the need to predict the public's changing attitude to the excellent screening programme. Tiny differences in the underlying assumptions (mostly: how badly will the screening programme be damaged?) can dramatically sway the result. And because everyone takes this stuff very seriously, arguments ensue.

Once again: I'm not a medical doctor. Neither am I an epidemiologist, I just try to keep an eye on some of the more interesting debates.

*Guys can get genital HPV infections, but because they're external, very easily visible (warts) and take many months or years to become a problem, HPV-related penile cancer is extremely rare. Treating guys is more about eliminating us as a transmission vector than about protecting us. A no-brainer in a perfect world, but probably not worth the financial cost in this world.
posted by metaBugs at 1:52 PM on May 30, 2011 [1 favorite]

It may be that the foundation is not that great despite looking like one of the best things on Earth, but it seems like the haters came from the position of hating Bill Gates and then looked for evidence in the foundation, which is never a very healthy way to go through life.
posted by smackfu at 10:17 AM on May 31, 2011

Well, I don't know if you count me among the "haters" but I come at this issue primarily as someone who's salary is payed by a Gates Foundation grant. My critiques are based on seeing the actual results of the policies of his foundation. Sure, I am inclined to feel negative toward the richest people in the world for other reasons, but there are a number of philanthropists and foundations that I basically respect and mostly agree with.

(And peripheral to the topic of this post post: as I mentioned, I live in a city where Gates set about to, and succeeded in, dismantling most of the stable aspects of our public schools. Now his money is gone, the large schools he dismantled are still broken up - or trying to put themselves back to what they were before he came, and by all measurable outcomes - dropout rates, test scores, enrollment, etc - things are worse than ever. So again, I come at this from a fairly personal and fairly direct experience with the outcomes of his money.)
posted by serazin at 3:44 PM on May 31, 2011

I live in a city where Gates set about to, and succeeded in, dismantling most of the stable aspects of our public schools

Interesting! Also - this. And some make nice stuff and some serious (pdf) wonkery (it wasn't Gates alone, fwiw).
posted by IndigoJones at 5:47 PM on May 31, 2011

Wait, I'm confused - you're linking to articles that both support and oppose my claim that the Gates money divided and fucked OUSD. Are you arguing that I'm wrong or right? Or just providing contextual links?
posted by serazin at 7:37 PM on May 31, 2011

It wasn't Gates alone dismantling OUSD, but like with the international health money: other funders follow Gates. He makes policy and we (the schools, NGOs and governments that have no choice but to take his aid) have no choice but to go along with his policy decisions.

(My kid is an OUSD student, I am a former OUSD student, and I have and have had several close friends who teach for OUSD. Everyone might not agree with my assessment of what he did to our schools, but I certainly do have direct experience here.)
posted by serazin at 7:44 PM on May 31, 2011

Contextual links. I have no dog in that fight.
posted by IndigoJones at 5:33 AM on June 6, 2011

Sorry for getting defensive IndigoJones, and thanks for the links.
posted by serazin at 8:29 AM on June 6, 2011