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Friday, June 27, 2008

For Bill Gates on his Last Day at Microsoft

posted by on June 27 at 12:29 PM

Dear Bill,

Congratulations on your last day at Microsoft and welcome to the world of biomedical research!

Everyone I know who endured a ‘billg’ review agrees—you’re apparently a bit of an ass. Quick to question and call bullshit, to point out errors or inconsistency, and to demand the best, willing to yell if yelling is needed.

Excellent! We need an ass working in public health right now—right here in the United States. Peter J. Hotez makes the case in PLoS Neglected Tropical Diseases:

In 1962, an estimated 40 million Americans lived in poverty, almost one-quarter of the US population. Today, the poverty rate in the US is roughly half of what it was when The Other America was first published, however, the total number of people living in poverty remains about the same. We now recognize that this group of 36.5 million impoverished Americans is at higher risk for heart disease, cancer, and other chronic diseases compared to the rest of the US population. However, it is not well known that just as the poorest people in the low-income countries of Africa, Asia, and Central and South America have the highest rates of the neglected tropical diseases (NTDs), there is evidence to suggest that large numbers of the poorest Americans living in the US also suffer from some of these unique infections.

Like what? Hookworm—causing malnutrition and severe anemia—is assumed to be eliminated in the South. Why assumed? We stopped looking for it in 1970. The last study completed showed the disease still exists. Why stop looking? “…because they only occur among impoverished people and mostly underrepresented minorities, I believe that there has been a lack of political will to study the problem, so that these diseases of poverty have been allowed to simply remain neglected,” notes Dr. Hotez.

Imagine this Toxocariasis worm slowly chewing its way through your body—migrating through your skin, causing horrible itching, through your lungs, causing horrible asthma, and even across your eye.

We know that playgrounds in poor cities are full of toxocariasis eggs. In Bridgeport and New Haven Connecticut around 10% of children have evidence of current or past infection with these guys. Ten percent!

Another? Cysticercosis tapeworms are surprisingly common, particularly among Hispanics.
This tapeworm, in the process of smashing the brain, can cause seizures; in certain Los Angeles hospitals about 10% of seizures are caused by cysticercosis.

I’ll let Dr. Hotez finish up for me:

We need to begin erasing these horrific health disparities by stepping up measures to conduct active and national-scale surveillance for soil-transmitted helminth infections, especially toxocariasis, as well as cysticercosis and congenital toxoplasmosis. In addition, based on data suggesting that the NTDs cutaneous leishmaniasis, ratborne leptospirosis and hantavirus infection, dengue fever, brucellosis, tuberculosis caused by Mycobacterium bovis, trichomoniasis, and louse-borne trench fever are emerging among the poor in the US, it is imperative that we address these conditions as well…

The fact that reliable numbers on the actual prevalence of the NTDs are simply not available is reflective of their neglected status, and their disproportionate impact on minorities and poor people. There is an urgent need to support studies that (1) assess the disease burden resulting from the NTDs in the United States and (2) identify the minority populations at greatest risk, and then to (3) identify simple and cost-effective public health solutions. Accordingly, PLoS Neglected Tropical Diseases is pleased to consider and review articles on this vitally important topic. There are no excuses for allowing such glaring health disparities to persist in one of the world’s wealthiest countries.

We don’t like hard realities in the United States. We don’t like thinking of ourselves as in the same category as the poorest nations on the planet. When it comes to horrific diseases, the poor in the United States might be as burdened as the poorest around the world. Human beings with these diseases cannot study, cannot develop fully, cannot reach their full potential. To not even bother looking, to willfully ignore the problem is deeply immoral.

We need an ass to stand up and demand we find out the true extent of this problem, demand we accept reality so that we can start to fix it. BillG, you are just than man for the job. Have at it!

With Sincerity,
Jonathan Golob

RSS icon Comments


Dear Jonathan,

I will give you a large quantity of alcohol if you would please promise to never again publish photos of flesh-eating worms, parasites, burrowing ticks, etc., particularly when accompanied by medical images of such living in someone's brain. Would you at least put them after the jump if you're posting during lunch?

With No Small Measure of Throw-up in My Mouth,


P.S. You owe me the sandwich I am now not able to eat.

Posted by Ralph | June 27, 2008 1:09 PM

Keep publishing the pictures, Jonathan. As long as our neighbors have these horrible diseases, we need to see them. God, I want science back in American public policy so bad.

Posted by Fnarf | June 27, 2008 1:13 PM

Bravo, Jonathan. I do wonder why the Gates Foundation isn't focusing more attention to its own backyard.

Posted by laterite | June 27, 2008 1:38 PM

Mr. Gates, who is going to feed all these people you save from deadly disease? I mean, I appreciate what you do, but hunger is already a severe problem in so many places. And if you can save them from starving, who will feed their children? Maybe birth control is an area you can work on as well.

Posted by Vince | June 27, 2008 2:21 PM

Jesus fucking christ.

Thanks for that.

Posted by Matthew | June 27, 2008 2:21 PM

Hey, I remember that House episode too!

Posted by K | June 27, 2008 2:30 PM


Two points to consider:
1. Not everyone with these infections dies. In fact, most live--just with less energy and intellect. Treat them, particularly as children, and you end up with more from the same amount of eating.

2. Increasing survival to adulthood--most of these illnesses disproportionately affect children--can actually decrease birthrates and population growth. It's a paradox I described a while ago.


And sorry Ralph. When I read this article in PLoS NTD, I was really shocked.
Think about this: A decent percentage of the people that picked the lettuce, harvested the grain, baked the bread in a factory and slaughtered the animals in your sandwich--castigated as illegal immigrants by the dominant political party in the country--probably had tapeworm eggs growing in them.

This whole situation enrages me.

Posted by Jonathan Golob | June 27, 2008 2:32 PM

how do i get screened for these worms?

Posted by Bellevue Ave | June 27, 2008 2:41 PM

Well, as someone who works in this area, I don't agree with your assumptions.

First, if Bill G spent his entire Foundation holdings on research, it would be less than our annual budget for scientific research.

Secondly, costs for programs in the US are dramatically higher than for those in the poorest countries that are hit the hardest = e.g. Africa - and thus you get more bang for the buck overseas.

Thirdly, he's focussed on deliverables, much less than the underlying research which the Government should be paying for.

We do actually have human trials of vaccines for malaria and other such things, but they are trials, and we are still trying to figure out the safety, cost, delivery, and other factors at this time.

Want a miracle? Pray to the FSM.

Posted by Will in Seattle | June 27, 2008 2:56 PM

Oh Will--

Let's say that the Gates Foundation funds a study to nail down the percentage of Americans with these neglected tropical diseases--a carefully done, comprehensive study.

This study comes back showing that an astonishing percentage of Americans, US citizens, have diseases more associated with impoverished tropical countries.

Wouldn't pharma take notice? The NIH? Wouldn't new drugs be rapidly developed to treat this vast new market? It would be an American market, treated totally differently than say drugs targeted for Sub-Saharan Africa. A drug target useful only for problems in poor countries is far less attractive than a drug target that can also be used to treat Americans.

This small investment in a prevalence study--hell, you don't even need to spring for a more complicated incidence study--would probably do more to develop new anti-parasitics than anything else.

Posted by Jonathan Golob | June 27, 2008 3:07 PM

Some quick thoughts...

First, I don't know how sexy this research is to the various biomed disciplines. I'd consider it quite sexy and I know some epidemiologists and pathobiologists who would too. But, part of the sex appeal is the financing. Money would most likely have to come from the NIH which would have to justify spending money on this rather than on breast cancer or heart disease or diabetes or... and people already whine so much about paying taxes. Not that it can't be done. The HIV budget, for example, got fatter over time and lots of biomed folk made careers on research in the field (heck an NIH AIDS training grant kept me in ramen noodles for a few years). So, yes, it's all politics - the politics of getting people to want to spend the money (which, practically, means spending the money on this rather than something else).

Posted by umvue | June 27, 2008 3:13 PM

If you wanted bang for your buck on malaria, you wouldn't fund vaccine trials, you'd negotiate a deal on a hundred million mosquito nets. I'll bet you could find someone to make them for a quarter apiece with an order that large.

Posted by Fnarf | June 27, 2008 3:16 PM


Not only that, but health care for poor people can also increase the income of poor families.

Posted by keshmeshi | June 27, 2008 3:27 PM

Pharma would only care if they could make big dollars on it.

Migrant farmworkers usually don't have big dollars.

So, the short answer is ... no, they won't care.

Seriously, the reason why people don't get TB in the US and Canada has a lot more to do with how rich they are and how much Big Pharma makes by treating it here instead of other places.

Posted by Will in Seattle | June 27, 2008 3:31 PM

Yes, Yes let's save all the humans from parasites and diseases. So they can grow up to join the military or rebel group and kill each other with weapons of mass destruction ( guns ).
Paradox my ass. If you are going to save these people from diseases you better have an education and a job also waiting for them. Otherwise us first-world nations get a few hours of news entertainment watching genocide happen in Africa on cable or satellite.

Posted by robot2501 | June 28, 2008 9:37 AM

Say "YES" to War on Iraq by Dan Savage Oct. 2002

"War may be bad for children and other living things, but there are times when peace is worse for children and other living things, and this is one of those times."

"The War on Iraq will make it clear to our friends and enemies in the Middle East (and elsewhere) that we mean business: Free your people, reform your societies, liberalize, and democratize... or we're going to come over there, remove you from power, free your people, and reform your societies for ourselves."

Washington Post June 27, 2008

"Bomb Kills Marines, Iraqi Tribal Leaders
At Least 40 Die in Two Separate Attacks"

Posted by danfansarewarmongersupporters | June 28, 2008 9:51 AM

Yep, deeply immoral.

And nobody cares. Didn't you get the memo? Ronald Reagan, circa 1981. Something about it being okay to stop giving a damn about anybody but yourself.

You're not one of those fancy elitists, are you?

Wanna buy a monkey?

Posted by CP | June 28, 2008 10:28 AM

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