For Bill Gates on his Last Day at Microsoft

Jun 27th, 2008 | By | Category: Featured Articles, Public Health

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