The Empiricist

Bill Gates, world’s richest person, donates a staggeringly huge amount of money to charity. But he doesn’t just write a check to UNESCO or the Red Cross. He and his wife have their own foundation – the Gates Foundation – that enables them to donate money wherever they want.

I guess that’s one of the perks of being super-wealthy. You get to set up a foundation and commit random acts of kindness on a colossal scale. Worried about malaria? No worries, just throw a few hundred million at it and save a few million lives. AIDS? Same deal.

You’d think that this behavior is beyond reproach. It’s so Good that it borders on comic-book superhero goodness. Bill and Melinda should wear capes and underwear inside out. “Look Melinda! A plague has infested central Africa! Children are dying! We must cure it now! To the Gatesmobile at once!”

You’d think that we’d be watching fictionalised accounts on network TV of the exploits of our real-life heroes, complete with voiceovers, explosions, and happy endings, and a cameo by Michael Caine. And maybe a helicopter or two.

You’d think so, but you’d be wrong.

The Lancet, increasingly prone to take positions on politics and policy, has devoted several articles and an editorial to criticising the Gates Foundation. What are their sins? Well, for one thing, just giving out money to causes and organisations they personally like.

Grant making by the Gates Foundation seems to be largely managed through an informal system of personal networks and relationships rather than by a more transparent process based on independent and technical peer review.

Another thing, they gave way too much money to American based charities.

Additionally, the foundation’s generous funding of organisations in the UK and USA accentuates existing disparities between developed and developing countries while neglecting support for the civic and public institutional capacities of low-income and middle-income countries.

“neglecting support for civic and public institutional capacities?” This sounds awfully like they are suggesting the foundation give the money to foreign governments. Surely they jest. I refuse to believe that such an esteemed journal would say something so crass and stupid.

But the Gates’ biggest sin is to promote medicine over poverty alleviation. They focus too much on giving Africans “high tech” solutions like immunisation, (which will directly save lives) over solving the structural inequalities and social barriers to achieving health and wealth (which won’t).

To quote from the article by McCoy et al:

The Gates Foundation is a major contributor to global health with enormous financial power and policy leverage. Its decisions can have a substantial influence on other organisations. The foundation’s emphasis on technology, however, can detract attention from the social determinants of health while promoting an approach to health improvement that is heavily dependent on clinical technologies.

The editorial lists five changes that are needed by the Gates Foundation, including:

“improve governance.” No, the Lancet don’t mean better paper trails or QA principles, they mean letting the place be run by “diverse leaders with experience in global health”. In other words, they mean putting the same tired old faces in charge of the money stash.

“be more transparent and accountable in your decision making.” Note the “your”. They are obviously speaking directly to Bill himself. The hubris is breathtaking, as is the departure from any pretense of being a science journal. At any rate, by “accountability” they mean accountability to a huge range of other organisations, who would love more of a say in where the money goes.

“aligning yourself more with the needs of those in greatest suffering.” In other words, we want you to spend your money just like everyone else in the aid industry. Novelty is not welcome. And also, we don’t like the way you sponsor pet projects.

“do more to invest in health systems and research capacity in low-income countries.” In other words, we want you to sink lots of money into the yawning black pit that is third world bureaucracy.

“Finally, listen and be prepared to engage with your friends.” In other words, let us tell you how to spend your money.

A couple of points.

1) The whole point of having a private foundation is so you can give to your own pet projects. Hate malaria? Away you go. Think land mines are a problem? Or does child labor really get under your skin. Off you go and fix it. Otherwise, you’d just write a check.

2) The Gates Foundation is an interesting experiment in a couple of ways. First, by observing it we can find out if private charity more effective than the moribund bureaucracies of the major aid organisations. I suspect it might be. Second, maybe directly targeting specific health problems will have knock-on effects. I suspect that also might be true, but we won’t know until we try.

3) throwing money into third world bureaucracies -which seems to be the Lancet’s preferred approach – is a stupid strategy. This is patently self-evident and should not need explanation.

4) The Lancet wants transparency, peer review, more committees, more influence from other NGO’s… are you snoring yet? It basically wants the Gates Foundation to be run like every other aid organisation. But current approaches to aid don’t work. It’s time for some fresh thinking and maybe the Gates Foundation will bring that.

The Lancet’s articles and editorials are nothing but a naked play for greater control of  lucrative cash stream. Sure, it’s all wrapped up in noble sentiments and concern for the world’s poor, but it’s really about trying to spend Bill and Melinda Gates’ money on their behalf.

Expect to see more attempts to wrestle the Gates’ wealth away from them, especially that portion of their wealth that they have set aside to do good.