Gates: Large Epidemics Need a More Agile Response 140
jones_supa writes: Writing in the NY Times about the recent Ebola crisis, Bill Gates says this disease has made the world realize we are not properly prepared to deal with a global epidemic. Even if we signed up lots of experts right away, few organizations are capable of moving thousands of people, some of them infected, to different locations on the globe, with a week's notice. Data is another crucial problem. During the Ebola epidemic, the database that tracks cases has not always been accurate. This is partly because the situation is chaotic, but also because much of the case reporting has been done first on paper.
There's also our failure to invest in effective medical tools like tests, drugs and vaccines. On average, it has taken an estimated one to three days for test results to come back — an eternity when you need to quarantine people. Drugs that might help stop Ebola were not tested in patients until after the epidemic had peaked, partly because the world has no clear process for expediting drug approvals. Compare all of this to the preparation that nations put into defense, which has high-quality mobile units ready to be deployed quickly.
There's also our failure to invest in effective medical tools like tests, drugs and vaccines. On average, it has taken an estimated one to three days for test results to come back — an eternity when you need to quarantine people. Drugs that might help stop Ebola were not tested in patients until after the epidemic had peaked, partly because the world has no clear process for expediting drug approvals. Compare all of this to the preparation that nations put into defense, which has high-quality mobile units ready to be deployed quickly.
So when's the first scrum? (Score:3, Insightful)
With apologies to programming-motherfucker.com (Score:4, Funny)
Do you practice it?
We are a community of motherfucking clinicians who have been humiliated by pseudoscientific quackery for years. Do you know what they call alternative medicine that works? Medicine, Motherfucker.
We are tired of antivaxxers, homoeopaths, naturopaths, chiropractics, acupuncturists, faith healers, and anyone else getting in the way of Medicine, Motherfucker.
We are tired of being told we're money-grubbing idiots who need to be manipulated to work in a Allopathic Medicine chain gang without any time to explore the natural healing powers of measles and whooping cough because none of the 10 insurance companies that are responding to customer demand for acupuncture coverage can do... Medicine, Motherfucker.
We must destroy these methodologies that get in the way of...Medicine, Motherfucker.
They claim to value / They really value / We fucking do:
Individuals and interactions / Tons of billable hours / Medicine, Motherfucker
Removing toxins and chemicals / Tons of pointless tests / Medicine, Motherfucker
Health Freedom / Bleeding patients dry / Medicine, Motherfucker
Fighting the Establishment / Paranoia and conspiracy theory / Medicine, Motherfucker
We think the shit on the left, is really just the con in the middle, and that we really need to just do the thing on the right... Medicine, Motherfucker.
Signed,
Anon. C. Owhard.
And the Medicinal Motherfuckers.
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You sound angry. Perhaps some nice Cognitive Behavioral Therapy [wikipedia.org].
Or just a nap.
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That's a bit optimistic. Some of them are total schmucks that couldn't find their way out of a wet paper bag. Some of them can't even manage as well as some of the quacks.
I kid you not. The first doc I saw regarding my current condition missed obvious stuff that a genuine quack managed to see.
A lot of people in a similar situation are mired by "professionals" who don't do well enough to understand what's going on even if they do manage to catch the obvious physical symptoms.
Like anything else, Sturgeons law
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More about that here [slashdot.org] in response to another poster who thinks medicine went downhill after the '70s.
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I'd be interested in what problems and treatments you specifically experienced success with. Of course that is personal. I do not mean to be invasive/rude, so I do not at all expect a reply.
Yes, it is personal, but in the interest of debate, here's why I trust my doctors:
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If it's something rare or not well understood then doctors are very hit and miss.
Chiropractic and Acupuncture have worked much better than doctors in my case, but I certainly know that doctors have their place.
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I don't think that anything I've posted here is a secret on slashdot, so sharing it one more time is no big deal. However, a lot happened after 1979.
The term PTSD didn't even exist until 1980, and its acceptance took time. Before that, the symptoms were known under different names, such as "battle fatigue." That it could be present in children and adults who had never gone to war was a new concept. Effective treatment is the only reason I didn't kill myself.
The invention of OCT (optical coherence tomogra
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Yeah, that was my first thought, followed by involuntary cringing. It's sad how something that was supposed to bring hope to developers buckling under the yoke of waterfall development has instead become associated with every unreasonable request made by every airline-magazine reading executive.
Moving Infected People (Score:3, Insightful)
I don't think infected individuals should be moved, or at least not moved far.
The number one concern is to limit contamination, so quarantine should be as absolute as possible.
Hard hearted? Maybe, but definitely practical.
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Re:Moving Infected People (Score:5, Insightful)
As I said, not moved far.
Take that as "moved as little as possible".
If they are in a city, move them to the closest hospital IN THAT CITY.
With the last ebola mess, they were flying obviously infected people all over the place.
Re:Moving Infected People (Score:5, Insightful)
With the last ebola mess, they were flying obviously infected people all over the place.
For a disease like ebola, that is no big deal. It is important to keep a grip on reality. There was a lot of scare-mongering over ebola, nearly all of it misplaced. Ebola can easily be stopped dead in its tracks by soap and/or hand sanitizer. It spread in Liberia, Sierra Leone, and (especially) Guinea, because those three countries have basically no health infrastructure, deep mistrust of outsiders, very low literacy, and little understanding of the germ theory of disease. Ebola was never able to gain a foothold in neighboring countries, such as Senegal, Ghana, or Nigeria, which have higher literacy and at least rudimentary health care systems. To think that ebola could spread in first world countries like America, or Europe is not realistic.
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Exactly this. Ebola was a boon for the media and a disaster for the people involved but it was never a threat to the first or second world.
Not quite as hard to catch as HIV, but much harder to catch than influenza or measles. A bit aside from Gate's issue which seems to be predicated on some nonsensical idea that these places in deep, dark Africa without even clean (much less running) water, without even soap and without even a concept of the germ theory of disease - much less electronics and computers
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Are you going to quarantine an entire flight of people at once in an airport?
Not to be a heartless dick, but it's not that hard to do if someone shows symptoms en route. The airplane is a somewhat sealed metal tube, and an airport has a lot of acreage that can park that plane out far enough away from everyone else....
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Depends on the symptoms. Are you going to quarantine an entire flight when a passenger has a fever or is throwing up ?
Re:Moving Infected People (Score:5, Insightful)
Depends on the symptoms. Are you going to quarantine an entire flight when a passenger has a fever or is throwing up ?
No, because you are not going to know about it. What possible incentive does a stewardess have to report that illness, when she knows that she will be quarantined along with the passengers, and possibly left to die on a sealed airplane? The problem with draconian solutions is that they incentivize counter-productive behavior.
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My question was a rhetorical one, but since it got moderated "-1 don't understand", I'll rephrase it in a more direct way.
Not to be a heartless dick, but it's not that hard to do if someone shows symptoms en route
The problem is that most symptoms that are developed en route are going to be simple things like a fever or vomiting. These aren't clear enough to be recognized as a symptom of a dangerous disease. Taking a blood or mucus sample, and running a real test could take hours, if not days, and that's too long to keep a plane full of people waiting.
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Running a real test will not "take days". However, a blood test may not be helpful for days. The last doctor we imported for treatment was like this. Despite the fact that he was starting to exhibit symptoms, blood tests didn't indicate he had Ebola.
Properly quarantining people is problematic enough when it's just one obnoxious nurse. Forget about an entire plane full of entitled 1st worlders.
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Add to that the fact that with most infectious diseases, the symptoms that would make it evident that they are ill are unlikely to manifest just on the flight. Most of the time, there's a gestation period of a few days to a week before the person who caught shows symptoms, and in some cases they can pass it on before they become symptomatic.
That's the biggest problem with relying on quarantine. Either you always quarantine every incoming international flight until you make sure that no one on board has som
Re:Moving Infected People (Score:4, Interesting)
Agreed.
While yes, the act of moving someone to an advanced care facility would be preferable for the person involved, I would counter that maybe, just maybe, that advanced care facility (or as much of it as possible) should be relocated to where the infected are. The absolute last thing you want to do is to start flying infected people outside of the infection zone to other places.
I already know the problems presented: The infected area is usually in some third-world shithole with little-to-no infrastructure, much of the equipment is big, heavy, and expensive, etc... but much of it can be made portable with sufficient engineering, and a good chunk of it doesn't even have to be brought along, or can be minimized (e.g. the ventilation/filtering systems that the centers here have to keep quarantine).
If Bill Gates wants to do something with all that cash, maybe he can hire a few engineers an medical types to build a deployable care center that can be flown out to $3rdWorldShitHole in less than 24 hours, and be put to use immediately when an epidemic strikes. Hell, build a bunch of them, include a big pile of needed supplies with each, then pre-position them in or near areas that are most likely to see recurring epidemics.
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a deployable care center that can be flown out to $3rdWorldShitHole in less than 24 hours, and be put to use immediately when an epidemic strikes. Hell, build a bunch of them, include a big pile of needed supplies with each, then pre-position them in or near areas that are most likely to see recurring epidemics.
This is exactly what the summary is talking about. We have "high-quality mobile units ready to be deployed quickly" for military but
we don't have the equivalent on the medical side. It was insane that we did not have deployable quarantine units that could be sent to
the location so instead we attempted to fly them to a quarantine unit elsewhere. To add to the insanity, the only plane that was
capable of transporting an ebola patient could only transport ONE passenger at a time. I'm pretty sure that's the
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You do realize that Medicine Without Borders was able to contain the Ebola epidemic with not much beyond plastic sheets, gloves, goggles and bleach. If they had a couple of C17's with pallets of that stuff and the buy in from locals who are still stuck in a witchcraft-based culture they could have done much better. High tech pods really weren't needed.
Pretty much all of the epidemic infectious diseases can be treated similarly. What is needed is a long term commitment to the issue and some way to get th
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That's the point everyone keeps missing. We don't need some high tech pod with a billion circuits and electronics, we need modular low-tech pods with diesel generators, solar panels, and sanitation facilities. People keep trying to throw technology at places like Africa... this isn't star trek. We don't have replicators and magic wave-this-to-fix-it beams that can maintain high tech stuff without any local support infrastructure. Anything going to something like the Ebola outbreak needs to be fixable with d
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I think they should model it on the Red Cross which has extensive protocols for equipment and people to respond to a disaster. They also have pre-positioned supplies in areas where they have a likelihood of disaster.
The WHO is not prepared or organized to do this but the Red Cross (just down the street in Geneva) is so perhaps the WHO could take a walk down the hill and learn from them.
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The number one concern is to limit contamination, so quarantine should be as absolute as possible.
Many health professionals think this is one of the dumbest things you can do. Strict quarantine policies discourage people from reporting infections, and cause people to flee at the first sign of trouble, so they can get out before the quarantine cordon is in place. During the ebola outbreak, some quarantines were imposed, and, in hindsight, they are regarded as a mistake. As people flee, they are crammed onto crowded buses, deprived of sleep, exposed to the weather, and dispersed far away from the healt
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Interesting. I was not aware that there was a debate about the practice of quarantine. The idea of "moving" infected, or possibly infected people certainly seems counter-intuitive.
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Interesting. I was not aware that there was a debate about the practice of quarantine.
You didn't hear about the political backlash over the NY and NJ quarantines, that were imposed to deal with the zero infections that occurred there?
The idea of "moving" infected, or possibly infected people certainly seems counter-intuitive.
They idea that broad and draconian quarantines cause more people to move, also seems counter-intuitive, but it is true. Limited quarantines of actually infected people, that are being effectively treated, usually makes sense. Going beyond that is generally counter-productive.
The best way to stop ebola is soap, not draconian quarantines.
ebola (Score:5, Insightful)
The major reason why ebola was able to grow was simply poor basic health care practices in some countries. Simple rules, like not touching dead or sick people, and washing your hands regularly would have helped a lot more than "databases" and "global warning and response systems".
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Washing hands? These primitive savages still haven't figured out that you should keep human waste in a central location far away from your water supply and that you shouldn't bathe in water that you're later planning to drink.
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It is not reasonable to expect people to not touch dead or sick people and it is absurd to think that proper hand washing would prevent the transmission of Ebola. Ebola is primarily a caregivers disease because the people most likely to get it are those caring for someone near t
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It is not reasonable to expect people to not touch dead or sick people
If the consequence is that you'll catch the disease and end up with a serious chance of dying yourself, it's a very reasonable request. And when people refuse to follow such basic advice, there's little hope that a "global warning and response systems" can save them.
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It is not reasonable to expect people to not touch dead or sick people and it is absurd to think that proper hand washing would prevent the transmission of Ebola.
Sure, it's reasonable. And proper hand washing doesn't have to completely prevent transmission, it just has to help reduce new transmissions to below the point where exponential growth in infections occurs. Through these means, exponential growth of Ebola has ceased in West Africa.
Many just don't take it seriously. (Score:2)
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Probably not. Consider that most countries in Africa are run by some very corrupt mofos, up until recently Ebola was something that only happened in some isolated village, and logistics can be a nightmare when the port/airport authorities all want bribes before they allow you to bring your stuff in past their little checkpoints...
Wait: BillG hates America? (Score:1)
He clearly suggested spending less on Defense Dept and more on socialist anarchist anti-American [[sarcasm]] !
We can't have that now, can we?
Re:Why should we care? (Score:4, Insightful)
I am going to post a devil's advocate question, because there are people who will ask this:
Why should we care about an epidemic/pandemic in some other area of the globe?
Two words: Global Travel. Some dude wanting to flee that epidemic may have just enough resources to hop a plane ride or two, to get to safety with his relatives in the US... ...and we get to find out that even he didn't know he was infected until he landed and started spreading the love on US soil.
It's already happened once (that we know of) during this last one.
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because the larger an epidemic grows the more expensive it is to deal with and the greater the chance of an infected person escaping and starting an outbreak elsewhere. The ebola epidemic got big enough to suck badly for the three main countries involved and there were a few minor outbreaks in other countries but fortunately the outbreak was contained in time to avoid any signficant outbreaks in the rest of the world.
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Why should we care about an epidemic/pandemic in some other area of the globe?
To make the world a less shitty place for people. I'm sure we can look a bit farther than just our own navels.
FDA-as-disease-process (Score:2)
The vast majority of drugs should be fast track. The number of deaths that occur with letting a drug out early (before full problems are realized) is vastly smaller than the numbers of deaths that occur because drugs are held up ten years.
The FDA is built on a mathematically false premise. But you konw, a dead guy from some drug, boy can those politicians decry "unconscionable profits".
How many are standing up to decry the ten
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DES was approved by the FDA, so clearly the FDA was not helpful in preventing the drug from reaching the market.
Thalidomide was not approved by the FDA primarily due to bureaucratic delay. While the FDA doctors would not approve it as they were waiting for evidence it was safe and effective, they would have approved it eventually were it not for the birth defects that starting showing up in other countries. Drug testing protocols simply did not test pregnant women. I.e., the US was largely spared thalidomid
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W. Africa needs: hospitals, physicans, equipment (Score:3)
He concludes the article stating:
run the course (Score:1)
Nor will we ever be (Score:3)
We will never be prepared for a global epidemic as long as anti-scientific morons are able to influence and/or dictate policy.
For example: The vaccination efforts of the last century have effectively been wiped out thanks to the idiotic anti-vaxxer movement, causing measles cases to surge, and are continuing to increase. I'm planning on talking to my doctor about the possibility of a measles booster just to keep my family safe.
And then there's the whole Thimerosol thing, which single-handedly destroyed our ability to easily distribute vaccines en masse. All because some assholes with zero chemistry knowledge freaked out because there was a mercury atom in the molecule. It doesn't occur to these people that if they took common table salt and consumed their component elements, your body would dissolve, punctuated by explosions.
So no, I expect that we are going to see more and more small epidemics of various diseases, and it's probably going to get significantly worse, all thanks to uneducated morons who think their ignorance has the same weight as hard-won knowledge.
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While it's terrible that there still measles cases out there, they still remain statical NOISE. They are few and far between even when compared to obscure diseases you have never even heard of.
The overall goal of vaccination is still in effect. For the VAST majority of people, anti-vaxxers are IRRELEVANT because pretty much all of the rest of us are vacinated. Those vaccinations don't just innoculate us from the disease but they also innoculate us against the stupidity of the anti-vaxxers.
That's why I see l
those anti-vaxer idiots (Score:2)
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Of course, the fools that want to protect their own children from the dangers of vaccines are just idiots and no harm ever comes from vaccines, so don't question why the government is collecting hundreds of millions of dollars into a compensation fund.
Instead of adding it all up, you should consider that it's still only $2.25 per shot, which puts a limit on what they expect to have to compensate per child.
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Actually, there IS a very good reason. It's called insurance, because shit happens. There will be a small segment of people who react badly to vaccines, because there are small segments of people who react badly to all sorts of ridiculous things, from onions to sunlight.
Unfortunately, a majority of these people don't even know until AFTER they've already been exposed and go into anaphylactic shock or worse.
But the benefit to getting the entire population vaccinated is so overwhelmingly great that the idea
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What citations could you possibly need? Haven't you read the news at any point in the past several years?
Large swaths of North America have had almost zero cases for a couple of decades. And in the course of the last decade or so, we've gone from that to vilifying disneyland for being a disease vector, and clumps of outbreaks have been appearing in various major population centres, especially around those where the anti-vaxxer movements have been highest.
I'm not going to waste my time spoonfeeding you inf
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http://lmgtfy.com/?q=rct+mmr [lmgtfy.com]
Anything else, smartass?
Deployed quickly? (Score:2)
But (Score:2)
With the help of Microsoft Surface Tablets running Microsoft Windows, connected to Microsoft Windows Servers and running Microsoft Windows Apps will fix everything, trust Bill, just spend the money and he will magically fix everything....
Moving people? WTF? (Score:2)
"...few organizations are capable of moving thousands of people, some of them infected, to different locations on the globe"
Why in the hell would you want to move infected people to different locations on the globe? Furthermore, why would you move '1000's of people together when some of them might be infected? Putting a few sick people on a crowded bus or a plane is a great way to spread disease.
The typical response to a disease outbreak is quarantine because you want to keep the infection localized and
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To spread the disease. He has already managed to get the virus "Windows" onto almost every PC -- for this he has also shipped thousands of infected CD-ROMS across the globe.
Now his next target are humans.
How in the world has Gates become an expert? (Score:2)
Resources would help (Score:1)
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I bet the maintenance(and fuel) cost of an aircraft carrier is 10x what is would cost to set up and maintain emergency sites in 99.9% of the world.
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A towed mega boat. Not the most efficient means of travel. Certainly not something you want to wait on when you are trying to get ahead of something quickly.
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US fleet carriers are not tremendously fast. There's been a tremendous amount of nonsense written about it. The reactors aren't that powerful, and no matter how much stuff you put in the hull all that energy has to be transmitted through the screws into the water. Look at the propellors, folks, because that is a genuine bottleneck. They don't expend fuel as such, being nuclear powered.
What they can do is maintain nearly full speed pretty much indefinitely, while other ships would spend a tremendous a
Bill Gates sponsors quackery (Score:2)
Speaking of epidemics, there is that HIV epidemic in Africa. And how does the Gates Foundation help? By promoting male genital mutilation, aka circumcision -- which is damn well proven to be completely useless to prevent HIV infections. [circumstitions.com]
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And he's a giant hypocrite, he invests his money into bad companies that f**k the world up and then acts the saint trying to make the world a better place with the interest.
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Your circumstitions.com website belongs with the anti-vaxers and flat earth societies.
Please, try a Google search and pick a reputable web site such as this:
http://www.who.int/hiv/topics/... [who.int]
From the WHO:
"There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. WHO/UNAIDS reco
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Now here [circumstitions.com] is an explanation of why that study is simply worthless, why that "60%" number is meaningless, and how, even if it was absolutely correct, it would mean 56 circumcisions would be necessary to prevent a single case of HIV infection, and it would still fail to prevent another case -- whereas giving everyone condoms instead would have prevented both cases.
We could do better (Score:2)
As much as I hate to agree with Bill Gates, I do think we could do a better job when it comes to handling epidemics.
BTW, a "global epidemic" is called a pandemic, but perhaps that's splitting hairs.
Anyway, an epidemic can turn into a pandemic pretty quickly these days, so we need to be more nimble.
uhhh....good? (Score:2)
>> few organizations are capable of moving thousands of people, some of them infected, to different locations on the globe,
Isn't that a good thing? I mean Quarantining is a good idea right?
Narcissism and Sociopathy (Score:2)
Narcissism and sociopathy are probably the most harmful diseases currently known to man, leading directly to wholesale slaughter, destruction of the environment, rampant poverty, etc. The sooner that we can put people like the referenced into a controlled medicated environment where they can no longer have such a negative affect on the world the better.
Worst pandemic of all (Score:1)
Microsoft Windows. Solve that (AKA Linux bug #1) and the world will be a better place.
Gates in NEJM (Score:1)
Longer piece [nejm.org] on same topic for different audience in the New England Journal of Medicine.
Re:Gates? (Score:5, Insightful)
Perhaps because gates primary focus has been charity and philanthropy for almost as long as he was in the microcomputer game.
Why was this flagged -1? Bill Gates is president of one of the largest organizations helping to fight disease in the world.
He has as much validity as the president of Red Cross or any other large relief organization. This is why his opinion
matters. He's also uniquely positioned where he can help bankroll what is needed if necessary where most other large
relief organizations would have a much harder time changing their focus.
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-1 disagrees with established opinion
You can't point out the good qualities of a perceived villain here without down mods
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No. We just don't buy the whitewash. It's a really old trick. It's like anything else the guy ever did. He just copies things that other people have already done. He usually does so badly.
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so then we should discredit any good he tries to do simply because HE is the one trying to do it?
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Not "discredit", apply a suitable amount of skepticism.
He's a medicore talent at best in his own chosen field. He is mostly notable for being more business oriented than his rivals and being much more ruthless.
He is by no stretch of the imagination an "expert". He's more of the typical "pointy haired boss" or the PHBs boss.
At best he's a figurehead and real leadership comes from elsewhere.
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Perhaps because gates primary focus has been charity and philanthropy for almost as long as he was in the microcomputer game.
Yeah, and his efforts have been similarly helpful....
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Perhaps because gates primary focus has been charity and philanthropy for almost as long as he was in the microcomputer game.
Yeah, and his efforts have been similarly helpful....
Agreed, both are very respectable efforts, although not perfect in hindsight.
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Why do people give credence to anything this guy says, beyond Microsoft, or more generally, microcomputers, I'll never know.
Maybe because of the vast amount of charity work he has done in the past two decades. His work (not specifically himself but experts that work for him) on malaria, HIV, vaccines worldwide, and other huge issues here and in the third world.
Even if you hate Microsoft, why would you completely ignore his charity work?
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It is mainly to trick gullible people like you into believing that doing charity is a positive trait. The kind of people that are most loathable are the robber barons who then try to cover up their past tricks with doing things 'for the good'.
And US charity is paternalistic, it is always done with disdain for those who receive it.
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If only Bill Gates was a Billionaire, then he could spend money to implement his ideas instead of criticizing others.
I fail to see why he deserves this. He is asked what he thinks went wrong with the Ebola crisis. He gives a very sensible answer. That's called discussion. It is essential for a functioning society, and there is far too little of it, as opposed to scare-mongering and partisan sniping.
Perceived and real evils from Mr. Gates' past are irrelevant to this discussion. The man has a sensible opinion, he is in a position to know about the subject, so his contribution to the discussion is valuable. If someone dis