ROFLing & crying INC.

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In advance of the Big Announcement this Thursday, I made a vlogbrothers video today on how we end TB–with the comprehensive care plan often known as S-T-P, which is short for “Search, Treat, and Prevent.” But one thing I didn’t discuss in that video is the downstream benefits of comprehensive TB care.

Once you’ve hired community health workers to screen for TB, it becomes much easier to screen for other illnesses like diabetes, high blood pressure, and non-TB lung issues (especially lung cancer). TB is notoriously a disease of vicious cycles–a disease of malnutrition that makes malnutrition worse, a disease of poverty that makes poverty worse, and so on–but addressing TB can be a story of virtuous cycles: TB survivors become TB advocates, as I’ve seen with my friend Henry in Sierra Leone. More effective TB treatment leads to less stigmatization of the disease, as communities come to see the disease as curable and survivable rather than terrifying and deadly. And better access to TB care leads to a stronger overall healthcare system, because more community health workers are better connected to more primary healthcare clinics, which allows communities to better address all kinds of health problems.

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Mycobacterium tuberculosis is not the only bacteria of its family that causes a lot of human suffering; there is a closely related species called mycobacterium leprae that causes the disease known as Hansen's Disease, or more commonly leprosy. There are still around 200,000 cases of leprosy diagnosed each year around the world, and while the disease is curable, it also remains–especially if not caught and treated early–a significant driver of suffering and disability in our world. 

There are many connections between TB and leprosy: Not only are the bacteria that cause these illnesses very similar, but patients have often expressed similarities in experience. TB patients who were encouraged or forced to live in sanitariums often compared themselves to lepers. One disheartening parallel between the diseases is that in both cases, those living with these illnesses are often abandoned by their families and must make new social connections within the new community of “leper” or “consumptive.” Also, both Hansen’s Disease and TB continue to exist largely because of systemic failures rather than due to a lack of knowledge or technology.

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I really recommend Dr. Salmaan Keshavjee’s TED talk about how we ended TB in the U.S., and how we can end it using the same strategy around the world.

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Last link from me today: I’ve been thinking a lot about the complex intersection between public and private investment (for reasons that will be clear on Thursday!) and I keep coming back to one infographic in an excellent paper (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256883) about the public money that was poured into the creation of the GeneXpert Machine, which can quickly and accurately test for TB. The GeneXpert machine has created a lot of profit for Danaher’s shareholders, and it has also created some societal benefit, but it could create a lot more societal benefit if it created less profit for Danaher’s shareholders. This tension seems to me one of the defining features of 21st century life. Anyway, here is the infographic:

That’s the money–over $250,000,000 of it–that came from taxpayers (mostly in the U.S. and Europe) to fund the creation of the GeneXpert Machine. And yet, this tech largely funded by the public is controlled entirely by private enterprise. I’m troubled by that model of value allocation, even if I still believe that private money and private enterprise have important roles to play in fueling innovation. But taking a quarter billion dollars of public money and then claiming total ownership over a technology, and using that ownership to deny the technology to the world’s poorest people, seems like a deeply flawed system of resource distribution to me.

I’ll see you on Thursday. I’m nervous and excited.

DFTBA,

In fact, I think that's the reason why I don't want to do it... anyway

If this gets to 30 notes, I do that thing

50 notes, I call to ask if my doctor's appointment has been scheduled (I've been avoiding it for two weeks now)

100 notes, I go wash my shoes that have long needed washing and are just sitting there, existing, waiting for me to deign to wash them.

200 notes, I finish organizing my room (I organized it halfway and then left a bunch of things that still don't have a defined place)

500 notes, I use the things I have to bleach and color my hair. The only thing that has stopped me is the fear of doing it wrong or being too lazy to maintain it.

1k notes, I stop doing things that I know will trigger my chronic pain with the pure intention of confirming that the pain was indeed real (don't do this. 0 recommended).

5k notes, I try some new food without fear of wasting money by buying something I most likely won't like (my autism hates new foods)

10k notes, I wear my bi flag earrings in front of someone I wouldn't usually wear them with. I trust that they possibly wouldn't have a problem with me being bi, but I would never get up the courage to tell them anything

Would love to see some of your favorite D20 quotes commented on here. Make my morning chilling in this bed in the hospital.

"My love, for you are my love; my one true love, you don't need to enter because you're already there, and you don't need to be real because you already are"

"Can't stop being dominant"

The first man says, “I’m here because I criticized Evgeny Prigozhin”

The second man says, “I’m here because I spoke in favor of Evgeny Prigozhin”

it translates to: "Neil Gaiman looks like one of those dudes who would be embarrassed to complain if his lunch order was wrong" (and that's a compliment!)