Archives for October 2014

The Future of Global Health

23 min reading time

The Future of Global Health

Reading Time: 23 minutes


Enjoy these two important recaps from the 2014 10x Medical Device Conference.

The first is from CEO of Infinitum Humanitarian Systems Eric Rasmussen, MD, MDM, FACP who helped the Medical Devices Group understand the depth of the challenges to global health.

You really have to watch his talk (some of the images will take your breath away) for the full impact of the presentation and please share it on social media and with your colleagues.

Click to see: Who’s speaking at our 2015 event in San Diego?

In the second, Terry Mandel and Alberto Rodriguez-Navarro shared their stories of designing, selling, procuring, and using medical devices in low-resources settings around the world. Eric Rasmussen joined the panel to answer questions.

This talk begins with an overview of the enormous market, the cost of unaddressed needs, the stark challenges, and the abundant opportunities to grow bottom lines while improving health access for billions of under-served patients.

I’ve included the transcript to Eric’s presentation to read here, if you prefer.

Eric Rasmussen: The opportunity to be here is very nice, thank you. And just in case nothing else I have to tell you is of any value whatever, Parlan published that. And I’m going to show a couple of books and pamphlets today, and there is one, and if we stop right there you would have something that would probably give you a little bit of value, and so my day is complete.

And by the way, we didn’t talk much about it but I am a physician, Internal Medicine, Critical Care, used to be director of an ICU, used to be chairman of a Department of Medicine and all that stuff, and do other things now, like look at research like this.

This is the other bit of information that I hope you’ll take away with you. We’re talking a lot about smartphones and how we’re going to use their apps and so forth and so on. University of Surrey did an immersion of the cellphones that were in their students’ pockets into car keys and a couple of other kinds of things, and then just let it grow. So that’s what’s currently sitting on your cellphones. Yippee.

Okay, so we’re going to talk a lot about infectious disease, but not quite yet. We’re going to talk about this first. Is that not a gorgeous image? There are so many reasons for going into space, I agree with Elon Musk, but that is super typhoon Haiyan which, when Daniel and I last saw each other back in November, was approaching Palau.

It leveled the Island of Palau and continued in. And while Palau was uncommunicative because they were trying to pick themselves up out of the sand, it hit the Philippines and, of course, that got global attention.

So nobody paid much attention to Palau, which was every bit as badly hit as Leyte Gulf. It was a spectacular storm with consequences that look like that. It was the fourth strongest storm ever measured on planet Earth. It was the strongest storm ever measured at landfall and it had consequences, of course.

See the 2015 speakers and agenda

See the 2015 speakers and agenda

I took a team in to Manila staging, then down to Cebu City, and from there through the blessings of the Royal Australian Air Force into Tacloban, and from there down the Leyte Gulf on the Western Shore, and the place was very, very broken.

Out of that came some decisions with the Roddenberry Foundation—those are the Star Trek people, the Star Trek franchise, Gene Roddenberry was the creator of Star Trek—to put together a disaster response team on a permanent basis to do some particular things that I’ll talk to you about in a minute, but first you need a little bit of context.

Because while we are sitting here being medical device people, and I did spend the nine years at DARPA as a principal investigator and did have a lot to do with medical devices and had huge fun, many things where I play these days have nothing digital within them. I took that photograph. That is Banda Aceh, and there are on the order of 35,000 bodies between us and those hills in the background.

So, many, many, many things did not work. We’re going to go on and talk about them a little bit because the vulnerabilities related to that are something that I think, in your designs, you need to keep in mind.

By the way, I’m a big fan of digital art, digital abstract art, so you’ll see a little. Otherwise, people would commit suicide after my talks.


Eric Rasmussen: So, if you take a good look at China, India, Southeast Asia, you have more people in that little circle than on the rest of the planet. That means that there hasn’t been much opportunity for infrastructure to be built to take care of those people when that’s required, and in fact, it really is required. Say the last seven years or so, we have been mostly city, less urban, less rural, for the first time in human history, and because there has been such a migration into cities, very little infrastructure has been built. People who live within those communities are highly vulnerable and they’re going to get more so because this is where we’re going. The 9 billion people that you’re hearing about in 2050 is probably a pretty good estimate. That’s [00:06:43] human habitat in 2010, the best one we probably have, but 95% of the 2 billion that are going to appear over the next 30 years or so are going to be in the developing world, mostly in the cities of the developing world, mostly in the slums of the cities of the developing world. You’ll notice that Europe and Canada and the US and Japan are actually dropping in absolute numbers. Everything else is going into these cities, in places that we don’t yet know very well.

The consequences look like this. You heard Daniel mention earlier today that William Gibson, famously back in his MPR interview in 1993, said, “The future is already here, it’s just unevenly distributed,” and we in this room often think that it’s going to go from the big beautiful buildings and flow into the shacks and that’s probably not true. At least for historical precedent, there’s nothing to say it goes that way very fast. In fact, the inequality, as you’re well aware, is becoming more striking every year. So a lot of what’s happening over there on the left side of the screen is likely to be encroaching our way if we want to use it [00:07:55] as an hour.

And here’s the first of a couple of eye-watering charts but it’s important that you get the point here. These are the top 20 population centers on the globe as of about a year and a half ago, probably still true, and over here on my side where it says annual growth is how much it’s increasing annually in each one of those population centers. And because all of us have forgotten the rule of seven days, I’ve been kind enough to put it over on the right-hand side so that you’ll understand what a doubling time is for a given annual growth rate. You’ll be able to use this in your portfolios. So what you have there is the recognition that every place with a black check mark, which you might consider in the developing world that’s a little soft, um, is substantial, right? That’s an awful lot of population centers in the developing world.

The big numbers with the red circles show that between about 15- and 30-year doubling times, places like Karachi at number 13 is going to be larger than Tokyo, is now if not checked in some fashion, and there are an awful lot of ways that population growth in Karachi could be checked, most of them extremely unpleasant. So just a heads-up there.

The green arrows, you’ll know, they’re the developing world, and they show the fact that there’s a leveling and probably an absolute reduction in population in those countries. Certainly, that’s true for Moscow at number 18. The reason there’s any growth in Moscow at all is because there’s migration from the rural to the city. Russia is depopulating in a fairly impressive way. That’s what we’re talking about some other time because there are going to be consequences to that that we’re watching right this week.

Infant mortality. Just since we’re docs in great part here, for those who have not kept track of how we’re doing, the Millennium Development Goals have actually done okay in a couple of places. You may not be familiar with the term, we won’t get into it much here, but if you look over on the left side you’ll see that Monaco is doing wonderfully. If you want to ensure that your child lives, be Monacan, and if you want to think that your child has a one in five chance of dying, Afghanistan is your place.

Interestingly, I’m going to show you some stats in just a second about what’s really happening in Afghanista
n to that mortality, but you’ll notice that Afghanistan is almost twice as bad as the next nation for infant mortality. It’s stunningly bad, and there are a couple of interesting reasons.

And speaking of Nigeria and the capture of schoolgirls, I made this side a little bit smaller than the far side because I wanted to capture Nigeria down there at the bottom, because right now about one child in 14 dies in Nigeria, and if you don’t think that is leading into some of the emotion around the Boko Haram abductions, you might be overlooking an important social point. And by the way, we’re 47th. Don’t get me started.

So, MDGs, Millennium Development Goals. Now, that’s intended to be impossible to read except for the people in the front row that have their glasses on, but what it really says is that for all of those green arrows over on the right, since 1950 and roughly 65 years or so, they have managed to cut their infant mortality rate in half. Even these incredibly horrible places have managed to cut their infant mortality rate in half. That’s more reduction in infant mortality rate in the last 60 years than in the previous 1500, so not so bad.

You’ll also note that for the ones with the red circles, they’ve had wars. They have still managed to reduce their infant mortality. However, you’ll notice that during their wars, their infant mortality rate goes up. Really clear correlation. I didn’t want to make the chart. I wanted to just see that you see the raw numbers, but they’re cool. War is bad for children and we knew that. It is possible to take a truly horrible place and make things a little bit better over time. We kind of knew that.

And Afghanistan, although admittedly horrible for their infant mortality rate, is a hell of a lot better than they used to be and there has been a consistent reduction every decade. So, these things are achievable. This is stuff that is worth doing because good stuff happens and we are a nice example of that.

Take a moment to let this sink in. If you were a white male born in 1900, your life expectancy was 47. By the time it was the turn of the millennium, if you were born a white male, you had a life expectancy about 60% longer. Again, that’s more than we achieved in 2000 years. If you were a black male in 1900, you had a futile life span. Your life expectancy was 33. Now, mind you, much of that was skewed by the infant mortality rate in the black population, no surprise there, but still, amazing figure and look what happened. One hundred years later, we have doubled the life span of black males in the United States. That has got to be worth at least comment. It is possible to make social changes, to make public health changes, to make fairness and justice changes and have a real impact. Congratulations, everybody involved.

Disasters is kind of what I do for a living. I work in slums. I work in natural disasters, industrial disasters. I have shifted out of clinical medicine into kind of upstream stuff. Those things have happened just in the past three-odd years. Super typhoon Haiyan you heard a little bit about.

The Russian heat wave. How many people died in the Russian heat wave between 15 June and 15 August 2010? How many people? Give me an order of magnitude. Oh, you people, I’m never feeding you before my talks again.

So, 55,000 died in the Russian heat wave in basically two months. As many people as the United States lost in the entire Vietnam war died in a heat wave in Russia. By the way, the wheat fires that are right above that – also obviously a part of this cause. They lost about one-third of the Russian wheat crop, which spiked prices all over the globe and sparked eventually food riots.

These are very complex systems that are worth studying and not many people do, but some do. Queensland floods were also complicated. The Pakistan floods, how many people were displaced in the 2010 Pakistan floods? I’m almost deaf, by the way, so I’m going to need you to yell at me, what?

Woman: One million.

Woman 2: Five thousand.

Eric Rasmussen: [Laughs] Twenty million, almost the population of California, was displaced from their homes for an extended period of time. So, clearly things are getting a little rough out there.

This is a paper that was published—it actually was an abstract in nature, it originally came out of Ecology and Society from the Stockholm Resilience Institute and they did a beautiful job with this—and they decided that climate change was just too politicizing a term, even though it’s absolute truth in any important fashion except if you can’t do math cause you skipped fourth grade. Climate change they did list as one of the nine planetary boundaries because the planetary boundaries are for our survival. The earth is going to continue, obviously, but if we intend to be a part of it actively, ticking along normally as we do, we are testing a number of systems that we need to fuss with.

For example, the nitrogen cycle has already been exceeded in any reasonable boundary. Biodiversity loss is as you know the Sixth Mass Extinction, you guys all know that. But down there in the corner, global freshwater use, you’ll notice that yellow is not too far out there. However, there’s worry. Some of that worry we saw last Tuesday with the publication of this, right?

This is the US Government’s official study. This is the thing that president Obama was talking about last Tuesday. It is well worth reading and I recommend it to you because as medical device people this is going to affect you a little bit in all kinds of interesting systemic ways.

Here’s one that may not affect you directly but you got to know about because, especially if you want DoD contracts or HHS contracts or DHS contracts, national security is going to be affected by water security, and the CIA wrote about that in a 2003 report that said water wars 2015, and I think they probably nailed it beautifully.

The Syrian War that is going on right now has some interesting root cause analysis that says it started with a drought, an unprecedented Syrian drought that caused farmers to lose their herds, lose their crops, move to the cities, get no care, get angry, and the spiral begins. That is a gross oversimplification, I grant that, but it is a component that is not often recognized. Drought helped spark the Syrian War.

And that’s really unfortunate because for those of us who need to work with these populations, there are a million people that weren’t in Lebanon before that are there now that have lost everything. Lebanon is not capable of managing that number of people, has gone to UNHCR. UNHCR, United Nations High Commissioner for Refugees, has said, “We’re a little tiny organization. We were originally designed for much, much less than what we’re being asked to do. We have 15 million to take care of around the world. We can’t help you very much.”

So, the consequences are a health spiral into the abyss in the camps that are in Lebanon, in the camps that are in Turkey, and in the camps that are inside Iraq, of all places. There are a lot of Syrians that went into Iraq, just a heads-up, not many people know that. And one of the reasons we don’t know it is because we can’t track public health very well anymore.

Laurie Garrett with the Council on Foreign Relations, Pulitzer-Prize-winning journalist several times over, wrote a great book that is about the size of my pathology textbook at Stanford that is called Betrayal of Trust, and it’s a careful documentation of the decline of global public health in part for disease-specific reasons, in part for financial reasons as people began to concentrate on other things, and probably that’s a pennywise, pound-foolish decision over time.

I took that photograph of the woman who worked for Grameen Kalyan in Bangladesh, and she taught me quite a bit about how things w
ork in Bangladesh. She is the only community health worker for five villages. She visits every one of those five villages every single day of the year. She is profoundly dedicated to her job. She’s very good at her job and her resources are almost zero. She’s on a bicycle and she’s got a 2G phone.

So what she’s dealing with is different to what we’re dealing with. We’ve been very successful. Lots of things that used to be disturbing for us have gone out of our public consciousness, even to the point of people deciding not to vaccinate because it’s more natural to be natural. Again, arithmetic, but those successes which are worth celebrating in so many ways are not echoed outside of our borders. So I could’ve put a number of things on this slide and chose these. The ones in purple are in the news today as of yesterday. We’re all talking about MERS. We have the second US case.

We’re looking at the Ebola outbreak that MSF says is unprecedented and a new strain and has moved into areas where Ebola has never been seen before. And of course, we’re very familiar with totally drug-resistant TB. Started with a cluster of 12 cases in South Africa, is now in nine countries, I’ve forgotten, but it’s very, very bad news. And NDM-1, the New Delhi metalloproteinase that is the plasmid-mediated resistance factor that is doing all kinds of very bad things to ensure that nobody can never use antibiotics again. Okay, that’s a little hyperbole as well, I’m sorry.

Zoonotic diseases, 75% agriculture and livestock pathogens. An awful lot of people—I took this photograph too, this is in Cambodia—an awful lot of people don’t recognize the dependence of that massive population in Southeast Asia, India, and China on livestock, home livestock, the stuff that is underneath the house. So here we have H5N1, H1N1, and normal influenza all kind of clustered around the garden, right? The pigs and the chickens live one level up with the woman and her husband and her two children. She’s a very nice lady. She is raising them for food, not for market, because she has lost her husband. He is now off somewhere in Dubai doing remittance labor and she hasn’t actually heard from him for a year or two, so he may well be dead. But this is what we’re talking about when we look into infectious diseases and their transmissibility from a zoonotic cause. There is an awful lot of mixing going on day-to-day.

And then there are the people who make it extremely difficult to recognize that they are from the same planet. This is a terrific group of people that have been agricultural and pastoralists, very light agriculture and pastoralists across Somalia to Kenya to Sudan to Somalia and they travel with the seasons. They travel with the herds.

They speak no language that any one of us was able to communicate within, and I have no idea what’s going on in their head as I tried to approach them for micronutrient deficiencies, for generalized malnutrition, for dehydration. It’s very difficult to communicate. That’s not a tiny fraction of the world. You could find these populations in Papua, New Guinea. You can find them in Bolivia. You can find them in Southern Brazil. Just a heads-up when you’re looking at devices that are trying to treat people that are not quite like you.

And here, a bunch of people who are very much like you, they just happen to live in Rio de Janeiro. This is [00:23:29], one of the Favelas, bless you Daniel, and it’s tough to live in that region. And when you look at medical devices and where they need to work, there are hundreds of thousands of people living in places like this in individual cities around the world and delivering care is tough, but you need to deliver that care because on any given day, at least according to Grameen Kalyan in Dhaka, a place I’ve spent quite a bit of time now, one person in three has something diagnostically wrong. It could be parasites, it could be diarrhea from a waterborne illness, it could be any number of things, but one person in three is sick if you listen to the Grameen Kalyan, which is the medical group for Grameen stats.

So you do have people who are not far away. I took this photograph not 15 miles from that last one. You do have people who are smart, eager, very willing to help, completely professional, dedicated to the task, and again, zero resource. So when you’re talking about medical devices and what you’re going to do for this population that is burgeoning and will be your market, please keep people like that in mind.

Unfortunately, Thailand, which has been a poster child for success in Southeast Asia, is on the edge of collapse. I don’t know if you are tracking what’s happening down there but I worked a lot in Bangkok, and a lot of people that we all know work in Southeast Asia, and Thailand is kind of the stable place where you go, until now. A judge has just removed the prime minister. There is fighting in the streets. There will soon, I think, be blood in the streets. And when you don’t have a functioning state, public health is one of the first things to go. That includes down to the clinic level in the villages that don’t get resupplied, and none of them have power because fuel doesn’t move. So, a heads-up on medical devices.

And then, sometimes if you’re lucky, you manage to gather everybody who needs care together in one place. This is Dadaab. Dadaab is a Somali camp and as a consequence of that camp, the lensed aquifer, the water supply for that camp is dropping a meter a year. It was intended to house about 30,000 to 35,000 people and two years ago it became the third largest city in Kenya, something like 750,000 people, nobody is quite sure. The Kenyan Government did not allow us to put Dadaab where we needed to put it, nearer fresh water source. They said, “No, our people need that.”

And by the way, we hear this all over the world, “Your people can have this piece of shit place that nobody cares about and you guys make it work.” And that’s exactly what happened with Dadaab.

And because it’s a lensed aquifer, a non-recharging body of water underneath the ground, the little rainfall that does fall does not refill that aquifer, and we’re trucking. And trucking for a camp like that is a lot of water, a lot of fuel, a lot of expense, and people are not willing to keep that expense.

But if you send those people back to where they came from in Somalia, which is a nonfunctioning very dangerous place, that’s called refoulement, and it’s against the law, International Humanitarian Law. You can’t do that. So they’re staying but they will not be allowed elsewhere in Kenya because Somalis and Kenyans don’t get along. So the Kenyan Government has no intention of letting 800,000 Somalis kind of wander about. Understandable, but this is the choice that was made and I’m looking for solutions by the way.

So we call these things these days “compound crises” where you have each of those things that are either physical or they’re behavioral or they’re circumstantial or they’re demographic and the result in many cases is emerging infections. Tajikistan has a remittance population that goes up into Russia. The males 15 to 35, 15 to 40, go up into Russia. They work day labor jobs, then they come back down again in the wintertime. In the meantime, they’ve made enough money. When oil prices were 130 and above in Russia, there were lots of construction going on, plenty of day labor, lots of remittances. When oil prices crashed for Gazprom and not at Rosneft and the rest, the day labor stopped, the construction jobs stopped, petty theft began, people got thrown into local jails and then deported. In the jails, they picked up IV drug abuse, HIV, and multi-drug-resistant TB. When they returned to Tajikistan, because Tajikistan used to be a Soviet State and is now kind of semi-independent, they can support the center, Dushanbe, for medical care, the big medical centers. They ca
n support the tiny rural clinics. They can’t do anything in between. So where the care used to be given for long-term chronic diseases and acute infectious diseases, that later is gone, which means the multi-drug-resistant TB is getting partial treatment at the clinics, they kind of get referred, they kind of go back and forth, and is becoming totally drug resistant. Food for thought.

So my teams put together some thoughts on what a Maslow’s hierarchy might look like for this kind of thing and we got that kind of [00:29:08] butter bottom, water, energy, food, and it kind of builds to something like political stability, because if you don’t have political stability, even if it’s a lousy government, you cannot get systems to work very well. Now, somebody in the room is going to say, “Well, actually, Somalia works fine.” You’re right, Somalia is the exception that proves the rule. They have been traders for 3000 years and they know how to make stuff work without a central authority. Not many other places do, and you get stopped at the border of customs, there are checks, you bribe everybody, there’s violence, you can’t count on things from point to point, and there is often a gender bias in these locations that make it very difficult for women to work effectively. Women are a large portion, of course, of the humanitarian response community, and so you wind up with exceptional problems.

In looking at how to approach those kinds of decisions, we go to data. And by the way, I just had to share that photograph with you because I thought it was spectacular, but it’s not spectacular unless you know what it is. That’s a candle that’s just been blown out. So that’s the smoke from a candle and the particulates with their birefringence. I just thought that was gorgeous. So, we’ve talked a lot about big data. We will talk about it a little bit for just a moment or two here. We use OpenStreetMap quite a bit, and because that wasn’t enough—we had all of those other 18 categories you saw in the Olympic rings—we needed to do something different. So we formed this thing called the World-Wide Human Geography Data Working Group. Odd acronym, very awkward, I would much rather we had something with a vowel in it, but that’s what we have. So, we call it wigwig, my wife calls it the pollywogs, and we’re not going to get into that. It’s a long marriage.

So we have with that group the ability to put together some tools that allow us to collect some data so that we are ready to respond in the various places that look like they’re at high risk. We have created something called a human security taxonomy, and I need help with that because it is 897 data elements that we as professional disaster responders have determined we need at the site of a disaster. So if the minister of the interior were to meet my plane on the tarmac and take out this 64-gig thumb drive I have in my pocket and say, “This is what the place looked like before it got broken. Here’s your transportation, your communications, your water supply, your ISPs, your Internet dropdown spots, your fiber optics, your fuel depots, your food storage,” that’s what the human security taxonomy is.

So we have iterated about nine times on that and we’ve got it pretty stable right now and I’m looking about…looking to visualize it out of the database design that is being worked on at the moment by the University of California at San Diego. AntZ’s visualization tool done by Dr. Dave Warner, some of you in the room may know him, MD, PhD, Neuroscientist, and there is value in everything that you see there but it’s tough and we could use some help.

Here’s another effort that is going on in big data. This is called Global Pulse in the Office of the Secretary General for the United Nations run by a guy named Robert Kirkpatrick. They are watching around the world for things before they get acute so that we can have relief prepositioning and intervention capabilities put in place to see if we can stop things from getting as bad as they might otherwise. We don’t know how to do this very well yet and we welcome some help.

And for those people that don’t keep track of what bad things are going on in the world, people are doing this for you. There is one. This is out of the National Academy of Sciences in Japan. BioCaster is the best I know of, although there are a number of others including some here in the US that are excellent, like HealthMappers and ProMED, but in that case you can dial all the way down into the reports and get quite a bit of information. It’s updated very frequently.

The last thing I want to talk about is some of the basics associated with the supplies and what we need to do to ensure that what we need can be delivered. The Government of Qatar has decided that they want to become food-secure for their nation. At the moment, they import 97% of their calories for their nation. They want to become food-secure, all of those calories from internal by 2030. So they’re going in this direction, and if anybody wants to know more about how they intend to do it, it’s a five-step process. It’s very cool. It requires lots of sensors that have not yet been invented and I’d be interested to hear anybody with ideas. I talk with them fairly frequently.

And the other thing I wanted to show you was water. I took that photograph. I was the joint task surgeon for Katrina, for the US Navy, and we had a lot of logistic support getting response in New Orleans. That’s what water looks like. That broke down in Tacloban in super typhoon Haiyan and my team wound up running out of water. And UNICEF, those would be the water people, also ran out of water and they shared the last third of a 5-gallon Jerrycan between their team and ours for the 12 hours before the flights got in. So, we decided that it would be really good since we had lots and lots of water onsite that was, of course, completely undrinkable as you can see—that man is carrying very bad water indeed—to fix this. So the Roddenberry Foundation that I mentioned earlier and this technology, although there are a number of them – we happened to choose this one for several interesting reasons mostly related to power consumption in addition to the fact that they’re just efficacious. That’s a 3-liter bag. There’s a mesh nanomaterial. It’s very, very cool stuff. And we said, “Can you do any better than that?” because that is 3 liters every four hours. Three liters every four hours. They built this, which is 500 gallons a day, because it turns out that the sunlight had frequencies that were appropriate for the nanomaterial photocatalytic mesh, and if you tune the LEDs inside you can get a consistent very low-power-consumption intensification of the water purification process with some microfluidics coming down across the mesh. We thought that looked reasonably rugged and I love the little glowing blue light. And unlike reverse osmosis, the usual thing we have to do in the field, this has zero water waste. Reverse osmosis through a [00:37:06] membrane loses 30% or so of water and it is very low-maintenance with very, very low consumables, altogether a significant, in fact, exponential, Daniel, improvement on the purification of water in the developing world.

That’s the first time the system has ever been used in the field. It was on the Mount Hood watershed east of Portland, Oregon about 48 hours ago. You’ll notice that’s last weekend’s date. And that’s the team from Johns Hopkins, Stanford, Harvard, University of Chicago and wherever I…Tec de Monterrey. And we have the river in front of us. We took contaminated water, ran it through the system, put it in the clean water, tested the clean water, and it’s beautiful. We also filmed underwater. You’ll notice my little GoPro label here. We filmed underwater in the river to show just how bad the water was and it was truly terrible. So…and yet I’m standing here.

So, on the list of things that we can’t do…t
his is for you guys, okay? I don’t do the invention stuff anymore. I spent a lot of time at DARPA, we built some very cool stuff, but I don’t do this stuff anymore. I’m a user, I’m upstream, I’m the guy in the field that’s hoping you’re doing this well. I need that. Some of that, I know, is being done to a field level of capability. Others, not so much. The clean water, the analysis that you see – number two there, the one here in yellow is water canary. That was a TED Talk from Sonaar Luthra two years ago at TEDGlobal in Edinburgh. I was impressed. I was just with Sonaar a couple of weeks ago and there is a little tiny mass spectrometer inside that yellow case, down to the size of a chip. It’s pretty impressive technology. He’s working with Clay Shirky out of NYU who a number of us in the room will probably know.

And there’s a place where a lot of this stuff is coming together. The Buckminster Fuller Institute is one of those locations – the design challenge they hold every year. Another is this, which is LAUNCH. LAUNCH is the most interesting public-private partnership I know about, although Daniel knows a lot more about public-private partnerships than I do. But this is, as you see up there, Nike, USAID, the State Department, and NASA. How cool is that for a pairing? The opportunity to solve problems through LAUNCH looks encouraging. And because it is a federally-funded public-private partnership, everything they discover has to be open sourced, has to be given away, and that’s…I’m on the board now and that’s turning out to be true. It’s what we’re doing. So, heads-up.

So the last thing I wanted to give you…wow, I’m going to be right on time, that’s so cool. The last thing I wanted to give you is some books that I’m finding influential. There’s one. Al Gore takes all kinds of grief for all kinds of reasons. I’m personally a little puzzled about that. He’s very, very smart, very experienced and quite hardworking, working on good stuff as far as I can tell. That’s his most recent book and he did it on mind maps of all things. I would bet a large fraction of us have at some time or another used mind maps. That entire book is filled with mind maps and how each of these problems ramify into something else. It’s quite cool. And I found the sixth that he chose—the Six Drivers of Global Change—to be completely consistent with what we see at Singularity, what we see at Exponential Medicine. This is consistent, and that’s not surprising because he’s on…he’s on…what board is he on? Right down the street…

Man: Kleiner Perkins.

Eric Rasmussen: Kleiner Perkins, right, right, right. So his visibility on new technology and problems that are unfolding is substantial. These are two others that are much less well-known. One is by the man who may become the president of Afghanistan in the next 30 days, Ashraf Ghani. Ashraf used to be an economist at the World Bank. I knew him as he shifted from there out to become the finance minister under Karzai after the fall of the Taliban in 2002. He’s been out there and back and forth. He formed something called the Institute for State Effectiveness based on this book, which was published by the Rockefeller Brothers Foundation. And his partner, Clare Lockhart, was a barrister, originally a little village girl out of Northern Scotland who managed to get to Oxford and then to Cambridge and then to the Temple Bar in London, then became a development economist for the World Bank, and then she turned 28, right? It’s that kind of human. Absolutely superb people who wrote this book about what it takes to get a citizenry to trust a central authority. It’s a terrific book and has great relevance for national security, something that I care quite a bit about after 25 years in uniform, but also for development aid. USAID is a 20-billion-dollar agency and it is an instrument of US foreign policy. I’d like it to be done well. I’d like it to not be wasted. They’ve done a nice job explaining how it could not…could be done well.

The other one, the Polak and Warwick book I gave away as Christmas gifts last year which was published in August – Business Solution to Poverty. It’s entirely possible to make a very great deal of money very fairly by taking care of the populations that are coming up in these places that are extremely dense and rather poor. You can help them get better in very affordable ways and make yourself an adequate amount of money as well, the whole concept of the social business, which is where I’ll end.

If we look at human security, those Olympic rings as a desirable goal, then one of those clearly was related to health and all of them in some ways are related to health, and it’s good business to take your medical devices out into those populations and make them work well. It’s beautiful engineering, science, art, and design—ask Apple, they’re succeeding—and it’s a market of systems, which means anything you touch is likely to have great waves elsewhere. Muhammad Yunus in his 2006 Nobel Peace Prize speech described the concept of a social business: “If you wanted to carve out whatever business you are currently in into a social business, you’ll find that there are tax benefits, there are regulatory benefits, there are financial benefits or complexity benefits, and you’ll have more fun.” I wish you all a lot of that. Thanks very much.


Joe Hage: Thank you, Eric.

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