Hi. I've Started Writing A Semi-weekly TB Newsletter, If You're Interested In That Kind Of Thing. Here's

Hi. I've started writing a semi-weekly TB Newsletter, if you're interested in that kind of thing. Here's the second letter--about public-private partnerships, leprosy, and my forthcoming big announcement about expanding access to tuberculosis care. You'll hear more about that on Thursday. Anyway, here's the newsletter. You can sign up here.

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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,

John

I wonder if work just.. got harder in the 2000s, comparatively.

Pro-writing tip: if your story doesn't need a number, don't put a fucking number in it.

Nothing, I mean nothing, activates reader pedantry like a number.

I have seen it a thousand times in writing workshops. People just can't resist nitpicking a number. For example, "This scifi story takes place 200 years in the future and they have faster than light travel because it's plot convenient," will immediately drag every armchair scientist out of the woodwork to say why there's no way that technology would exist in only 200 years.

Dates, ages, math, spans of time, I don't know what it is but the second a specific number shows up, your reader is thinking, and they're thinking critically but it's about whether that information is correct. They are now doing the math and have gone off drawing conclusions and getting distracted from your story or worse, putting it down entirely because umm, that sword could not have existed in that Medieval year, or this character couldn't be this old because it means they were an infant when this other story event happened that they're supposed to know about, or these two events now overlap in the timeline, or... etc etc etc.

Unless you are 1000% certain that a specific number is adding to your narrative, and you know rock-solid, backwards and forwards that the information attached to that number is correct and consistent throughout the entire story, do yourself a favor, and don't bring that evil down upon your head.

Being a writer is saying you're going to write and then doing literally anything else

there’s a website where you put in two musicians/artists and it makes a playlist that slowly transitions from one musician’s style of music to the other’s

it’s really fun

I might have something for you then--

"It's gonna be you or me, Daniel." he whispers, his voice so fucking close. I was beginning to think his knife was more than a courtesy, and the heaving of his chest right behind me made it difficult to focus. Warm, wet blood, slowly dripping down my neck; he was a master of his art, truly, and my limbs grew weak as my weight shifted onto him. His breath, his heartbeat, my favourite sounds, he's warm through all these layers and--

"Raph~" I trace my fingertips along his jaw, underneath his blush. He was cute. "I can't." his earthquake of a growl, deep and soft, surrendering. He halts, taking in my smell, licking off the blood. He's mine, and he knows it, beautifully mine, with me wincing in pleasure, the promise to be good. We will ruin us, someday, but it will have been for love.

i think having a sharp object held to my throat can be very very romantic. intimate. sexy, even. this is because i am normal.