The Awesome Coffee Club

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A Big TB Announcement

Greetings from Washington D.C., where I spent the morning meeting with senators before joining a panel that included TB survivor Shaka Brown, Dr. Phil LoBue of the CDC, and Dr. Atul Gawande of USAID. Dr. Gawande announced a major new project to bring truly comprehensive tuberculosis care to regions in Ethiopia and the Philippines. Over the next four years, this project can bring over $80,000,000 in new money to fight TB in these two high-burden countries.

Our family is committing an additional $1,000,000 a year to help fund the project in the Philippines, which has the fourth highest burden of tuberculosis globally.

Here’s how it breaks down: The Department of Health in the Philippines has made TB reduction a major priority and has provided $11,000,0000 per year in matching funds to go alongside $10,000,000 contributed by USAID and an additional $1,000,000 donated by us. This $22,000,000 per year will fund everything from X-Ray machines, medications, and GeneXpert tests to training and employing a huge surge of community health workers, nurses, and doctors who are calling themselves TB Warriors. In an area that includes nearly 3,000,000 people, these TB Warriors will screen for TB, identify cases, provide curative treatment, and offer preventative therapy to close contacts of the ill. We know this Search-Treat-Prevent model is the key to ending tuberculosis, but we hope this project will be both a beacon and a blueprint to show that It’s possible to radically reduce the burden of TB in communities quickly and permanently. It will also, we believe, save many, many lives.

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I believe we can’t end TB without these kinds of public/private partnerships. After all, that’s how we ended smallpox and radically reduced the global burden of polio. It’s also how we’ve driven down death from malaria and HIV. For too long, TB hasn’t had the kind of government or private support needed to accelerate the fight against the disease, but I really hope that’s starting to change. I’m grateful to USAID for spearheading this project, and also to the Philippine Ministry of Health for showing such commitment and prioritizing TB.

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One reason this project is even possible: Both the cost of diagnosis (through GeneXpert tests) and the cost of treatment with bedaquiline are far lower than they were a year ago, and that is due to public pressure campaigns, many of which were organized by nerdfighteria. I’m not asking you for money (yet); Hank and I will be funding this in partnership with a few people in nerdfighteria who are making major gifts. But I am asking you to continue pressuring the corporations that profit from the world’s poorest people to lower their prices. I’ve seen some of the budgets, and it’s absolutely jaw-dropping how many more tests and pills are available because of what you’ve done as a community.

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I don’t yet have the details on which region of the Philippines we’ll be working in, but it will be an area that includes millions of people–perhaps as many as 3 million. And it will include urban, suburban, and rural areas to see the different responses needed to provide comprehensive care in different communities. This will not (to start!) be a nationwide campaign, because even though $80,000,000 is a lot of money, it’s not enough to fund comprehensive care in a nation as large as the Philippines. But we hope that it will serve as a model–to the nation, to the region, and to the world–of what’s possible. 

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I’m really excited (and grateful) that our community gets to have a front-row seat to see the challenges and hopefully the successes of implementing comprehensive care. Just in the planning, this project has involved so many contributors–NGOs in the Philippines, global organizations like the Partners in Health community, USAID, the national Ministry of Health in the Philippines, and regional health authorities as well. There are a lot of partners here, but they’ve been working together extremely well over the last few months to plan for this project, which will start more or less immediately thanks to their incredibly hard work.

tuberculosis

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:

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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

tuberculosis it's so funny how this became my job not like my paying job but the one i do and think about all the time like of all things it was this this is my hobby anyway beats jkr's horrible fucking hobby anyday

benjaminthecoathanger asked:

hi! i just wanted to clog up your inbox a little to say that your books made a big impression on me as a teenager (you were one of my favourite authors for years! and i still look back at your books fondly) and that i went to watch the film of the fault in our stars as a teen freshly in remission from cancer and it made me cry, not out of plot reasons but because the film showed augustus getting the same chemotherapy that i did and i knew what the side effects were going to be, which in hindsight was either the least ideal time or most ideal time to watch that film hahaha. so thanks, for both writing a book that stuck with me (for obvious reasons perhaps) and for giving me a reason to cry in a cinema hahaha

anyway, this is a very long winded way to say i’m glad you’re back on tumblr. it’s good to see you again :)

My favorite thing to be is someone’s favorite author when they are a teenager, and then for them to grow older and get into other books. They read Toni Morrison and Neil Gaiman and whoever else and they get new favorite authors!

It is hard to explain why this makes me so happy, but it’s like they allowed me to have this big and important place in their lives, and hopefully I helped a little with their growing up, and now they are grown and ready for other stuff.

It’s like they graduate from me! But then if I am lucky they still hold a soft spot in their hearts for me, their old alma mater. And maybe sometimes they even go back and read those books and think these are pretty good actually, and then one day give them to their own kids when their own kids are teens.

That is my very favorite thing. Thank you for choosing me as your favorite author. Thank you for graduating. Thank you for bringing your whole self to The Fault in Our Stars with such openness and generosity. Thank you. Thank you. Thank you.

thanks
indiainswiftland
indiainswiftland

I've said it before and i'll say it again: THAT IS NOT A FUCKING METAPHOR, JOHN GREEN

sizzlingsandwichperfection-blog

Thanks for tagging me in this. I agree that what Gus thinks is the metaphor is not the metaphor in The Fault in Our Stars, but I do think there is nonetheless a metaphor lurking there.

In The Fault in Our Stars, Gus is indeed engaging in classic teenage attention-seeking by putting a cigarette in his mouth but not smoking it, and he justifies this by claiming it’s a metaphor for his agency, for his control over what happens to him. “You put the killing thing between your teeth but don’t give it the power to kill you.” As if you have the power.

But of course, the reader knows this is not a good metaphor. This is not how power or agency work–you don’t actually have control over what happens to you, and (as Gus eventually realizes at the very end of the novel) you don’t have any say in whether you get hurt in this world.

The actual metaphor is that despite our furious attempts to establish a feeling of agency, we never actually have it. And so of course Gus is wrong when he says, “It’s a metaphor.” The actual metaphor is that when Gus desperately needs to express his agency over what happens to him, he’s not even strong enough to buy a pack of cigarettes, let alone make a choice about whether to smoke them. That’s the metaphor–Gus thinks the cigarette stands for the control individuals have over their fate; the actual metaphor is that the cigarette stands for the control we lack, for the fault that is in our stars.

metaphors cigarettes the fault in our stars

frognonymous asked:

My advertising pitch for good store is that sometimes your order comes with an incredible vintage skater garfield that fulfills all your hopes and dreams and is the best mail you've opened all year

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We love to see it! I’ll pass this along to the team at the warehouse; I know they’ll be delighted to have brought a bit of joy!

a-b-c-andy asked:

My mother still refuses to purchase sun basin soap for the home even after I have explained to her the benefits of it. How do I convince her to buy it?

I’m gonna level with you in the way that only an unpaid intern will: I don’t actually care if you buy sun basin soap or awesome coffee.

I care that you have access to good soap and good coffee that does not make the world worse. As long as you’re not buying liquid soap or starbucks coffee, I’m good with it! If your mom is happy, okay! She is happy! We like happy moms!

I just happen to know that awesome coffee and sun basin soap are great products, and that all the profit goes to charity.

coffee company