Independence Health Department Annual Report 2013: Fill & Download for Free

Anonymized patient data is already easily and legally available to the highest bidder, if one knows where to look. But its use in research isn't as much of a priority among the main healthcare data brokers as is making money off of it. Thus, at the intersection of business and science of health, there are currently three main approaches towards health data sharing, the first two prioritizing business while the last one prioritizes science,Hold on to patients' health data as tightly as possible as if it were the proverbial gold mine, an approach exemplified by Myriad Genetics, also the approach discussed in the Newsweek article referenced in the question.Sell it behind the scenes to the highest bidder, all legally of course, an approach exemplified by IMS Health.Partner with academic partners and share it fully with them, an approach exemplified by 23andMe.Which course(s) will prevail will depend on how the politics of health plays out, specifically future legislation and the outcome of legal challenges to any or even every one of these three prevailing approaches.The Health Data Marketplace Where Anonymized Patient Dossiers Are Freely Bought & SoldIn a Feb 2016 Scientific American article (1), Adam Tanner states that IMS Health dominates the medical data trading industry. Apparently it automatically receives Petabyte (>10^15), yes with a p, of data from computerized records of pharmacies, insurance companies, and medical organizations including US federal and state health departments. Specifically, Tanner states that 3/4ths of all retail pharmacies in the US send some portion of their electronic records to IMS Health but that's not all.According to Tanner, IMS Health itself claims to have half a billion individual patient 'dossiers' from the US to Australia. Anonymized to protect patient privacy, they're stripped of individual identifiers such as social security numbers, names, addresses. This way, data transfer to and from IMS Health and other data brokers doesn't violate medical privacy rules such as the 1996 US Health Insurance Portability and Accountability Act (HIPAA), which applies only to transfer of medical information directly tied to a patient's identity.Even anonymized, such data's extremely lucrative. For example, Tanner's article (1) quotes Marc Berger who heads the analysis of anonymized patient data at Pfizer as saying it annually pays US $12 million to buy health data from a variety of sources including IMS Health.As well, the public is largely unaware of the extent to which such companies go to maintain their business practices. For example, HIPAA only applies to patient records, not to doctors' prescribing habits. Starting in the 1990s, IMS Health started selling US doctors' prescribing data. Obviously this helps pharma companies tailor their sales pitches to individual doctors. According to Tanner, even though 36 US states, the US Department of Justice and advocacy groups challenged such a practice, IMS Health fought all the way to the US Supreme Court and prevailed in 2011 on the grounds of corporate 'free speech' (2). Upshot? Even today, US doctors' prescribing habits are up for grabs, sold and traded freely in the marketplace.One bright spot in this otherwise bleak story? IMS Health also shares some data for free or at a discount with academia. As proof of its academic partnerships, IMS Health's web-site offers a browsable database of >3000 scientific publications (3) they claim span 'virtually all therapy areas and projects completed in more than 50 countries worldwide' (4).Health Data Privacy Concerns: Anonymized Data's Not Always So AnonymousIn a famous example from 1997 (5), back when she was still a graduate student, Latanya Sweeney identified then Massachusetts Governor William Weld through publicly available hospital records. Apparently all it took for her to identify him from anonymized hospital records was to compare them with the voter registration rolls for the governor's city of residence, Cambridge, MA. Doing so, Sweeney was able to pinpoint records based on age and gender that could only pertain to Weld. This included a recent hospital visit, diagnosis and prescriptions.Of course, Weld being a public figure with a highly publicized hospitalization obviously helped Sweeney succeed in rather easily re-identifying him (6).As an outcome of Sweeney's re-identification of Weld, important changes were made to HIPAA. These include public records now including only 3-digit rather than 5-digit zip code and only year, not year and day of birth. These changes do make it more difficult to re-identify people from anonymized patient data (7).Despite such changes, it's still possible to re-identify medical research study participants (see table below from 8).While people like George M. Church and Steven Pinker are openly unconcerned about their health data privacy (9), human history provides compelling countervailing examples of research abuse in the form of Nazi experimentation and the Tuskegee syphilis experiment. Scope for health data misuse can't simply be wished away. Instead, such misuse can only be thwarted by improving or expanding scope of specific laws. For example, today in the US, the HIPAA Privacy Rule only covers government-funded research but could be expanded to cover the private sector as well (10).The 23andMe Model: Share Patient Data With Academics To Advance Medical ResearchIn the 23AndMe model, people send it their saliva and consent to allow it to use anonymized information derived from it for research.In the most recent example, their collaboration with researchers from the Massachusetts General Hospital and the University of Pennsylvania, published in Nature Genetics, studied 75607 self-reported depressive individuals with 231747 healthy controls, and identified 17 independent Single-nucleotide polymorphism from 15 genetic loci associated with risk of major depression in people of European ancestry (11).Interesting nuggets from this study include overlap with genetic regions involved in neuronal development, schizophrenia, neuroticism. This suggests future studies examining these conditions in tandem may yield more insights.Caveat about 23AndMe samples is the scientific one about the source, i.e., saliva. Presence of digestive enzymes and microbes makes saliva less reliable than blood.While such data is very far from helping provide patients better Rx, it's part of the process involved in the first step necessary for improved medicine, namely, identifying specific genomic targets for Rx.As well, 23AndMe's approach is certainly refreshing considering how business-related profit motive prevails among dominant players like IMS Health in the health data marketplace.SummationIn short, the extremely lucrative market for legally buying and selling patient data proves it's already perceived to be quite valuable. Many of us are simply unaware of the extent of this marketplace or even that it exists at all. 23AndMe's proactive partnering with academia, while laudable, is very much an outlier. Such practices can only become the norm if the public actively pushes their governments to make it so through legislation. For that to happen, first the fact that anonymized patient data is already freely legally bought and sold needs to become common knowledge. Understandably the major operators assiduously fly under the radar, careful not to attract undue attention. Onus is on the media to highlight this practice of legally buying and selling health data records, and for the public to fully inform itself of its pros and cons, obviously mainly cons. Another option, already being practiced by the Framingham Heart Study and by the US state of Rhode Island, is to offer study participants the option of choosing to forbid collection of their medical information for commercial use (1). Again such options can only become more mainstream with greater public awareness of the dangers of unfettered market control of patient health data, a situation that's not theoretical but rather, as the examples of Myriad Genetics and IMS Health show, already a practical reality.Bibliography1. Tanner, Adam. "For Sale: Your Medical Records." Scientific American 314.2 (2016): 26-27. How Data Brokers Make Money Off Your Medical Records2. https://scholar.google.com/scholar_case?case=838098438403992670&q=IMS+Health&hl=en&as_sdt=400063. IMS HEOR Bibliographies4. Real World Evidence5. Sweeney, Latanya. "k-anonymity: A model for protecting privacy." International Journal of Uncertainty, Fuzziness and Knowledge-Based Systems 10.05 (2002): 557-570. http://www.cs.colostate.edu/~cs656/reading/kanonymity.pdf6. Barth-Jones, Daniel C. "The're-identification' of Governor William Weld's medical information: a critical re-examination of health data identification risks and privacy protections, then and now." Then and Now (July 2012) (2012). https://fpf.org/wp-content/uploads/The-Re-identification-of-Governor-Welds-Medical-Information-Daniel-Barth-Jones.pdf7. Techpinions, Steve Wildstrom, July 9, 2012. Can You Be Identified from Anonymous Data? It’s Not So Simple8. Milius, Djims, et al. "The International Cancer Genome Consortium's evolving data-protection policies." Nature biotechnology 32.6 (2014): 519-523.9. Forbes, Adam Tanner, April 25, 2013. Harvard Professor Re-Identifies Anonymous Volunteers In DNA Study10. Contreras, Jorge L. "The president says patients should own their genetic data. He's wrong." Nature Biotechnology 34.6 (2016): 585-586.11. Hyde CL et al, Nature Genetics, Published 1 August, 2016. http://www.nature.com/ng/journal/vaop/ncurrent/full/ng.3623.htmlThanks for the A2A, Jonathan Brill.

I didn’t feel that Obama was the president of Black people or that it was his job to make Black lives better. There is relatively little a president can do to help members of a specific race, and that is if we grant that helping a specific race is something presidents should be in the business of doing.Insofar as Obama benefited Black people, it was because his policies were more likely to favor the poor than those of the Republican Party. And because the poor in the US are disproportionately non-White, this had the indirect effect of helping Black people. A program like Obamacare, which taxed the rich to provide subsidized health insurance to the poor, was a prime example of this. In states that expanded Medicaid, the health gap between the white and non-white uninsured rate decreased.[1]The program helped people of all races. There just happened to be more Black people—and even more Latinos—to help.This was the main way in which Obama focused on helping Black people. But there was also another way, although it didn’t bear much fruit at the time. Obama’s Justice Department took reports of police brutality seriously. This is why the Ferguson Report was released. Michael Brown may not have been the innocent he was initially assumed to be, but the discriminatory practices found at all levels of law enforcement in Ferguson, MO were really appalling. In the short term, the report was met by a yawn in most of conservative America, except for a few lonely voices like Jason Lee Steorts.[2]But now, the rest of America has belatedly caught up to the fact that what the report documented was the mundane reality of a racist pattern of policing in the US, not an isolated incident. And many of us are glad that there was a president in office in 2014 who took the issue seriously enough to investigate and issue a public report.Those are the big things as I see it. If you want a full list, you can find it here: Progress of the African-American Community During the Obama AdministrationLabor Market, Income and PovertyThe unemployment rate for African Americans peaked at 16.8 percent in March 2010, after experiencing a larger percentage-point increase from its pre-recession average to its peak than the overall unemployment rate did. Since then, the African-American unemployment rate has seen a larger percentage-point decline in the recovery, falling much faster than the overall unemployment rate over the last year.The real median income of black households increased by 4.1 percent between 2014 and 2015.The President enacted permanent expansions of the Earned Income Tax Credit and Child Tax Credit, which together now provide about 2 million African-American working families with an average tax cut of about $1,000 each.A recent report from the Census Bureau shows the remarkable progress that American families have made as the recovery continues to strengthen. Real median household income grew 5.2 percent from 2014 to 2015, the fastest annual growth on record. Income grew for households across the income distribution, with the fastest growth among lower- and middle-income households. The number of people in poverty fell by 3.5 million, leading the poverty rate to fall from 14.8 percent to 13.5 percent, the largest one-year drop since 1968, with even larger improvements including for African Americans, Hispanic Americans, and children.The poverty rate for African Americans fell faster in 2015 than in any year since 1999. While the poverty rate fell for across all racial and ethnic groups this year, it fell 2.1 percentage points (p.p.) for African Americans, resulting in 700,000 fewer African Americans in poverty.African American children also made large gains in 2015, with the poverty rate falling 4.2 percentage points and 400,000 fewer children in poverty.HealthSince the start of Affordable Care Act's first open enrollment period at the end of 2013, the uninsured rate among non-elderly African Americans has declined by more than half. Over that period, about 3 million uninsured nonelderly, African-American adults gained health coverage.Teen pregnancy among African-American women is at an historic low. The birth rate per 1,000 African-American teen females has fallen from 60.4 in 2008, before President Obama entered office, to 34.9 in 2014.Life expectancy at birth is the highest it’s ever been for African Americans. In 2014, life expectancy at birth was 72.5 years for African-American males and 78.4 for African-American females, the highest point in the historical series for both genders.EducationThe high school graduation rate for African-American students is at its highest point in history. In the 2013-2014 academic year, 72.5 percent of African-American public high school students graduated within four years.Since the President took office, over one million more black and Hispanic students enrolled in college.Among African-Americans and Hispanic students 25 and older, high school completion is higher than ever before. Among African Americans, Hispanics, and Asian students 25 and older, Bachelor’s degree attainment is higher than ever before. As of 2015, 88 percent of the African-American population 25 and older had at least a high school degree and 23percent had at least a Bachelor’s degree.Support for HBCUsThe U.S. Department of Education (ED) is responsible for funding more than $4 billion for HBCUs each year.Pell Grant funding for HBCU students increased significantly between 2007 and 2014, growing from $523 million to $824 million.The President’s FY 2017 budget request proposes a new, $30 million competitive grant program, called the HBCU and Minority Serving Institutions (MSIs) Innovation for Completion Fund, designed to support innovative and evidence-based, student-centered strategies and interventions to increase the number of low-income students completing degree programs at HBCUs and MSIs.The First in the World (FITW) program provided unique opportunities for HBCUs to compete for grants focused on innovation to drive student success.In 2014, Hampton University received a grant award of $3.5 million.In FY 2015, three FITW awards were made to HBCUs, including Jackson State University ($2.9 million), Delaware State University ($2.6 million) and Spelman College ($2.7 million).While Congress did not fund the program in fiscal year 2016, the President’s 2017 budget request includes $100 million for the First in the World program, with up to $30 million set aside for HBCUs and MSIs.Criminal JusticeThe incarceration rates for African-American men and women fell during each year of the Obama Administration and are at their lowest points in over two decades. The imprisonment rates for African-American men and women were at their lowest points since the early 1990s and late 1980s, respectively, of 2014, the latest year for which Bureau of Justice Statistics data are available.The number of juveniles in secure detention has been reduced dramatically over the last decade. The number of juveniles committed or detained, a disproportionate number of whom are African American, fell more than 30% between 2007 and 2013.The President has ordered the Justice Department to ban the use of solitary confinement for juveniles held in federal custody. There are presently no more juveniles being held in restrictive housing federally.My Brother’s KeeperPresident Obama launched the My Brother’s Keeper initiative on February 27, 2014 to address persistent opportunity gaps faced by boys and young men of color and ensure that all young people can reach their full potential.Nearly 250 communities in all 50 states, 19 Tribal Nations, Washington, DC and Puerto Rico have accepted the President’s My Brother’s Keeper Community Challenge to dedicate resources and execute their own strategic plans to ensure all young people can reach their full potential.Inspired by the President’s call to action, philanthropic and other private organizations have committed to provide more than $600 million in grants and in-kind resources and $1 billion in low-interest financing to expand opportunity for young people – more than tripling the initial private sector investment since 2014.In May 2014, the MBK Task Force gave President Obama nearly 80 recommendations to address persistent opportunity gaps faced by young people, including boys and young men of color. Agencies have been working individually and collectively since to respond to recommendations with federal policy initiatives, grant programs, and guidance. Today, more than 80% of MBK Task Force Recommendations are complete or on track.Advancing Equity for Women and Girls of ColorIn 2014, the Council on Women and Girls (CWG) launched a specific work stream called “Advancing Equity for Women and Girls of Color” to ensure that policies and programs across the federal government appropriately take into account the unique obstacles that women and girls of color can face. In fall 2015, CWG released a report that identified five data-driven issue areas where interventions can promote opportunities for success at school, work, and in the community.This work has also inspired independent commitments to advance equity, including a $100 million, 5-year-funding initiative by Prosperity Together—a coalition of women’s foundations—to improve economic prosperity for low-income women and women and girls of color and a $75 million funding commitment by the Collaborative to Advance Equity through Research—an affiliation of American colleges, universities, research organizations, publishers and public interest institutions led by Wake Forest University—to support existing and new research efforts about women and girls of color.At the United State of Women Summit in June 2016, eight organizations launched “Young Women’s Initiatives,” place-based, data-driven programs that will focus in on the local needs of young women of color. Those organizations include the Women’s Foundation of Minnesota, the Women’s Foundation of California, the Women's Foundation for a Greater Memphis, the Washington Area Women’s Foundation, the Dallas Women’s Foundation, the Women’s Fund of Greater Birmingham, the Women’s Fund of Western Massachusetts, and the New York Women’s Foundation.Small BusinessThere are 8 million minority-owned firms in the U.S.—a 38% increase since 2007.In early 2015, the U.S. Small Business Administration (SBA) launched the MBK Millennial Entrepreneurs Initiative, which seeks to address the challenges faced by underserved millennials, including boys and young men of color, through self-employment and entrepreneurship. A major component of this effort included the six-part video series, titled “Biz My Way,” which encourages millennials to follow their passion in business.In fiscal year 2015, underserved markets received 32,563 loans totaling $13 billion, compared with 25,799 loans and $10.47 billion in fiscal year 2014, an increase of 26 percent in number of loans and 24 percent in dollar amount.Last year, the SBA issued a new rule that makes most individuals currently on probation or parole eligible for a SBA microloan—a loan of up to $50,000 that helps small businesses start up. And in August 2016, SBA together with the W.K. Kellogg Foundation and Justine Petersen, launched the Aspire Entrepreneurship Initiative, a $2.1 Million pilot initiative to provide entrepreneurship education and microloans to returning citizens in Detroit, Chicago, Louisville and St. Louis.Civil Rights DivisionThe Department of Justice’s Civil Rights Division continued to enforce federal law. Over the last eight years, the Division has vigorously protected the civil rights of individuals in housing, lending, employment, voting, education, and disability rights and through hate crimes and law enforcement misconduct prosecutions and law enforcement pattern and practice cases.African-American Judicial AppointeesPresident Obama has made 62 lifetime appointments of African Americans to serve on the federal bench.This includes 9 African-American circuit court judges.It also includes the appointment of 53 African American district court judges—including 26 African-American women appointed to the federal court, which is more African-American women appointed by any President in history.In total, 19% of the President’s confirmed judges have been African American, compared to 16% under President Bill Clinton and 7% under President George W. Bush.Five states now have their first African-American circuit judge; 10 states now have their first African-American female lifetime-appointed federal judge; and 3 districts now have their first African-American district judge.Also, the President appointed the first Haitian-American lifetime-appointed federal judge, the first Afro-Caribbean-born district judge, the first African-American female circuit judge in the Sixth Circuit, and the first African-American circuit judge on the First Circuit (who was also the first African-American female lifetime-appointed federal judge to serve anywhere in the First Circuit).The President is committed to continuing to ensure diversity on the federal bench. This year, the President nominated Myra Selby of Indiana to the Seventh Circuit, Abdul Kallon of Alabama to the Eleventh Circuit, and Rebecca Haywood of Pennsylvania to the Third Circuit. If confirmed, each of these would be a judicial first—Myra Selby would be the first African-American circuit judge from Indiana, Abdul Kallon would be the first African-American circuit judge from Alabama, and Rebecca Haywood would be the first African-American woman on the Third Circuit. In addition, two of the President’s district court nominees—Stephanie Finely and Patricia Timmons-Goodson—would be the first African-American lifetime-appointed federal judges in each of their respective districts, if confirmed.You will see a politician taking credit for many things that would have happened with or without him. That much is par for the course. But you can generally see the pattern I outlined in my first point: actions taken to help the poor tend to disproportionately help people of color in a society where race and socioeconomic status are inextricably linked.Footnotes[1] Did the Affordable Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage?[2] The Ferguson Report and the Right | National Review

There are two parts to this question, one, estimating how much of Gates Foundation money funds vaccines, and two, speculating why.Part One shows data from peer-reviewed studies that suggests that more than half of Gates Foundation money goes to vaccines and technology-heavy efforts, and that technological bias is the main driver for this.Part Two shows the much smaller proportion of Gates Foundation money that funds cheaper public health effort such as clean water and insecticide-treated bed nets for malaria, and a huge chunk that funds alternatives to traditional US higher education.Part OneIs there published peer-reviewed scrutiny of Gates Foundation grants? Yes, at least one. McCoy, David, et al. "The Bill & Melinda Gates Foundation's grant-making programme for global health."The Lancet 373.9675 (2009): 1645-1653. Page on utah.eduWhat did this study explore? It examined 1094 global health grants given by Gates Foundation between January 1998 until December 2007.The study and a few others make key observations on how much Gates Foundation money is spent on what and why.WhatMore than half but not all goes to vaccines. From McCoy et al.2. 'Another striking finding is the large number of US-based recipients of grants, a feature that is common among US foundations in general.'. McCoy et al Page 1650, 2nd column, 3rd para.3. 'The finding that one organisation, PATH, was awarded nearly $1 billion stands out and raises the question as to whether some organisations might be better characterised as agents of the foundation rather than as independent grantees'. McCoy et al Page 1650, 2nd column, 3rd para.4. 'The University of Washington (also based in Seattle), received grants worth nearly $280 million in the same period, and the Institute for OneWorld Health, together with Johns Hopkins University, Harvard University, and Columbia University were together given grants worth a total of $559 million. This large amount of funding concentrated within a small number of US-based institutions raises questions about their privileged status among organisations operating in global health'. McCoy et al Page 1650, 2nd column, 4th para.5. 'Grant making by the Gates Foundation seems to be largely managed through an informal system of personal networks and relationships rather than by a more transparent process based on independent and technical peer review. Although a panel of six individuals exists to advise on and assess the foundation’s strategies, the process by which individual proposals for projects are solicited, adjudicated, and funded is unclear'. McCoy et al Page 1650, 2nd column, 5th para.6. A 2012 report by the OECD (Organisation for Economic Co-Operation and Development), Meeting Global Challenges through Better Governance: International Co-operation in Science, Technology and Innovation, OECD Publishing. Resolve a DOI Name 10.1787/9789264178700-en Page on ieabioenergy.com makes similar criticisms as well as some praise.From Page 70-71, Section 3.4 Conclusions,'Lack of solicitation. Most grants do not appear to be awarded through direct competition or completely open requests for proposals. The Foundation often approaches (or is approached by) an organisation which it has found to be a leader in a particular area and negotiates a project directly. The process is flexible, rapid and non-bureaucratic but may be seen to lack transparency and legitimacy in terms of democratic decision making. Because the Gates Foundation is based on private money, legitimacy and accountability issues may differ from those relating to funding based on public money. Legitimacy issues arise basically because the size of the Foundation enables it to define to a large extent the global health agenda, a role formerly assigned to more democratically controlled organisations, mainly the WHO'.Preparatory work. The Gates Foundation puts a lot of effort into studying the state of knowledge and the important actors before entering a specific area. It therefore has a high level of knowledge of a subject before entering into new partnerships. This seems to allow for better alignment of the goals of the Foundation and its grantees.Concentrated decision-making. The Foundation’s broad strategic decisions are made by a handful of people, mainly the trustees, so that a very small group of people determine where large amounts of money go. This is seen as problematic, as strictly speaking they are not experts, despite their commitment to global health issues. According to interviewees, the lack of a well-functioning board with people from diverse backgrounds and countries is a weakness. The way priorities are set is seen not only as a problem of legitimacy but also as an obstacle to innovation. This relates to findings in innovation literature that users, rather than states, small groups of individuals or single companies, are normally in the best position to pick technologies.It could be that the two major activities of the Foundation – creating impact based on science, technology and innovation and engaging other actors through advocacy – require very different actions to gain legitimacy. Whereas the first might benefit from a broader and more heterogeneous set of activities and involved actors, the latter could benefit from a more representative high-level board. A related criticism is insufficient transparency regarding the priority-setting process and the solicitation and awarding of grants.Follow-up through milestones. Whereas other funders follow up on projects through annual reports on results, the Gates Foundation defines, together with grantees, a set of milestones to be reached during various stages of the projects. The actual effects are not really clear, but it does put stronger emphasis on progress and impact in line with the Foundation’s orientation.Deliverables. The Gates Foundation makes clear that it is ultimately not interested in scientific publications or new technologies for their own sake but rather in impact. Grantees are well aware of this and some praise the Foundation for being more flexible in terms of deliverables'. Also see Section 3.5. Lessons Learned.WhyWhy is Gates funding skewed to technology-heavy efforts like vaccines rather than cheaper public health efforts such as clean water? Again, from McCoy, David, et al. "The Bill & Melinda Gates Foundation's grant-making programme for global health." The Lancet 373.9675 (2009): 1645-1653.Page on utah.edu'funding was disproportionately allocated to the development of new technologies rather than towards overcoming the barriers to the use of existing technologies.20 This technological bias reflects the priorities of Bill Gates himself. In his recent annual letter, he stated that “optimism about technology is a fundamental part of the foundation’s approach” and he described the key approach to eliminating the main causes of early childhood mortality as “the invention of a handful of new vaccines and getting them into widespread usage”'. Page 1651, column 1 para 4, column 2 para 1.'One argument used to make the case that the Gates Foundation over-emphasises technology and new vaccine development is that many existing cost-effective technologies do not reach the people who need them because of poverty or health system failings'. 'Thus, rather than viewing the hundreds of thousands of child deaths from rotavirus infection as a clinical problem that needs a vaccine solution, a better approach might be to view it as a public health problem that needs a social, economic, or political intervention to ensure universal access to clean water and sanitation'. Page 1652, column 1, para 3.A similar criticism about Gates' over-reliance on technology as opposed to investment on cheaper infrastructure investment into clean water, hygiene and electricity is made by a 2014 University of Michigan, Department of Afroamerican and African Studies Bachelor of Science thesis by Jaclyn Sylvain. Page on umich.edu. See Chapter 3 from page 48 onwards.A 2014 peer-reviewed paper by Professor Anne-Emmanuelle Birn at the University of Toronto Dalla Lana School of Public Health also spotlights Gates' technological bias (Birn, Anne-Emanuelle. "Philanthrocapitalism, past and present: the Rockefeller Foundation, the Gates Foundation, and the setting (s) of the international/global health agenda." Hypothesis 10.1 (2013). Page on hypothesisjournal.com).It also highlights pertinent cases of conflicts of interest in the operations of the Gates Foundation. These range from its indirect pharmaceutical holdings, to its patenting of pharmaceutical drugs to its outsize influence on sovereign governments. For example, the study (see page 14, columns 4 and 5) highlights inadequate informed consent and adverse events monitoring of a Gates' funded HPV trial of young low-income girls in India that has raised questions in the Indian parliament.Part TwoOTOH, there are a few comparatively small-scale examples of Gates funding efforts other than vaccines, including yes, clean water. And a huge $2 billion between 2000 and 2008 on US higher education.The Carter Center has been waging an arduous and gutsy campaign to eradicate the Guinea worm. Guinea what? The Guinea worm causes Guinea worm disease or Dracunculiasis (Dracunculiasis), a ghastly and painful disease that incubates up to a year and releases female worms as long as 2 to 3 feet in length! Humans become infected when they drink water contaminated with water fleas containing guinea worm larvae. Access to clean water is the main way to eradicate Guinea worm disease.When the Carter Center got involved in Guinea Worm eradication efforts in 1986, there were 26500 affected villages (1) with approx. 3.5 million cases per year (2). The reported total number of cases in 2014 was a mere 126 (3)! The Gates foundation awarded the Carter Center its 2006 Award for Global Health for their Guinea worm eradication efforts (4), and in 2008, with the UK government pledged $55 million for its final eradication (5).Malaria prevention. Low tech prevention measures such as insecticide-treated bed nets go a long way in preventing malaria (6). In 2006, the Gates foundation pledged a dollar-for dollar $3 million to the non-profit Nothing But Nets (7).Higher education in the US. Efforts apparently not very effective but huge sums spent (approx. $2 billion from 2000 to 2008). From PRIVATIZING EDBibliography for Part Two.'Watch Out, Guinea Worm, Here Comes Jimmy Carter'Eradication ProgramJimmy Carter's Work to Defeat Guinea Worm Highlighted in New ExhibitCarter Center News and PublicationsCarter Center Receives Historic Guinea Worm Challenge Grant from Gates FoundationInsecticide-treated bed nets and curtains for preventing malariaBill Gates Recognizes Nothing But Nets in NewsweekIn sum, it's illuminating there are only a handful of peer-reviewed studies that scrutinize the how, how much and why of funding decisions by the world's largest private foundation for Public Health, the Bill and Melinda Gates Foundation. Professor Anne-Emmanuelle Birn suggests 'most observers (and grant recipients) fear offending the powerful foundation' (Page 14, column 4, para 2). These few studies suggest less-than-optimal transparency of taxpayer-subsidized dollars and a technological bias that funds vaccines and technology-heavy public health efforts at the expense of cheaper, more tractable public health measures such as clean water, hygiene, child nutrition and infrastructure development.Thanks for the A2A, Nicolai Thomsen.