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					Profile




 TwenTy firsT
 cenTury naTiVe
 Larry Brilliant is executive director of Google’s philanthropic arm. Tony Delamothe talked to
 him about his medical career, Google’s global health projects, and how the appointment finally
 made sense of his life




 i
      n their first founders’ letter, Larry Page   bring the energies and talents of Google engi-     technology and Silicon Valley and making
      and Sergey Brin said they wanted to          neers and Google resources to bear,” says Bril-    them available to the entire disaster response
      “make Google an institution that             liant. Altogether, $75m (£38m; €47m) has           community, reports Brilliant. These include
      makes the world a better place.” They        been committed to projects in three areas:         some that Google make or support (geoblog-
      committed 1% of the company’s equity         global health, poverty, and climate change.        ging, and visualisation tools such as Google
 and 1% of its annual profits to philanthropy         Unsurprisingly, given Brilliant’s back-         Earth) and systems that allow mobile phone
 and set up Google.org as the main route to        ground (of which more later), the initia-          text messages to be sent in one language and
 disburse these funds. Two years ago, they         tive on global health is called Predict and        read in another (for example, Hebrew/Ara-
 put Larry Brilliant in charge, and earlier this   Prevent. It “supports efforts to empower           bic and Khmer/Burmese). Google has also
 year he announced the five core initiatives       communities to predict and prevent events          entered a joint arrangement with the Gordon
 that will provide the focus of Google’s phil-     before they become local, regional, or glo-        and Betty Moore Foundation to provide a
 anthropic efforts over the next 5-10 years.       bal crises, by identifying ‘hot spots’ and ena-    satellite based early warning system for
   “We tried to pick areas that allowed us to      bling a rapid response.” The initial focus is      drought and famine.
                                                   on southeast Asia and tropical Africa.                InSTEDD’s most ambitious project is
                                                      Brilliant joined Google shortly after win-      the Mekong River Surveillance System, a
                                                   ning a Technology, Entertainment, Design           partnership with the Global Security Initia-
                                                   (TED) prize in 2006. (These are awarded            tive, which Google is funding along with
                                                   annually to three people, who each receive         the Rockefeller Foundation. It encompasses
                                                   $100 000 to grant their “one wish to change        Thailand, Vietnam, Cambodia, Lao People’s
                                                   the world.”) Brilliant’s wish was to “help build   Democratic Republic, Myanmar, and Yun-
                                                   a global system to detect each new disease or      nan province, China.
                                                   disaster as quickly as it emerges or occurs.”         “We all know there’s a high probability
                                                   The system became InSTEDD (Innovative              that H5N1 will emerge from there,” says
                                                   Support to Emergencies, Diseases and Dis-          Brilliant. “We can’t be certain, but we’ll
                                                   asters), whose brief was broadened to offer        know that the world will be a little safer if
                                                   relief agencies ways of communicating and          all six of these health ministers share a com-
                                                   sharing data, thus allowing coordinated early      mon vocabulary, protocol, plan of action,
                                                   responses to disasters.                            and [early warning] technology.”
                                                      Brilliant’s vision was heavily influenced          Google also funds a service called Health-
                                                   by his experiences of programmes to eradi-         Map, which integrates disease “outbreak
                                                   cate smallpox, blindness, and polio in India,      data of varying reliability,” ranging from
                                                   as well as contemporary anxieties about            news sources (such as Google News) to col-
                                                   pandemic flu. But with his new responsibili-       lated personal accounts (such as the Inter-
                                                   ties at Google, Brilliant had to hand his new      national Society for Infectious Diseases’
                                                   baby on. Nevertheless, InSTEDD receives            electronic reporting system, ProMED) to
                                                   the largest grant among the recipients of          validated official alerts (such as from World
 Brilliant: his wish was to “help build a global   Predict and Prevent.                               Health Organization).
 system to detect each new disease or disaster        Eric Rasmussen, InSTEDD’s new chief                “The internet, the web, and mobile phones
 as quickly as it emerges or occurs.”              executive officer, is taking the tools of          have now penetrated so much that the old

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                                                                                                                                             Profile



                                                                                                         Analysing blindness survey data on an Apple
                                                                                                         computer given to Brilliant by Steve Jobs
                                                                                                         (Nepal, 1979-80).

                                                                                                            But before Alcatraz there was London,
                                                                                                         and nearly a year’s attachment as a medical
                                                                                                         student with Martin Bax, paediatrician and
                                                                                                         editor of both Developmental and Child Neurol-
                                                                                                         ogy and the literary magazine, Ambit. “During
                                                                                                         the day he would take me to Guy’s, and at
                                                                                                         night he got me involved in social activism.
                                                                                                         He was the secretary of the Medical Associa-
                                                                                                         tion for Prevention of War and I went with
                                                                                                         him to the Paris peace talks [about Vietnam]
                                                                                                         and to Stockholm to meet John Takman (who
                                                                                                         was closely involved with Bertrand Russell’s
                                                                                                         war crimes tribunal). So Martin was my first
                                                                                                         teacher of international health … he was so
                                                                                                         important to my life that when I went to work
                                                                                                         for WHO he was my only reference.”
                                                                                                            Brilliant’s attempts to follow his guru’s
 style of waiting for a city to report to a county,   willing to continue.” The goal isn’t profit-       advice were initially unsuccessful, until he
 a county to report to a state, a state to report     ability; it’s sustainability.                      cut his beard and swapped his robes for a suit
 to a nation for a nation to report to WHO               “How do you get something to be like            and tie. On his umpteenth visit to the WHO
 has now been circumvented by local people            the Aravind Eye Hospital, which is the             office in New Delhi, he bumped into the per-
 reporting to newspapers electronically and           best eye hospital in the world?” asks Bril-        son heading up WHO’s smallpox eradication
 that being picked up 10 000 miles away. The          liant. “It’s very profitable, yet they see three   programme, although they didn’t yet have
 change in the way that technology has grown          quarters of the patients for free. One quarter     a programme in India. Brilliant was inter-
 now makes possible several                                                 pay enough money for         viewed on the spot and offered a job. Ten
 other ways of gathering         “He says he’s a doctor.                    the other three quarters     years later, after smallpox had been eradi-
 that data, displaying that
 data, and putting that in the
                                  He seems like a nice                      and all the research and
                                                                            the extensions—they’ve
                                                                                                         cated, Brilliant came across the interview
                                                                                                         notes when he was packing up the files: “He
 hands of people who can          guy. Appears to have                      built six hospitals. And     says he’s a doctor. He seems like a nice guy.
 respond,” says Brilliant.                                                  they give back sight to      Appears to have gone native.”
    While the signal to               gone native”                          300 000 people a year.          The appointment changed Brilliant’s life
 noise ratio is the single biggest problem,           We’re looking for models like that, which          dramatically. “I was told that I would become
 the next is gaming the system, says Brilliant.       are sustainable. You can’t be sustainable if       transformed and that instead of taking my
 “You must be really careful to ‘first, do no         every year your budget comes from char-            pleasure from watching the fall of a child’s tem-
 harm’—remember, we learnt that at medical            ity.” He cites Sir John Wilson, who founded        perature spike I would have to take my satis-
 school. Because if you have some central-            SightSavers, as his inspiration.                   faction from the epidemic and remove myself
 ised agency that reports every rumour of a                                                              from being exposed to patients so much.
 case of pandemic flu then some nefarious             Enlightenment and transformation                   Those are difficult emotional transitions.
 person could put out false information. We           Brilliant has an extraordinary CV. As well as         “You had to leave aside the hands on expe-
 don’t want to create a scare. We’re dealing          a medical degree he has a master’s degree in       rience and start working through people. If
 with systems which by their nature have a            public health. But the public record begins        you then move into foundation work you take
 high sensitivity and low specificity.”               with him delivering a baby on Alcatraz             another step back, because now you’re fund-
    While these projects are being funded             Island, which was being occupied at the time       ing the person who’s looking at the epidemic
 with traditional “handouts,” several of              by Native Americans. Hailed as an expert           curve. And at Google.org we’ve taken a step
 Google’s five core initiatives will involve          on Native American affairs on his return to        even further back than that because we’ve
 sharing risks with commercial companies.             the mainland, he “wound up on every TV             spent the last 18 months thinking about what
 These include the initiative to accelerate the       show.” On the basis of his media appear-           we would fund. It’s a kind of thinking that we
 commercialisation of electric vehicles and the       ances he was offered the role of doctor in         don’t get trained for in medicine.” Compared
 attempt to make electricity from renewables          Medicine Ball Caravan (described by Block-         to the one to one doctor-patient relationship
 at a price cheaper than coal.                        buster as “a scaled down Woodstock-ish rock        this was harder and “more fraught with moral
    “Nearly half the carbon dioxide in the            concert documentary”), which followed a            error,” comments Brilliant.
 atmosphere is caused by either power                 large troupe of performers across the US.
 plants or vehicular traffic,” says Brilliant.        Several bus rides later he arrived at a Hima-      From ideas to business
 “You couldn’t solve this problem unless              layan ashram, where guru Neem Karoli Baba          I had encountered Brilliant a few years ear-
 you created an industry where people were            told him to work for the United Nations and        lier in the pages of The Well, an account of
 making enough of a profit that they were             help eradicate smallpox.                           one of the oldest and most influential online

BMJ | 3 May 2008 | VoluMe 336                                                                                                                           987
Profile



 communities. It didn’t seem like the same
 person who was in front of me. The Brilliant
                                                   whaT’s NEw oN BMJ.CoM
 in the book was an astute businessman who
 had approached Stewart Brand (founder of                                                                   I hope to write about things that may
 the Whole Earth Catalog, a vast print compen-                                                           interest doctors, other health workers and
 dium of “alternative” wisdom), with the idea                                                            policy makers, about what it’s like to have life
 of introducing Brand’s Whole Earth commu-                                                               threatening disease; to be on the other side of
 nity to a computer conferencing system.                                                                 the doctor-patient divide, and to experience
    Brilliant’s interest in this technology had                                                          21st century health care for a chronic
 been sparked by a helicopter crash in the                                                               disease...”
 wilds of Nepal, where he was running a                                                                     To follow Anna’s story, and to join the
 blindness survey for WHO. “Steve Jobs had                                                               growing number of people who have
 given me an Apple computer and modem                                                                    responded to her blog, go to blogs.bmj.com/
 and I was able to acquire a signal from a sat-                                                          bmj/category/from-the-other-side/
 ellite by using a phone system and bounced        Anna Donald: “i lit up like a Christmas tree on
 the signal back to the University of Michi-       the scans”                                            elsewhere on the blogs…
 gan, where I was a professor. And then                                                                  Two weeks ago Simon Chapman, professor
 something quite remarkable in my expe-            on the blogs                                          in public health at the University of Sydney,
 rience happened: we created a telephone           If you read one blog this week, make it Anna          revived bmj.com’s carbon blog by urging
 computer call (which we now call computer         Donald’s. Diagnosed with metastatic breast            medical conference delegates to ration their
 conferencing). Within 72 hours of this one        cancer in February 2007 (“I lit up like a             flying. Stay up late and use interactive video
 hour call—‘everybody typing, no voices’—a         Christmas tree on the scans”), Anna’s “From           links instead, he said.
 replacement engine had been dispatched            the other side” blog is all about facing life-           Now Ian Roberts, professor of public health
 from Paris and installed.’’ In his 12 years       threatening illness as a doctor. She returned         at the London School of Hygiene and Tropical
 working with the United Nations Brilliant         to her native Australia last year after living in     Medicine, blogs about biofuels, obesity and
 had never seen anything work so smoothly          London, Boston and Oxford for 17 years.               transport.
 in an emergency. “So I became convinced               Here is an extract from her first blog:              Dismayed at Gordon Brown’s failure to link
 that technology and service to emergencies            “I am slowly adjusting to the art of living       the three when he emerged from his recent
 was also a calling for epidemiologists.”          one day at a time. Not my usual style, to put it      food summit, Ian concludes: “Car use causes
                                                   mildly. My prognosis is dismal, but I’ve come         obesity, obesity increases car use and rising
 Making sense                                      across sufficient, well documented ‘miracle’          obesity increases food consumption and
 Six months later, Brilliant was describing the    cures (including Ian Gawler, a vet and friend         worsens global warming.
 events to his house guest, Steve Jobs, who        in Australia who recovered from advanced                 “If that sounds like a vicious circle with dire
 had just started Apple. “I was asking him for     sarcoma minus a leg, and who now runs                 implications for global food security and the
 more money for [our philanthropic idea],          courses for people with cancer) to convince me        environment then you are on the right track.”
 and he said, ‘Don’t ask me for money; take        that recovery is possible. The question is, is it        Join the debate and have your say at
 that and make it into a company.’” So Bril-       possible in me?                                       blogs.bmj.com/bmj/category/carbon/
 liant turned the computer conferencing idea
 into a company, took it public, and made
 enough money to bankroll the Seva Founda-
 tion. (Twenty eight years later, the foundation   Making a Difference poll result
 has helped restore the sight of more than two     Palliative care for non-malignant disease is the area in which
 million people in 27 countries. It has worked     doctors can make the greatest difference to patient care.
 in partnership with the Aravind Eye Hospi-           More than 4000 people from all over the world voted in a bmj.
 tal, which Brilliant so admires.)                 com poll to decide which of six projects would make the most
    And this successful business venture           improvement to patient care. The results, announced at the
 wasn’t a one off. As his biography on             International Quality Forum in Paris, last week, are:
 Google’s website states (perhaps to counter                                                                              Number        Proportion (%)
 anxieties that they’re handing out a no limit
                                                    Palliative care for all at the end of life                             1549               39%
 credit card to an old hippie) he has been
 chief executive of “two public companies           Combating drug resistant infections in poor countries                   869               22%

 and other venture-backed start-ups.”               Better care for the elderly with multiple health problems               681               17%
    Brilliant anticipates my last question:         Improving chronic pain management                                       484               12%
 “How can you be one person and have two            Reducing excessive drinking in young women                              329               8%
 such very different sides? When I came to
                                                    Helping to reduce adverse drug reactions in the elderly                 111               3%
 Google my children said to me: ‘Dad, for
 the first time, your life makes sense.’”
 Tony Delamothe is deputy editor, BMJ              Next bmj.com poll
 tdelamothe@bmj.com                                Does it matter that medical graduates don’t get jobs as doctors?
 competing interests: None declared.

988                                                                                                                                BMJ | 3 May 2008 | VoluMe 336

				
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