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

And so, the Dice Wars began…

just chucking dice at each other

Ok I am going to do this simply because the first thing I will put here I NEED to do it and I have 0 motivation to do it even though it is EXTREMELY important

In fact, I think that's the reason why I don't want to do it... anyway

If this gets to 30 notes, I do that thing

50 notes, I call to ask if my doctor's appointment has been scheduled (I've been avoiding it for two weeks now)

100 notes, I go wash my shoes that have long needed washing and are just sitting there, existing, waiting for me to deign to wash them.

200 notes, I finish organizing my room (I organized it halfway and then left a bunch of things that still don't have a defined place)

500 notes, I use the things I have to bleach and color my hair. The only thing that has stopped me is the fear of doing it wrong or being too lazy to maintain it.

1k notes, I stop doing things that I know will trigger my chronic pain with the pure intention of confirming that the pain was indeed real (don't do this. 0 recommended).

5k notes, I try some new food without fear of wasting money by buying something I most likely won't like (my autism hates new foods)

10k notes, I wear my bi flag earrings in front of someone I wouldn't usually wear them with. I trust that they possibly wouldn't have a problem with me being bi, but I would never get up the courage to tell them anything

20k notes, wtf I have absolutely no idea. If it comes to this, ehhh... Honestly, I have no idea what I'm doing here. Do I promise to be honest in therapy and stop telling them that everything is perfect even though nothing has ever been perfect? Yeah, that probably works. Please don't go this far, I don't know how to do this. Maybe I should... but... it would be awful to learn it

This is gonna be some classic over sharing from a teen cause. I'm terribly sorry.

So I'm in a band, like a shitty covers band of teenagers that has been a big source of drama in my life ever since we've gotten a singer that has not come to 6 of the last 8 rehearsals we've had and we know we wanna kick her out cause we can't get better without a singer while trying to have songs with lyrics BUT the rest of the lot go to school with her and they don't want the drama. That and we'd need a singer.

Anyway, it all ended when we discovered that actually we can write songs and perform those without paying copyright thingys and she didn't learn shit, BUT that means I have to sing. For context: I sing in the shower on a good day and I already play keyboards sorta filling a lead role but since I'm kinda shameless when dealing with an audience i got the gig, yay.

To top it all off, we got a gig in two weeks at a festival sponsored by the local government, as in we're getting paid to perform. With a massively inexperienced singer. And now I've gotta learn both how to sing *and* how to sing and play at the same time. And I'm kinda panicking big time.

So yeah, long way of saying that a potentially significant audience will listen to songs me and my friends have written for the first time and it's up to me to live up to a band of well rehearsed and prepared musicians with exactly no idea of how to sing and not a lot of natural talent. If anyone knows how to either get better at that or how to control my nerves the reblogs and comments are there. Thank you digital void, you've been a wonderful listener.

"I need you, Emily Axford, to describe to me what a sexy rat is"

"My love, for you are my love; my one true love, you don't need to enter because you're already there, and you don't need to be real because you already are"

"Can't stop being dominant"

Hope this helps!

Alright I’m recovering from adult tonsillectomy surgery round two!

Would love to see some of your favorite D20 quotes commented on here. Make my morning chilling in this bed in the hospital.

So when dropout said they had content filmed that can last them until December for D20, it meant having brennan and siobhan locked in the green room to film 2 side quests and probably 1 intrepid heroes season back to back

**insert 4 am in a warehouse clip by ally**

tolkien fans on tumblr are u still out there!! like/reblog if u are im trying to find you!! <3

Reblog if you honestly have NEVER sent anon hate.

It pains me that only 14,000 people can honestly reblog this

Three men are in a Russian prison cell

The first man says, “I’m here because I criticized Evgeny Prigozhin”

The second man says, “I’m here because I spoke in favor of Evgeny Prigozhin”

The third man says, “I am Evgeny Prigozhin”

1996 photos (a Polaroid and the proposed cover) that were meant to have been on the cover of Wired magazine in the UK. I think I preferred the one they finally used from a different part of the photoshoot because it was impossible to see what I looked like in it, so I was on the cover of a magazine and anonymous at the same time. But these were sweet. I guess they would have painted out the wires if they had used one of them.

What's the most important thing in a cat's life? I'm asking to my cat, but she answer with "meow".

Why don't you believe her?

ADHD Icon Showdown: Round 2

HI hi mr. Gaiman I LOVE your works, um this is awkward but anyways couple things: will there be any lgbtq+ characters in GO S2 other than the ones we already have? Because I adore the fact you made a book about two genderless beings falling in love thank you for that

Hi. It's not awkward at all. You'll have to wait and see, as with all other Season 2 questions.

Neil!!!! just thought you should see this cute tweet!

it translates to: "Neil Gaiman looks like one of those dudes who would be embarrassed to complain if his lunch order was wrong" (and that's a compliment!)

Well, that's an accurate personality description at any rate...