Bill Gates And Bono On Their Alliance Of Fortune, Fame And Giving

Forbes: While you two are an odd pairing on paper, I have a theory that you were separated at birth–there are more similarities than you might think.

Bono: Tallness!

Forbes: You both played chess growing up. You both started college–neither of you finished it. You both built global businesses. You both were affected deeply by your first trips to Africa–Bono after Live Aid, and Bill before your honeymoon with Melinda on safari–and you both consider Nelson Mandela one of your top heroes.

So given this, Bill, true or false: The first time you had a chance to meet Bono you didn’t really want to because you thought it would be a waste of time?

Bill Gates: Yeah, we have a mutual friend, Paul Allen, and Paul said to me several times, “You know, Bono is really serious about poverty and the stuff you’re working on; you should talk to him.” And I have to admit, I did not make it a priority. And then there was a Davos [meeting] that was in New York after 9/11, so Bono, Bill Clinton and I met, and I was kind of amazed that he actually knew what he was talking about and had a real commitment to making things happen. It was phenomenal. Ever since then we’ve been big partners in crime.

Forbes: Bono, you’ve said that you’ve learned a lot from Bill. What has he taught you, and why did you seek him out?

Bono: Before I tell you what I learned from Bill, I’ll tell you what I taught him. It’s an interesting story about not judging your friends. I said to Paul Allen, “Would you help me get to Bill Gates? Because we really need to professionalize our operation, and we need funding, and I know that he’s interested in the same things that we are, and Melinda, too.” Paul’s a kind of shy guy, but he usually answers my e-mails, and he stopped answering them. Actually, I got a little cross with Paul, and I said, “Well, that’s not very nice.” This is the one thing I’ve ever asked him to do.

I had no idea, of course, that he’d been asking Bill, but Bill was actually like, “No, I don’t want to meet him! It’s Sonny Bono, or whatever.”

I went up to see Bill and Melinda, and I said, “Look, we have an organization, and we’ve got very, very smart people. Brilliant people. But we need to professionalize.” President Bush had taken over the White House. Our rather relaxed attire going into Bill Clinton’s White House we felt was no longer appropriate, and we really needed to be more formal. So we got a million dollars from Bill [Gates]. And then he later told the New York Times or somebody that that was the best million dollars he ever spent. That’s a great compliment, coming from Bill Gates, and it makes funding a lot easier.

But what was shocking for me as an activist was to learn how important the role of commerce was in ending extreme poverty and the role that entrepreneurial capitalism has played in taking people out of extreme poverty. Right now capitalism is in the dark. It’s on trial. There’s a sense of the “us” and “them,” the 99%, the 1%, those who’ve gamed the situation, those who’ve been screwed by the situation. Some of these accusations, of course, are ridiculously far-fetched. But some of them are not. It’s critical that [entrepreneurial philanthropy] somehow coheres in the 21st century into a new sort of shape and form. What I learned from Bill and Melinda is that it wasn’t just going to be their cash that would be put to work but that the most important thing that they would contribute would be their brainpower.

Forbes: Bono, I believe you have called yourself an “adventure capitalist.” Maybe talk a little about RED, where you’re taking your advocacy and tying it into commerce to promote change and raise a tremendous amount of money.

Bono: I remember going to see Bob Rubin just after he left being Treasury Secretary. We asked him his advice on tackling HIV/ AIDS. And he said, “You know, if you want to move the dial on this, you’ve got to go about it like Nike almost. You’ve got to explain to, say, America the scale of the problem and how the problem can be solved. And you’ll probably have to spend $50 million doing that, the same way Nike spent marketing their ideas.” I said, “Bob, where do we get $50 million?” He said, “That’s your problem!”

We formed RED. And now RED, with the help of the Gates Foundation–by the way I couldn’t do anything I do without the Gates Foundation–was an attempt to sort of piggyback the great companies like Apple or Microsoft, Armani, the fashion company, Starbucks. At the French Open all the great tennis players came out with their red tennis rackets, because the Head company has gone RED. So we use RED not just to raise the… I think it’s $207 million we have raised so far to buy AIDS drugs for those people who can’t afford them–but to create heat and excitement around the issue of solving the problem. When lawmakers met in Congress in difficult times they would feel heat. We used to get this thing up on the Hill here in the U.S., and [they weren't] feeling that one, that AIDS emergency. So we wanted to be in shopping malls, where they would feel it. When they walked down the street and saw a Gap T-shirt, they’d feel it. When it comes to appropriations–and this year was a struggle to get funding for the Global Fund [which provides money to combat AIDS, tuberculosis and malaria]–the heat is very important. That’s what RED does. It creates heat, so that when the other organization, ONE, can actually go in Berlin, in France, in Paris, in London, we go after the big government budgets and tackle it that way.

Forbes: Bono is the activist who’s become a capitalist. Bill, you’re one of the alltime capitalists and philanthropists who’s now had to increase how much you work with governments. Can entrepreneurial philanthropy and activism be practiced purely, or do they inherently need to be merged?

Gates: I think the key to all philanthropy is how you unlock the much larger sectors–the government sector and the business sector. Say you have a goal, like reducing the number of children under 5 who die every year. The direct philanthropy in terms of inventing vaccines, buying vaccines, getting them delivered, isn’t really going to make a big dent in that problem. Unless you get the brilliant minds of the pharmaceutical companies engaged in the invention, unless you get the government aid budgets from the generous rich countries engaged, and unless you get the people on the ground–which in many cases are working with the developing country and how they train and manage all these primary health care workers. Unless you’re deeply engaged with that, you’re probably not going to have a big impact.

There are pieces, like some of the research, like the malaria vaccine piece, where philanthropy actually can fund a very substantial, even the majority of that. But when you get into the delivery mode, the $130 billion a year of government aid budgets focused on these poor countries, making sure that gets used the right way, that it’s not being cut because of budget problems and that you’re drawing in the power of the private sector that’s developing these countries–that’s part of how you’re going to win and get that number to drop in half in the next 15 years.

Forbes: Corruption is such a big part of it. How do you make sure that the money you put into these countries isn’t just propping up bad governments?

Gates: Well, it depends on how measurable the sector you’re operating in is. In the case of health, figuring out how many people survived by getting HIV drugs is pretty straightforward. Figuring out your vaccine coverage that reduces measles, that’s down from over a million a year to $300,000 a year. That is one of the most straightforward things. And because you buy the vaccines and ship them into the country, you know you’re controlling that procurement piece–you have a little bit of training money, a little bit of labor money, maybe a few percent of that can go astray.

But it’s not like building a road, when you send money to the government and no road shows up, or you know you’re paying twice as much for it. The health and agricultural sectors, which are very critical to the poorest–getting the health right, the nutrition right–those things actually you can operate in a mode where at most corruption would be 5%, and if you can’t withstand a few percent, like someone who came to the training session, then you’re an idealist who really doesn’t belong in the game of helping poor countries.

Bono: There’s a cure for that disease of corruption. There’s a vaccine, at least. We call it transparency. One of the things we’ve been working on in the ONE Campaign, and have been working on with the support of Bill and Melinda Gates, is a revolution. A transparency revolution. This wave of transparency is coming through all manners of commerce, just bringing daylight so that people can see what’s going on in those transactions and judge for themselves if their governments are dealing with them fairly.

Forbes: Hand in hand with transparency, of course, are numbers. Bono, you recently have come out of the closet: You’ve admitted you’re a numbers geek. Talk a bit about “factivism.”

Bono: Well, that’s just me pretending to be Bill. I’m Irish; we do emotion very well. You’re just experiencing some of it, and it can go on and on and on! I’ve learned to be an evidence-based activist, to cut through the crap, find out what works and find out what doesn’t work. Repeat what works, increase it and stop doing what doesn’t work. I don’t come from a hippie tradition of let’s-all-hold-hands and the world’s going to be a better place. My thing’s much more punk rock.

I enjoy the math, actually. The math is incredible! I was telling people recently there are 9 million people on AIDS medication. In 2003 there was 50,000. This is the most extraordinary thing. I just want to give thanks to the taxpayers who are paying for that. Because this is a remarkable thing. Numbers work. In the last ten years infant mortality is down. I think it’s 7,256 less deaths a day. That’s down from 9.4 million to 7.2, something like that. I love these numbers. These are sexy numbers. They rhyme somewhere in my head.

Forbes: Okay, so based on numbers and data, what’s the biggest course change either of you made?

Gates: You’re always learning–field visits, meeting with scientists, looking at the numbers; it’s a collage of those things that come together. For our health work, it’s been figuring out how primary health care systems can be really well run–and that gets you the vaccine coverage, it teaches the mother about things to do before birth and after birth, the nutrition things, the reproductive health supplies. It’s amazing how some countries spend very little on their primary health care system and they get 95% of the kids vaccinated, and some spend a lot more and get 30% vaccinated. So the importance of personnel systems and helping get those right, the measurement, training, hiring.

In our U.S. education work, it’s been the most dramatic where we’ve been focused on school structure in the first four years and not so much on helping the teachers learn from the very, very good teachers. And that shifted around, because we saw about 10% or 15% improvements with the thing we called the small schools initiative–that just wasn’t going to be enough. So we got very focused on how do teachers get feedback, what are the exemplars doing right, can you help people improve–essentially, their personnel system and not just the compensation piece, because that turns out to be secondary to the idea of professional development, analysis and measurement. It’s kind of obvious at this point, but it took a lot of time and money to have that be a primary model that we apply.

Bono: Applying transparency to development, actually, was a big lesson for us. It’s strange, but the two parties most important in the transaction that we call development assistance are the two sides of the equation who know the least about it. The taxpayer and the child who’s been vaccinated or the student who sits in a class. That has got to change. And I think it will be wonderful when it does.

I remember, for instance, we worked on debt cancelation, and we were in a ghetto outside of Accra. There were no latrines for, whatever it was, 80,000 people living there. And years later, after fighting for debt cancelation and having this money well spent by the Ghanaian government, I saw the latrines! I was like, “Wow, I have to use these!” I went in, if you’ll excuse me, and I’m standing there and I look up on the wall, and it says “Paid for by HIPC.” HIPC. What’s HIPC? Well, I’ll tell you what HIPC is. HIPC was the UN’s idea for Heavily Indebted Poor Countries Initiative. And they were largely leading the vanguard on this debt cancelation. But that was their signage! Does anyone know what that was?

In the Oval Office with President Bush before the AIDS initiative, I remember saying to him, “You can paint those pills red, white and blue if you have to, Mr. President. If you do this, this will be the best advertisement for the United States ever.” And it has been.

Forbes: If this rock thing doesn’t work out, I’m sure K Street has a job for you. I know you come from a family of salesmen–you’ve become maybe the most effective lobbyist in the world. How have you embraced that?

Bono: Well, thank you. It’s the ideas that win the day, and when we go for a meeting with Angela Merkel, say, a couple of months ago or together, me and Bill, went to see pretty much most of the French government a few months ago, we tried to bring ideas with us that will solve the problem that we are presenting. Our strategy, you could call it sort of inside-game maneuvering with those ideas–but then outside mobilization, so there’s always a moment where you can lean in with the policymaker and just say, if they are being rude to you: “Coming to a stadium near you. … ”

Forbes: Last question. There’s a lot of pressure on you guys, as people expect big things. Do your amazing first acts create self-imposed pressure for your second acts?

Gates: Well, yes. But that’s fun. You have the possibility to fail. I think Warren’s generosity to the foundation made that even more acute, because if it’s money that you made yourself, it’s like “Okay, I have a right to make a mistake.” With his money, even though he’s been nice enough to say it’s okay to fail, I don’t feel like I should. It’s kind of fun. You want to wake up in the morning thinking, Am I working hard enough? Am I thinking hard enough? Have I found the right people? Why isn’t this thing that I thought would go well not going well? That’s kind of a dynamic thing, and I feel glad that that kind of challenge–philanthropy has that every bit as much as my previous work did.

Bono: I haven’t left my day job yet, though there’s always this possibility when U2 puts out an album that no one will be there to buy it. And according to my band, if I keep doing these type of events, that’s going to be closer than we thought. I have a tricky one, you know, because I have to balance being an artist, which is my gift, and being this salesperson. In U2, I sell melodies, I sell songs. Here I try to sell ideas, but I have to believe in them, and then I’m a pretty good salesman. There is a huge pressure in not wanting to screw up the position that you’ve been put in. I do feel that, and I know that everyone in ONE feels that and everyone in RED feels that, because we’re serving. Though Nelson Mandela asked us to serve and Desmond Tutu threatened us on a regular basis that if we stop serving we wouldn’t go to heaven, the pressure is internal, as Bill says.

In this kind of work you do see people crack under that because these are matters of life and death a lot of the time. So it’s lucky that we get to, Bill and myself, drink heavily. That’s a joke. But we actually do have a lot of fun doing this. It’s very exciting to see the progress that’s been made in the last ten years. And you get to hang out with Warren Buffett, who is a comedian.

forbes.com

How America's Richest People Are Bringing Hope To The Eighth-Poorest Nation In The World

Standing beneath the canopy of the largest rain forest in western Africa, a young woman named Rose recalled a recent trip along the dirt path that runs through Zeagbay, the remote Liberian village where she lives. Her daughter, Blessing, had developed a fever, so Rose slung the five-month-old onto her back and began the hike to the nearest health clinic–22 hours away. Five hours in, Blessing died.

While she described her lost baby as a hole in her heart, Rose maintained a detached calm as she recounted the nightmare in her native Krahn, a language spoken by only 139,000 people worldwide. Death is no stranger in Zeagbay: In a town of fewer than 250, 10 children under 5 have died over the past two years. Life expectancy here is 29, the same as in medieval Europe during the plague.

According to the IMF, Liberia is the eighth-poorest country in the world and one that only a decade ago was engulfed in a 14-year-long civil war that featured the full set of sub-Saharan Africa’s gruesome horrors: child soldiers, endless rapes, beheadings via machete. About 250,000 of Liberia’s 4 million citizens perished in the conflict, and the war devastated the country’s economy and infrastructure. Against this backdrop Rose’s tragedy seems sadly predictable, even inevitable.

But Liberia is also unique. A peace movement of women ended the civil war, and the country boasts Africa’s first female democratically elected head of state, Nobel Peace Prize winner Ellen Johnson Sirleaf, who has embraced entrepreneurship as a long-term fix to her nation’s many woes. The country’s leaders, from government to private-sector to nonprofit, recognize that sustainable self-reliance ultimately requires market-based solutions. “We are not poor,” says Axel Addy, Liberia’s commerce minister. “We just haven’t tapped our potential to get beyond begging.” And for Americans, helping Liberia carries the same kind of moral responsibility as one might feel caring for a troubled family member.

The country was founded by freed American slaves, part of an ill-conceived plan in the 1820s to solve the slavery issue by sending blacks (most of whom had been born in the U.S.) back to Africa. The capital, Monrovia, bears the name of then president James Monroe. Their red-white-and-blue flag sports the star and stripes, their currency is called the dollar, and their map is speckled with names like Virginia, Maryland and Bunker Hill.

Armed with these justifications for both the heart and the head, for the past six months FORBES has engaged in an experiment: Can focusing some of the world’s greatest entrepreneurial and philanthropic minds on the problems of one specific country make a tangible difference? With that in mind, we made Liberia the centerpiece of the second annual Forbes 400 Summit on Philanthropy, attended in June by more than 150 billionaires and near-billionaires. President Sirleaf and several of the country’s top social entrepreneurs addressed the participants, who then broke into groups to see how they could help them. In October FORBES followed up, leading a delegation of a dozen top philanthropists and private sector altruists to Liberia on a three-day mission to see their how their ideas worked in action.

IF THERE IS HOPE FOR THE NEXT GENERATION of Roses–and their kids–it comes from people like 32-year-old Raj Panjabi. A Liberian native, faculty member at Harvard Medical School and protégé of Paul Farmer of Mountains Beyond Mountains fame, Panjabi has returned to his homeland knowing that the solution to health care in places like Zeagbay is neither aid, which buys time but does nothing systemic to change the reality of a 22-hour walk for help, nor medical breakthroughs, since the tools to treat Blessing, who likely died of malaria, have existed for decades and cost a few dollars.

It’s jobs. Medical care is scarce even in urban Liberia–when the civil war ended, just 51 doctors remained in the entire country. So Panjabi’s nonprofit, Last Mile Health, recruits, trains and hires bright local villagers to serve as “frontline health workers,” who provide basic immunizations, diagnoses and medicines for 30,000 patients in the Liberian rainforest. In a region with 85% unemployment, Last Mile pays workers $60 a month and then incentivizes them based on completing immunizations, pre-natal treatments and the like. In the 41 current Last Mile villages, the child mortality rate has decreased by over 33% while the number of women receiving prenatal care soared from 15% to 97%. Says a smiling Markson Tarley, a 34-year-old frontline worker teeing up the Last Mile program in Zeagbay: “People call me ‘doctor.’ ”

The villagers, meanwhile, well understand that Panjabi’s jobs initiative can mean the difference between life and death for their children. The FORBES delegation, there to support Panjabi’s plans to expand into Zeagbay’s region, received a hero’s welcome, complete with the highest honor: the village elder presenting his peer–whom he quickly identified as 59-year-old former Morgan Stanley Smith Barney president Charlie Johnston–with a live chicken.

The helicopter flight back to Monrovia displayed the abundant resources available for Liberia. As we flew closer to the ocean, massive iron ore excavations, led by ArcelorMittal, filled up the landscape. The coastline, meanwhile, conjures what Florida’s Gold Coast must have looked like to a seagull 200 years ago–unspoiled green paradise brushed against thick white beaches, which roll on, untouched, for dozens of miles until the approach of Monrovia.

For all its beachfront charm, though, Liberia’s capital proves a textbook case study in the issues confounding urban Africa. Specifically, West Point, Monrovia’s largest slum, where 75,000 people cram up against the South Atlantic in an endless maze of wooden shacks that lack electricity and running water, much less sanitation.

Commerce here plays out at a subsistence level, from those selling a key source of protein–bony dried fish, possibly plucked from the same water that the sewage runs into–for a few pennies to the $1 prostitutes, some as young as 10. But at the elbow of one alley (West Point’s pathways are nameless), something more ambitious is going on. A pilot “trash-to-cash” program, seeded by the Bill & Melinda Gates Foundation (and 10% cofunded by the Liberian government, ensuring buy-in), generates $128,000 in revenue–and 300 jobs, which in turn provide for over 2,000 dependents–by collecting and repurposing West Point’s waste, which is otherwise destined to litter their neighborhood or clog the water supply.

A wooden door swings open to reveal the program’s most innovative aspect: 15 single mothers, the first of two shifts, crammed into a space no bigger than a backyard shed, vintage sewing machines in front of them all. Since June they have been taking plastic containers and turning them into stylish hats, backpacks and coats that, if tagged with a designer name, would surely run hundreds of dollars in New York boutiques–a huge opportunity, since the cost to produce each item is minuscule.

That’s part of what makes Liberia so intriguing. The ROI in terms of helping people, or in potential financial returns, is exponential. “Frontier markets like Liberia appear to be uncorrelated to both developed and emerging markets,” says Robert Hain, the chairman of City Financial, who joined the FORBES Liberia delegation. “This can provide investors with important diversity and performance–because frontier markets are underdeveloped, the potential for growth is high.”

That’s also why the FORBES delegation ended its trip with a larger-scale attempt to reach Liberia’s startups. Almost 400 people showed up at Monrovia’s city hall for what was billed as Liberia’s first entrepreneurial exchange. For all its issues–corruption remains a particular concern–the World Bank now ranks Liberia among the five easiest countries in Africa to start a company. “Liberia is ready–and ready now–for business,” Addy, the commerce minister, told attendees. “We, as the government, are banking on you, the entrepreneur.”

The exchange–some of the most successful entrepreneurs in the world, talking with civil war survivors trying to forge a new kind of living–was telling. Sometimes, the groups were speaking different languages–solid advice in the U.S. about setting up advisory boards or avoiding dilution were met with blank stares from a woman who in buying a single, used copy machine is trying to fashion herself as Liberia’s Xerox. When Jennifer King, whose family recently pledged $150 million to Stanford to nurture entrepreneurs in Africa, asked how many people in the audience had more than $150,000 in revenues (the current threshold, she told them, for the Stanford program), less than a half-dozen raise their hands.

But ultimately the language of entrepreneurship proves even more universal than English. After panels on raising capital and growing a business, an informal meet-and-greet turned into a networking frenzy, with dozens of business cards pressed into every open hand. Rather than chat, one local designer quickly charged Francine LeFrak, whose family has made more than $5 billion in New York real estate, $30 for two colorful hats, each proudly stamped “Made in Liberia.” A nascent e-entrepreneur, stymied by the fact that PayPal operates in 191 countries but not Liberia, wrangled an introduction to the U.S. ambassador, who in turn said she’d see if she could solve the bottleneck.

For the final session, Building Markets, a nonprofit that helps the most promising Liberian entrepreneurs get access to capital and contracts, hand-selected nine for a West African version of Shark Tank. Competitors included a group that makes flour from plantains, a concern that wants to consolidate local rice growers so that they have enough scale to sell countrywide and two different electricity companies–no small idea in a country that doesn’t have power outside its capital. City Financial’s Hain was particularly smitten by a proposal for Liberia’s first fleet of container trucks to service those burgeoning iron ore discoveries: “That’s a highly investable idea.”

Hain hopes to get the chance to put these ideas into practice soon. In partnership with Building Markets, he’s in the midst of putting together a frontier market fund of between $50 million and $75 million, which will invest heavily in Liberia. LeFrak and King each committed to fund a village for Last Mile Health, and King also promised to expand her family’s $150 million Stanford program here. Perhaps most dramatically, Raj Panjabi closed in on a major commitment that could, in one stroke, bring health care to 1 million Liberians.

In a country with a GDP of just $1.75 billion, this is progress, which we’ll be keeping tabs on. As Mother Mary Brownell, who started the Liberia Women ?Initiative in 1994 and proved instrumental in stopping the civil war, put it: “When I was on mission, we used to sing a song: ‘We don’t know where we’re going. But we’re going. …’ ”

forbes.com

The Danger of Values by Michael Jinkins

One of the more disturbing features of American culture today has to do with the meaning and status of "values." During election cycles we often hear about the voting preferences of "value voters," a phrase that gives the impression that only some voters have values while others do not. In fact, all voters have values, as do all people. The real question is not whether everyone has values, it is how one handles one's values. There is a real danger about values, and the danger has both theological and political dimensions.

When we say we value something, we are saying that the thing or idea we value matters to us, that it is of concern. We orient and order our lives -- to some degree, maybe to a considerable degree -- relative to this thing or idea we value.

The political danger of values has to do with a pretty pedestrian fact: Every thing or idea we value exists in relationship to other things and ideas we value. Sometimes these values will be in conflict with one another. And often it will not be easy (and sometimes it will not be possible) to determine that one value has priority over the other. Thus irreducible tensions among some values are inevitable. And sometimes the choices we make between values leads to unavoidable losses.

Any society that wishes to negotiate its way through decision-making and policy-making must recognize these basic facts and develop political structures and processes that allow us to go about the business of living together as a society. The U.S. Constitution recognizes the fact that values compete with one another, that balances must be achieved among the competing values, and that the arrangements of one time and place may not fit another occasion or place. In other words, the Constitution enshrines the fact that values inevitably compete.

To take one example from the proverbial "front page" of our newspapers, there is a real tension between "the right to privacy" and "national security." To take another example, there is a genuine tension between "public safety" and "the right to bear arms." Each of these values is enshrined in the U.S. Constitution. And all of these values find themselves in tension with other values from time to time.

This has always been the case. Nothing new here, including the tendency of some people to try to make absolute a value that is relative. This is where, of course, politics (which always includes the negotiation of various values as well as interests in the public arena) gets very knotty indeed. When a person or a group refuses to recognize the relative nature of a particular thing or idea they value (that is, when they refuse to accept the fact that every value exists in relationship to other values, and claims that a particular value trumps all others all the time), then it may be very difficult -- if not impossible -- to negotiate life together in society.

Absolutism of values is not just a political problem, however, but a theological problem, at least for persons of faith. Here I shall speak primarily from a Christian perspective, though the argument applies to all three Abrahamic faiths.

When we make a value absolute we run the real danger of substituting a value we hold for the God we worship. In other words, there is a way of holding our values that can lead us into idolatry. In this sense, the higher the value, the greater the danger. Any "good" (even a very great "good") can become evil if substituted for the place of God.

As Kathryn Tanner observes, "Replacing the divine with the human or confusing the human with the divine threatens ... to make a Christian way of life an idol." In her book,Theories of Culture: A New Agenda for Theology (Fortress, 1997, 126), Tanner gives new depth and precision to a theological concern that has spanned the ages of classical theology from St. Augustine to Paul Tillich. "Faith," as Tillich said, "is the state of being ultimately concerned." And to substitute our conditional and finite concerns for our ultimate concern is to construct an idol (Tillich, Dynamics of Faith, Harper, 1957, 1, 3, 14).

Tanner insists that while our ultimate allegiance as Christians is to God, and that the claim God makes on our lives is unconditional and absolute, we must be very careful making claims in the name of God. As she says:

Even in Christ, the human never approximates the divine but remains distinct and unmixed, no third thing approaching the divine by way of the alteration of its own properties. The Word can be identified with a particular human being, Jesus Christ. But his Christian disciples ever follow him at a distance. And the Incarnate Word is only at best indirectly identifiable with even those human words of the Bible that Christians believe effectively witness to him (Theories of Culture, 126).

To claim, in other words, absolute status for my values does not mean that I am being more righteous or faithful. In fact, ironically, if I claim absolute status for my values, my action calls into question my basic faith in God, because I have placed my values (and this includes whatever I construe as "my Christian values") in a place above God. Not only is it possible to be so "value oriented" that I just can't live sociably with other people, I can become so "value oriented' that I can deny God.

Of course, we don't really need theologians to tell us this. Jesus' Sermon on the Mount remains the definitive text on religiosity that does not reflect God (see Matthew, chapters 5-7). Jesus calls us to reflect God's perfection by the quality of our mercy, not the intractability of our values.

LUCRATIVE LIFESAVERS

The hopes and perils of betting on cancer treatments

New weapons are emerging in the war on cancer. That is good news not just for patients but also for drug companies. The biggest ones, faced with falling sales as their existing medicines go off-patent, are investing in smaller firms with promising cancer treatments under development, hoping to secure the next blockbuster.

On August 25th Amgen, the world’s biggest biotechnology company by sales, said it would pay $10.4 billion for another American firm, Onyx. The target firm’s crown jewel is Kyprolis, a treatment for multiple myeloma, a type of blood cancer. The next day AstraZeneca, a British drugs firm, said it would snap up Amplimmune, an American firm working on ways to trigger the immune system to fight cancer.

Oncology is attractive for several reasons. First, the understanding of cancer is evolving rapidly. In the 20th century treatment relied on surgery, radiation and chemotherapy. These now seem rudimentary. Immunotherapy—getting the immune system to attack cancer—has gone from theory into practice. Genomics has helped scientists target specific mutations that promote cancer. Another area of excitement for cancer researchers is epigenetics, which alters how a gene acts without meddling with the sequence of DNA.

Second, regulators have speeded up their approval of cancer drugs. Of the 39 medicines approved by America’s Food and Drug Administration (FDA) in 2012, 11 were for cancer. These included Kyprolis, which was granted “accelerated approval”, based on a smaller clinical trial than usual, for use as a last-ditch treatment for patients with multiple myeloma.

Third, and most controversial, cancer drugs can fetch exorbitant prices, particularly in America (see table). “The idea is that there’s nothing else available, so you can ask for a high price,” explains Howard Liang of Leerink Swann, an investment bank. A typical course of treatment with Kyprolis lasting, say, five months, can cost around $50,000.

Little surprise, then, that big drugmakers are keen to develop their own cancer drugs, form partnerships with smaller firms that have promising treatments in the pipeline, and buy such companies outright. Kyprolis was first developed by a small firm called Proteolix, which was bought by Onyx, now acquired by Amgen. In 2009 Bristol-Myers Squibb, an American drug giant, paid $2.4 billion for Medarex, which had an experimental immunotherapy drug. That drug, for melanoma (a skin cancer), is now sold in America for $120,000 for a full course of treatment.

There are risks, however. Even a drug seemingly destined for fame and fortune can fall flat. The FDA has approved Kyprolis only for patients who have already tried at least two other treatments. Its annual sales could reach $3 billion, reckons Goldman Sachs. But that requires approval beyond America, and data showing that Kyprolis is worth giving to earlier-stage patients. AstraZeneca is buying Amplimmune largely for two cancer drugs still in early testing. “If you are not willing to take risks, you cannot be in this area,” says Bahija Jallal, an executive at AstraZeneca.

The biggest question in the long term is whether health insurers and governments will keep paying up. Onyx and Bayer, a German firm, share the profits of Nexavar, a kidney-cancer drug. Last year Indian regulators granted a local firm a “compulsory licence” to sell Nexavar copies for a fraction of Bayer’s price. The response elsewhere is less extreme. But companies face new scrutiny over their prices, particularly in Europe. In April more than 100 experts in chronic myeloid leukaemia (another blood cancer) signed a paper to protest against the high cost of drugs. For now, however, Amgen should be able to continue charging handsomely for Kyprolis.

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FINALLY, A MALARIA VACCINE IN SIGHT

Have you experienced a malaria infestation before? Who hasn’t, you may say. There are some africans who have never had malaria, though Africa is an endemic region. But if you have and continually do, then you will heave a sigh of relief at this news. See some statistics also.

According to the World Health Organisation (WHO), there were about 200m cases of malaria around the world in 2010, with 660,000 deaths, 90% of which were in Africa, mostly of young children. The prospect of a vaccine is therefore exciting to patients and health experts alike. But developing one is difficult. Malarial parasites, though small and single-celled, are much more complex than the bacteria and viruses that are the usual targets of vaccines. To date there has been no successful vaccine against such a complex organism. Work on RTS,S has been going on for decades.

A case of malaria starts when a mosquito’s bite delivers parasites into a person’s bloodstream. These travel to the liver, where they hide, mature, multiply and eventually emerge back into the bloodstream to invade and destroy its red cells. The vaccine contains a protein found on the surface of the parasite, combined with an antigen for hepatitis B that prompts an immune response, plus an added immune-system booster. RTS,S seems to provoke antibodies and killer cells that attack the parasite before it leaves the liver.

The most ambitious clinical trial of a malaria vaccine has shown some effectiveness in children over an 18-month period. While its efficacy is modest, it is nonetheless a significant advance in the long struggle to control a disease that kills some 600,000 people a year, mostly children under the age of 5.

The trial, conducted at 11 research centers in seven African countries, involved more than 15,000 patients who took a new malaria vaccine developed by GlaxoSmithKline or a non-malarial vaccine given to control groups. Young children who were 5 months to 17 months old when first vaccinated with the Glaxo vaccine had 46 percent fewer cases of clinical malaria than the control groups. Infants who were 6 weeks to 12 weeks old when first vaccinated had 27 percent fewer cases.

Glaxo spent more than $350 million over 25 years to develop the vaccine for military personnel and travelers and expects to invest an additional $260 million to complete development. But Glaxo was reluctant to pay for pediatric trials in impoverished nations on its own, so the Bill and Melinda Gates Foundation provided $200 million through the nonprofit PATH Malaria Vaccine Initiative to drive development and testing over the finish line.

If the results hold up after further follow-up, the vaccine will be the first ever shown to be effective on a large scale against a disease-causing parasite, an organism that is much harder to neutralize than viruses or bacteria. The vaccine attacks the parasite at its earliest stages, before it can multiply in the liver and re-enter the bloodstream to infect red blood cells. The trials were conducted in real-world conditions in which a large majority of young children and infants were already protected by sleeping under insecticide-treated bed nets and other prevention measures. The vaccine protected them further.

The Gates Foundation called the trial “an important scientific milestone” for demonstrating that developing a vaccine against a parasite is possible. Glaxo said it would seek a scientific opinion from the European Medicines Agency next year in hopes that the World Health Organization will recommend the vaccine’s use as early as 2015. There are still scientific and practical hurdles to surmount — a final judgment on safety and efficacy and an analysis of the public health impact and cost-effectiveness of using this vaccine. With no other broadly tested vaccine on the immediate horizon, we can hope Glaxo’s passes muster.