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Barely Contained Rage: An Open Letter to Danaher and Cepheid

2023-09-12 · letter vlog · John · 8:26 · watch on YouTube

Topic: Global development · mode: Advocacy & fundraising · tags: civic or action cta, heavy topic

In an open letter John argues that Danaher and its subsidiary Cepheid use a printer-ink business model to overcharge poor countries for GeneXpert tuberculosis test cartridges, and asks viewers to press them by phone, email and social media for $5 tests.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — TB deaths and Danaher's opportunity to save hundreds of thousands of lives

  • ★★★ John says 1.6 million people will die of tuberculosis this year (2023), more than malaria and HIV combined, which infuriates him because TB is curable. — 00:00:00 · tuberculosis, malaria
  • ★★★ John says Danaher, a company most have never heard of, could save hundreds of thousands of lives over the next 10 years, and wants everyone to encourage it to do so. — 00:00:13
  • ★★ John says tuberculosis has killed over a billion people in the last 200 years, with little progress because testing and treatment remain out of reach for millions. — 00:00:20 · tuberculosis

00:00:29 — Why TB diagnosis fails: undiagnosed cases and 130-year-old sputum microscopy

  • ★★ John says that of the 10 million people who will get sick with TB this year (2023), about 4 million will go undiagnosed, often dying before an accurate test. — 00:00:29 · tuberculosis
  • ★★ John says most diagnosed TB cases are still found by someone looking at a sputum sample through a microscope, exactly as 130 years ago. — 00:00:44 · tuberculosis
  • ★★ John says microscopy misses over half of cases, especially in young children and immunocompromised people, and cannot detect drug resistance, so many get the wrong regimen and die. — 00:00:58

00:01:27 — The GeneXpert machine by Cepheid/Danaher, and tests poor countries cannot afford

  • ★★★ John says the fast, accurate test exists: the GeneXpert machine, made by Cepheid, owned by Danaher, which tests for TB and drug response and also HIV, COVID and other diseases. — 00:01:27
  • ★★ John says that everywhere he has travelled in high-TB-burden countries people praise the GeneXpert machine, and thanks Cepheid and Danaher for building it. — 00:01:44
  • ★★ John recalls a lab tech in Sierra Leone telling him the machine is amazing, if only they could afford the tests. — 00:02:05 · Sierra Leone
  • ★★★ John explains the printer-ink business model (cheap machines, overpriced locked-in consumables, as with razor blades and Nespresso pods) and says Danaher uses it for TB tests. — 00:02:14

00:02:31 — The printer-ink business model: cartridge prices, production costs, profit margins and public funding

  • ★★ John says Danaher's CEO Rainer Blair literally called these razor blade business models in mission-critical applications. — 00:02:44

    “these are razor blade business models in mission critical applications”

  • ★★ John says this sounds like Danaher bragging to its shareholders about ripping off the world's poorest people. — 00:02:55

  • ★★★ John says Danaher charges $10 per standard cartridge (TB plus resistance to a first-line antibiotic) and $15 for the cartridge testing resistance to four more drugs. — 00:03:00
  • ★★ John says extensively drug-resistant TB must be identified quickly to stop its spread, yet those cartridges cost Danaher no more to make than the regular ones. — 00:03:29
  • ★★★ John says Danaher refuses to share cost data, but a 2019 study commissioned by Doctors Without Borders found each cartridge costs $3 to $4.50 to make, for TB, HIV or anything else. — 00:03:38
  • ★★★ John says, based on the study, Danaher makes at least a 220% profit margin on regular TB cartridges and nearly 500% on the extensively drug-resistant ones. — 00:04:06
  • ★★ John calls those profit margins unconscionable. — 00:04:15
  • ★★★ John apologizes for sounding angry but says he is angry: he has known many people who went undiagnosed for months or years, and some died for lack of a timely accurate test. — 00:04:27 · tuberculosis
  • ★★★ John says the margins do not improve access; Danaher overcharges poor countries and blocks competition by locking them into its machines. — 00:04:36
  • ★★ John says Danaher and Cepheid received over $250 million of public funding to develop these tests, mostly from taxpayers. — 00:04:57
  • ★★★ John says Danaher's prices should acknowledge that GeneXpert tests are publicly funded public goods, not means to enrich the world's richest at the expense of the poorest. — 00:05:04

00:05:26 — The $5 campaign so far and the ask: calls, emails, social media, employees speaking up

  • ★★ John says since 2019 PIH, Doctors Without Borders and others have urged Danaher to cut prices to $5 per cartridge, through letters and public lobbying, with no response. — 00:05:26 · Partners In Health
  • ★★ John says those organizations have now asked the brothers and viewers to join them in the next step. — 00:05:48 · Partners In Health
  • ★ John says Danaher is a company with $8 billion in profit and is not hurting. — 00:05:52
  • ★★ John says Danaher is hard to pressure as it owns little consumer-facing, except Pantone, which it is spinning off while its shareholders keep Pantone shares, so maybe pressure applies there. (hedged) — 00:05:55
  • ★★★ John says Danaher must learn this is a bad business decision: people are watching and will make it cost Danaher more in reputation, recruiting and business than $5 tests would cost in profit. — 00:06:11
  • ★★★ John asks viewers to spend five minutes calling or emailing via the linked contacts and to tell Danaher on social media they won't accept this injustice. — 00:06:24 · Twitter, Facebook, Instagram
  • ★★ John says Danaher is on Twitter, Facebook, Instagram and Threads, and he and Hank will be in all those places amplifying viewers' messages. — 00:06:44 · Hank Green, Twitter, Facebook, Instagram
  • ★★ John asks viewers who work at Cepheid or Danaher to tell their bosses they are not okay with this. — 00:06:54
  • ★★ John says employees speaking up was an essential part of the pressure that led Johnson & Johnson to swiftly allow generic competition for bedaquiline. — 00:07:03
  • ★★★ John says lowering the tests' price to $5 would likely save hundreds of thousands of lives over the next 10 years. (hedged) — 00:07:13

00:07:23 — Polite but impassioned reminders; message to Danaher executives; sign-off

  • ★★★ John says Danaher choosing profits over people is not inevitable: most people want to do right and sometimes just need polite but impassioned reminders. — 00:07:23

    “polite but impassioned reminders”

  • ★★ John says he has benefited from such reminders even when they made him uncomfortable, and believes Cepheid, Danaher and their executives will too. — 00:07:33

  • ★★★ John tells Danaher's executives that building something is only valuable if those who need it most can access it; it is time for $5 tests and people over profits. — 00:07:52

In the description and comments

  • ★★★ An update in the description and John's comment says that thanks to tbfighters.org and partners, Danaher agreed to make no profit on standard TB cartridges, in a deal brokered by the Global Fund, USAID and the Stop TB Partnership. — video description
  • ★★ In his comment John says this is not the end of the work: the XDR cartridge price still needs to come down, but the deal is very significant. — creator comment
  • ★★ The description asks viewers to let Danaher and Cepheid know how they feel on social media, linking Instagram, Twitter, Facebook and LinkedIn. — video description · Instagram, Twitter, Facebook
  • ★ In a comment John, saying he never asks this, asks viewers to share the video widely. — creator comment
  • ★★ The description thanks Rosianna Halse Rojas, Dr. Carole Mitnick of Harvard, MSF and PIH staff, and all the nerdfighters who worked together to make tbfighters.org. — video description · Rosianna Halse Rojas, Partners In Health, Nerdfighteria

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Cepheid · Danaher Corporation · GeneXpert · tuberculosis

Also: People: Rainer Blair

Organizations: Facebook · Instagram · Johnson & Johnson · Médecins Sans Frontières · Pantone · Partners In Health · Threads · Twitter

Concepts: antimicrobial resistance · extensively drug-resistant tuberculosis · HIV/AIDS · malaria · Microscope · public good · razor and blades model

Places: Sierra Leone

Products: Bedaquiline · Nespresso

Only in the description or credits: Carole Mitnick · Global Fund to Fight AIDS, Tuberculosis and Malaria · Harvard University · LinkedIn · Rosianna Halse Rojas · Stop TB Partnership · TBFighters · United States Agency for International Development

Also centred on Cepheid: Talking Tuberculosis, GeneXpert, J&J, and more with MY HEROES · So, um.... GOOD NEWS?!?!?!

Also centred on Danaher Corporation: Talking Tuberculosis, GeneXpert, J&J, and more with MY HEROES · So, um.... GOOD NEWS?!?!?! · End of a Rough Year · I Own Danaher · Is It 2010? IT'S A PARTS VIDEO · I Don't Want them to Get Away With It…

Also centred on GeneXpert: Talking Tuberculosis, GeneXpert, J&J, and more with MY HEROES · I Don't Want them to Get Away With It…

Later videos replying to this one

Part of an exchange of 3 videos, 2023-09-12 – 2023-09-19.