Informatics, Global Health and Sutton’s Second Law

I recently attended the 25th anniversary celebration for the Mectizan (ivermectin) Donation Program (http://www.mectizan.org/).  Today the program is closing in on eliminating onchocerciasis, or river blindness, in several nations.  President Jimmy Carter, former Merck CEO Roy Vagelos and former CDC director and Task Force for Global Health founder Bill Foege took the stage to recall how the program was born and succeeded out of a combination of luck and determination.  Each admitted having no clear idea about how to realize the program at first, and each offered grains of wisdom learned since.

Dr. Vagelos recalled that the decision to give Mectizan away, as much and for as long as needed to combat onchocerciasis, was made for lack of an ethical alternative, though several were explored.  Unexpectedly rapid regulatory approval and high expectations forced the executive decision even before the Merck board could be consulted.  The decision had an unexpected long-term impact.  Chemists, doctors, even factory workers flocked to Merck to work for the company with a clear moral compass.  Merck did well by doing right.

President Carter said the program illustrates the oft-overlooked power of volunteers.  The distribution of Mectizan is powered by local volunteers worldwide, including Lions Clubs who mobilize a small army of local business and community leaders in most nations touched by the disease.

Mectizan 25th Anniversary Event

Dr. Foege suggested that this program’s success, in contrast to many other public health campaigns, illustrates Sutton’s lesser known second law: “I get more done with a gentle voice and a revolver than with a gentle voice alone.”(1)   An effective tool made the difference.  “After people took Mectizan, some had the first itch-free day that they could ever remember,” Foege said.  This rapid, obvious improvement in quality of life for some helped sell the drug’s benefits to all.

These lessons should give heart to informaticians who are rapidly prototyping, piloting and iterating real tools in the field, and those using volunteers (such as in open source development) to shape the work collectively.   An application that “scratches the itch,” brings rapid uptake and success.  Vaporous promises and endless planning likely have the opposite effect.  We must not underestimate the power of the “revolver” in the hand over well-intentioned talk, nor the power of volunteers motivated by their communities’ needs.

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Notes: (1) Paraphrased. I could not find attribution of this remark to Mr. Sutton, though he is quoted “You can’t rob a bank on charm and personality,” which carries the same message!

Pictured in the photograph L to R: Dr. William Foege, Dr. Roy Vagelos, President Jimmy Carter, moderator and Task Force for Global Health President/CEO Mark Rosenberg.

Additional information on the 25th anniversary event available at http://www.mectizan.org/news/mectizan-donation-program-celebrates-25-years-of-partnership-and-progress .

Keywords: public health informatics, Seth Foldy, health informatics, open source, Jimmy Carter, William Foege, Roy Vangelos

One thought on “Informatics, Global Health and Sutton’s Second Law

  1. I have since seen several references to an Al Capone quote which is probably the actual origin for “Sutton’s Second Law”: “You can get much farther with a kind word and a gun than you can with a kind word alone.”

    Capone’s public relations are not nearly as cuddly as Willie Sutton’s (with reason), but Dr. Foege’s point remains: start with a powerful tool in hand.

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