Saturday, September 16, 2006

Artículos sueltos

by Michael Ledeen
It seems at least a decade ago, and I am still angry, maybe even angrier. 9/11/01 was the day they killed Barbara Olson, one of Barbara Ledeen’s closest friends, and we have yet to take proper vengeance. The terrible details of her doom still seem quite incredible. She delayed her departure for California by a day so that she could wish her husband happy birthday before racing for the airport. This act of love delivered her to the hands of the killers, perhaps the ultimate example of “no good deed goes unpunished.”
That morning I was in the barber shop, watching it all unfold on a small tv set, and by the time I was finished I had seen the pictures of mobs of people walking out of downtown Washington, headed for safety. I was so furious I drove down to AEI, against that sad exodus, and I was glad I had, because many European friends called, most of them saying “you must be terribly frightened.” I told them no, we were not frightened, we were angry, and we were going to be angry for a long time.
There are many who are saying that we have lost that anger, that we have reverted to a 9/10 state of mind. I have my doubts.
Certainly nobody in my house has reverted, and my sense of the American people is that they have not either. But many of our opposition leaders, journalists, broadcasters, and editors, and, apparently, the overwhelming majority of the professoriate, clearly have. Otherwise it would not be possible for them to actively undermine the war. It is wrong to say they have forgotten the significance of 9/11, because they never grasped it. For them, patriotism has always been unworthy of sophisticates like themselves, and fighting enemies on foreign battlefields is something that rubes and rednecks do. They understand neither the world nor their fellow countrymen. They think we can achieve peace by being nice–did you hear Senator Biden prattling on and on about the need to talk to our Iranian enemies?—and they don’t know that our commissioned officers are college graduates, many of them from the best universities. I doubt more than a small fraction of leading journalists know that you need a college degree to get a Marine commission. Their ignorance about, and contempt for our military, fester beneath the surface of their reportage.
How I wish Barbara Olson had the chance to confront them, live and in color. She knew them well, these self-satisfied, self-indulgent ignoramuses whose misunderstanding of the world was acquired at overpriced universities and at elegant dinner tables where they dined with like-minded people. How she would have ridiculed them and their alma maters, the Harvards, Georgetowns, Virginias and Chicagos who have just given their stages to Mohammed Khatami, the mass murderer who is pimping for the evil regime of the Islamic Republic of Iran.
She would not restrict her acid wit to those schools. She would also direct it at an administration that has failed so miserably to explain the urgency we need to destroy her murderers. She would surely demand an accounting from all those who signed off on Khatami’s visa. How could you? she would ask. You know–you say all the time–that Iran is the greatest supporter of the terrorists. You know–everybody knows–that the villains who organized my murder found sanctuary and support in Iran when they slinked out of Afghanistan. How could you then open our country to its former president? Have you no shame?
I have plenty of time to listen to constructive criticism of our war strategy; I have done plenty of it myself. I crave revenge, as do most Americans. But I have no time for the fools and fabricators who invert reality, who warn that the greatest threat to a decent world is a bloodthirsty America that is actively planning an invasion of Iran, when the truth is that this administration is so feckless that it will not even support the millions of freedom fighters already there.
Most of the fools and fabricators are Lefties, but there are plenty on the Right, and the Republican Party has an abundance of them. Indeed, some of them sit at the right hand of the president. Karen Hughes, one of W’s closest friends and advisers, permitted herself this bit of politically correct appeasement-speak last December 19th, apologizing to our enemies on al Jazeera:
“The U.S. acknowledged [after] the events of September 11 that our policies might have created feelings of frustration and hatred, [causing those individuals] to board those airplanes, [fly them into the twin towers], and kill people. We want to change these circumstances, and this is what we are doing today…”
Barbara would have no time for any of the Bidens, Hagels, Lugars, Deans, Kennedys and Murthas who tell us we are wrong to be angry, wrong to seek the destruction of our enemies, wrong to advance freedom, wrong to defend our borders, wrong to use every technological miracle to discover and divine our enemies’ intentions, wrong to lock away captured killers.
She would spit at the very idea of coming to terms with those who want us dead or dominated. She would have cancelled her subscriptions to the New York Times and the Washington Post, because she would not want the poison in her house, and she would not want to give a nickel to the corrupt rich kids who own and guide the papers.
She would be right. And she must be avenged.

Michael Ledeen is resident scholar in the Freedom Chair at the American Enterprise Institute. He has served in the White House as a national security adviser, and in the Departments of Defense and State. He is author of, most recently, Machiavelli on Modern Leadership: Why Machiavelli’s Iron Rules Are As Timely and Important Today As Five Centuries Ago. Ledeen has appeared on PBS’s NewsHour and CNN’s Larry King Live, among others, and has been published in the Wall Street Journal, The American Spectator, International Economy, Commentary, and the Washington Times.


Modern Ways Open India’s Doors to Diabetes

CHENNAI, India — There are many ways to understand diabetes in this choking city of automakers and software companies, where the disease seems as commonplace as saris. One way is through the story of P. Ganam, 50, a proper woman reduced to fake gold.

Her husband, K. Palayam, had diabetes do its corrosive job on him: ulcers bore into both feet and cost him a leg. To pay for his care in a country where health insurance is rare, P. Ganam sold all her cherished jewelry — gold, as she saw it, swapped for life.

She was asked about the necklaces and bracelets she was now wearing.

They were, as it happened, worthless impostors.

“Diabetes,” she said, “has the gold.”

And now, Ms. Ganam, the scaffolding of her hard-won middle-class existence already undone, has diabetes too.

In its hushed but unrelenting manner, Type 2 diabetes is engulfing India, swallowing up the legs and jewels of those comfortable enough to put on weight in a country better known for famine. Here, juxtaposed alongside the stick-thin poverty, the malaria and the AIDS, the number of diabetics now totals around 35 million, and counting.

The future looks only more ominous as India hurtles into the present, modernizing and urbanizing at blinding speed. Even more of its 1.1 billion people seem destined to become heavier and more vulnerable to Type 2 diabetes, a disease of high blood sugar brought on by obesity, inactivity and genes, often culminating in blindness, amputations and heart failure. In 20 years, projections are that there may be a staggering 75 million Indian diabetics.

“Diabetes unfortunately is the price you pay for progress,” said Dr. A. Ramachandran, the managing director of the M.V. Hospital for Diabetes, in Chennai (formerly Madras).

For decades, Type 2 diabetes has been the “rich man’s burden,” a problem for industrialized countries to solve.

But as the sugar disease, as it is often called, has penetrated the United States and other developed nations, it has also trespassed deep into the far more populous developing world.

In Italy or Germany or Japan, diabetes is on the rise. In Bahrain and Cambodia and Mexico — where industrialization and Western food habits have taken hold— it is rising even faster. For the world has now reached the point, according to the United Nations, where more people are overweight than undernourished.

Diabetes does not convey the ghastly despair of AIDS or other killers. But more people worldwide now die from chronic diseases like diabetes than from communicable diseases. And the World Health Organization expects that of the more than 350 million diabetics projected in 2025, three-fourths will inhabit the third world.

“I’m concerned for virtually every country where there’s modernization going on, because of the diabetes that follows,” said Dr. Paul Zimmet, the director of the International Diabetes Institute in Melbourne, Australia. “I’m fearful of the resources ever being available to address it.”

India and China are already home to more diabetics than any other country. Prevalence among adults in India is estimated about 6 percent, two-thirds of that in the United States, but the illness is traveling faster, particularly in the country’s large cities.

Throughout the world, Type 2 diabetes, once predominantly a disease of the old, has been striking younger people. But because Indians have such a pronounced genetic vulnerability to the disease, they tend to contract it 10 years earlier than people in developed countries. It is because India is so youthful — half the population is under 25 — that the future of diabetes here is so chilling.

In this boiling city of five million perched on the Bay of Bengal, amid the bleating horns of the autorickshaws and the shriveled mendicants peddling combs on the dust-beaten streets, diabetes can be found everywhere.

A Noxious Sign of Success

The conventional way to see India is to inspect the want — the want for food, the want for money, the want for life. The 300 million who struggle below the poverty line. The debt-crippled farmers who kill themselves. The millions of children with too little to eat.

But there is another way to see it: through its newfound excesses and expanding middle and upper classes. In a changing India, it seems to go this way: make good money and get cars, get houses, get servants, get meals out, get diabetes.

In perverse fashion, obesity and diabetes stand almost as joint totems of success.

Last year, for instance, the MW fast-food and ice cream restaurant in this city proclaimed a special promotion: “Overweight? Congratulations.” The limited-time deal afforded diners savings equal to 50 percent of their weight (in kilograms). The heaviest arrival lugged in 135 kilograms (297 pounds) and ate lustily at 67.5 percent off.

Too much food has pernicious implications for a people with a genetic susceptibility to diabetes, possibly the byproduct of ancestral genes developed to hoard fat during cycles of feast and famine. This vulnerability was first spotted decades ago when immigrant Indians settled in Western countries and in their retrofitted lifestyles got diabetes at levels dwarfing those in India. Now Westernization has come to India and is bringing the disease home.

Though 70 percent of the population remains rural, Indians are steadily forsaking paddy fields for a city lifestyle that entails less movement, more fattening foods and higher stress: a toxic brew for diabetes. In Chennai, about 16 percent of adults are thought to have the disease, one of India’s highest concentrations, more than the soaring levels in New York, and triple the rate two decades ago. Three local hospitals, quaintly known as the sugar hospitals, are devoted to the illness.

The traditional Indian diet can itself be generous with calories. But urban residents switch from ragi and fresh vegetables to fried fast food and processed goods. The pungent aromas of quick-food emporiums waft everywhere here: Sowbakiya Fast Food, Nic-Nac Fast Food, Pizza Hut. Coke and Pepsi are pervasive, but rarely their diet versions.

The country boasts a ravenous sweet tooth, hence the ubiquitous sweet shops, where customers eagerly lap up laddu and badam pista rolls. Sweets are obligatory at social occasions — birthdays, office parties, mourning observances for the dead — and during any visit to someone’s home, a signal of how welcome the visitors are and that God is present.

“When you come to the office after getting a haircut, people say, ‘So where are the sweets?’ ” said Dr. N. Murugesan, the project director at the M.V. Hospital for Diabetes.

The sovereignty of sweets can pose ticklish choices for a doctor. Trying to set an example, Dr. V. Mohan, chairman of the Diabetes Specialities Centre, a local hospital, said he had omitted sweets at a business affair he arranged, and nearly incited a riot. Last year, his daughter was married. Lesson learned, he laid out a spread of regular sweets on one side of the hall and on the other stationed a table laden with sugar-free treats. Everyone left smiling.

In the United States, an inverse correlation persists between income and diabetes. Since fattening food is cheap, the poor become heavier than the rich, and they exercise less and receive inferior health care. In India, the disease tends to directly track income.

“Jokingly in talks, I say you haven’t made it in society until you get a touch of diabetes,” Dr. Mohan said. He points out that people who once balanced water jugs and construction material on their heads now carry nothing heavier than a cellphone. At a four-star restaurant, it is not unusual to see a patron yank out his kit and give himself an insulin injection.

The very wealthy have begun to recoil at ballooning waistlines, and there has been a rise in slimming centers and stomach-shrinking operations. In high-end stores, one can find a CD, “Music for Diabetes,” with raga selections chosen to dampen stress.

The rest of urban India, however, sits and eats.

In Chennai, workers in the software industry rank among the envied elite. Doctors worry about their habits — tapping keys for exercise, ingesting junk food at the computer. Dr. C. R. Anand Moses, a local diabetologist, sees a steady parade of eager software professionals, devoured by diabetes. “They work impossible hours sitting still,” he said.

S. Venkatesh, 28, a thick-around-the-middle programmer, knows the diabetes narrative. Much of his work is for Western companies that operate during the Indian night. So he works in the dark, sleeps in the day.

“The software industry is full of pressure, because you are paid well,” he said. “In India, if you work in software, your hours are the office.”

His sole exercise is to sometimes climb the stairs. A year and a half ago, he found out he had diabetes.

Unshod, and Unprotected

The diabetic foot is a recurrent backdrop among the unending cases that clog the waiting area at the M.V. Hospital. Dr. Ramachandran, its managing director, sees the parade of festering sores and frightful infections. He knows that only creative thinking can help.

The difficulty is that bare feet prevail here. People shuck their shoes before funneling into homes, some offices and always the temple. Farmers go barefoot in the country. In the cities, autorickshaw operators thunder through town, flesh pressed against hot pedals.

Diabetes, though, ruins sensation in the legs, and foot infections go undetected and are often a preamble to amputations. So doctors like Dr. Ramachandran strongly recommend against going barefoot. Yet the culture demands precisely the opposite.

Seeking a middle ground, Dr. Ramachandran presses his patients to don what he calls Temple Socks during worship. They are made at his hospital, conventional socks with rubber bases stitched inside. They are a slow sell.

Dr. Vijay Viswanathan, the hospital’s joint director, gives patients stickers to affix to their bathroom mirrors: “Take care of your feet.” Like doctors elsewhere, he promotes custom shoes. He drifted into them because of leprosy footwear.

Leprosy damages feet and requires special shoes, with tougher undersoles and without nails or sharp edges, that also suit diabetics. But when the diabetics in the telltale footwear appeared at restaurants, they were shooed away, thought to be lepers. So now the hospital makes distinctly different designs.

The consequences of the diabetic foot can be grim. While the affliction knows no class distinctions, the solutions do.

In his lectures, Dr. Ramachandran recounts the case of an impoverished diabetic with a hideously infected leg. Unable to find medical care, he laid the leg across the railroad tracks. The next train to hurtle past did the surgery.

For a limb replacement, the very poor may make do with a $50 wooden leg that does not bend. A woman like Mrs. Chitrarangarajan, 49, who runs a school for the autistic and is married to an oil executive, opts for the best. Her right leg was surrendered to diabetes in 2001. She found a German leg for $6,000 and ordered it over the Internet.

S. P. M. Ameer owned a shoe store when diabetes befell him 30 years ago. Soon, circulatory problems attacked, he closed his shop, he lost his wife, then his leg last January.

Now, at 58, occupying a mirthless room in a cheap hotel on a rackety side street, he no longer recognized the solemn shape of his life. He rarely left his squalid room. “Who hires a man without a leg?” he asked.

He had yet to arrange for a prosthesis. He had no way to pay for one. “God has to apply,” he said.

These stories circulate. But the cultural imperatives hold strong. Even in the sugar hospitals, with admonishments plastered on the walls, some patients insouciantly stride about barefoot. Directly outside the office of one local sugar doctor, beside a sign preaching against the perils of bare feet, another sign notified patients to remove their shoes before entering. And so, barefoot, they sat before him and heard him lecture them not to go barefoot.

Sick Without a Safety Net

Krishnasamy Srinivasan, 66, did not look good. He rarely did anymore. He was recumbent in a hospital bed, his shirt off, his eyes underslung with bags. He had come in by train for another checkup. He now lived deep in the suburbs, where it was cheaper, part of the sad new mix of his life.

He had done very well as a textile exporter, came to own four homes, and enjoyed rental income from those he did not occupy. Then diabetes hit when he was 40. He paid it little mind as it marinated inside his body. Over the last 15 years came heart problems and the need for bypass surgery. His kidneys deteriorated. He is now on dialysis.

He held up the needle-marked right arm of his malfunctioning body, identifying it as “my dialysis arm.”

He had to stop working. To cover the medical costs, he sold three of the homes. His family has been living off the evaporating proceeds, their past irreclaimable.

Diabetes is bankrupting people in the country, often the reasonably well off, and mainly because of a lack of insurance.

Few in India have health insurance, and among those who do, policies generally do not cover diabetes. Middle-class diabetics often exhaust a quarter or more of their income on medications and care. Instances abound where the sick must sell their possessions and compress their lives to feed the diabetes maw.

S. Kalyanasundaram, the chief regional manager in charge at the Chennai office of the National Insurance Company, one of the country’s biggest, explained that the issue with insurance was the odds. “Insurance can only work if the law of averages applies,” he said. “There are too many people with diabetes.”

Some concepts are easy to sell in India, Mr. Kalyanasundaram said, but health insurance is not one of them. “The capacity to pay is not there,” he said. “And many people take disease as a God-given thing to just accept. So why buy insurance?”

Things are beginning to change, even the possibility that policies may cover diabetes for an appropriate premium, but who knows how much they will change? Mr. Kalyanasundaram mentioned that certain preferential customers merited customized policies with an unorthodox clause. If they have diabetes and claim no expenses for four years, then afterward their diabetes will be covered.

“We are testing a belief,” he said. “We think it possible that if diabetes doesn’t manifest in those four years, then it will not manifest in the future.”

It was an odd thought for a disease that usually worsens with time. As for the results, he said it was too early to know how the test was going. “We are still testing.”

With many things it is still too early in India. And so rural dwellers often cope with unavailable or inaccessible health care, frequently relying on unlicensed doctors, many knowing little, if anything, about diabetes. Diabetes researchers estimate that three-quarters of those stricken with the disease in rural villages do not know they have it.

In urban areas, the sick, other than the poorest, prefer to bypass beleaguered government hospitals and seek private care. But without insurance, the cost of a long-term illness can be crushing.

Mr. Srinivasan’s wife, Srinivasan Muthammal, 61, also has the sugar, but not its complications yet. Like her husband, she is overweight. As she listened to him talk of their black hours, her face was frozen.

“We are angry with the god,” she said. “You gave us four houses in four directions and all the wealth, and now you have taken it all away. Why?”

Mr. Srinivasan suggested they had cash for one more year, perhaps a little more.

“I’m angry with the diabetes,” he said. “You are a pauper all because of the sugar.”

Till Diabetes Do Us Part

Divorce is rare in India, but in these changing times it is very much on the upsweep. Diabetes, here and there, even figures in the marital strife. Women may be stigmatized. Men find themselves impotent and then newly single.

K. Sumathi, a Chennai lawyer who sometimes deals in the accelerating number of divorces, appreciates the impact of diabetes in a country where different centuries breathe side by side.

She said a young woman with diabetes, for example, is often deemed damaged and unmarriageable, or must marry into a lower caste. Indian law recognizes five broad grounds for divorce, one being if either spouse acquires a chronic disease. Diabetes can rapidly debilitate a breadwinner and impose impotency, either outcome a solid marriage wrecker.

She told the story of a recent case: A wife, living as custom has it with her in-laws, said the stress of the circumstances contributed to her getting diabetes. She wound up in a diabetic coma and had to be hospitalized. Her husband, a dentist, chose to attend to cavities rather than visit her. The divorce was completed seven months ago.

There was also the account of a husband who accused his unhappy wife of sneaking extra sugar in his tea, hoping he would acquire diabetes and die. It proved to be a poor concept. He survived. The marriage did not.

J. Vasanthakumari, a marriage counselor who is friendly with Ms. Sumathi, said she has seen the disease percolate in the back stories of some of her clientele. Diabetes. Then sexual dysfunction. Unhappiness. Appointments with her.

“You must understand one basic thing,” she said. “People in personal matters will not bring diabetes to the surface. But women tell me, ‘He’s not affectionate, he’s not taking care of me, he’s not like before.’ It’s the diabetes.”

She went on: “Sometimes someone gets diabetes partly because he’s an alcoholic. The marriage falls apart. The real reason is the alcoholism. But the diabetes becomes the last straw on the camel’s back.”

Folklore and Frustration

The shabby disease remedy shop was small for its outsize promises. A dusty storefront crunched between souvenir stands, it sat near the Kapaleeswarar temple, a familiar tourist choice in Chennai. Inside spilled a teetering mass of ready relief for arthritis, heartburn, gout, piles. Beneath the scalding sun, an ox cart pounded past, scattering a swarm of people padding down the street.

The grizzled proprietor, who was asked if he had anything for diabetes, readily proffered a bottle of pea-soup-colored liquid. It cost roughly $3. Its exact contents, the man said, were as privileged as Coke’s formula. But drink a capful twice a day for three months, he assured, and the diabetes would vanish.

Though no universal cure exists for diabetes, “cures” and other mischievous medicines nonetheless abound in India. Much of the population gravitates to cryptic beliefs threaded with untruths that are hard to nullify.

People believe in bitter gourd juice and fenugreek, an Indian spice, which can temper sugar levels, but are not cures. Some years ago, the wood water cure gained considerable traction. Drink water stored overnight in a tumbler made of Pterocarpus marsupium heartwood, the promotion went, and it would wash away the diabetes.

All this exasperates Dr. Murugesan. He is among those trying to stanch the spread of the disease. Diabetes education is hard enough, without tomfoolery and witchcraft to discredit.

He had something to show on his desktop computer at the M.V. Hospital for Diabetes, a prevention program known as “Chubby Cheeks.” Animated mothers on the screen merrily admitted that they associated being chubby with health. Animated chubby students chafed that their parents refused to let them play, but forced them to study endlessly so they could become doctors and engineers. They studied, they sat, they enlarged. Dr. Murugesan takes his cautionary tale around to schools and waves it like a lantern.

Dr. Murugesan is himself an Indian diabetes story. A health educator, he devoted 20 years to erasing leprosy in southern India. Two years ago, with that scourge largely beaten back, he itched for a fresh menace. He chose diabetes. He saw its rapid ascent.

What’s more, he had diabetes.

Upon enlisting in the sugar fight, he felt it behooved him to test the blood sugar levels of his own family, and he excavated truths he had not wished for. His wife, daughter and one of his sons were all bordering on becoming diabetic. His other son, just 28 then, already had diabetes.

“I say it’s like Jesus Christ,” he said. “When you don’t look for him, he’s not there. When you look for him, he’s there. You look for diabetes, and it’s there.”

Prevention, he recognizes, is a mountainous climb in a country with a severe shortage of medical workers. What health care money exists is overwhelmingly applied to infectious perils.

The health minister, Dr. Anbumani Ramadoss, recently said he would begin a diabetes program, but the timetable and scope are unclear. Indian politicians in pursuit of votes rarely campaign on matters of health, but promise the poor cheap rice or free color televisions.

All of which perpetuates a dual continuum. Rural Indians flock to the cities, only to encounter diabetes, while Westernization sweeps its way to the villages, carrying diabetes as its passenger.

Thus Dr. Mohan, among other efforts, dispatches prevention teams to Chunampet, a cluster of villages a couple of hours south that are a feeder area for Chennai. Most of the villagers have no idea what diabetes is.

Meanwhile, Dr. Murugesan has enlistees operating in the Srinivasapuram slum, a grid of cramped thatched huts and makeshift tents that hug Chennai’s long beach.

The diabetes rates among these raggedly lives are notably below those of the middle and upper classes. But they are catching up.

When evening gushes over the slum and the mosquitoes emerge, a scattering of diabetics drift over to the tiny Vijaya Medical shop. They are poor at “self-poking,” as they explain, and have no refrigerators to chill their insulin. Some fill mud pots with water and stuff their vials in there. Others rely on the medical shop proprietor, a merry young man with legs withered by polio.

He tapes their names to the appropriate bottles and, each day, administers shots.

Misconceptions populate the conversations. Some residents say they occasionally have diabetes: a few years with it, then a few years without it. They think that diabetes pays visits.

Others are rabid apologists for the disease. Uninterested in eating less, they say that when they feel like a big meal, a luscious plate of sweets, they just swallow an extra pill or inject themselves with more insulin.

“They don’t understand,” Dr. Murugesan said. “They don’t see the darkness of this disease.”

Late in the day, back at the M.V. Hospital, he trooped upstairs to the rooftop auditorium, where 40-odd doctors had assembled to talk about prevention efforts. One thing they talked of uncomfortably: A particular profession in India, they heard, a well-paying one involving a lot of standing around, had practitioners who did not necessarily heed their own advice.

The profession was thick with diabetes. It was doctors themselves.


Philanthropy Google’s Way: Not the Usual

SAN FRANCISCO, Sept. 13 — The ambitious founders of Google, the popular search engine company, have set up a philanthropy, giving it seed money of about $1 billion and a mandate to tackle poverty, disease and global warming.

But unlike most charities, this one will be for-profit, allowing it to fund start-up companies, form partnerships with venture capitalists and even lobby Congress. It will also pay taxes.

One of its maiden projects reflects the philanthropy’s nontraditional approach. According to people briefed on the program, the organization, called, plans to develop an ultra-fuel-efficient plug-in hybrid car engine that runs on ethanol, electricity and gasoline.

The philanthropy is consulting with hybrid-engine scientists and automakers, and has arranged for the purchase of a small fleet of cars with plans to convert the engines so that their gas mileage exceeds 100 miles per gallon. The goal of the project is to reduce dependence on oil while alleviating the effects of global warming. is drawing skeptics for both its structure and its ambitions. It is a slingshot compared with the artillery of charities established by older captains of industry. Its financing pales next to the tens of billions that the Bill and Melinda Gates Foundation will have at its disposal, especially with the coming infusion of some $3 billion a year from Warren E. Buffett, the founder of Berkshire Hathaway.

But Google’s philanthropic work is coming early in the company’s lifetime. Microsoft was 25 years old before Bill Gates set up his foundation, which is a tax-exempt organization and separate from Microsoft.

By choosing for-profit status, Google will have to pay taxes if company shares are sold at a profit — or if corporate earnings are used — to finance Any resulting venture that shows a profit will also have to pay taxes. Shareholders may not like the fact that the tax forms will not be made public, but kept private as part of the tax filings of the parent, Google Inc.

Google’s founders, Larry Page and Sergey Brin, believe for-profit status will greatly increase their philanthropy’s range and flexibility. It could, for example, form a company to sell the converted cars, finance that company in partnership with venture capitalists, and even hire a lobbyist to pressure Congress to pass legislation granting a tax credit to consumers who buy the cars.

The executive director whom Mr. Page and Mr. Brin have hired, Dr. Larry Brilliant, is every bit as iconoclastic as Google’s philanthropic arm. Dr. Brilliant, a 61-year-old physician and public health expert, has studied under a Hindu guru in a monastery at the foothills of the Himalayas and worked as a Silicon Valley entrepreneur.

In one project, which Dr. Brilliant brought with him to the job, will try to develop a system to detect disease outbreaks early.

Dr. Brilliant likens the traditional structure of corporate foundations to a musician confined to playing only the high register on a piano. “ can play on the entire keyboard,” Dr. Brilliant said in an interview. “It can start companies, build industries, pay consultants, lobby, give money to individuals and make a profit.”

While declining to comment on the car project specifically, Dr. Brilliant said he would hope to see such ventures make a profit. “But if they didn’t, we wouldn’t care,” he said. “We’re not doing it for the profit. And if we didn’t get our capital back, so what? The emphasis is on social returns, not economic returns.”

Development of ultra-high-mileage cars is under way at a number of companies, from Toyota to tiny start-ups. Making an engine that uses E85 — a mixture of 85 percent ethanol and 15 percent gasoline — is not difficult, but the lack of availability of the fuel presents a challenge, said Brett Smith, a senior industry analyst at the Center for Automotive Research in Ann Arbor, Mich.

Another barrier, Mr. Smith said, lies in the batteries for so-called plug-in hybrids, which require more powerful batteries that charge more quickly than the current generation of hybrid batteries.

There are skeptics, too, among tax lawyers and other pragmatists familiar with the world of philanthropy. They wonder whether Google’s directors might be tempted to take back some of the largess in an economic downturn.

“The money is at the beck and call of the board of directors and shareholders,” said Marcus S. Owens, a tax lawyer in Washington who spent a decade as director of the exempt organizations division of the Internal Revenue Service. “It’s possible the shareholders of Google might someday object, especially if we go into an economic depression and that money is needed to shore up the company.”

And there is the question of how many of the planet’s problems can truly be addressed by a single corporate entity.

But even while expressing reservations about Google’s approach, Mr. Owens said that the structure of “eliminates all the constraints that might otherwise apply.”

The only conventional part of is the Google Foundation, a nonprofit with an endowment of $90 million that is constrained in how it spends by the 501(c)(3) section of the Internal Revenue Service code.

Google’s big philanthropic experiment lies in the part of where the bulk of the funding now resides. This part of will be fully taxable, with the ability to invest in a full spectrum of programs and companies.

All of’s spending, Dr. Brilliant said, will be in keeping with its mission, and there is to be no “blowback.” That is, should make a profit with one of its ventures, those funds will not go to the search engine business, but will stay within

Google had existed for only six years, when, in advance of the company’s initial public offering in August 2004, Mr. Page and Mr. Brin told potential investors that they planned to set aside 1 percent of the company’s stock and an equal percentage of profits for philanthropy. By the end of 2004, was formed.

The company has said it plans to spend the money over the next 20 years, and the Google board recently approved a more rapid disbursement rate, $175 million over the next two years.

“Poor people can’t wait,” Dr. Brilliant said. “Dying people can’t wait for some 20-year plan. It’s not what we’re doing here.”

Ventures that grow out of could be seen to have a competitive edge because they do not need to show a financial profit. But financial returns from a project like the high-mileage car are not necessarily the aim.

“I think how you count profit is the issue here,” said Peter Hero, president of the Community Foundation of Silicon Valley, a charitable foundation with about $1 billion in assets. “ is measuring return on cleaner air and quality of life. Their bottom line isn’t just financial. It’s environmental and social.”

Once was formed, the company spent months searching for an executive director. There was no lack of interest in the job.

“Literally thousands of people worldwide got in touch with us,” said Sheryl Sandberg, the Google vice president who led the search. “We’d get someone who was an amazing technology entrepreneur but who didn’t know anything about the developing world.”

Then along came Dr. Brilliant, an affable man generous with bearhugs and self-deprecating humor whose unlikely résumé looks like a composite career summary of multiple high achievers.

After receiving his medical degree, Dr. Brilliant studied for two years with Neem Karoli Baba, a famous Hindu guru.

As Dr. Brilliant tells the story, in 1973, shortly before the guru’s death, he told Dr. Brilliant to “take off the ashram whites” and use his skills as a physician to help eradicate smallpox, which was devastating India at the time.

Dr. Brilliant joined a team of United Nations workers who painstakingly worked their way through India inoculating people against the disease. In 1980, the World Health Organization declared that smallpox had been eradicated.

In 1978, Dr. Brilliant started the Seva Foundation, which focuses on preventing and curing blindness throughout Asia and Latin America. In 1985, Dr. Brilliant was a co-founder of the Well, a seminal online community. Throughout the 1990’s and early 2000’s, he ran several high-tech companies in Silicon Valley.

Dr. Brilliant first heard about in early 2005 while lying in bed in India, sick with dysentery. He had gone there to work with the polio eradication program of the United Nations and, while recovering, he saw news of in a local newspaper.

He sent an inquiry to the only e-mail address he could find: He got no response.

This year, Dr. Brilliant was awarded the TED Prize, an award given at the annual Technology, Entertainment and Design conference, a gathering of leaders from the technology and entertainment industries. The prize awards three recipients $100,000, and a “wish” for how to change world.

Dr. Brilliant’s wish was for the creation of an “early detection, rapid response” system for disease outbreaks. The idea would be an open-source, nongovernmental, public access network for detecting, reporting and responding to pandemics.

Some Google insiders heard about the award and invited Dr. Brilliant to give a talk at the company. Mr. Page and Eric E. Schmidt, Google’s chief executive, were in the audience as Dr. Brilliant described the polio eradication efforts of the United Nations. They agreed they had found their director and began to recruit him.

At first, Dr. Brilliant said, he was thrilled. But then he turned skeptical, largely because of the for-profit structure of the organization.

“I got weak knees,” he said. “It was weird. It was precedent setting.” After several lengthy conversations with executives at Google, Dr. Brilliant changed his mind. Six months into the job, he has traveled to India to visit eye clinics and polio vaccination projects with Mr. Page, and to China to discuss clean energy alternatives. Next week, he leaves for Africa to visit Google grant recipients in Ghana.

Dr. Brilliant said he had no desire to “reinvent the wheel” by working on projects others are already involved in. And although Google is a high-tech company, that does not mean that will be throwing around high-tech solutions.

“Why would we put Wi-Fi in a place where what they need is food and clean water?” he said.

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