A prescription for heroes

Bill Gates hasn't quite entered his anecdotage, but as he moves further away from full-time management at Microsoft he's becoming more thoughtful about life outside. Not that he's changed his spots — his statement that: "Hey, if you can castrate some guy's product, why not?" says more about Microsoft's business approach than any five company mission statements.

That's not his only interest in medical matters. Most tellingly, he muses that he might have chosen to work in medicine: "That would have been a close second. Even if I had known [about medicine], I don't think it would have drawn me away... from the personal computer. I don't think it would have topped it."

It is easy to be flippant about how medicine would have developed had Dr Gates earned his stethoscope, even if there's plenty of diagnostic evidence that the pharmaceutical companies have nothing to learn from the man on the use and abuse of intellectual property and positions of power.

It's more interesting, though, to take the good aspects of Gates' legacy and see how they might inform the problems facing the health industry. The PC market — which has now evolved into by far the major portion of the IT world — has benefited enormously from the standards in hardware and software which Microsoft's dominance has created, even and especially where those standards rebelliously refuse to stay in Microsoft's control. A huge, open and interoperating market means that innovation thrives without concomitant tie-in and lock-out. Huge advances, such as virtualisation, can be deployed quickly, cheaply and with minimal fuss — and with maximum impact across the board.

Health, however, is an expensive, fragmented world, a morass of incompatible fiefdoms with jealously guarded borders. It is the IT world before the flood, when doing anything not explicitly allowed was expensive and difficult. It also affects everyone, with direct consequences for our lives and happiness. With an ageing world and increased expectations, those inefficiencies are threatening to swamp the science and severely limit what we can do to help ourselves.

It is magnificent that Bill Gates and friends are funding and running altruistic programmes to directly attack some of the most outstanding health issues in the developing world. The human race needs to prove to itself that it can do good, regardless of the many ways it's found to do bad. But Gates should spare some time to consider how his experience and skills could be used to push reform in health across the board, how IT levels of innovation, interoperability and efficiency can be coupled to the dysfunctional health systems of every country.

And if he can persuade himself that the correct way to "be number one" is "to do the most good" rather than "own the most money", that famous bloody-minded no-holds-barred competitiveness may yet make him a hero for the ages. It's that or a cartoon demon with a castration complex. Your call, Bill.