Doctor America
Dr. Larry Brilliant has rescued the world’s poorest people from two dread diseases. Now he’s been offered a chance to change the world with a wish. He says he’s open to suggestions.

BY STEVE HEILIG

Consider this career résumé: Vanquisher of horrible and widespread disease—not just one, but maybe two. Leader of an organization that has saved millions from blindness. Doctor and epidemiologist; philanthropist and successful start-up CEO; volunteer for major relief efforts following massive disasters—such as 2004’s Asian tsunami—and for prevention of threatening ones, such as Avian influenza. Movie actor (at least once). Friend to world leaders and the world’s poorest. Self-proclaimed “luckiest man in the world.”
That’s Larry Brilliant, M.D. He’s the founding chairman of the SEVA Foundation, a Berkeley-based nonprofit with health projects worldwide but best known for innovative anti-blindness projects in India and Nepal—and for being guided and supported by a unique blend of some of the most renowned experts in public health and famed counterculture icons such as Ram Dass, Wavy Gravy and the Grateful Dead family. Brilliant played a key role in the eradication of smallpox in the 1970s, and has subsequently worked on a similar effort to banish polio from India. As a “social venture capitalist” he’s also founded several computer companies and started—with Stewart Brand—the first online community, known as The Well, which presaged the Internet.

Burly and bearded, Brilliant is both quick to laugh and no-nonsense in demeanor, and seems to make an effort to downplay his role in many of these accomplishments. But most recently, he was formally recognized as someone with “ideas and passions big enough to change the world” and handed an award that allows him to dream larger than ever before—which for Brilliant is really saying something. And he’s asked for your help in formulating that dream. We asked him to talk about that award, his life so far and about what keeps him going.

Let’s start with your name. Was it difficult, as a kid, to be saddled with the moniker “Brilliant”?
Sometimes. My last name is a terrific one to have about 50 percent of the time. When you do something good, it’s great; when you screw up, it’s abysmal. And so yes, as a kid I heard every single slur you might imagine, especially from other kids—but even some teachers would call me “NOT so Brilliant.”
But another funny thing later happened due my name, when some Russian officials called me “Dr. Brilliantov.” It turns out that was the name of my grandfather, who was born in a little Russian village called Melnitzkov—which by some reckonings can be translated from the Russian to mean “Mill Valley.”

So how and when did you decide you wanted to become a doctor?
I’m not so sure I wanted to as much as my mother wanted me to! I grew up in Detroit, and in college I got very much interested in that “meaning of life” stuff and majored in philosophy. I applied to Harvard Law School and was accepted, but while I was still in school my dad died and after witnessing that whole process I was again very interested in medical issues. At the last minute I changed my mind and in June of my senior year I went to Wayne Medical School and asked them to accept me, and they did, which was a very kind thing, as I had not been pre-med.

How did you end up here in the Bay Area?
When I was still in medical school, there was a new Office of Equal Opportunity set up under President Johnson in April of 1967. They wanted to deny federal funding to any hospital that discriminated based on race—which was a real problem then. So I and another 49 medical students got federal picture-ID cards that read “Civil Rights Specialist.” I got sent down to Mississippi to check on how African-Americans got treated. But soon one of the medical students got shot at and they evacuated us so fast our heads spun. I got reassigned to San Francisco, landing in the middle of the Summer of Love with my civil rights ID…[laughing] And as you might imagine, I’ve never been the same since!

But you still had to finish your medical education, right?
Right, so I went back to Detroit. But after finishing med school, I came back out here to San Francisco for an internship at Presbyterian Hospital. I thought I’d become a surgeon, but it was not to be. I was a bit of a rabble-rouser and when the Native Americans occupied Alcatraz in 1970 I went out there to be their doctor. I delivered a baby there and there was a cover story in the Chronicle on that. Somebody from Warner Brothers called and asked me to play a young doctor in a movie called The Great American Medicine Ball Caravan and there were all these rock stars in it, so I got to know some of them.

And that led to you first going overseas?
Yes. At that point lots of young people were going overland from Europe to India and Nepal, and I went on one of those journeys. In those days you could go into any village and everyone would be so wonderful to you just because you were an American. A number of us made a vow that we would someday do something to give back to the people there and that’s when the seeds of SEVA were sown.

We’ll come back to that amazing work. While in Asia, you became a champion of public health work to eradicate a terrible disease…
Yes, but again, that was not via any usual path. My wife and I became very interested in a particular teacher or guru, Neem Karoli Baba, and stayed in his monastery in the Himalayas. One day he said to me, “Doctor America”—that was his name for me—“It’s time for you to leave the monastery and go to the United Nations and help eradicate smallpox.” So I took a 17-hour bus ride to New Delhi and told the officials there, “I’m here to work for you.” Mind you, I’d never seen a case of smallpox other than in a textbook. They said, “Thank you very much, we’ll call you.” So I went back, told my guru, and he said, “Go back and ask again.” So I did—15 times. They kept saying, “You again?” and each time I got a little smarter, cut my hair, changed my robes for a suit.
The last time there, for the first time I saw another American—a tall guy who turned out to be the head of the smallpox program at World Health Organization headquarters in Geneva, who told me there was no such program—but two days later I got a telegram saying India was starting a smallpox program and I was hired! So I started as a young mascot, learning smallpox and management and epidemiology until I ended up running the program. We eradicated smallpox there within 10 years—an amazing experience.

A truly historic one, in fact. And that was how you really got going on the work to fight blindness via SEVA?
Yes. It’s hard to explain the feeling—if you’re a mountain climber and you climb the highest peak, you want to do it again. If you’re a doctor and you’re part of a team which eradicates a horrible disease, well, you want to do that again! So a group of about 10 of us decided to try something else, on our own instead of with WHO. We chose blindness—we’d seen so much of it caused by smallpox, and really thought we could do something in Nepal. We did the first blindness survey there and found a major cause was cataract, which was a surprise as WHO had thought it was more from trachoma and glaucoma. So we started cataract surgery and prevention efforts, and over the last 25 years SEVA has worked in over 20 countries. The statistic we’re proudest of is that our projects have given back sight to over 2 million blind people. Our project in Nepal, where we started, does 35,000 surgeries per year. In Tibet we do two-thirds of all the eye surgery. We work in Tanzania, Cambodia, Mexico, Guatemala and so on.
In Nepal, I’ve witnessed the moment at a SEVA clinic when someone has those post-surgery bandages taken off and sees his family for the first time in decades. Everybody in the village was crying and I’ll never forget it…
There’s nothing like it. And like I say, you want to witness something like that over and over again if you can. It’s true also for when you see the curve of an epidemic go down, even to zero. When it works, it’s magic.

Thus you’ve gone on to work on other common but preventable diseases in poor nations. You went back to Asia after the horrific tsunami last year—what did you do there?
I’m the luckiest guy in the world—I got to see the last case of smallpox in the world, and now, just a few months ago, I may have seen the last case of polio in India. These are like amazing bookends for me, over 30 years apart. I’d gone back over to Sri Lanka and India just after the tsunami, as SEVA raised funds for the relief effort and wanted me to find good projects to give it to. How could I not go—I’m an epidemiologist who knows that part of the world, who speaks Hindi and Urdu, and we expected tremendous epidemics in the wake of the flood. I ended up staying over five months.
It was so hard and so staggering—even though I may have seen 5,000 kids die of smallpox, I wasn’t prepared for the death and destruction there this time. But while there, the WHO asked me to help with their polio program. We had 300,000 workers just in the state where I was running the program, and 4 million in India as a whole. They did active house searches to find every case and do containment, with vaccination of every child. Half a billion were given in June—the numbers are beyond my ability to comprehend, really. But we may have seen the last cases in India last summer. We’re still waiting to know for sure.

I wonder if you saw any parallels or lessons from the tsunami when Hurricane Katrina hit our own country?
The difference between the tsunami and Katrina is that the response to the tsunami was so well organized. We dropped satellite telephones on a grid every 250 meters, so that you were never far from a working phone—even over water we had flotation devices. So there was not this fear of not being able to communicate that we saw in New Orleans. Why couldn’t FEMA do that? And we made a philosophical commitment to keep families together, not to dump teenage girls into strange places with lots of strange men, for example, so we dropped tents for each family—none of this awful stuff of warehousing tens of thousands of people in the Superdome. You could even have put such tents in the Superdome. And that’s just the start. FEMA blew it in a way that you can’t even begin to describe.

And this was in the wealthiest nation in the world, not the poorest regions of Asia…
That’s right—and we’re seeing the “FEMA-ization” of all our health agencies—the CDC, the FDA, the NIH…Bush has put a lot of political hacks and cronies in highly paid positions they are unqualified to even apply for. But if you have a government that is run by people who hate government, it can’t work. Ask any CEO if you can run well a company you hate. They’ll tell you “no way.”

I guess we don’t have to ask what you think of the current White House occupants, then. But now we are hearing about a potentially huge epidemic of Avian flu. You’re working on that, and what do you think the real risks are and what should be done?
I’ve just hosted a global meeting on Avian flu in San Francisco, bringing governmental and private experts together to try to put some rational thinking behind preventing and responding to the flu. We are facing an event of low probability—it’s actually a low chance that this virus will mutate into a both highly lethal and highly transmissible [illness] before we have sufficient vaccine or antivirals—with a good system to deliver them. It could be a 10-20 percent chance of that happening, but if it does, in the worst case, this will be the worst thing in our lifetimes. Hundreds of millions of people will die, entire societies could collapse, and we will have nations and states that will be winners or losers. We don’t have enough respirators, masks, beds, hospitals, drugs, doctors, nurses, police—and again, this is in the richest country. We won’t be able to protect those who are supposed to protect us—would you go to work if your children were dependent on you and going to work essentially meant that you walked unprotected into the Colosseum with the lions?

But some would say that doctors and nurses, at least, have made a commitment to take such risks in bad times, such as when we did not know if the AIDS virus was easily transmitted to health workers. Right or wrong?
Right. There will be a lot of heroes—but others who will stay home. And you can’t blame them, especially if they feel they can’t really help people anyway. Humans will make their own choices. As a planner I want to make sure there is sufficient capacity to deal the best we can, as in the middle of an epidemic there is no time to try to understand the ethics.

You’ve deservedly received some great recognition for your work, including, recently, the UC Berkeley School of Public Health “Hero” award. But this new “wish” award is something else altogether. What’s it all about?
It’s a potentially life-changing thing, really, It comes from a group called TED, which stands for Technology, Education and Design—a bunch of very successful and bright people who have been meeting for 25 years, including the Silicon Valley “digerati,” big venture capital firms and so on. They actually have a person whose wonderful job title is “Wish Coordinator.” So every year they give this award, which comes with an amazing statue that floats with magnetic energy, and $100,000. But the major part is that all these very wealthy individuals and companies pledge to fulfill whatever the awardee’s big wish is—with no restrictions on that wish, although you’re not supposed to ask for a Mercedes or something like that. I told my kids that the award is not really about me—TED tries to find people who are outrageous enough that they’ll come back and ask for something really important. Last year it went to Bono, who asked for a million Americans to send $40 each to help rid Africa of AIDS—and in fact so far they’ve raised almost $200 million for his wish. So I’ve been asked to think as big as I can, to get $100 million or more. And I have to deliver the wish by February 23.

Any clues as to your wish yet?
I’m thinking about it, believe me. I’ve asked anyone to send ideas to an e-mail account set up to receive suggestions. It’s larryswish@seva.org. The idea is that it doesn’t have to be just my wish—in fact, it might be better for my soul and my karma that it’s not my wish. But I’ll sure as hell be the mouthpiece for it, and try to find the best wish I can, and I’ll present it and fight for it. Because it’s me, it will be in the area of global health, and needs to be something where the primary beneficiary are the poorest of our world.
My main decision criteria is a statement by Mahatma Gandhi, who said, “Before you consider what your next act will be, visualize the poorest, most wretched human being you have met in your life, and ask yourself if what you do will benefit that person.” That was his “talisman” to protect against evil, and to protect myself against thinking I’m important in all this, it’s my guiding idea in this thing too—and I’ve met some very poor and sick people in my life. The wish has to be sustainable over the long run. I’m looking for suggestions—but please don’t call me at home!

Try not to be too modest in answering this one—to what do you most attribute your incredible contributions and successes? What keeps you going in pursuing such huge goals?
Look, I’m just a dumb jerk like all the rest of us. But the difference, again, is that I’m the luckiest guy in the world. How do I keep going? I guess I go by my heart. I originally got into public health work way back when my spiritual teacher told me to. After 9/11 I resigned from my companies to work on bioterrorism response, especially related to smallpox, as my country had been attacked. And after the tsunami I packed my bags and went there, as my adopted region had been hit.
Life is funny, you know. It can be hard to know if you’re doing the right thing. I’ve had no grand plan and one thing has led to another. You have to have trust and faith in what the next step might be. Last month I went back to that ashram in India where my teacher had sent me off to work in public health long ago. I hadn’t been there in a decade. I went there to kind of check in on how I was doing—I didn’t know how I’d feel, if I’d squandered my opportunities or been faithful to the ideals of public health or even if blindness had been the right thing to work on. My teacher had died but it was really a wonderful experience to be back there—but I didn’t get a clear answer as to whether I’d been a “good boy” or not.
As I was leaving, though, there was a beggar there—and there are very few beggars up in the Himalayas, it’s just too cold in winter. This beggar was blind, from smallpox—one of those last cases in the world we had seen decades ago. There are probably less than 100 of those people still alive in the world, and the fact that one of them was there, right then, was for me a sign that I’d done at least one right thing. I just sat down and cried.

You’ve done some innovative work in the business world as well—is that just for the money, or do you find it interesting as well?
Oh, it’s not boring. But I’m like a drug addict with a habit, and my habit is working in poor countries where there are people who have nothing and are suffering—smallpox, polio, blindness, the tsunami and now bird flu. For the past two years I have been paid one dollar a year at SEVA. But I live in Marin. That picture doesn’t work—you can’t live here and send three kids to school with my kind of habit.
So once in a while I sneak and skulk into the business world and get into corporate America and try to make some money. When I have enough money I go back and feed my habit, and when the money runs low I go back into the business world. That may sound psychotic, but it’s worked for me, and also made me rethink all my preconceptions about the importance of business in this world. I feel blessed to work in an economic system that rewards creativity and ideas, because it’s not necessary for me to actually run something for a long time. I can turn it over to somebody who knows what the hell they’re doing. But I can then go off and spend months in India, as I just did.

Would you agree that you are also lucky to have landed here in Marin, where there are many people of great expertise, ideas and resources who might support your work?
Oh, undoubtedly. People like Bobby Weir, Stewart Brand, Dean Ornish—just to name a few of the more visible names—have been of incredible help. There are many many more, from the people at the Sweetwater onward. My support system in Marin is just amazing to me. It’s a unique place. There’s a lot of other places in the world where people would really think twice about inviting somebody like me to their country club [laughs]. But here, well, I may still be seen as a bit strange but there are many others who seem to think that’s not always such a bad thing!

PHOTO OF LARRY BRILLIANT BY ROBERT VENTE

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