Sparks: How tech billionaires are disrupting biomedical science

The philanthropist's gift and the researcher's silence are the same river, and the man who calls this generosity has never stood downstream where the current changes direction.

The grant agreement is signed in a boardroom where no one has sat with a patient through a failed trial, and yet the terms of that agreement will determine which failures are permitted.

They call it philanthropy; the benefactor who funds the study also owns the journal that publishes it, and until we name this arrangement correctly, no reform of it can begin.

If the fortune was made by capturing attention and is now spent directing inquiry, then the question is not whether the science is funded but whose attention the science now serves.

As water finds the channel dug for it and abandons the channel that silts, so the research follows the funding trench, and the trenches not dug are the questions never asked.

In the laboratories of the wealthy patron the equipment is finer than any I saw in Cairo or Delhi, and the questions asked are narrower, and the two facts are not unrelated.

Things that are elegant: a bequest that outlives the donor's vanity; things that are hateful: a laboratory renamed for a man who never washed a beaker.

They say private money is saving science, which is true in the same way that a man who buys the only well in town is saving the town's thirst, and charging it by the cup.

Count the papers retracted from funded labs, the negative results filed and never published, the protocols amended when the funder's patience thinned - the pattern is a system, and the system has a name.