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The numbers are as plain as 1-2-3. Over one million annual deaths from malaria, almost two million from tuberculosis, and more than three million from HIV/AIDS, most of which occur in underdeveloped countries.1 Among the young, the situation is even more jarring: 2·4 million children dead from perinatal causes, another 1·9 million from lower respiratory infections, 1·6 million from diarrhoeal diseases. And on and on. At the same time, the approximately US$75 billion a year globally spent on medical research all but ignores the problems of the developing world, as expressed in the so-called 10/90 gap, whereby only 10 % of health sciences ’ research dollars address the health problems of 90 % of the world’s population.2,3 Moreover, only a small portion of this research is published in major medical journals.4 Enter the Bill and Melinda Gates Foundation, endowed with 26 billion and a larger annual global health budget than WHO. In January, 2003, th