Episode 16

Sepsis Nearly Killed Me. It Just Took NASCAR Champ Kyle Busch.

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Sepsis almost killed me after a visit to a Connecticut doctor’s office for an unpleasant biopsy. This was after decades of working in some of the most dangerous parts of the world and contracting cerebral malaria, meningitis, two never‑before‑seen tropical diseases, and others, so it was not on my bingo card to contract sepsis in Connecticut.

One year later, the sudden death of two‑time NASCAR champion Kyle Busch from bacterial pneumonia and sepsis shows how fast this condition moves and how indiscriminately it strikes. To honor Kyle Busch’s passing and my own near‑death experience, I went to the best source I could find on a disease few Americans are aware of.

In this episode of The Unpopular View, I speak with Dr. Niranjan “Tex” Kisson, President of the Global Sepsis Alliance, co‑chair of World Sepsis Day, and endowed chair in acute and critical care for global child health at the University of British Columbia and BC Children’s Hospital. Tex helped push the World Health Assembly to recognize sepsis as a global health priority in 2017 and now co‑chairs the Global Sepsis Innovations Platform, coordinating research, diagnostics, and treatment across 36 organizations.

We break down what sepsis actually is, why it can arise from common infections, and why the world’s medical community took so long to recognize it as a distinct and deadly condition. Tex walks through staggering numbers: tens of millions of cases and millions of deaths, with sepsis implicated in one in five global deaths in 2020 and one in three during the COVID‑19 period.

We also explore why sepsis care is a “bellwether” of health system quality, how investments in sepsis programs in Australia and British Columbia generated extraordinary returns — including one program that delivered roughly 112 dollars in value for every dollar invested — and why decisions made in Washington, Paris, London, and Geneva will determine whether hundreds of thousands of mothers and newborns in the Global South live or die.

If you want to understand how a single condition can expose the strengths and failures of our health systems, connect local stories to global realities, and offer one of the highest‑ROI investments in modern medicine, this conversation is for you. This is segment 1 of 3. After discussing the facts around sepsis in the U.S. in particular, segment 2 focuses on the Global South, and segment 3 looks at what needs to happen to slow the dramatic pace of sepsis in North America and globally.

Episode 2100:21:20

USAID Is Gone. What Should Replace It? | Emily Brearley (3/3)

USAID has been dismantled. The World Bank's own evaluations keep finding what its projects don't achieve.

USAID has been dismantled. The World Bank's own evaluations keep finding what its projects don't achieve. So the question is no longer whether the aid architecture is broken — it's whether anything should replace it.

In the final segment of my three-part conversation with Dr. Emily Brearley — development economist, 25 years at the World Bank and other international institutions, and author of Aid Inferno: How to Reduce Poverty, Combat Global Warming, and Be a Good Person — we each put a blueprint on the table.

We agree on some fundamantal issues and disagree on some important details.

Emily's answer is what she calls Solution 42: sharply narrow what institutions like the World Bank attempt. Stick to the sectors they demonstrably do well. Build in transparency and citizen involvement in project selection and evaluation. Fund a small number of high-impact projects chosen by people in recipient countries themselves. It rhymes with Esther Duflo's evidence-first approach.

We also agree that a social contract is a fundamental missing piece — clear goals, trade-offs and obligations that people on the ground can actually hold institutions to that are negotiated. In 40+ years of fieldwork I never saw one written, and neither USAID nor the World Bank has ever framed a project in those terms. Emily agrees that's a major gap.

Where we diverge somewhat is on who does the work. Should nationals do everything, or is there a place for foreigners with unique capacity building contributions to make?

ABOUT THE GUEST Dr. Emily Brearley is a development economist and former World Bank economist with ~25 years across the World Bank and other international institutions, leading programs in Africa, Latin America and Asia. Aid Inferno is a case-study-driven critique built on World Bank evaluation data arguing that development finance rewards spending and institutional survival over outcomes and accountability.

ABOUT THE SHOW The Unpopular View is for the exhausted middle — evidence over outrage, and criticism that doesn't spare either orthodoxy. Hosted by Michael Brown, international development consultant and author of Redeeming REDD (Routledge, 2013) and Climate Mitigation in the Land Sector of the Global South (Routledge, 2026).

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Episode 2000:24:33

The Poverty Industry: Dr. Emily Brearley on Why Foreign Aid Keeps Failing

Dr. Emily Brearley spent roughly 25 years inside the World Bank, USAID, and the Inter-American Development Bank — and came out arguing that the aid system is structurally built to avoid measuring its own failure.

Dr. Emily Brearley spent roughly 25 years inside the World Bank, USAID, and the Inter-American Development Bank — and came out arguing that the aid system is structurally built to avoid measuring its own failure. Her book, Aid Inferno: How to Reduce Poverty, Combat Global Warming and Be a Good Person, uses World Bank evaluation data and her own decades in the machine to make the case that a large slice of the development world has become a "poverty industry" — contractors and big NGOs rewarded for spending and survival, not outcomes.

Host Michael Brown brings his own 40+ years running USAID and NGO-funded projects for NGOs and consulting firms mainly in the USAID ecosystem, across the Horn of Africa, the Sahel, Central and Southern Africa, and Madagascar and other areas in the Global South. Michael largely agrees with Emily's structural critique, while pushing on where it might go further: the missing "social contract" between institutions and the communities they claim to serve, and why communities in landscapes can feature in worthy projects IF appropriateness and feasibility drive planning (which they currently largely do not). This is the only way he argues for aid to scale.

In this episode:

Was there ever a real deal between aid institutions and the people they were meant to help? Why does the old "poor countries just need more money" theory keep failing on its own terms? What actually separates a development intervention that works from one that quietly fails? Where cash transfers and bigger loans fit — and where they risk repeating the same mistakes closer to the ground

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Episode 1900:24:12

Is Foreign Aid a Scam? Two Development Insiders Agree It's Broken, Differ on Scale and Fixes

Views on foreign aid have rarely been this polarized — whether American taxpayers should fund health, education, governance, agriculture, and conservation programs aimed at uplifting the poorest of the poor, and, in conservation's case, protecting planetary resources for every...

Views on foreign aid have rarely been this polarized — whether American taxpayers should fund health, education, governance, agriculture, and conservation programs aimed at uplifting the poorest of the poor, and, in conservation's case, protecting planetary resources for everyone. This conversation doesn't resolve that debate, but it grounds it: a development professional's account of four decades in the field — a World Bank rangeland project vilified in Graham Hancock's "Lords of Poverty", a Mali irrigation project that worked because farmers wanted it, an NGO program shut down after seven years of success "because we can," and a $20M initiative that began as an 8-country program, was already whittled down to 4, and then died outright when a D.C. bureaucrat used a (purposeful) mix-up with Kazakhstan as the reason to deny it moving forward. The verdict: appropriateness and feasibility, not funding levels or good intentions, determine whether aid succeeds. This of course considers whether the governance framework is enabling to begin with.

Michael and guest Emily Brearley — a former World Bank economist and author of Aid Inferno — agree on the goal: aid needs a real social contract to work at all. Where they differ is on scale and on the fix, especially whether big-vision programming at scale is worth attempting in the first place. Both agree the pre-DOGE aid model hasn't shown evidence of working, and that whatever comes next has to change. This is Segment 1 of 3: what's gone wrong, and what could come next.

Michael's own arguments are laid out at greater length in Redeeming REDD and Climate Mitigation in the Land Sector of the Global South: Making it Work for People and Planet. Emily's case is made in Aid Inferno.

Segment 1 of 3. Coming next: Segment 2 — Can Aid Scale? — weighing the small, proven Mali project against the big, negotiated institutional model. Then Segment 3 — Can Aid Be Fixed, or Should It Be Scrapped? — two competing paths to a possible new social contract.

00:00 The Central Rangelands project and Graham Hancock's critique 01:44 Mali: motor pumps, ownership, and why farmers made it work 02:37 Seven successful years, shut down "because we can" 03:08 Founding Innovative Resources Management 03:39 From 8 countries to 4 to zero — the "Kazakhstan" excuse that killed it for good 04:09 Verdict: money isn't the problem — appropriateness is 04:49 Introducing Emily Brearley, former World Bank economist and author of Aid Inferno

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Sepsis Nearly Killed Me. It Just Took NASCAR Champ Kyle Busch. | The Unpopular View | The Unpopular View