In July 2010, I attended the International AIDS Conference in Vienna, Austria. Representatives of the Gates Foundation’s HIV team set-up shop inside the venue with a private conference room. For those of us working for civil society organizations, a meeting with the Gates Foundation was highly coveted yet illusive – you had to know someone who knew someone. A friend secured an appointment and labored for days over how, in her five minute allotted slot, she could present her nonprofit. I waited for her anxiously outside the venue, knowing this was a make or break meeting for her small organization, which seeded activism around HIV and human rights worldwide. “How did it go?,” I asked when she emerged. “No idea,” she replied. “They asked me what our competitive advantage was; I don’t think they understood what we actually do.”

In the book, No Such Thing as a Free Gift: The Gates Foundation and the Price of Philanthropy, the sociologist Linsey McGoey traces the evolution of private philanthropy’s ‘father knows best’ approach to giving. As McGoey explains, foundations used to have a hands off approach to their grantees, with the understanding that those working closely on social issues best understood how to affect change. Now, most foundations are intimately involved in trying to shape their grantees’ methods, including the Gates Foundation.  “The question is whether the practices associated with the new philanthropy – such as tighter control of grantee decision-making; a demand for swifter indicators of project success – might be stifling ingenuity and progress rather than engendering it.”

The first half of the book approaches philanthropy from both a philosophical and historical perspective, questioning the power imbalance implicit in giving and charity, then interrogating the rise of foundations in the U.S. McGoey reveals that the new religion of ‘philanthrocapitalism’ – applying business models to giving – is nothing new. What is different though is the scale of private giving and the power philanthropists now wield over governments. The second half of the book focuses on the Gates Foundation in particular because of their endowment and the lack of independent analysis about their impact.

McGoey reviews available literature and conducts interviews around three of the Gates Foundation’s major areas of investment – education in the U.S., global health and agriculture –to paint a loose picture of the Foundation’s portfolio and highlight areas where the Foundation’s performance needs independent appraisal (less time is devoted to the Foundation’s successes, although some are briefly mentioned). She questions whether Bill Gates’s methods are in line with his aims – for example, the Foundation wants to end AIDS, yet also believes in upholding the intellectual property regimes of pharmaceutical companies which then prevents access to affordable HIV treatment for millions of people.

When you have as much money as the Gates Foundation, it turns out you can buy your way into some pretty powerful places – Bill and Melinda Gates regularly advise world leaders on everything from global warming to family planning, despite having no prior background on these issues. They are also essentially unaccountable, reporting only to their trustees – themselves, plus Warren Buffett. McGoey wants us to understand the danger in having private individuals, no matter how good their intentions are, influencing policy decisions. (In a recent interview, Melinda Gates defended her new role as a self-appointed global ambassador for women’s issues. “I considered other women leaders. But I couldn’t find the one who embodied to me the voice of women around the world. And so I thought, ‘If I’m the one, then I just need to do it. I have to have courage and not worry.”)

In addition, McGoey raises critical questions about how the Gates Foundation approaches its work. An emphasis on human rights has long been noticeably absent from the Gates Foundation’s methods; one of the most alarming examples in the book concerns the Gates Foundation’s support for HPV trials in India. The Gates Foundation funded PATH – a Seattle based health and technology organization that it frequently partners with – to conduct the HPV trials on thousands of girls aged 10-14 in Gujarat and Andhra Pradesh, India. The Indian government halted the trials mid-way through over concerns of improper conduct – turns out PATH had violated a number of ethical protocols, like not getting witness signatures on consent forms and not providing health insurance to the girls during the trial. The Gates Foundation press office told McGoey it was a problem of misinformation and that she should speak to PATH (but they did not respond to her inquiries).

McGoey’s book does not attempt to thoroughly assess the full impact of Gates’s giving. Rather, it lays out a blueprint for future work that is urgently needed to answer a set of interrelated questions: what are the harms caused by the Gates Foundation and what are the true benefits? And can the Gates Foundation ever achieve its lofty aims without first admitting its own role in perpetuating structural inequality and then investing in political organizing to overturn it?

Recently, one of the Gates Foundation’s fellow philanthropic institutions, the Ford Foundation, announced after some soul searching a major shift in its strategic direction: Ford will now do everything possible to address economic inequality. It remains to be seen how this vision will play out in funding decisions, but on the surface it is an interesting move from a Foundation that used to be a champion of the business approach to philanthropy. Wrote Ford Foundation President Darren Walker in an e-letter earlier this year,

We foundations need to reject inherited, assumed, paternalist instincts—an impulse to put grant-making rather than change making at the center of our worldview… we need to interrogate the fundamental root causes of inequality, even, and especially, when it means that we ourselves will be implicated.

So, what could the Gates Foundation do differently? It could start by engaging publicly and reflectively on the questions asked in McGoey’s book. Bill Gates was just in Paris for the climate change negotiations, where he told French President Francis Hollande what heads of state should do differently and launched a new fund. Outside the nexus of power, people who have worked on climate change for decades protested around the world before and after the summit because they want more than investing in companies to solve climate change, they want climate justice. Sometime, it would be nice to see Bill and Melinda out there on the streets marching, learning from people who are not just the recipients of programs or in thrall to their millions but politically organized, already aware of appropriate solutions for their communities. Bill and Melinda just might learn something.

*No such thing as a free gift: the Gates Foundation and the price of philanthropy (2015) by Linsey McGoey is published by Verso Books.