To shift the global food system towards sustainability is going to be expensive. At every turn, those in the food system have been impoverished by systems of exploitation and extraction. So when foundations with billions of dollars in endowments offer to help problems in the food system, it feels like a relief. But if you’ve an eye on the changes they have brought to food and medicine, the giants of international philanthropy deserve your scepticism. The histories of medicine and the food system are filled with examples of powerful organizations, whose wealth is made from the great monopolies of their age, engaging in concerted policy actions to drive farming towards the technologies that spawned their wealth. As Rockefeller and oil were to the 20th century, Gates and big data are promising to be for the 21st. Yet, in food and medicine, these technologies drive us away from the practices of healing and reparation that can restore humans’ relationship with the web of life. Drawing ideas from their forthcoming book Inflamed, Rupa Marya and Raj Patel will offer examples of how colonialism lives on through the activities and practices of the world’s richest organisations.