Thanks for writing this. PIH and Paulâs work were a big inspiration to me, and were one of my early exposures to two ideas that are essential to EA: one, that people matter just as much no matter where they are or how hidden their suffering is from me; and two, that my money earmarked for helping people will go so, so, so much farther investing in the health and wellbeing of the poorest of the poor than in causes that may be more visible to me.
I have a couple of lessons that I learned from PIH and Paul Farmer that I will attempt to apply to my life as a whole and my EA thinking and action. These lessons are meant for me, to solidify my thinking and write something I could remind myself with, but I thought I would share my takeaways with the community as well.
1) Sometimes, you have to change your level of perspective to truly understand what the most effective use of time, resources, etc is. When Paul and PIH were faced with multi drug-resistant tuberculosis (MDR-TB) in Peru, they were told by the WHO, the medical community, and the government over and over that it was too expensive- better to spend the money on lots of cheap drugs to treat lots of sick but curable patients than to spend it all on a few very sick patients. This math is important to do, and we must factor in the opportunity cost when using our resources; we owe it to the people whose suffering our money, time and energy could help to grapple with and make decisions about who and how to spend it to maximize the effectiveness. However, it is also true that sometimes, a proof of concept that you can indeed treat a disease, albeit at great cost, can lead to a mobilization to lower the cost. People get energized by a problem of degree, and get discouraged by a problem of impossibility. People who do the impossible at great cost are invaluable.
2) Listen, ask questions, and listen some more. When you feel like youâve listened enough, thatâs a good signal that you should listen some more. There are things you know; there are things you donât know but can learn; and there are things which itâs just better to leverage someone elseâs knowledge. Paul was a Harvard-trained MD and PhD, with extensive experience in poor, rural healthcare, who spoke fluent French and Creole. And yet, he still relied heavily on local knowledge and experts. This was not done to make his organization more diverse, or to cloak his ideas in the voice of the locals, but because that partnership made him more effective at treating the health of his patients. He listened so much that it was a superpower. This is a lesson that I have learned and relearned, and will have to learn again.
3) It takes all kinds. I am not religious, Paul was motivated explicitly by religious ideas. EA looks at cost per DALY and QALY (among other things, of course), PIH looked at each human life as worthy of the best medical care and support that money could buy. It is important to be true to your values, but it is also important to shun the narcissism of small differences. Find ways to make the world a better place, celebrate those who are, make making the world a better place something more people (with all sorts of different motivations) want to do, and make making the world a better place more and more effective.
4) Inspiring others can truly be a massive impact. The sheer number of my classmates who were inspired to pursue a career in public health because of Paul Farmer and PIH was truly amazing to me. Personally, however, I actively shut myself down from oversharing my own âgood deedsâ. In my younger days, I bragged, lied, and used my intelligence to bullshit. An essential part of growing up for me has been to develop an allergy to my own bragging, to be comfortable with who I am and let my actions speak for themselves. I think something I will have to continue to struggle with is when and how to share in a way that normalizes doing good, without it being about stroking my own ego or gaining praise and recognition. This is something I havenât fully figured out yet, but I am working on it and getting better.
5) The best in anything have most of the impact. 80kâs conventional wisdom is not to go into medicine, or if you do, work in a rich country and donate your salary. And yet this man is one of the most successful people at improving the world in the past half century. People like Paul Farmer do not come around every day, and it is good to give advice that helps drastically improve the good an average life can do; 80k people will say this too, that their top cause areas may be good on average but specifically your best potential impact has a lot to do with you, what makes you tick, what you have an advantage in. That said, we can do more as a community and I can do more individually to take and encourage others to take the idea of being the best at whatever youâre the best at, and using that bestness to improve the world.
Thanks for writing this. PIH and Paulâs work were a big inspiration to me, and were one of my early exposures to two ideas that are essential to EA: one, that people matter just as much no matter where they are or how hidden their suffering is from me; and two, that my money earmarked for helping people will go so, so, so much farther investing in the health and wellbeing of the poorest of the poor than in causes that may be more visible to me.
I have a couple of lessons that I learned from PIH and Paul Farmer that I will attempt to apply to my life as a whole and my EA thinking and action. These lessons are meant for me, to solidify my thinking and write something I could remind myself with, but I thought I would share my takeaways with the community as well.
1) Sometimes, you have to change your level of perspective to truly understand what the most effective use of time, resources, etc is. When Paul and PIH were faced with multi drug-resistant tuberculosis (MDR-TB) in Peru, they were told by the WHO, the medical community, and the government over and over that it was too expensive- better to spend the money on lots of cheap drugs to treat lots of sick but curable patients than to spend it all on a few very sick patients. This math is important to do, and we must factor in the opportunity cost when using our resources; we owe it to the people whose suffering our money, time and energy could help to grapple with and make decisions about who and how to spend it to maximize the effectiveness. However, it is also true that sometimes, a proof of concept that you can indeed treat a disease, albeit at great cost, can lead to a mobilization to lower the cost. People get energized by a problem of degree, and get discouraged by a problem of impossibility. People who do the impossible at great cost are invaluable.
2) Listen, ask questions, and listen some more. When you feel like youâve listened enough, thatâs a good signal that you should listen some more. There are things you know; there are things you donât know but can learn; and there are things which itâs just better to leverage someone elseâs knowledge. Paul was a Harvard-trained MD and PhD, with extensive experience in poor, rural healthcare, who spoke fluent French and Creole. And yet, he still relied heavily on local knowledge and experts. This was not done to make his organization more diverse, or to cloak his ideas in the voice of the locals, but because that partnership made him more effective at treating the health of his patients. He listened so much that it was a superpower. This is a lesson that I have learned and relearned, and will have to learn again.
3) It takes all kinds. I am not religious, Paul was motivated explicitly by religious ideas. EA looks at cost per DALY and QALY (among other things, of course), PIH looked at each human life as worthy of the best medical care and support that money could buy. It is important to be true to your values, but it is also important to shun the narcissism of small differences. Find ways to make the world a better place, celebrate those who are, make making the world a better place something more people (with all sorts of different motivations) want to do, and make making the world a better place more and more effective.
4) Inspiring others can truly be a massive impact. The sheer number of my classmates who were inspired to pursue a career in public health because of Paul Farmer and PIH was truly amazing to me. Personally, however, I actively shut myself down from oversharing my own âgood deedsâ. In my younger days, I bragged, lied, and used my intelligence to bullshit. An essential part of growing up for me has been to develop an allergy to my own bragging, to be comfortable with who I am and let my actions speak for themselves. I think something I will have to continue to struggle with is when and how to share in a way that normalizes doing good, without it being about stroking my own ego or gaining praise and recognition. This is something I havenât fully figured out yet, but I am working on it and getting better.
5) The best in anything have most of the impact. 80kâs conventional wisdom is not to go into medicine, or if you do, work in a rich country and donate your salary. And yet this man is one of the most successful people at improving the world in the past half century. People like Paul Farmer do not come around every day, and it is good to give advice that helps drastically improve the good an average life can do; 80k people will say this too, that their top cause areas may be good on average but specifically your best potential impact has a lot to do with you, what makes you tick, what you have an advantage in. That said, we can do more as a community and I can do more individually to take and encourage others to take the idea of being the best at whatever youâre the best at, and using that bestness to improve the world.