To clarify, my point is not just there’s no direct empirical evidence of AMF’s specific distributions saving lives. My point is that there is no direct evidence of any non-RCT/”real world” distributions saving lives.
Further, this is not because nobody is looking for such evidence. GiveWell’s macro review of the evidence suggests every time somebody has looked for evidence of non-RCT/”real world” distributions saving lives they’ve come up with nothing.
I agree with your summary of the GiveWell argument (strong RCT evidence + AMF as competent distributor). However, in order to turn these two facts into a prediction about future we need to add the assumption that the RCT evidence applies to future distributions. This is the weak link in the chain. As you say, differences in malarial load could distort things. Differences in the underlying health of the population, differences in net usage and increasing insecticide resistance are other contenders, along with many more I’m sure. If we can’t see any evidence of impact after distributing hundreds of millions of bednets then it seems reasonable to question if this key assumption is leading us astray.
Thanks Linch, interesting thoughts.
To clarify, my point is not just there’s no direct empirical evidence of AMF’s specific distributions saving lives. My point is that there is no direct evidence of any non-RCT/”real world” distributions saving lives.
Further, this is not because nobody is looking for such evidence. GiveWell’s macro review of the evidence suggests every time somebody has looked for evidence of non-RCT/”real world” distributions saving lives they’ve come up with nothing.
I agree with your summary of the GiveWell argument (strong RCT evidence + AMF as competent distributor). However, in order to turn these two facts into a prediction about future we need to add the assumption that the RCT evidence applies to future distributions. This is the weak link in the chain. As you say, differences in malarial load could distort things. Differences in the underlying health of the population, differences in net usage and increasing insecticide resistance are other contenders, along with many more I’m sure. If we can’t see any evidence of impact after distributing hundreds of millions of bednets then it seems reasonable to question if this key assumption is leading us astray.