There is also an active High Impact Medicine community in Aus, with about 15 members and two fellowship cohorts currently running!
Akhil
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Yes, we would appreciate you sharing your working. We will also clarify that on the application form, thanks for asking :)
Yeah great question! There were some similarities and differences from our normal research process
Similarities
We predominantly looked for ideas where there were good feedback loops to measure the impact of the charity and the good that it was doing
Our research process largely worked and could be adapted to biosecurity as a cause area
We considered the potential of the negative impact of our ideas, and ideas where this was more likely were far less likely to pass through our research stages
Differences
We had to very seriously consider information hazards in our idea, which is not a consideration we had given much weight on or considered at all for other cause areas
Had to rely a bit more on expert opinion and ‘lower’ quality forms of evidence like theoretic evidence, case studies
We had a lot more uncertainty about our cost-effectiveness analyses, since estimates vary a lot depending on priors about likelihood of future pandemics and how bad they could be; to an extent, these uncertainties were multiplicative, which made quantification particularly challenging
We had to coordinate and talk a lot more to EA biosecurity folk- the space is small and growing, and it was important to coordinate to make sure we were not duplicating something that was already happening in a way that might be harmful
We are happy to chat to anyone interested in biosecurity who might want to start a charity and wants to talk more about our research process and the ideas we are most excited about in this space
Given the uncertainty in the chronology of events and nature of how authorship and review occurred, would it have not made sense to reach out to Cremer and Kemp before posting this? It would make any commentary much less speculative and heated. If the OP has done this and not received a reply, they should make that clear (but my understanding is that this was not done, which imo is a significant oversight)
Hey Gavin, good question. My intuition is that:
The medications, at least while they are patented, are likely to be quite expensive and therefore unlikely to be super cost-effective. I have some links in the article that go into estimating cost-effectiveness of GLP-1 agonists, and it doesn’t look too exciting. That being said, if there was a way to make them cheaper by 2-3 orders of magnitude (not sure how feasible), maybe this picture changes.
In addition, I would worry that access to them (as with all medicines) does reduce how scalable an itervention it is.
Yeah, I think that this is probably an area of pharma where the market has sufficient incentives and is vast, and don’t think there is that much scope for and/or benefit of a new organisation, profit or non profit :)
Great post!
I think I would separate out two parts of this post
FMT and being an FMT donor as an effective way to do good
Being an FMT donor as a means of earning money, hopefully to give
On the first, I would be a lot more hesitant about some of the claims that are being made. The evidence for FMT is young, and relatively weak. I think it is far from being a potential treatment of a broad range of chronic diseases; FMT is currently approved for recurrent C. difficile infection in the UK. Things we do not know:
Is it helpful for other chronic diseases? If so, how much and is it cost-effective?
Can it be safely administered at home? You make the claim that donation and use of FMT can happen outside of the hospital setting; this is currently not recommended.
Do we need super donors? There is a growing literature around the effectivneess of autologous FMT (use of your own stool for transplantation) may be as effective as a donation from someone else (one paper I am aware of, but I am sure there are many more). I would be hesitant in putting too much stock in one apprpoach early on in the R&D of this area.
On the second, I don’t have strong opinions. I think it is worth more explicitly flagging that a super donor is quite a rare statistical occurrence, and that the activation energy and cost to be accepted and donate stool for the first time might not make net positive from a cost-effectiveness perspective ( I have not modelled this, but I wouldnt be surprised if this was the case
Yeah it is a little bit of a counter-inuitive presentation.
Basically of vaccines low income countries did receive in 2021, they averted 180 300 (171 400–188 900) deaths.
If LIC had achieved the WHO target of 40% vaccination rate, they would have averted an additional 200 000 (187 900–211 900) deaths
200 000/ 180 300 = 111%
Great work. I think point 4 is really interesting:
4. Progress on the policy side is driving progress on the industry side and vice versa
I think this is perhaps applicable to other cause areas where a combination of industry and policy action might be helpful (e.g. corporate campaigns on cage-free chickens and policy change on the same, e.g. incentivising pandemic prevention investment).
How easy/hard was it for you to understand the incentives of different stakeholders and map their relationships?
Do you have any advice for others on how to approach this?
These are really nicely designed- well done! Look forward to them being available in the UK
Hi Yonatan,
That is really interesting; I think policy advocacy to change laws that prevent or reduce VAWG is a promising avenue, so thank you for sharing your experience from Israel.
On your second point, yeah I would probably agree that it likely affects more women and girls; completely my intuition and from my personal experience as a doctor, but I would also be unsurprised if it was higher. More research would help with this!
Hi Deborah, I completely agree. I think that in particular, the economic and social costs of VAWG extend beyond the victim, and likely have quite significant broader and society level effects.
I think you are right that it is difficult to assess in dollar terms- I have not been able to find anything that explores this in a robust or quantitative way, but I think some of the links that Julia and others pointed to are good starts.
Thank you for your comment and taking the time to read this.
I think that comparisons about which is a greater scale and which is more neglected is unlikely to be solved in this thread.
I focused on violence against women and girls because the root causes, types of violence and interventions for violence against women and violence against men were sufficiently different that it did not make sense to consider them together.
However, I would certainly be interested in seeing a report on violence against men; I have relatively little knowledge on the field, so don’t feel qualified to make claims about whether it might be a promising cause area.
Hey Julia really great point. And that World Bank resource that you point to is an excellent read. Thank you :)
Hey Darren, great point! Fear of violence and the broader affects of that was not something that I had considered, but seems like it is a significant issue that is worth investigation.
In terms of the context within which violence happens (or its source), from my understanding, most of it is within the domestic environment, with the vast majority being by someone who is known to the victim.
Broadly, I think that root cause analysis would be a really interesting step in ‘unlocking’ new and potentially promising investigations in this space. WIth more time, I would love to do this
If you have any more resources on the same, please send them across
Thank you for the comment Saulius- I think interventions for women’s empowerment may have some overlap with those for VAWG. The example that you point to, No Means No Worldwide, is a great example- strongly inter-related.
Great question :) So this model used accounts for multiple different types of alleviated health burden from each year free from IPV. Specifically, each year free from IPV prevents chronic conditions that cause disability that lasts many years, femicide, as well as acute issues within that year itself. That would explain why 1 year free from IPV can be more than 1, and in this case roughly converts to 2.5 DALYs.
Hey Guy completely agree with you; I think that the ‘Worldview Investigations’ sub-section of this prize might be looking for this; from my perspective, something like this would be quite valuable.
With the caveat that I did not do a geographical assessment in this shallow, I would guess that it would be likely that this would be initially targeted in certain LMIC countries (especially in Africa and Asia) as they have a high and increasing burden of VAWG and have been the focus of prior studies in this space. However, it is also true that the burden of VAWG is considerable and not significantly dissimilar between LMIC and HIC, so I have low confidence on this claim.
Hi Ben- thanks! I didn’t have the time to do a robust cost-effectiveness analysis of this intervention, and with low certainty, I didn’t feel comfortable making direct comparisons to AMF/other direct interventions. However, I think that an estimate roughly $50-80/DALY for purely health effects seems reasonable.
As mentioned in the text, I imagine the benefit-cost profile is multiplied by a factor of 2-5 if economic benefits are considered
High Impact Medicine and Probably good recently produced a report on medical careers that gives more in-depth consideration to clinical careers in low and middle income countries- you can check it out here: https://www.highimpactmedicine.org/our-research/medicalcareers