Akhil

• AkhilJun 7, 2022, 3:37 PM

  1 point

  0 ∶ 0

  in reply to: Julia_Wise🔸’s comment on: New cause area: Violence against women and girls

  Hey Julia really great point. And that World Bank resource that you point to is an excellent read. Thank you :)

• AkhilJun 7, 2022, 3:05 PM

  14 points

  0 ∶ 0

  in reply to: Darren_Tindall’s comment on: New cause area: Violence against women and girls

  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

• AkhilJun 7, 2022, 3:02 PM

  5 points

  0 ∶ 0

  in reply to: saulius’s comment on: New cause area: Violence against women and girls

  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.

• AkhilJun 7, 2022, 2:58 PM

  10 points

  0 ∶ 0

  in reply to: Sjlver’s comment on: New cause area: Violence against women and girls

  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.

• AkhilJun 7, 2022, 9:17 AM

  6 points

  0 ∶ 0

  in reply to: Guy Raveh’s comment on: New cause area: Violence against women and girls

  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.

• AkhilJun 6, 2022, 5:40 PM

  10 points

  1 ∶ 0

  in reply to: RogerAckroyd’s comment on: New cause area: Violence against women and girls

  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.

• AkhilJun 6, 2022, 5:38 PM

  10 points

  0 ∶ 0

  in reply to: ben.smith’s comment on: New cause area: Violence against women and girls

  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

New cause area: Violence against women and girls

• AkhilJun 3, 2022, 9:22 AM

  11 points

  2 ∶ 2

  in reply to: Gregory Lewis🔸’s comment on: High Im­pact Medicine, 6 months later - Up­date & Key Les­sons

  Hi Greg,

  Thank you for your comment.

  Big picture, I wanted to clarify two specific points where you have misunderstood the aims of the organisation (we take full responsibility for these issues however as if you have got this impression it is possible others have too).

  1. We do not necessarily encourage people to apply for and study medicine. We are not giving any advice to high school level students about degree choices and paths to impact. To quote what you wrote, “medicine often selects for able, conscientious, and altruistic people, who can do a lot of good if they turn their hand to something else.” We think this is likely true, which is why we think specifically performing outreach to, and helping people who are already studying and practicing medicine find highly impactful careers, is likely to be an appealing option.

  2. We foreground transparency in all our communications with our members—and am sorry this is not something you agree with when you write that our reasons are opaque, but I think this is a strong claim to make . We aim to talk honestly about the impact of clinical medicine; discussing the articles that you have written throughout the fellowship as well as other pieces on the issue e.g. Dr Launer’s article referencing yours in the BMJ. We do not have a specific ideology we want to sell anyone on—we want to present people with important information and allow them to form their own conclusions through discussions. Disagreement with EA or existing articles is not something to be feared, but to seek out in order to improve our understanding of impact. We think this is reasonably important for community building

  Specifically, I think our difference in opinion is the way we approach the idea of impact in medicine—this involves some specific disagreements (below) but also general framing and outlook.

  On some of the specific points:

  1. High Impact Medicine not a misnomer- I disagree with your assessment of the situation; yourself, and all the people who you mention in the article, were or are doctors, and fit under what we would define to be High Impact Medics. When you are conducting outreach, I think it makes sense to describe the profession that someone currently has, even if you were to recommend jobs ‘tangential to or wholly apart from’ jobs in that profession.

  2. On the career capital and skills of medical degrees for opportunities outside medicine- I think I have addressed the above somewhat in reframing the purpose of our organisation away from pushing students into medical degrees. However, I would push back further on your claim that several years of training and practice as a medic is not good experience for several highly impactful careers. I think that it is quite difficult to attribute how much highly impactful people who are medics can attribute their career success to medicine. For someone like yourself, it might be reasonably easy to say very little.; however, I think there are very likely other individuals for which this is not the case (In our experience, and in having interviews with lots of folk doing highly impactful things, this is the case. In fact, it rings true for several of the medics you mention).

  3. For the case of Alice who seeks to maximise her impact as a doctor - I think Alice would disagree with you here and there are a bunch of high impact opportunities within medicine that we foreground:

  • Health policy work, which is often: 1. taken alongside clinical work 2. in some instances can be done well from a bottoms up approach while working in a clinical setting, 3. Often earmarks and wants the perspective of clinicians.

  • Effective giving and earning to give- I think doctors in a lot of countries, especially with growth of private medicine, have quite a high earning capacity. Especially for those medics who are further along or who really love their clinical work, earning to give within medicine seems like it might be the best EtG option

  • Working in a LIC, particularly if you are also involved in training local healthcare workforce, likely has 2-3 orders of magnitude more impact than being a junior doctor in a big metropolitan city (happy to send the studies that support this). I think you and I may disagree on the object level about whether this reaches the bar of “other EA jobs”- I think it might. In addition, if you take into consideration that not everyone has the capacity or capability to do other EA jobs, in a lot of cases, doing some of the above might be the highest impact opportunities for that person.

  4. To address your concern about whether our messaging might lead someone to think that clinical practice in a LIC or a giving pledge are equivalently good to the other individuals you cite. Firstly I think this is highly unlikely given the content of our fellowship (with case studies from some of these individuals) and podcast (a number of these individuals are interviewed) and we make clear that there is a range of impact possible from a medical background. Secondly, in circumstances for which that is not feasible or realistic for an individual, or in which that is unlikely to be the case for them, we still think it is robustly good for them to increase their impact 2-3 orders of magnitude in the ways described above.

  This is part of ‘big tent’ effective Altruism as we discuss above and may not be something you value as highly as we do. In general though I think this approach is likely to engage a whole lot more people initially than a ‘door in the face’ approach and that encouraging initial steps e.g. pledges or working in a LMIC will increase the likelihood of subsequent change, rather than feeling you have achieved your impact quota. We are reasonably confident that we portray the relative impact of different career options and decisions with high transparency, and enable people to maximise their impact as much they can—though perhaps we emphasise personal fit more than you would.

  Speaking to all fellows at a 1:1 level after the fellowship and from the resources they have read over the fellowship, we think the risk we have lost ‘potential impact’ through individuals conflating different career options as equivalently good is very low—and rather the impact of individuals choosing to make impactful career decisions downstream predominates (hence this article).

  Happy to chat more about all of this and thanks for your thoughts!

• AkhilJun 2, 2022, 8:42 AM

  1 point

  0 ∶ 0

  in reply to: MichaelPlant’s comment on: High Im­pact Medicine, 6 months later - Up­date & Key Les­sons

  Yeah so our fellowship kind of dives into ways that medics can increase their impact, and EA cause areas where they might be particularly suited/​have some comparative advantage. Some specific and non-exhaustive examples

  • For those interested in global health and development, medics might have a comparative advantage in working in the space due to clinical knowledge of area, respect and career capital

  • For those interested in health security/​ biosecurity, there seems like there is an increasing role for medics who might act as a conduit between researchers and policymakers, as well as doctors and other public health professionals who are implementers on the ground.

  • Within clinical medicine, there might be robust ways to improve the amount of good people do e.g. through where they choose to work—i.e. LIC vs HIC, earning to give.

  • There are lots of skills that medics have (triage and prioritisation, systematic approach to problems, generally strong people skills) that make them a good fit for things like operations roles or careers advising e.g. at 80K ;)

  If you are interested, happy to send you across our course curriculum!

• AkhilJun 2, 2022, 8:34 AM

  12 points

  0 ∶ 0

  in reply to: Luke Freeman’s comment on: High Im­pact Medicine, 6 months later - Up­date & Key Les­sons

  Thanks Luke, I definitely think that autonomy and agency, particularly for professionals who are already established in a career, is a good approach to take, and might be a slight difference between community building in university/​for professional groups (at least anecdotally, this is our experience).

  And on footnote (2), I think this is actually something reasonably important I want to write more about-for instance, in our fellowship, we noticed that people responded well to information that was from well-known sources like high impact journals or news sources, and we found that if we had too many docs from sources they were unfamilar with (EA Forum), it bred some hesitation and skepticism. Although I think there is a wealth of absolutely fantastic material on ‘EA sources’, I think this is an important thing to be aware of in doing outreach to people unfamiliar with EA!

• AkhilMay 30, 2022, 7:30 AM

  3 points

  0 ∶ 0

  in reply to: MathiasKB🔸’s comment on: High Im­pact Medicine, 6 months later - Up­date & Key Les­sons

  Let’s separate this out

  1. There are some medics who completely buy EA and have changed their entire career directly in line with EA philosophy

  2. There are some medics who are looking to increase and maximise the impact of their careers, but who aren’t sold on all or aspects of EA. They also may have a particular cause area preference e.g. global medical education, that isn’t thought of as a high impact cause area by EAs

  I think our philosophy is to work with both of these groups, rather than just (1).^[1] I think the way we do that is by acknowledging that EA is fundamentally a question; we talk through EA ideology and frameworks without being prescriptive about the ‘answers’ and conclusions of what people should work on.

  I think that this recent summary on a post on the forum is quite helpful here

  I think the “bait and switch” of EA (sell the “EA is a question” but seem to deliver “EA is these specific conclusions”) is self-limiting for our total impact. This is self-limiting because:

  • It limits the size of our community (put off people who see it as a bait and switch)

  • It limits the quality of the community (groupthink, echo chambers, overfishing small ponds etc)

  • We lose allies

  • We create enemies

  • Impact is a product of: size (community + allies) * quality (community + allies) - actions of enemies actively working against us.

  • If we decrease size and quality of community and allies while increasing the size and veracity of people working against us then we limit our impact.

  1. ^

     We do fundamentally serve (1) and think this is a great group of people we shouldnt miss either!

• AkhilMay 29, 2022, 3:48 PM

  3 points

  0 ∶ 0

  in reply to: Stefan_Schubert’s comment on: Re­vis­it­ing the karma system

  I don’t think I am too convinced by the logical flow of your argument, which if I understand correctly is:

  more karma = more informed = higher value on opinion

  I think that at each of these steps (more karma --> more informed, more informed --> higher value of opinion), you lose a bunch of definition, such that I am a lot less convinced of this.

• AkhilMay 29, 2022, 1:53 PM

  3 points

  0 ∶ 0

  in reply to: Kevin Lacker’s comment on: High Im­pact Medicine, 6 months later - Up­date & Key Les­sons

  I think I sit somewhere between you both- broadly we think that there shouldn’t be “one” road to impact ; whether that be bed nets or something else Our explicit purpose is to use EA frameworks and thinking to help people reach their own conclusions. We think that common EA causes are very promising and Very likely to be highly impactful, but we err on the side of caution in being overly prescriptive.

• AkhilMay 29, 2022, 7:25 AM

  40 points

  0 ∶ 0

  on: Will there be an EA an­swer to the pre­dictable famines later this year?

  Thanks for raising this question!

  Undernourishment (not getting enough and the right types of caloric intake, a subset of malnutrition) is a massive issue currently, affecting 660 million people; especially in children,^[1] it can have significant long-term health sequelae e.g. stunting. And you are right, as a consequence of the war in Ukraine, it is likely to get worse.

  Although cash transfers do have a positive impact on degree and rates of undernourishment, it likely isn’t the most directly cost-effective way of addressing this issue.^[2]

  There are a couple things that we could do (disclaimer: have read about this area before, spent 10 minutes on this):

  1. Fund and scale up CMAM programs around the world- A couple of reviews, including this pretty good one by Save the Children, rate community management of acute malnutrition or CMAM, as one the most cost-effective intervention. CMAM involves treating severe acute malnutrition (SAM), especially in young children, via therapeutic feeding in predominantly outpatient facilities.

  2. Cautiously increase funding in other interventions that are promising- There are several other interventions that may be very cost-effective for undernutrition and malnutrition- Large Scale Food Fortification, Multiple Micronutrient Supplementation for pregnant women, and small-quantity Lipid-based Nutrient Supplementation for children 6-23 months.

  3. Work with governments to create healthier and more resilient food systems- this has a slightly longer ToC but can be quite effective e.g. Reductions in childhood stunting in Peru, from a rate of 29.8% in 2005 to 18.1% in 2011, have been attributed to improved policy and institutional coordination, pooled funding for nutrition and binding nutrition targets, as well as the creation of a civil society platform, the Child Malnutrition Initiative^[3]

  1. ^

     More info on the Our World in Data page on undernourishment

  2. ^

     There is mixed evidence here. Some studies have shown it to be reasonably cost-effective (e.g. this one in Pakistan, but this one in Burkina Faso did not)

  3. ^

     Directly from Aid Forum: http://​​www.aidforum.org/​​topics/​​food-security/​​four-ways-to-reduce-malnutrition/​​

• AkhilMay 28, 2022, 3:55 PM

  6 points

  0 ∶ 0

  in reply to: Joey🔸’s comment on: Why should I care about in­sects?

  In expanding what Joey said, I think another aspect of why insect work may be a bit less tractable is to do with optics. I think in the broader public sphere, insect farming has been seen as a potential solution to food insecurity and a sustainable agricultural solution requiring less land and water etc. This may make it somewhat harder to gain significant traction in the space.

  That being said, I think one particularly large area where work might be interesting in working on is slowing down insect farming for animal feed, which I imagine would cause less public disagreement than slowing down insect farming for human consumption purposes.

High Im­pact Medicine, 6 months later - Up­date & Key Les­sons

• AkhilMay 27, 2022, 12:51 PM

  18 points

  0 ∶ 0

  on: On be­ing am­bi­tious: failing suc­cess­fully & less unnecessarily

  Great post Luke! I just wanted to add another argument to point 8:

  8. We need to be careful how we talk about ambition (or we might overload and disappoint people)

  I think another related aspect to this (in my experience with High Impact Medicine) is that you also want to be careful about this because even though people might be ambitious, their personal and professional situation might preclude them from taking an ‘ambitious’ leap. Even though on the whole I think it is net positive to encourage people to be ambitious, we should also caveat this with an appreciation of different career and life situations. I think a failure to inadequately do this can make people feel like they are not doing or are enough.

• AkhilMar 19, 2022, 7:25 PM

  7 points

  0 ∶ 0

  on: $100 bounty for the best ideas to red team

  Red team: Scrutinize this career profile on medical careers. Why might it turn out to be misleading /​counterproductive /​unhelpful for a young aspiring EA?

• AkhilMar 19, 2022, 7:23 PM

  11 points

  0 ∶ 0

  on: $100 bounty for the best ideas to red team

  Red team: Why might one not believe in the arguments for wild animals having net negative welfare?