Thank you for spotting that!
Akhil
Karma: 2,001
Equity should be a part of effectiveness evaluations
“But translating into utility or QALYs already accounts for this; it’s generally easier to increase the utility/health of someone with less.”
I think there are certainly cases where this is true, and the premise of this argument is that there are cases where this might not be the case. If we take the burden of mental health or chronic illnesses, I think there are many possible and actual examples where it may be”easier” to increase the utility of those living in a HIC as opposed to a LMIC
I am also interested as to how you make the distinction between a marginal dollar and a marginal QALY if we recognise there is a significant gap in both income and health outcomes between say, Nigeria and the UK
Hey, a great write-up!
Completely agree that:
Air pollution causes a massive amount of morbidity and mortality.
Air pollution is something outside of the individual control (unlike, say, alcohol or tobacco consumption), and therefore policy work seems to a particularly important and tractable approach.
What I am unsure about:
I wonder whether a lack of information about the levels of pollution and its causes is a significant barrier to policy change. Intuitively to me, it seems like we know the things that cause air pollution and areas where air pollution is worse, and additional data on this is unlikely to make a massive difference to the likelihood of policy change. I’m not too confident about this, however, and would love to hear your thoughts otherwise.
Improved air quality monitoring seems like it could be really useful for:
Holding governments with already existing policies for air quality accountable e.g. if a government has a policy to keep the level of air pollution below a certain level, having a lot of monitors would make it a lot easier to check whether this was the case, and hopefully drive up compliance
This is a fairly neglected area imo, and it is great to see more people thinking about it :)
Risk modelling and preparedness for climate-induced risks
Research That Will Help Us Improve
Climate change is a risk factor for several threats to the long-term future of humanity. It increases the likelihood of infectious diseases, including novel pathogens. As well as this, it is correlated with increased fragility of states and greater propensity for conflict. Therefore an organisation that models the climate resilience of social, health and political systems, and subsequently seeks to strengthen and improve their preparedness, may reduce the likelihood of significant threats to humanity’s long-term future
Teaching secondary school students about the most pressing issues for humanity’s long-term future
Values and Reflective Processes, Effective Altruism
Secondary education focuses mostly on the past and present, and tends not to address the most pressing issues for humanity’s long-term future. I would like to see textbooks, courses, and/or curriculum reform that promote evidence-based and thoughtful discourse about the major threats facing the long-term future of humanity. Secondary school students are a promising group for such outreach and education because they have their whole careers ahead of them, and numerous studies have shown that they care about the future. This may serve a significant benefit in making more young people care about these issues and support them with either their time or money
Red team: Why might one not believe in the arguments for wild animals having net negative welfare?
Red team: Scrutinize this career profile on medical careers. Why might it turn out to be misleading /counterproductive /unhelpful for a young aspiring EA?
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.
High Impact Medicine, 6 months later - Update & Key Lessons
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.
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):
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.
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.
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]
- ^
More info on the Our World in Data page on undernourishment
- ^
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)
- ^
Directly from Aid Forum: http://www.aidforum.org/topics/food-security/four-ways-to-reduce-malnutrition/
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.
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.
Let’s separate this out
There are some medics who completely buy EA and have changed their entire career directly in line with EA philosophy
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.
- ^
We do fundamentally serve (1) and think this is a great group of people we shouldnt miss either!
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!
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!
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!
Great suggestions, and agree with all the points made- I especially think the value of a weekly/fortnightly catch-up is under-appreciated. I recently started a new job, and my boss and I did a 13 question get-to-know you style exercise, to understand more about the motivations, working style and personality of one another. It took about an hour, but I think it is a seriously good investment. I think we both came away with it understanding each a lot more, which is a great start to a working relationship. The questions were:
#1: Where on the spectrum of introvert to extrovert would you place yourself?
#2: What’s your preferred way to receive feedback, in terms of speed? (E.g., right away). What’s your preferred format?
#3: What’s your orientation toward conflict?
#4: How would you describe your communication style?
#5: What motivates you the most, in your work life?
#6: What’s your favourite way to decompress after work?
#7: Who’s been the best coworker or team you’ve worked with? Why?
#8: Who’s the best boss or mentor you’ve ever had? Why?
#9: When have you worked with someone and noticed it not going well? What happened, and what was that person doing?
#10: What do you tend to have a longer learning curve around, compared to others?
#11: What do you tend to pick up very quickly, compared to others?
#12: What’s your biggest work-related pet peeves (i.e., that thing that other people do that totally annoys you when you work with them)?
#13: What does “work-life balance” mean to you?