Medical marijuana fell outside the scope of our consulting project, but I think the evidence is weak for medical marijuana as a promising intervention: “When researchers extended their analysis through 2013, they found that the association between having any medical marijuana law and lower rates of opioid deaths completely disappeared. Moreover, the association between states with medical marijuana dispensaries and opioid mortality fell substantially as well.” https://www.rand.org/news/press/2018/02/06.html
It’s definitely an interesting/intriguing idea, but it also carries risks of increasing some of the harms associated with marijuana use. Curious to see more evidence come out about it.
Hi, I’m the Founder of the Philanthropy Advisory Fellowship. We’ve published a bunch of our reports on our website: http://harvardea.org/philanthropy-advisory-fellowship/We often post them in the EA forum as well. Sorry it was hard to find.
Thanks for writing up this review of Mental Health as an EA cause area! As you know this is an issue near and dear to my heart. You’ve done a great job summarizing many of the most interesting and important issues in this space.
I wanted to point out a few areas where I think this report could be improved:
DALY count: This article provides good reasons why mental health really repferents 13% rather than 7% of global DALY burden: https://www.ncbi.nlm.nih.gov/pubmed/26851330
Trace Lithium: I think it is important to distinguish between “Lithium in the Water Supply” as a research topic (looking at naturally varying levels of lithium) versus as an intervention. If we determine that the trace lithium hypothesis is correct, i.e. that lithium is a nutritionally necessary mineral that many people are deficient in, then the best intervention would be for the FDA to issue a Recommended Daily Intake so that it gets added to fortified foods, such as vitamins. This way, people can see when Li has been added to their food, and have autonomy over consuming it. Adding lithium to the public water supply would be ethically problematic, politically difficult, and unnecessary.
Unfortunately, evidence for the trace lithium hypothesis has weakened since OpenPhil wrote their report, due to this study in Demark (however, the range of Li concentrations was limited): http://www.mdpi.com/1660-4601/14/6/627/pdf
Suicide and Crisis Hotlines: This is a promising area for research. I haven’t seen any strong RCT’s on these interventions yet.
Marijuana and Opioid overdoses: New evidence has come out since you wrote this post, showing a more complex relationship. The author of the study said, “Before we embrace marijuana as a strategy to combat the opioid epidemic, we need to fully understand the mechanism through which these laws may be helping and see if that mechanism still matters in today’s changing opioid crisis.”
MDMA for PTSD: While promising, I think the risk profile of MDMA and worldwide perception and political realities around it make it a less tractable intervention. I think Propranolol is more promising because it’s already on the WHO List of Essential Medicines and very safe, as I argued in my report: http://www.harvardea.org/blog/2016/7/13/paf-mental-health-in-sub-saharan-africa
DARE: The bulk of evidence on the original DARE program showed that it had no effect—I think it’s an overstatement to say it increased drug consumption. It’s also important to point out that DARE has been overhauled with help of the research community, and their new program, Keepin’ it Real, has shown modest signs of success: https://www.scientificamerican.com/article/the-new-d-a-r-e-program-this-one-works/
Methadone: I haven’t read Elizabeth Pisani’s book, but I don’t think it’s fair to say that it doesn’t reduce addiction—it’s more accurate to say it doesn’t reduce dependence. Addiction is defined in the DSM-V as causing problems in the patient’s work/personal life, so when patients are stabilized on methadone maintenance programs (as many are), working and living normal healthy lives, they are no longer considered addicted.
Looking forward to the next iteration of this!
Great analysis! Very fair and balanced.
As you point out, increasing the prescriptions of opioids in the US lead to an enormous disaster—drug overdoses now kill more Americans each year than car crashes. The regulatory environment in the US isn’t great, but it’s decades ahead of what most developing countries have. The fact that the US still hasn’t figured out a sensible policy to managing prescription opioids makes me very skeptical that developing countries could pull it off safely.
E.g., look at these two articles. This one points out that there are already deceptive marketing practices around opioids happening in China: https://www.bloomberg.com/news/articles/2016-12-18/china-s-oxycontin-boom-is-a-goldmine-for-this-drugmaker
And this one looks at the aggressive expansion of painkillers into developing countries: http://www.scmp.com/news/world/article/2057240/big-push-opioid-epidemic-killing-oxycontins-us-market-so-makers-target
Rather than trying to expand access, the better strategy may be to advise developing countries on drug control policies to be able to better monitor opioid misuse and handle the inevitable increased availability of drugs.
Note: I’m working on a tech startup that helps people who overuse substances.
Re: DALY’s for physical vs. mental health, in our full report we cite Vigo 2016 ( http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00505-2/abstract ) which lays out a strong argument for using a 2x adjustment for mental health DALY’s. That’s the approach we take in the paper.
Re: Propranolol, I spoke with Dr. Alain Brunet at McGill University, who conducted some of the studies you’re referring to and was very helpful in explaining the science behind it and the potential.
I agree that helplines could have a very high impact. It’s not mentioned in the paper, but we did look into it—we weren’t able to find an organization that we had enough confidence in to recommend. Could be an interesting challenge for an EA social entrepreneur or philanthropist to take on, though!
Thanks! We only presented this report to Draper Richards Kaplan Foundation about a month ago, but we do plan to do a long-term follow-up to see if/how they act on our recommendations. The foundation has substantial (>$100M) resources at its disposal.
As for the behavior change aspect, that’s definitely a problem. I recommend GiveWell’s report on Development Media International, which is one of the leading organizations working on the behavior-change aspect of this problem: http://www.givewell.org/international/top-charities/DMI
So far, the evidence is mixed on DMI, but we chose to recommend them to another PAF client: http://www.harvardea.org/blog/2016/3/5/corporate-philanthropy-fill-in
Part of our recommendations in this WaSH report are based on whether we think these new technologies will be able to achieve widespread adoption, based on the underlying technology, marketing strategy, business model, and team. One example of a social enterprise that has done this successfully is Sanergy: http://saner.gy/
This is definitely something I’m interested in learning more about, and haven’t seen a thorough analysis from an EA perspective anywhere. I respect both Bjorn Lomborg and Martin Rees on this subject, even though they have opposing views. Bjorn Lomborg thinks that cost-benefit analysis shows reducing carbon emissions to be a bad investment compared to global health spending, and that we should instead just try to accept climate change and adapt to it. Martin Rees thinks Bjorn Lomborg is using the wrong discount rate in his calculations, and that the tail risk of catastrophic climate change alone makes its prevention a worthwhile investment. I haven’t dug any further than that yet.
We could definitely use more human-to-human connection in the EA community!
I think some of the posts here assume that people who are new to EA will reach out to local EA groups or ask to be connected to people. I think that most people are kind of shy.
It’s better if we can create a system that pulls people in, rather than waiting for them to reach out. 80,000 Hours used to have this kind of setup—you reached out for career advice, and then we would try to get you on Skype to connect socially and introduce you to other EA’s (even if they didn’t have time to do full coaching). Unfortunately, that funnel doesn’t exist anymore.
However, maybe we could set it up that when people create a new profile/account on some of the EA websites, we can have a volunteer team reach out to them and connect them to people in the same area or field of interest. I call it the EA Welcoming Committee.
As everyone who has posted so far has mentioned Bill’s article in the Harvard Law Record, I just wanted to respond in this one comment.
His article is definitely fiery, and probably overstates the case for earning-to-give. When Bill and I gave a presentation at the law school last semester, we included advice on how public interest/government lawyers can maximize impact by choosing high-priority causes and gaining leverage by changing policy.
There are a few comments on his article that were positive. I think people who already wanted to go into BigLaw were more receptive to it than those who already wanted to go into public interest/government.
Bill and the other members of HLS EA have accomplished a lot over the past semester—they’ve gotten around 40 people to sign the 2L Pledge ( https://www.facebook.com/events/1388997771424219/ ), over 5% of the 2L class. It’s a pledge to donate 1% of summer internship earnings to highly effective charities, which they hope to grow and turn into a post-graduation pledge next year.
Thanks Zack. The grad student group I co-founded, Harvard University Effective Altruism, is going well. We have a leadership team in place for next year that covers the Law School, Business School, School of Public Health, and School of Arts & Sciences. Our events with Cass Sunstein and Derek Parfit each drew over 100 people.
Interestingly, my article did generate some interest outside of HBS, as a number of people emailed me about it, but it didn’t provoke any discussion within HBS. I think it’s because my article wasn’t controversial enough; if I had to do it again, I would have pushed harder.
This sounds awesome! Is the idea that policy comments would get regulators to: consider a new policy they weren’t previously considering; change their mind about a proposed policy; help back them up politically for something they already want to do; or a combination of these? I’m not sure which type of impact policy comments are best for.