I’m a doctor working towards the dream that every human will have access to high quality healthcare. I’m a medic and director of OneDay Health, which has launched 53 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.
NickLaing
Karma: 13,985
My apologies @Vasco Grilo🔸 I was lazy there and didn’t read the whole article properly. Thanks for pointing out the important areas. Working memory and operant conditioning don’t carry any weight with me personally, I struggle to connect those with a meaningfully increased chance of pain experience. For example the portia spider has a very advanced working memory for very specific tasks which makes sense evolutionary, as do many other organisms, but i can’t imagine why these specific evolutionary advantages would also lead to sentience?
“Finally, higher order cognitive processes such as episodic memory and self-recognition, can yield insights into animal awareness. These have not been studied in S.P.U.D. subjects, and this would likely be impossible”
These higher order processes would be most convincing for me than the memory stuff, especially deeper levels of self recognition which I feel like could maybe be tested?
Perhaps a silly question, but I thought the mirror/parasite mirror test was related to “self recognition”, but you seem to mention that as something different.
I appreciate this paragraph, especially the extreme uncertainty and the welfare of fish being potentially close to zero even if sentient.
”I speculate carp have around 50 % (= (0.70 + 0.40)/2) chance of being sentient, but I have little reason to expect my intuitions are calibrated. I feel like anything from 0.1 % to 90 % is reasonable. In any case, I can see the welfare of fish being very close to 0 even if they are sentient. So I would rather prioritise decreasing uncertainty about their sentience and intensity of their experiences over investing in interventions helping fish.”
What kind of research do you think could decrease uncertainty about their sentience? I’m assuming you mean behavioural research? I think this kind of research is helpful to reduce uncertainty but doesn’t necessarily address fundamental questions about how brains work.
I think the world is more likely to not end then end, when TAI comes in so I feel like I have to vote agree here?
And one quick query from the main article
”Shelton, Constance (CJ), and Latifah in Latifah’s farm where she now grows Irish potatoes and cabbage. She invested $300 in her farm, and has been able to increase her profits from $5/week to $30/week. She plans to expand into mushroom farming next.”
Profits (not gross sales) of $30 a week subsistence farming in Rural Rwanda seem close to impossible. I imagine this is what she told you? Perhaps this was just during harvest season or something, then it would make more sense.
Perhaps not completely impossible though if she’s unlocked a particular market!
This is super interesting stuff thanks for posting!
The first thing that jumped out at me was that you are reading and analysing people’s messages that come through the chatbot. I’m sure they consented (as much as this is possible to truly consent with the level of education, and the cash incentive) and its all anonymised but it still seems weird.
I have so many ethical questions about this. None of them I think necessarily mean something like this isn’t worth trying, but I think it’s worth discussing. Here’s just a couple off the top of my headWhat do you do if they have a conversation about harming themselves or others? Do you react and do something about it or do you leave it be? Would people then be aware that what they type could illicit some kind of external response?
When they ask something like “”What business has quick profits” for which there is obviously no good answer, what does the bot do? I hope it doesn’t try and give business advice. When I asked Claude sonnet, the first answer it gave was
“Poultry farming is one of the most cited options. It has high demand for eggs and chicken meat, with startup capital of around 1–2.5 million RWF and potential returns in 2–3 months if well managed.”
In many rural contexts this might be a decent idea, but without proper disease treatment, housing, protection from theft etc. this advice could be a huge liability.
Also Who are you that you answer me?” is pretty haunting. I concur.I think there’s a huge amount to be gained potentially by trying chatbots in these settings, but its a bit of an ethical minefield and its a new fronteir for sure.
On this question “‘is there a hyper-competent person waking up every day feeling accountable for making sure this gets solved?’ for many Global health issues there are 30-50 people like that. Only with newer more niche ones like lead might there be 1 or a handful.
These are great examples from the past. I love the old-school “heros” you mention and wish we had more today. Even with those “DRI’s” you meantion of the past, I would imagine they were reall ymuch more part of a bigger global team, and in many cases the public figurehead rather than “the” responsible person.
I appreciate that @Mo Putera but Im not at all that. Your 100% right that I’m sold out for getting good healthcare to everyone, but there are probably >5000 people in the GHD world who both have a better track record and more power to move the needle on access to high quality healthcare than I. You probably get the wrong idea from me posting too much on the forum :D :D :D , I run a smallish growing org that rolls out a decent model that may or may not get more traction.
Even our One Nurse in One room model as great as I might think it is, is only likely to be useful and perhaps the “best option” to provide remote healthcare in a handful of countries. Many Sub-Saharan African countries already finding (or have found) their own way to solve the problem which is great—even if its less efficient.
I think there are surprisingly few examples of “DRIs” who really own an issue in Global health. I actually wish there were more. There is the odd huge name like the late Paul Farmer would be the best example of what you are talking about. He helped move the needle and policy on a lot on many things, such as
- MDR TB treatment rollout
- TB directly observed treatment (along the lines of what Spiro—New TB charity raising seed funds does.
- Community Health worker normalisation
On your systemic change question, I think systemic change in Global health is a multifaceted long-term grind. It takes a lot of effort, money, people working hard and good long term relationships and connections with the WHO and governments to make lasting change. The community Health worker movement is one of the best examples of successfully driven systemic change. It took 20+ years had a LOT of big names behind the campaign to get serious traction. This included Paul Farmer who I mentioned, plus big time advocates like President Sirleaf from Liberia. Plus tens of other people who are sold out spend their whole life on the issue. And they have a great advocacy org CHIC who co-ordinates and advocates led by another great woman Madeleine who recently posted here on the forum. There was no one Directly responsible” person—instead perhaps 20-50 hugely capable people co-ordinating and making this happen.
What I don’t think can work to create large-scale meaningful systemic change is funding a 3 year project through a big NGO which tries to do just that. Better to fund movements or organisations that already have committment and momentum. In some ways similar to your “DRI” idea, but unfortunately not as simple as funding 1 person.
Your “VAWG” example is a good one, because like with the community health worker movement there are hundreds of founders working on that issue who are dedicated to their work and as far as I know no one person who stands out as a clear leader of the movement Many of them are obsessive and brillian, but they won’t be directly responsible for the field in general. Maybe in their country or for their specific intervention, but not for the entire field.
I don’t know much about this field and I could be wrong, but I feel they haven’t yet co-ordinated and built a “coalition” of groups working on it with a super capable leader can be key to creating more systemic change
And I might be missing what you really mean by “DRI” here, but I’m just not sure that the principle applies outside of a handful of very niche interventions like the no-more-lead crew.
I would take them, they can pay them 200k if they like, if they can help us do a great job with AI… (Cry face)
Super interesting topic. It’s a bit of a nitpick but perhaps I’m more in favor of funding for organizations that do one solution (or a small handful) really well, than I am finding a “solution” persay.
I’m not sure there really are clear examples of funding “DRIs” in global health. At least not that I know of. The global health world moves around organizations more than people. Often when you bet on a smaller org and their solution you are basically betting on their CEO but it’s still indirect. @Mo Putera did you have any examples on this?
I was excited to hear about this “Claude Corps” initiative for NGOs, which helps orgs supercharge their benefits from AI then gutted to hear that its only going to be in the USA. Apparently they want to extend it overseas later, but the impact an intern li this could have right now for orgnisations like us at OneDay Health in Uganda would be mind-blowing. I hope they can expand the program overseas sooner rather than later!
- 150 million dollar program
- Intern works for 12 months with the NGO to supercharge AI use
- $85,000 payment to intern for the year
https://www.anthropic.com/news/claude-corps
Just because you work through government doesn’t make it systems change. Governments are usually happy to implement stuff if someone else is paying, then when the money dries up so does the work. I wouldn’t call their Malawi work systems change really.
What I would call systems change is their work convincing the UNHCR to give cash rather than food a lot of the time to refugees.
Wow I would invest 60-100 hours of time even as a founder for an expected value of 100,000 dollars. That’s crazy that org had that much funding!
Yes in the animal welfare and global health space the situation is nothing like that...
I don’t think it has shifted the scales yet, uncertainty remains huge on the Anthropic question. Not only on the amount, but I’m sure there will be many impactful cause areas which won’t benefit that will still need more money.
And even if 10 billion (or whatever) does end up coming in, It might change the ETG math less than we’d expect? Would be interested to see someone do some play-math with the numbers....
I think you could argue that “open source fades, propreitary moat” is a miss but not a clear miss. Yes there is a proliferation of decent open source models, but they are waaaaaay behind the fronteir and considering the money that’s pouring into the frontier companies, investors clearly think propreitary has a moat.
If the arms race argument is the central argument, I would argue that there is a clear moat. The open source models are not close enough to the frontier to reduce the urgency of an arms race.
This is a great idea, although this would be a big call for many of us to do who might hope that our org could get some of that funding. Even someone like myself who fires shots pretty freely might think twice. We wouldn’t want to rule our organisation out by writing too strong a Steelman against this. Any steelman would involve arguing that previous promises from founders and employees don’t carry much weight, which could be seen as a personal slight against someone who could conceivably give you money. Sometimes I wonder if I’ve already said too much!
@Marcus Abramovitch 🔸has written a bit on this he might have a comment here?
“but the WiFi was incredibly bad (maximum 1mbps)”.
Not only in Uganda huh..
I love your honesty about the issues with the retreat. I think at least one external speaker is always a boon to increase the excitement/novelty levels.
I remember when we were at Cambridge we combined the retreat with Wawrick university and that was absolutely rocking. Great to have new faces and people running sessions and increased the buzz a bit.
I like how you grounded the retreat in concrete practical thinking about the future. Nice one!
This could be correct but is so speculative and so many steps removed from the present that I give it very little weight. There are so many assumptions at play here. I think most of these assumptions are more likely than not, but with those probabilities multiplied together the whole scenario becomes less likely. Here are just a few potential ones.
1. More humans will always = more productive person-years. There are lots of war / resource shortage /climate change scenarios
2. We will invent cultured meat that everyone switches to.
3. AI just increases progress and doesn’t take the world in weird directions
4. More people reduces X-risk?
I couldn’t disagree more here, I think we need more of these kind of jobs on the jobboard.
Imagine if you are a kitchenhand and you are good at and like your job. Perhaps you don’t have any tertiary education but you’d love to be more impactful then your current work at Starbucks.
What a rare and great opportunity.
Yep I 100 percent agree.
I’m 80% to the intervention, 20% to research. I would love MORE money than now to go towards researching effectiveness (I’m guessing its a lot less than 20% on the margin right now)
I was shocked though after reading the recent animal welfare post at how mixed the evidence base seems to be as to the benefits of commonly touted interventions. I’m dubious about interventions that might move a chicken from a very net-negative life to a slightly-less net-negative life. I naively assumed that cage-free was better than it seems to be. After seeing @Lewis Bollard’s TED talk I kind of assumed that cage-free interventions at least probably moved chickens to a net-positive life?
I would love as well to be more certain about animal sentience and suffering, but I’m skeptical that many research suggestions I’ve seen will make much progress, as I don’t believe we can have much confidence in sentience’pain from only observing behaviour. I still think this area deserves more than the meagre funding it gets though.