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: 9,423
I disagree, giving habits are important to cultivate early, from a habit perspective even if from a dollar utility perspective you may be right.
Important to consider though!
The Best Health Systems Strengthening Interventions barely qualify as HSS—My take on RP’s report
Vote power should scale with karma
I think it should scale but less than it does now. The power goes to my head....
In all seriousness I thin + 2 for a new user strong upvote and +8 for a high Karma user is too much of a gap. Maybe +4 or +5 would be enough? I know this is a specific case, but I feel sometimes deep in an animal welfare threads you can make a reasonable comment and be downvoted to oblivion pretty quickly by a couple of heavy downvotes. But I would say that....
As anecdata here’s an example of a fairly reasonable comment from a few hours ago that would be negative karma without my strong upvote....
“The best reason not to involve the criticised person or org is if doing so would in practice stop you from posting your criticism. You can always ask the mod team for support if this is the case. Simply email forum...”
One of the biggest reasons I’ve considered, is just time delay. Posts on the forum disappear from the front page quickly, and memory fades quckly as well. For example right now I’m about to post a response to RP’s great analysis on Health Systems Strengthening interventions. Only part of is is criticism and not really very heavy. I probably won’t send it to them because I think I need to give 3 days really for a fair response, and its already over a week after the initial post so I’m already late.
If most of it was criticism, I would send it to them first
This is a tricky one with no clear solutionI don’t think
“If you can’t muster up an ounce of charisma, you will not be an effective leader”
I agree with this, in terms of human leadership. I think with people without much charisma can and should be in leadership positions, but thecharisma is 100 percent necessary so they need other leaders around them who possess that!
This article gave me 5% more energy today. I love the no fear, no bull#!@$, passionate approach. I hope this kindly packaged “get off your ass priveleged people” can spur some action, and great to see these sentiments front and center in a newspaper like the Guardian!
https://www.theguardian.com/lifeandstyle/2025/apr/19/no-youre-not-fine-just-the-way-you-are-time-to-quit-your-pointless-job-become-morally-ambitious-and-change-the-world?CMP=Share_AndroidApp_Other
Questions would just be finding out what the cost-effectiveness of money from current individual donors, philanthropies, Gates Foundation was, then calculating the difference if it went to the most cost-effective rganisations.
At Risk of violating @Linch’s principle “Assume by default that if something is missing in EA, nobody else is going to step up.”, I think it would be valuable to have a well researched estimate of the counterfactual value of getting investment from different investors (whether for profit or donors).
For example in global health, we could make GiveWell the baseline, as I doubt whether there is a ll funding source where switching as less impact, as the money will only ever be shifted from something slightly less effective. For example if my organisation received funding from GiveWell, we might only make slightly better use of that money than where it would otherwise have gone, and we’re not going to be increasing the overall donor pool either.
Who knows, for-profit investment dollars could be 10x −100x more counterfactually impactful than GiveWell, which could mean a for-profit company trying to do something good could plausibly be 10-100x less effective than a charity and still doing as much counterfactual good overall? Or is this a stretch?
This would be hard to estimate but doable, and must have been done at least on a casual scale by some people.
Examples ( and random guesses) of counterfactual comparisons of the value of each dollar given by a particular source might be something like....
1. GiveWell 1x
2. Gates Foundation 3x
3. Individual donors NEW donations 10x
4. Indivudal donors SHIFTING donations. 5x
5. Non EA-Aligned foundations 8x
6. Climate funding 5x
7. For-profit investors. 20x
Or this might be barking up the wrong tree, not sure (and I have mentioned it before)
I think this point is really important. If the charity raises 20 million from GiveWell that’s great, but counterfactual impact is unlikely to be very big. If they raise it though from other foundations or individuals, I would say the counterfactul impact per dollar might be 5-10x as much.
But in general agree with almost everythng @huw nicely points out here.
And yes don’t expevt @huw to account for this in a calculation. I think it would be nice to have a super well-researched estimate of “Value per dollar” of givewell funding vs. other foundations, and am surprised this hasn’t been done.
Thanks @CB🔸 I’d rather not get into this here in detail (its not what the post is about), but these numbers come from something like starting from the moral weights project numbers then discounting pretty heavily due to skepticism about the methodology being biased towards animals at most junctures. My starting point of 1 in a thousand isn’t far off RPs numbers. Your between 1 in 10 and one in 100 billion is also entirely reasonable.
I’m not at all confident they are morally irrelevant, my point was only that there’s a chance their suffering is relevant on the ballpark of human suffering—not necessarily all or nothing.
Thanks so much for this @Rethink Priorities. This is a great report and I think breaking quite a bit of new ground. I’ve got some strong (but not critically important) disagreements and a few corrections here, I’ll try ad find the time respond with a longer post later!
Hey there I love the C.S Lewis quote and the sentiment—but I think there is a small world where I can belive that insect suffering is moderately important.
My personal “P-Sentience” (Thanks AI doomers) for most insects might be somewhere between 1 in 1,000 and 1 in 100,000,000 (The moral weights project is great but not the gospel). In addition if they are sentient, then I would estimate their experience of pain might be between 0x and 1,000x less important than that of an individual human.
If this was in the ballpark, then insect suffering could be a “moderately important” issue. Still imporant—but in the realm of the importance of human suffering, not a lot more nor a lot less. OF course it being much more or much less important is far more likely.
I agree that most people would have a “P sentience” for insects far higher or far lower than mine, in which case it would be very imoprtant or utterly unimportant.
So I think you’re mostly right, but there is a small-ish possibility of it being moderately important too.
These are all good reasons.
I think 5he biggest reason you’ve missed against starting a for profit is risk of failure. It’s really really high, maybe 5x or 10x that of a non profit.
Again I really like your argument, and think that despite the risk of failure, more EAs should be trying their hand at for profits.
Wave is a beautiful company.
Just don’t name it Ajar AI or Anthropomorphic :D
100 percent agree. I dont understand the entire post because I don’t know the context. I don’t think alluding to something helps, better to say it explicitly.
Don’t be inclined to trust my in-the-field experience, Zipline has plenty of that too!
I just had a read of their study but couldn’t see how they calculated costing (the most important thing).
One thing to note is that vaccine supply chains currently often unnecessarily use trucks and cars rather than motorcycles because, well, GAVI has funded them so they may well be fairly comparing to status quo rather than other more efficient methods. For the life of me I don’t know why so many NGOs use cars for si many things that public transport and motorcycles could do sometimes orders of magnitude cheaper. Comparing to status quo is a fair enough thing to do (probably what I would do) but might not be investigating the most cost effective way of doing things.
Also I doubt they are including R and D and the real drone costs in the costs in of that study, but I’ll try and dig and get more detail.
It annoys me that most modeling studies focus so hard on their math method, rather than explaining now about how they estimate their cost input data—which is really what defines the model itself.
Yep Snakebite is one of the few slamdunk usecases for me here. Until we design a cheap, heat stable antivenom I think drones that can get there in under an hour might be the best option in quite a wide range of places.
Zipline have been around for about 10 years I think—boy do they have the cool factor. One big issue is that they can only carry as really tiny amount of stuff. Also the places where they can potentially save money have to be super hard to access, because a dirt cheap motorcycle which can go 50km for a dollar of fuel can carry 50x as much weight.
My lukewarm take is that hey have done well, but as with most things haven’t quite lived up to their initial hype.
Love this.Has there really not been an RCT on floor replacements yet? That surprises me as it would be a relatively easy RCT to do. EarthEnable from Rwanda just won the 2 million dollar Skoll award doing this at scale.
GiveWell must have considered it I would have thought?
“being funny is a virtue, being edgy is not” is pretty darn insightful, I’m going to use that in future as it rings so true with my experience.
And in my limited experience when humor is combined with epistemic humility (forgive the jargon :D) I have seen some beautiful moments of breakthrough with EA ideas.
Thanks so much man, these are awesome reflections and a great post to wake up to!
Am hoping the new “made me laugh” reaction might help on the humour and levity front, but haven’t seen it used much yet outside of April Fools.