Director of Strategy for the Centre for Effective Altruism. I previously ran new programs at Innovate Animal Ag and led the research team at a nonprofit focused on building $1B+ philanthropic initiatives/megaprojects. Before that I lived in Tanzania and ran some RCTs there.
Rory Fenton
Karma: 718
I have no particular take on LG, I was mostly focused on your question about the market failure. I’ve no reason to think LG couldn’t do a great job, this sounds very much like their area of expertise!
I can’t speak to this product in particular but my experience at One Acre Fund in Tanzania was that it’s often just really hard to physically distribute products to rural Africa without super high costs or damage. The practicalities of distribution are hard to solve, which I guess is more what Nick is looking to do here. Once you find a way to get the product in front of users and it saves them money, they’ll often buy it, I agree that it might not need to be given for free (not withstanding another practical note: if you need to charge, that also generates a bunch of logistics!)
Ah I am so jealous, you only get that first The Goal reading experience once :). I have recommended it more than any other book I’ve read, I think. I hope you enjoyed it even 10% as much as I did!
Nice, agreed. I could totally see cups being superior, I mostly was thinking of OAF from the perspective of having shareable lessons on e.g. marketing, impact measurement, stuff that might make ODH’s work a little easier. Will share what I hear!
The outsized benefits of removing bottlenecks: some personal experiences
Interesting idea. I know One Acre Fund had a (possibly just pilot) program distributing Afripads in Kenya (https://www.afripadsfoundation.org/the-challenge/). I happen to be chatting with old colleagues from the Kenya program soon, will share any lessons + connect you if useful.
Hey Vasco, I just joined CEA last month to start building out an internal monitoring and evaluation function. Getting into our impact in terms of things like career changes + donations is a top priority. For now, I’m still in learning mode, but I hope to have some defensible ideas on this soon!
Totally agreed! I very much assumed my audience was very EA and already stepping back on cause-prio + intervention choice every so often. You are right that that often isn’t the case, and the way I’ve framed things here might encourage some folks to just plough on and not ask important questions on whether they are working on the right thing, in the right way.
You probably won’t solve malaria or x-risk, and that’s ok
Love the clarity of the post but I agree with Geoffrey that the $ impact/household seems extremely low and I also don’t follow how you get to $1k+/HH (which would be like doubling household income).
Back calculating to estimate benefits/household:
$1.5m national savings over 5 years = $300k/year
Number of adopters:
50m people in Uganda
5 people/household means 10m households
1⁄3 of households use charcoal: 10m/3 = ~3m households use charcoal
1% adopt: 3m * 1% = 30k adopting households
Benefits/household: $300k/year over 30k adopting households = $10/household/ year (or just $1/person/year), which seems super low to me
I’d guess that’s at least part of why you don’t see more bean soaking already, the savings are just so modest, unless I’ve missed something in my calculation.
As you note, behaviour change around cooking practices is also super hard. When I worked at One Acre Fund Tanzania, our 2 biggest failures were introducing clean cookstoves and high-iron beans, both of which people just didn’t want to use because of how they conflicted existing norms, e.g. color of the new bean variety “bled” into ugali, making it look dirty.
So the $ benefits would make me skeptical of this as promising but I’m hoping I missed something big in my calculation!
Thanks Chris, that’s a cool idea. I will give it a go (in a few days, I have an EAG to recover from...)
One thing I should note is that other comments on this post are suggesting this is well known and applied, which doesn’t knock the idea but would reduce the value of doing more promotion. Conversely, my super quick, low-N look into cash RCTs (in my reply below to David Reinstein) suggests it is not so common. Since the approach you suggest would partly involve listing a bunch of RCTs and their treatment/control sizes (so we can see whether they are cost-optimised), it could also serve as a nice check of just how often this adjustment is/isn’t applied in RCTs
For bio, that’s way outside of my field, I defer to Joshua’s comment here on limited participant numbers, which makes sense. Though in a situation like early COVID vaccine trials, where perhaps you had limited treatment doses and potentially lots of willing volunteers, perhaps it would be more applicable? I guess pharma companies are heavily incentivised to optimise trial costs tho, if they don’t do it there’ll be a reason!
As a quick data point I just checked the 6 RCTs GiveDirectly list on their website. I figure cash is pretty expensive so it’s the kind of intervention where this makes sense.
It looks like most cash studies, certainly with just 1 treatment arm, aren’t optimising for cost:
Study Control Treatment The short-term impact of unconditional cash transfers to the poor: experimental evidence from Kenya 432 503 BENCHMARKING A CHILD NUTRITION PROGRAM
AGAINST CASH: EVIDENCE FROM RWANDA74 villages 74 villages (nutrition program)
100 (cash)Cash crop: evaluating large cash transfers to coffee
farming communities in Uganda1894 1894 Using Household Grants to Benchmark the Cost Effectiveness of a
USAID Workforce Readiness Program488 485 NGO program
762 cash
203 cash + NGOGeneral equilibrium effects of cash transfers:
experimental evidence from Kenya325 villages 328 villages Effects of a Universal Basic Income during the pandemic 100 villages 44 longterm UBI
80 shortterm UBI
71 lump sumSuggests either 1) there’s some value in sharing this idea more or 2) there’s a good reason these economists aren’t making this adjustment. Someone on Twitter suggested “problems caused by unbalanced samples and heteroskedasticity” but that was beyond my poor epidemiologist’s understanding and they didn’t clarify further.
Hi Christian—agreed but my argument here is really for fewer treatment participants, not smaller treatment doses
Ah, that’s helpful data. My experience in RCTs mostly comes from One Acre Fund, where we ran lots of RCTs internally on experimental programs, or just A/B tests, but that might not be very typical!
Hey Aidan—that’s a good point. I think it will probably apply to different extents for different cases, but probably not to all cases. Some scenarios I can imagine:
A charity uses its own funds to run an RCT of a program it already runs at scale:
In this case, you are right that treatment is happening “anyway” and in a sense the $ saved in having a smaller treatment group will just end up being spent on more “treatment”, just not in the RCT.
Even in this case I think the charity would prefer to fund its intervention in a non-RCT context: providing an intervention in an RCT context is inherently costlier than doing it under more normal circumstances, for example if you are delivering assets, your trucks have to drive past control villages to get to treatment ones, increasing delivery costs.
That’s pretty small though, I agree that otherwise the intervention is basically “already happening” and the effective savings are smaller than implied in my post
That said, if the charity has good reason to think their intervention works and so spending more on treatment is “good”, the value of the RCT in the first place seems lower to me
2) A charity uses its own funds to run an RCT of a trial program it doesn’t operate at scale:
In this case, the charity is running the RCT because it isn’t sure the intervention is a good one
Reducing the RCT treatment group frees up funds for the charity to spend on the programs that it does know work, with overall higher EV
3) A donor wants to fund RCTs to generate more evidence:
The donor is funding the RCT because they aren’t sure the intervention works
Keeping RCT costs lower means they can fund more RCTs, or more proven interventions
4) A charity applies for donor funds for an RCT of a new program:
In this case, the cheaper study is more likely to get funded, so the larger control/smaller treatment is a better option for the charity
Overall, I think cases 2/3/4 benefit from the cheaper study. Scenario 1 seems more like what you have in mind and is a good point, I just think there will be enough scenarios where the cheaper trial is useful, and in those cases the charity might consider this treatment/control optimisation.
Make RCTs cheaper: smaller treatment, bigger control groups
Hi Nick—thanks for the thoughtful post!
I think cash arms make a lot of intuitive sense, my main pushback would be a practical one: cash and intervention X will likely have different impact timelines (e.g. psychotherapy takes a few months to work but delivers sustained benefits, perhaps cash has massive welfare benefits immediately but they diminish quickly over time). This makes the timing of your endline study super important, to the point that when you run the endline is really what determines which intervention comes out on top, rather than the actual differences in the interventions. I have a post on this here with a bit more detail.
Your point on the ethics here is an interesting one, I agree that medical ethics might suggest “control” groups should still receive some kind of intervention. Part of the distinction could be that medical trials give sick patients placebos, which control patients accurately believe might be medicine, which feels perhaps deceptive, whereas control groups in development RCTs are well aware that they aren’t receiving any intervention (i.e. they know they haven’t received psychotherapy or cash), which feels more honest?
The downside is this changes the research question from “What is the impact of X?” to “How much better is X than cash”, and there are lots of cases were the counterfactual really would be inaction. A way around this might be to give control groups an intervention that we know to be “good” but that doesn’t affect the specific outcome of interest. e.g. I’ve worked on an agriculture RCT that gave control groups water/sanitation products that had no plausible way to affect their maize yield but at least meant they weren’t losing out. This might not apply to broad measures like WELBYs
I’m honestly not sure about the ethical side here though, interested to explore further.
I really appreciated this short, clear post. Thank you!
Hey!
LEEP is indeed working on this—I mentioned them in my original comment but I have no connection to them. I was thinking of a campaign on the $100M/year scale, comparable to Bloomberg’s work on tobacco. That could definitely be LEEP, my sense (from quick Googling and based purely on the small size of their reported team) is they would have to grow a lot to take on that kind of funding, so there could also be a place for a large existing advocacy org pivoting to lead elimination. I have not at all thought through the implementation side of things here.
I think part, but not all of that, is due to rationally putting a high premium on avoiding catastrophe, with poor families often operating barely above the limits of survival. You want to wait to sell your crops in 2 months when the market is better but what if your crops get eaten by pests, or the market actually collapses? For a poor family, that could spell total disaster, whereas at least by selling the crops today, at the low harvest season prices, you are guaranteed to get something. (That doesn’t explain the TV though! But I think cash transfer studies suggest that marginal funds are normally spent more wisely than on TVs)
That points to the value of interventions that reduce that risk, e.g. “I’ll lend you money at harvest time and you only pay me back if you can sell your crops at a higher price in the low season” type deals.