Jonas loves his wife, being in nature, and exploring interesting worlds both fictional and real. He uses his bamboo bike daily to get around in Munich. He’s currently a freelance software engineer, and was working at the Against Malaria Foundation and Google before that. Jonas enjoys playing Ultimate and dancing.
Sjlver
Karma: 367
What you write is almost right, but not 100%… we are getting at the heart of the problem here. Thanks for making me re-think this and state it more clearly!
Edited to add: I’ve now also read the discussion that you’ve linked to in your comment. It is now clear to me that the team has thought through issues like this… so I wouldn’t be angry if you prefer to use your time more wisely than for responding to my ramblings :)
Assume as an example that, without my vote, there is the following situation:
candidate A received 933 points from other voters
candidate B: 977 points
candidate C: 1000 points
candidate D: 1001 points
In this case:
If I put most of my votes to A, it gets in the top three along with C and D
If I put most of my votes to B, it gets in the top three along with C and D
If I split my 100 points just right, A and B both get in the top three
I understand that this is a constructed example with low probability of happening. It is meant to illustrate the case where, as a voter, I would like to support two candidates, but my support for one will hurt the other, and vice versa.
As a voter, I’d be particularly vexed if I had allocated 60 votes to A and 40 to B. In that case, I would have caused B to eliminate A, despite having more strongly supported A. This could not happen in approval voting, non-weighted instant run-off voting, or any Condorcet voting method.
As I wrote earlier, no voting system is perfect. For each system, one can construct silly counter-examples for which the system behaves counter-intuitively. For the subproblems “top-3 election” and “funding allocation”, there are known solutions, for which the counter-intuitive situations are somewhat well understood. In your case, you have combined the two sub-problems into one harder combined problem. This makes it more difficult to reason about corner-cases, and creates a few more undesired incentives for strategic voting.
I don’t think this is a critical flaw, so there is no urgent need to change things. If you did choose to change the approach, you might end up with two separate voting steps that are simpler and require fewer explanations than the current system.
Thanks for setting up this donation election!
Choosing voting methods is difficult, and no voting method is without flaw. Nevertheless, I am somewhat unhappy with the method proposed here, because it is very difficult for users to support multiple candidates. The problem arises because the method tried to do two things: (1) determine which candidates are in the top three, and (2) determine their relative popularity.
The problem: as a voter who likes two candidates A and B, I cannot support A without harming B, and vice versa. My rational behavior is to allocate all points to either A or B, to maximize the chance that one of them ends up in the top three. If I split my points between two candidates, I face the risk that neither makes it in the top three.
Other voting methods behave better with respect to this problem. For example, if we used approval voting to determine the top three, I could vote for both A and B without one vote harming the other. Similarly, in classical instant runoff voting without weights, I can put A and B at the top of my list, without having to work about negative consequences for either of them.
I think that this problem is best solved with a two-step voting process. In a first step, determine the top three candidates. In a second step, determine relative allocation of money. The second step would probably use different information than the first. This could be done with the current weights, if the first step considered only the order of candidates on the ballots.
This is very well written. Thanks! It’s the kind of article that sparks (my) curiosity.
I looked for some information on Helvetas’ website. Helvetas is a Swiss charity that has been running safe water interventions for about 50 years; they are funded by private donors, but also receive development aid money from the Swiss government.
Helvetas provides some ideas why water interventions might help, besides diarrhea:
Disproportionally helps women and girls: Women and girls in poor communities often spend several hours a day fetching water ⇒ big opportunity cost, probably unhealthy for their heads and back.
Unsafe water is used in critical situations, such as during child delivery. (edited to add: There are hints that this might be significant. For example, WHO and many organizations work to promote breastfeeding, and this is shown to reduce child mortality. Presumably many of the averted deaths would be due to unsafe water)
There are also positive effects of water management in general. These don’t apply to chlorination or to filters at existing wells… but I found it helpful to consider more holistic approaches to water:
Improving water resource management is also key to equitable development, climate change adaptation, disaster risk reduction, sustainable agriculture and the prevention of conflicts.
Unfortunately, Helvetas’ websites and reports are somewhat light on research. They provide numbers for the number of people reached by their programs, but to my knowledge there isn’t any cost-effectiveness analysis. +1 that we need more research!
Thanks! I completely understand… putting these systems in place can be time-consuming, and the regulations differ for each country.
I hope you’ll find great US/Canada candidates!
PS, but only tangentially related: I’ve recently documented the situation of someone working in Germany for an international organization, at https://blog.purpureus.net/posts/how-to-work-in-germany-for-a-foreign-organization/
This sounds interesting, thanks for posting!
I noted that the application is open to candidates in the US or Canada. Is that a strict requirement, or could you make exceptions?
Here are some reasons why I think that units of ~100 households are ideal. The post itself has more examples.
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It’s best for detailed planning. There is a type of humanitarian/development work that tries to reach every household in a region. Think vitamin A supplementation, vaccination programs, bednet distributions, cash transfers, … For these, one typically needs logistics per settlement, such as a contact person/agent/community health worker, some means of transportation, a specific amount of bednets/simcards/..., etc.
Of course, the higher levels of the location hierarchy (health areas, counties, districts, …) are also needed. But these are often not sufficient for planning. Also note that some programs use other units of planning altogether (e.g., schools or health centers), but the settlement is common.
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It’s great for monitoring. The interventions mentioned above typically want to reach 100% settlement coverage. It makes sense to monitor things at that level, i.e., ensure that each settlement is reached.
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It’s great for research. Many organizations use household sampling surveys. These are typically clustered, which means that researchers select a given number of “enumeration units”, and then sample a fixed number of households in each unit. Ideally, these enumeration units have roughly even size, clear and well-understood boundaries, and known population counts. The type of locations that I’m aiming for would make good enumeration units.
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This type of place name is used and known. For example, people in the region will know where “Kalamu” is. There will likely be a natural contact person, such as a village chief. There will be a road that leads there and a way to obtain transportation. One can ask questions like “is there cellphone coverage in Kalamu” and get a good answer. In the majority of cases, a place name is a well-understood, unambiguous and meaningful concept.
The final reason is about data availability: settlement names are usually the most detailed names available, and their names are reasonably stable and accepted. The data exists, we only need to collect and aggregate and publish it. In contrast, streets or buildings often don’t have names, so we can’t easily have more fine-grained data than place names. Plus, there are some solutions like Plus Codes for situations where address-like data are preferred.
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Thanks! This seems very relevant. I will try to contact the team.
Yes, I know about What Three Words. Thanks for the suggestion! It’s a good opportunity to clarify the different aims of my project and W3W.
W3W is essentially the same as a GPS coordinate, except more memorable and easier to pronounce. A W3W place does not necessarily correspond to anything particular in the real world (like a settlement). Thus, W3W does not provide any added value for planning purposes.
There are some other downsides, such as W3W being proprietary and based on (IMO) bad design choices (e.g., hard to localize).
A better alternative to W3W is https://maps.google.com/pluscodes/. Plus Codes are indeed useful in places where some form of address is needed, and they are seeing some adoption in developing countries.
My goal is somewhat different: I would like to collect and publish the natural, given names of places, along with boundaries and metadata. The ideal unit here is the settlement, village, community, or neighborhood—this is the level at which the data would most support humanitarian work, health services, elections, infrastructure development, etc.
A name for every place
Prediction markets haven’t moved all that much yet: https://manifold.markets/bcongdon/will-a-cell-cultured-meat-product-b
But I share your hopeful attitude :)
I find this an interesting discussion, and hope that it will continue.
My own knowledge of this domain is very limited. I’ll just mention some points from World Without End (WWE)… not because I endorse them, but to keep the discussion going:
Because of low energy density, wind and solar require 1-2 orders of magnitude more land use, metal, and concrete per kWh than nuclear power. EROEI (Energy returned on energy invested) is worse.
If batteries are used, the numbers become even worse; also greenhouse has emissions go up. WWE claims nuclear electricity emits about 6g CO2/kWh; wind 10g, battery storage +50g
Intermittency is important. According to WWE, it is harder to mitigate than you suggest, since mitigations increase cost.
Because of intermittency, wind and solar are typically complemented by power that is highly flexible (gas, coal, not nuclear). This means their impact on the climate isn’t all good, since they prevent phasing out gas and coal.
Thanks for the write-up, Michelle! You write about your “hope that other like-minded parents will share their lessons and suggestions”, so I decided to contribute a few thoughts.
I’m currently working as a software engineer for the Against Malaria Foundation (50%) and caring for our one-year old (50%). My wife also has a 50%-job.
Work time: Compared to what Michelle and Abby wrote, I have reduced my work time more strongly after becoming a parent. It felt important to me to experience my child growing up and to personally care for it. I can have 30 more productive years in my career, but seeing the first steps of one’s child is a once-in-a-lifetime opportunity.
I’m thankful that AMF made part-time work possible. It took some negotiation and insistence to make it happen. My life feels a lot more sustainable now than if I were to work full-time. I’d strongly recommend that everyone in a similar situation thinks carefully about their priorities and adjusts life/work accordingly.
Money: So far, our child has not increased our budget much, to my great surprise. We got tons of gifts and secondhand stuff (stroller, reusable diapers, 95% of her clothes), so there was little we had to buy. We don’t have to pay for childcare yet. Also, German’s social security is excellent, and partially compensates for the reduced salary during the first ~14 months of the child’s life.
Interestingly, having a child did so far not make us want to buy a house or care more about financial security (cf Geoffrey’s comment). This might come later… but so far the financial impact of having a child is far smaller than I expected.
Pregnancy can be tough: Absolutely. Also the time after birth, depending on how it goes. One year after giving birth, my wife still takes physiotherapy and has to refrain from some sports. Another tough point was that we had to stop breastfeeding after seven weeks due to complications… So although pregnancy and birth generally went well, the effects on the mother were hard. This topic isn’t talked much about, and I think both me and my wife underestimated the difficulties.
It’s OK to do things differently: More strongly, I think you have to do things differently, by necessity. Each family is unique. There’s a ton of contradicting advice. Fortunately, being a parent comes surprisingly naturally, and our species has done it successfully for thousands of years. My experience is that many of the “must-haves” and “must-dos” weren’t all that important.[1]
We benefited a lot from having trustworthy people close by. The midwives who supported us were fantastic, their visits throughout the first weeks of the baby’s life invaluable. This type of practical support and direct advice was much more important than the more indirect books, videos, etc.
Social aspects: I’ve been surprised by how much babies are a catalyst for interacting with other people. Everyone is attracted by them; starting conversations around babies is really easy. Being a young parent brings you in touch with other people at a similar stage in life; we formed several new local friendships thanks to our child.
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Note: one absolutely must take parenting seriously, and I don’t advise anyone to be careless. I wrote this paragraph because the advice I received, overall, made too strong claims, made parenting sound more difficult than it is, and made children seem more fragile than they are.
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I really liked this… the post made me think, and will continue to do that for some time. It doesn’t seem all that unrealistic to me 🤯
One little nit: you seem to write “century” when you mean “decade”.
Thanks for the thoughts!
I think we are getting closer to the core of your question here: the relationship between cases of malaria (or severe malaria more specifically) and deaths. I think that it would indeed be good to know more about the circumstances under which children die from malaria, and how this is affected by various kinds of medical care.
The question might partially touch upon SMC. Besides preventing malaria cases, it could also have an effect on severity (I’m thinking of Covid vaccines as an analogy). That said, the case for SMC (as I understand it) is that it’s an excellent way to prevent malaria infections. This is what the RCTs measure, and this is where its value comes from.
To answer the question, I believe it would be more helpful to do research into malaria as an illness, rather than doing an SMC trial replication. I continue to think that the evidence base for SMC is good enough. You have doubts since “most published research findings are false”, but “most published research findings” might be the wrong reference class here:
It includes observational studies, surveys, and other less reliable methods; here, we have RCTs.
It includes all published studies, also those with small samples and effect sizes. Here, we have >7 trials, >12k participants, and the effect (SMC’s reduction of malaria episodes) is >6 standard deviations away from zero.
It includes studies with effects that are multiple causal steps away from the intervention (e.g., deworming improves income) and have many confounding factors. Here, we are measuring the effect of a malaria medication on malaria, with clearly-understood underlying mechanisms.
You also ask about the settings in which SMC is rolled out. There is no specific answer here, since SMC is often rolled out for entire countries or regions, aiming to fully cover all eligible children. More than 30 million children received SMC last year. In their cost-effectiveness analysis, GiveWell looks at interventions by country and takes a number of relevant factors into account, such as the “mortality rate from malaria for 3-59 month olds”.
In general, malaria fatality (deaths per case) is trending downwards a bit, due to factors such as better access to medical care, better diagnosis, better education of parents, and certainly many others. It could make sense to make this explicit when doing a cost-effectiveness analysis.
I’d expect GiveWell to be mindful about these things and to have thought of the most-relevant factors. I don’t think additional RCTs would lead to large changes here.
Regarding the post-script about AMF: We are fortunate to have a board of trustees and leaders that think a lot about high-level questions and trends, both those closer to AMF’s work (e.g., resistance to insecticides used in nets) and those more peripheral (e.g., the impact of new vaccines). There is also good and regular communication between GiveWell and AMF. As for myself, the day-to-day preoccupations are often much more mundane ;-)
Looks like I can confirm this. Relevant passages from Cissé et al (2006):
The study was designed to measure Malaria, not deaths:
The primary outcome measure was a comparison of the occurence of clinical malaria between children in the two study groups.
Children with positive malaria tests received treatment:
Malaria morbidity was monitored through home visits every week and by detection of study children who presented at one of three health centres in the study area. At each assessment, axillary temperature was measured, and if it was 37.5C or greater, or if there was a history of fever or vomiting during the previous 24 h, a blood film was prepared. Results of the blood film examination were usually available within 2 h. Antimalarial treatment was given when appropriate according to the national guidelines: chloroquine as firstline treatment, quinine or sulfadoxine-pyrimethamine as second-line treatment in cases of failure of treatment with chloroquine, and injectable quinine for cases with persistent vomiting or severe malaria. Study children received iron supplementation if they presented at a health centre with an illness suggestive of anaemia, pale mucosae, or both.
I’ll still think more about this… but here we have at least a lead towards better understanding of low death numbers in SMC trials.
I appreciate the thoughts! I’m going to think about this more thoroughly… but here’s a quick guess about the low death numbers:
These trials involved measuring malaria prevalence in children. Presumably, children with a positive result would then get medication or be referred to a health center. Malaria is a curable disease, so this approach would save lives. Unfortunately, it’s also quite likely that the child would not receive appropriate treatment in the absence of a diagnosis, due to lack of knowledge of the parents, distance to health facilities, etc.
Anyway, it’s just a quick guess. Might be worth checking if the studies describe what happened to children with positive test results.
The Right-Fit Evidence group provides good resources related to this post. They publish guidance on what types of evidence implementers should collect to demonstrate and monitor the impact of their programs.
Notably, different types of evidence are ideal depending on the stage of a program. In the beginning, when there is lots of uncertainty about an intervention, a randomized controlled trial is great. At a later stage, when the program is scaling to many recipients, it is more important to monitor the program and ensure that the implementation is done well.
In the case of SMC, millions of children receive treatments. A wealth of monitoring data is collected, much more than could be obtained in an RCT. Even though that data isn’t randomized or controlled, its quantity might make up for these deficits and allow us to determine whether SMC works with sufficient confidence.
More information can be downloaded on the Right-Fit Evidence website. And here’s an introduction to their framework.
That seems fair. I agree that my request for an estimate is a big, maybe even unreasonable, request.
I asked because I am wondering if there really is enough reason to doubt the results of existing SMC trials. If I understand your post correctly, your main worry is not about actual errors in the trials; we don’t have concrete reasons to believe they are wrong. Indeed, the trials provide high-quality evidence that SMC reduces malaria cases, including severe cases.
Your worries seem to be that (1) studies are underpowered to quantify reduction in malaria deaths. I’m not sure if that is a big problem, given that there are clear causal links between malaria cases and malaria deaths. (2) The trials did not follow the new best practices that we’ve identified since they were published. This indeed makes the trials less reliable than we would wish for, but I’m not sure whether the problem extends to a meta-analysis of seven trials.
For all these reasons, I keep wondering: how strongly do you really believe these results are wrong? And by how much? Even some rough answer would be OK here… and I’m sure it would also help GiveWell when they evaluate this post.
Yes, absolutely.
As far as I can tell, that type of RCT indeed is not being done. I don’t know much about research on SMC specifically, but Givewell reports the following quote of Christian Lengeler, author of Cochrane Review of insecticide-treated bed nets:
To the best of my knowledge there have been no more RCTs with treated nets. There is a very strong consensus that it would not be ethical to do any more. I don’t think any committee in the world would grant permission to do such a trial.
For European people on a budget, here’s a multivitamin at €0.07 per day: https://www.amazon.de/-/en/Multivitamins-Minerals-Multivitamin-Essential-Vitamins/dp/B08BX439HX They don’t deliver to the US, though. And you might want to add in some omega 3 fatty acids (DHA/EPA) for a more complete supplementation