Link Post for January


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“A ball and a bat together cost $1.10. The bat costs $1.00 more than the ball. How much does the ball cost?” A fascinating article about why everyone gets this question wrong.

The media signal-boosts weird occurrences, which makes you think that very strange things happen more often than they actually do.

To learn a skill, read one book that explains the what of the skill, one that explains the why, and one that explains the how. I think this article could have used more examples of reference books, but I really enjoyed the author saying what you should look for in the negative reviews.

Effective Altruism

A guide to careers that don’t require a college degree for effective altruists.

Twelve pieces of general consensus about global poverty.

Many people claim that women reinvest ninety percent of their income into their family. However, further research suggests that this statistic doesn’t come from anywhere.

Social Justice

Content warning for drugs, suicide, abortion, miscarriage, pregnancy, corpse desecration, and probably a dozen other things I’m forgetting: how the concept of fetal personhood winds up trading off against women’s rights. Three things that hit home particularly hard for me: if you attempt suicide while pregnant you can be charged with attempted murder; if you die while pregnant you can be kept on life support against your previously stated wishes in order to keep the fetus alive; many doctors and CPS workers disapprove of pregnant people taking Suboxone, so pregnant people go off it and wind up relapsing and sometimes overdosing.

Gay escorts offer a service helping men get used to having sex without drugs. This is the sort of thing that warms my heart.

Cop apologizes for arresting people for trading in drugs. This is the sort of story that always warms my heart.

Just Plain Neat

A cable tech talks about the weird people she saw on the job, feat. Dick Cheney.

Meet the woman who invented cosplay.

Fake nude of Alexandria Ocasio-Cortez debunked by foot fetishists.  “”I’ve sucked enough toes in my life to recognize when something doesn’t look right… Because we can’t dorsi- or plantarflex our 2nd-5th toes independently I knew it wasn’t a matter of the toe being bent. I thought that maybe she has some form of brachydactyly but her Wikifeet page has clear evidence to the contrary.”

Poker player locks himself in solitary confinement for 20 days for $62,400.

Secret music composed by medieval nuns.

Put MSG In Everything You Cowards. Recommending partially for the cooking advice and partially for the delightfully belligerant tone.

The Stranger Regrets These Errors.


Scrupulosity Sequence #6: Intuitive Eating


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[content warning for discussion of food, dieting, and moralizing around food]

To the best of my knowledge, the only place that my approach to scrupulosity has been independently worked out (by a person who is not an effective altruist) is food/dieting, under the name “intuitive eating.” It makes sense that that would be the case: food and dieting are something a lot of people have dysregulated shame and guilt about. So in this post I’m going to write about intuitive eating as a case study, and then expand it in a later post.

Many people have a very, very unhealthy relationship with food. They might try diet after diet after diet, searching for the one that will cause them to finally lose weight, or they might stick to a single rigid diet, or they might feel constantly guilty about how they should be on a diet (but somehow that never actually stops them from getting the second slice of cake). They might restrict food for weeks or months, but then it’s a holiday or a vacation, or they feel like they “deserve it,” or they’ve given in and had one cookie and now their diet is Ruined. They might not feel able to refuse food that they don’t want; they might feel guilty about eating the food they don’t want, especially if it’s “unhealthy.” They might eat without intending to, or feel like they have to clean their plates. The very thought of a diet might make them eat until they’re stuffed; after all, they might diet tomorrow and then they won’t get any of this again!

Diet is a very personal matter and lots of different things work for different people. I don’t mean to say that the thing I describe is right for everyone. I have no particular expertise in eating disorders; if you have a history of anorexia, bulimia, or binge eating, talk to someone who knows more than me before deciding to eat intuitively. But one thing that works for many people is intuitive eating.

The core of intuitive eating is unconditional permission to eat. If you want to, you can have ice cream for dinner. You can eat a six-course meal and clean your plate every time. You can have whatever your forbidden food is: Twinkies, hot chocolate, cheese, bread, fettucine alfredo. And you can have salads, steamed broccoli, tofu stir-fry, and boneless skinless chicken breast.  You can turn down Aunt Ida’s disgusting meatloaf even if it will make Aunt Ida sad. You can have a bite of dinner and decide actually you’re still full from lunch.

If you’re good at intuitive eating, you can do some things that look a little bit like restriction: for example, I notice I compulsively eat certain kinds of candy when I keep them in the house, so I walk to the store when I want them. But if your relationship with food is a batshit mess, people who practice intuitive eating usually recommend you go to pretty extreme lengths to communicate to yourself that food is actually unrestricted. Buy the foods you used to not let yourself eat in enormous quantities, far more than you could actually eat, and whenever you run low restock. Carry a bag of foods you like around with you so that you can eat whenever you’re hungry. If you want fried rice for breakfast, pull out the wok and make some.

Now, maybe you’re the sort of person who, if you’re granted unconditional permission to eat, will proceed to eat nothing but brownies for breakfast, lunch, and dinner. I don’t mean to argue with people’s experiences of themselves; I’m just describing one strategy that works for many people.

But many people will eat enormous quantities of brownies for a while– maybe a few days, maybe a few weeks. And then they will finally understand, on a gut level, that the brownies are always going to be there. This is not the last hurrah of brownies; there is not going to be a diet and then no more brownies ever again. You don’t have to save up brownie-eating experiences because someday you will never get to have another brownie. You will always get to have another brownie.

And once you’ve left the Brownie Scarcity Mindset, you can notice things. Like… eating until you’re stuffed actually doesn’t feel very good, it actually makes you feel kind of sick. And “brownies for breakfast, lunch, and dinner” leaves you feeling kind of shaky and unsatisfied. And maybe you’re never going to be a big fan of kale, but you find yourself eyeing the cucumbers and going “you know, what would really hit the spot right now? A big salad with a bunch of different vegetables, drizzled with olive oil and covered in nuts and cheese.”

The question a lot of people are going to ask at this point is “but do you lose weight?” In my anecdotal experience and the experience of people I know who practice intuitive eating… sometimes? If you have been eating past the point of hunger for a long time, or eating on autopilot when you’re not full, then you might find yourself losing weight when you stop doing that. If you have been ignoring your hunger signals and undereating for a long time, then you might find yourself gaining weight. But most people seem to settle at a stable equilibrium which may shift permanently after medical events such as pregnancy or serious illness.

On the other hand, that is exactly the result most diets give people too. And intuitive eating has a lot of other advantages. You get to have brownies, which is important. The diet you’ll wind up eating is probably healthier. You’ll enjoy your food more. And most importantly of all you get to take all the shame and guilt and self-hatred you’ve associated with food, all the emotional energy you have wrapped up in your diet, and just… stop. You can do something else with it.

There’s a common framing around food where everyone is constantly tempted to make the worst diet choices possible. If left to their own devices, everyone would eat nothing but pizza topped with cheesy chicken nuggets topped with pasta with alfredo sauce. The only way to have a healthy diet is a constant effort of will where you nobly resist even having a bite of donuts, and whenever you do eat a donut you self-flagellate appropriately. (Be sure to comment a lot about how bad the food is and how fat you are while you eat it: punishing yourself for eating “bad” food is the only way to make sure you don’t do something horrible like enjoy it.)

And, in fact, you can just… not? There is no Food Police who will arrest you for having a hamburger. The food you eat doesn’t have to mean anything about your worth as a human being, unless you decide it does. You don’t have to feel shame or guilt about what you eat. And if you choose not to beat yourself up about food choices, you will probably not have some pizza/chicken nugget/pasta chimera for dinner every night, because… that’s kind of gross actually?

It is actually just okay to eat the food you want and that makes you feel good. Maybe that will cause you to eat more chocolate than is best for ideal health, but over time it will probably result in a reasonable and balanced diet. You don’t have to hate yourself.

Scrupulosity Sequence #5: Restorative Justice


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I am, in many ways, an unusually a bad person.

I have a personality disorder, it comes with the territory. If anyone who has been diagnosed with a cluster B personality disorder tries to tell you they haven’t ever done anything really really wrong, they probably aren’t self-aware enough to be safe being around.

So it is important to me to come up with a system that handles people who have done unusually wrong things well.

Throughout this particular post, I am talking about relatively serious wrongdoing– violations of common-sense morality, things that will make your wisest and most ethical friends go “what the fuck?” Much of the advice in this post is overkill for ordinary-scale wrongdoing that people do every day, and you shouldn’t apply it for that. Wait until later in the series.

This post is not going to be relevant to most of the people reading this. Most people don’t do things that are really really wrong. But I feel it would be irresponsible to address the issue of dysregulated guilt and shame without addressing the issue of feeling dysregulated guilt and shame because you actually did something awful.

A few years ago, I was coming to terms with the fact that I did The Worst Thing I’ve Ever Done In My Entire Life. Although I’m not going to share the details here, for obvious reasons, this is not a scrupulosity thing; I’ve run it by several sane friends with upright moralities and they’re like “wow, Ozy, that is in fact exceptionally bad. Don’t… don’t do that again.”

Naturally, I struggled with a lot of guilt and suicidality at the time. I’m naturally a pretty guilt-ridden and suicidal person, but I think pretty much everyone feels guilty when they have done a Very Wrong Thing, and perhaps has a passing thought of suicidality.

At the time, I read a Tumblr post by my longtime Internet friend Cliff Pervocracy. (Sadly, his blog was lost to the great Tumblr purge, so I have to reconstruct the post from memory.) Someone had asked him what to do: they’d discovered their friend had committed a rape a few decades ago, and they didn’t know the victim, and as far as the person could tell the friend hadn’t committed any rapes since and he had multiple exes who had nothing but positive things to say about him and so on. Should they stop talking to their friend because he was a rapist?

Cliff’s response was that he felt it was okay to decide not to be friends with someone because they committed a rape. It’s a normal preference, one that’s widely shared among many people, and one of the consequences of committing rape is that sometimes people don’t want to be your friend. But he said that he thought that you don’t have to. Solitary confinement is torture for a reason; people need friends. The ex-rapist doesn’t have the right to make people interact with him, but we as a society should say that it is okay to interact with him if you choose.

And, god, at the time that meant a lot to me, because I am less bad than a rapist, and if rapists deserved to be able to have friends and enjoy themselves and not self-flagellate for eternity, then by extension I must also deserve to be able to have friends and enjoy myself and not self-flagellate for eternity.

So I think that is the first part of a humane approach to people who have done really wrong things. There are some things you are entitled to that are completely non-negotiable, no matter how bad a person you are, no matter what you have done, no matter if you are Ted Bundy or Pol Pot or Thomas Midgley Jr. You have a right not to be tortured. You have a right not to be assaulted or killed, except when necessary to defend others. You have a right to food and water and shelter. You have a right to human interaction (but not to force unwilling people to interact with you, and that sometimes means sufficiently disliked people are doomed to loneliness– but it is a tragedy, every time). You have a right to fun and pleasure and recreation. You have a right to learn things if you want to, to make things if you want to, to exercise if you want to, to see the sun if you want to.

(Guess, from these beliefs, my opinion on the US prison system.)

And this means there are some things that ethics cannot demand from you. It cannot demand that you kill yourself. It cannot demand that you cut yourself. It cannot demand that you isolate yourself from everyone (although it can demand that you communicate honestly with other people and let them make their own choices about whether to interact with you). It cannot demand that you never watch a movie again.

All of those rights are important. But there is one right that I think is the most important right of all.

You have a right to a life that isn’t all about the worst thing you ever did.

Restorative justice is a big topic, and I’m only going to be able to glance at it here. For example, I’m not going to have the space to talk about restorative-justice alternatives to the prison system, or about the roles of community members and victims. I highly recommend The Little Book of Restorative Justice for a readable introduction, if what I’m saying whets your interest.

Restorative justice is a system that has three principles:

  1. Crime (or, as I’m using the concepts here, wrongdoing more broadly) is fundamentally a harm to people, as opposed to a violation of a law or rule.
  2. This harm creates certain obligations on the part of offenders and communities.
  3. Justice should seek to heal people and put right what went wrong, as opposed to determining blame and inflicting pain on the guilty.

The Little Book of Restorative Justice says our system of justice should provide the following things to offenders:

  1. Accountability that addresses the resulting harms, encourages empathy and responsibility, and transforms shame.
  2. Encouragement to experience personal transformation, including healing for the harms that contributed to their offending behavior, opportunities for treatment for addictions and/or other problems, and enhancement of personal competencies.
  3. Encouragement and support for integration into the community.
  4. For some, at least temporary restraint.

I think this is a good framework with which to approach serious wrongdoing that one has committed.

Of course, there are some ways in which a restorative justice approach applied to oneself is different than a restorative justice approach applied to society. For example, outside of a restorative justice system, it is often not possible to arrange to speak face-to-face with one’s victim and come to an agreement about appropriate means of restitution. (Indeed, for many sorts of wrongdoing, the victim would find an attempt to do so frightening or upsetting. Do not try to talk to victims of your actions against their will.)

But I think a broad framework of accountability, personal transformation, and reintegration is a useful tool for thinking about how to deal with having done wrong.

There are many ways to take accountability. A single sincere apology (ONLY IF YOUR VICTIM WANTS TO TALK TO YOU) is often appropriate. You should almost certainly tell at least one person what you did, honestly and completely, without leaving out any details or trying to make yourself look better than you are. In some cases, it may be appropriate to write a public confession.

If you have committed a violent felony against another person, in my opinion, accountability generally requires turning yourself in to the police. In countries outside the United States, accountability may also require turning yourself in for lesser crimes, but the United States prison system is batshit enough that I’m not willing to say that here.

I realize among some of my readers this recommendation may be controversial, since the US prison system violates the human rights of its inmates. I myself lean towards prison abolitionism. However, abolishing prisons would involve a fundamental restructuring of society that has not happened yet; it cannot happen willy-nilly by individual people choosing not to go to prison. In the meantime, the justice system has options for restraining people that everyday people do not. Taking accountability for a violent crime means putting yourself in a position where you actually can’t do the violent crime again.

Another important aspect of accountability is trying to repair what you’ve done wrong, as best you can. For example, if you have stolen something from someone, you should give back the value of what you stole, with interest. If you have destroyed someone’s reputation, you should set the record straight. It is usually not possible to repair the harm entirely, but it is often possible to do something. Repairing the harm may require significant emotional or material sacrifice, but it is absolutely necessary.

In actual restorative justice procedures, the victim and the offender often agree on a symbolic means of repairing the harm, such as community service. That can help victims feel like their emotional needs are being taken into account. This seems like not a very good course of action to recommend outside of an actual restorative justice procedure. Scrupulous people may end up using this as a reason to self-flagellate. If the victim is consulted, it may scare or upset them or make them feel like they’re being contacted against their will. If the victim is not consulted, they may never learn about it, and the symbolic means may not be something they find emotionally satisfying. Without an independent mediator, victims may demand an unreasonable amount, perhaps for revenge reasons. Nevertheless, as an offender, if you think a symbolic attempt to repair the harm is appropriate, it may be.

Personal transformation is another aspect of restorative justice. In essence, personal transformation means becoming the sort of person who would not do that particular sort of wrongdoing again. Reflect as honestly as possible about what caused you to hurt other people, and then think about how you could change it. For example, if you did wrong because of an addiction, you might think about how to get clean or sober. If you had a mismanaged mental illness, you might take medication or change your medications, go to therapy, or practice self-help techniques. If particular friends influenced you to hurt others, you might stop talking to them and seek out friends that will help you make better choices. If a particular circumstance tempted you, you might avoid it in the future. If your job involves committing atrocities, quit.

There are two circumstances that commonly come up with regards to personal transformation. First, personal transformation is sometimes really really hard. Some of the concrete steps I listed– quitting drinking, recovering from a mental illness, finding new friends, leaving a job or often a career– are extremely fucking hard. You need support from friends, loved ones, or your community. You need to expect to fail sometimes: addicts, alcoholics, and mentally ill people relapse.

Second, sometimes you discover that you are already transformed. The self-awareness to admit that you did something very very wrong without an outside prompt is often the product of a long process of personal growth, and sometimes the other product of that process of personal growth is that you’re no longer the sort of person who did that thing. That can lead to a sense of emptiness and of useless energy; what are you supposed to do now? There’s an urge to make up for what you’ve done when you’ve done wrong, and it can be frustrating when there’s nothing to channel it into.

The final step is reintegration into society. I discussed that step in greater detail above. Once you’ve made amends, repaired what you could of the harm, and stopped being the sort of person who would do that wrong, then you’re done. You have, as the phrase goes, paid your debt to society, and you don’t have to worry about it anymore.

You can have a life that is not about making up for the worst thing you have ever done.

GiveWell Top Charities Explained: Deworming



[This is the fifth post in a brief series explaining the current GiveWell top charities. You can get all the information in this post on GiveWell’s website, but my blog post is both shorter and less boring.]

GiveWell’s top charities list includes four deworming charities: Sightsavers, the END Fund, the Deworm the World Initiative, and the Schistosomiasis Control Initiative. I’m combining them into one post because a lot of the stuff I can say about them is the same.

The most important thing to know about deworming charities is that they are NOT HEALTH CHARITIES. Deworming charities are economic development charities. You might think they are health charities, because they give pills to people in order to treat their diseases, and that is a thing one generally does if one is a health charity. If one is an economic development charity, one gives people cows or job training or money or something. But in fact that is just the deworming charities’ very clever disguise.

Deworming works in the sense that if you have worms, and take the pills, you won’t have worms anymore. But the effects of being dewormed on health are very small. Having worms generally doesn’t kill you, and it’s rare for people to get very sick because they have worms. A lot of meta-analyses find very small or no effect of deworming on things like weight, height, anemia, school performance, or cognition.

So that might lead you to ask why there are four (four!) GiveWell top charities that deworm people if it doesn’t make people healthier. The answer is that it is possible– but by no means certain– that deworming has an effect on children’s long-term development that causes them to earn more income.

Miguel and Kremer (2004) found that deworming leads to a 25% decrease in school absenteeism. The ten-year followup finds that people who were dewormed as children work more, earn more, are more likely to work in the high-earning manufacturing sector, eat more meals, and have better self-reported health. GiveWell has seen a preliminary 15-year followup that shows similar results.

There are lots of reasons to be uncertain about this study. It’s only one study, and there might be alternate explanations for the findings, or there might have been publication bias. There was a lot of flooding in the study area, so people were more likely to have worms than if there was less flooding. Some researchers argue that Miguel and Kremer (2004) and the followup are at risk of significant methodological bias. (Others disagree, including David Roodman, who reanalyzed the studies for GiveWell.)

The big advantage of deworming is that it is very very cheap. A person can be dewormed for less than a dollar. If you take the ten-year followup seriously, the annualized rate of return on deworming is 32%— that is, for every dollar invested in deworming, you earn 32 cents back every year, presumably until the beneficiaries die or retire. If there’s even a five percent chance that deworming works as advertised, it’s a good investment. Under any reasonable estimate of the likelihood that deworming works, it’s one of the most cost-effective interventions for making people richer.

The primary negative impact of deworming is side effects from the medications: deworming medications have unpleasant side effects, including headache, nausea, upset stomach, vomiting, abdominal pain, and fever. Deworming programs may also interfere with the provision of routine health care services because all the nurses are temporarily busy giving deworming medicine instead. The relationship between deworming treatment and malaria is complex and poorly understood, but it may be that deworming causes children to have a higher density of malaria parasites in their blood.

I have prepared the following table to help you choose which deworming charity to donate to:


Name Program Room for more funding (in millions of dollars) Kinda sketchy? Coverage rate Open questions
Deworm The World Advocacy; monitoring/evaluation; technical assistance; funding $27 No 80-90% None
Schistosomiasias Control Initiative Advocacy; funding/ drug donations; monitoring/evaluation; technical assistance $16.9 Yes 80-90% Will SCI use additional funding to treat adults instead of children? How accurate are SCI’s coverage surveys?
END Fund Filling funding gaps in other orgs; technical assistance $45.8 Limited track record 50-60% Do their programs reach a high percentage of children targeted? How much money will they raise from other funders? Will GiveWell-directed donations increase the amount they budget for deworming?
Sightsavers Technical assistance; funding $1.6 Limited track record 58-99% Limited track record for implementing deworming. Spends a lot on fundraising. Will GiveWell-directed donations increase the amount they budget for deworming?

Why might you donate to deworming?

  • You like high-risk high-reward bets, and AI risk is just too fashionable.
  • You want to increase people’s income in a very cost-effective way, even if it might not work.
  • You care more about increasing incomes and economic development than you do about improved health outcomes or preventing the death of children.
  • In a war between epidemiologists and economists you are on Team Economist.
  • You have a phobia of parasitic worms.

Combination Existential Risks



I think this idea is pretty obvious so I’m sure someone has thought of it before, but I haven’t been able to find it in the existential risk literature, so I thought it was worth writing up.

Existential risk is often talked about in terms of single causes of human extinction: for example, a misaligned superintelligence, a bioengineered pandemic, or an asteroid. That makes sense, because if a single event can eradicate humanity, it’s worth your time to try to prevent it.

However, among nonhuman animals, extinctions very commonly have many causes. For example, the rhino is endangered because of poaching and habitat loss. Giraffes are endangered due to habitat loss and fragmentation, poaching, and the effects of civil unrest. The black-footed ferret is endangered because of habitat loss and population decline among its prey, the prairie dog, which in turn was caused by a combination of hunting and plague.

I don’t expect these case studies to be completely analogous to human extinction: habitat loss and hunting are not serious existential risks for humans. However, I think it is worth noting that there are many species for whom the combination of several threats posed an existential risk, even if any individual threat was not an existential risk in and of itself. I will call this “combination existential risks.”

What combination existential risks might humans face?

Most obviously and analogously to the nonhuman case, several forces may interact to reduce human populations. For example, a nuclear war may eradicate human life outside of New Zealand. The population shrinks as New Zealanders have difficulty adjusting to the new post-nuclear-war world. New Zealand then experiences a serious pandemic and a series of severe natural disasters, which reduce the population further. At that point, Allee effects come into play and humanity slowly goes extinct. In this scenario, stressors that individually would not be sufficient to cause human extinction (a nuclear war, a pandemic, natural disasters in New Zealand) combine to make it inevitable.

Secondly, an event may cause extinction to occur when it would otherwise not have occurred. For example, climate change may lead to severe international tensions, which results in a World War III that causes the annihilation of mankind. Alternately, the international tensions associated with climate change may cause an artificial intelligence arms race, which leads to the deployment of a misaligned superintelligence.

Third, two events may both be necessary for human extinction to happen. For example, a misaligned somewhat-but-not-extremely superhuman intelligence commissions a bioengineering lab to make a virus. The lab fails to recognize that the virus is a bioengineered pandemic that might wipe out humanity and manufactures the virus. In this case, both the misaligned somewhat-superhuman intelligence and the poor biosecurity protocols were necessary for human extinction to occur. (Of course, both poor biosecurity protocols and misaligned superintelligences are very risky on their own.)

This is, of course, not intended to be a complete taxonomy of potential combination existential risks.

I think people who think about existential risk should devote some of their energy to thinking about risks that are not themselves existential but might be existential if combined with other risks. For example, climate change is not an existential risk, but it plausibly plays a role in many combination existential risks, such as by increasing international tensions or by rendering much of the globe difficult to inhabit. Similarly, many global catastrophic risks may in fact be existential if combined with other global catastrophic risks, such as a nuclear war combined with a pandemic.

Climate Change Is, In General, Not An Existential Risk



[Everything in this post is true to the best of my knowledge, but I am not a climatologist and my last science class was in high school. It is very likely I have misunderstood something. I welcome corrections. Dedicated to Annie.]

I often see people say that climate change is going to kill us all, or that human extinction is inevitable due to climate change, or that if effective altruists were really concerned about existential risk we would put lots of effort into fighting climate change because all scientists agree that is the biggest existential risk.

As far as I can tell, absolutely none of this is true.

Climate Feedback, a nonpartisan website educating people about the scientific consensus on climate change, has written about human extinction from climate change. Christopher Colose, a postdoctoral research fellow at NASA GISS, puts it clearly:

Actual numbers are important here. The global temperature increase could indeed reach 4-5 degrees by 2100, if humans don’t do anything to our emissions, and beyond this patches of uninhabitable areas (for humans) could start to open up in the tropics, due to heat stress limits imposed by the evaporative limits of our body. Indeed, a world 5+ degrees warmer is a big cause for alarm, even if the world takes a linear path to that mark. The world also does not end in 2100, and while it is tempting to think of later dates as “very far off,” it is worth reminding ourselves that we would live on a different planet had people of the Viking era industrialized and emitted carbon uncontrollably.

Nonetheless, the near future climatic fate of New York probably looks more like the climate of South Carolina or Georgia than something from a Mad Max movie. This is still an important basis for concern given that the socio-political infrastructure that exists around the world is biased toward the modern climate.

Many of the nightmare scenarios in this article, such as no more food, unbreathable air, poisoned oceans, perpetual warfare, etc. are simply ridiculous, although food security is indeed an issue at stake (see David Battisti’s comments). A “business-as-usual” climate in 1-2 centuries still looks markedly different than the current one, but there’s no reason yet to think much of the world will become uninhabitable or look like a science fiction novel.

The IPCC, the world’s leading experts on climate change, publish regular reports about climate change which explain what the expert consensus about climate change is. The most recent report about the impacts of climate change was published in 2014. (The fifth assessment report is in drafts but has not been officially published.) It lists five reasons for concern about climate change:

  1. Unique and threatened systems— Climate change will destroy certain vulnerable cultures and ecosystems.
  2. Extreme weather events— Climate change increases the risk of some natural disasters, such as heat waves, coastal flooding, and extreme amounts of rain.
  3. Distribution of impacts— Climate change will disproportionately harm the global poor.
  4. Global aggregate impacts— Due to climate change, we’ll have a harder time getting the things we usually get from nature– pollination, flood control, bushmeat, and so on– which will harm the economy.
  5. Large-scale singular events— Some physical systems and ecosystems are at risk of abrupt and irreversible changes, such as the loss of the Greenland ice sheet.

Key risks are the potentially severe adverse consequences for humans resulting from climate change. The list of key risks is as follows:

i) Risk of death, injury, ill-health, or disrupted livelihoods in low-lying coastal zones and small island developing states and other small islands, due to storm surges, coastal flooding, and sea level rise. [RFC 1-5]
ii) Risk of severe ill-health and disrupted livelihoods for large urban populations due to inland flooding in some regions. [RFC 2 and 3]
iii) Systemic risks due to extreme weather events leading to breakdown of infrastructure networks and critical services such as electricity, water supply, and health and emergency services. [RFC 2-4]
iv) Risk of mortality and morbidity during periods of extreme heat, particularly for vulnerable urban populations and those working outdoors in urban or rural areas. [RFC 2 and 3]
v) Risk of food insecurity and the breakdown of food systems linked to warming, drought, flooding, and precipitation variability and extremes, particularly for poorer populations in urban and rural settings. [RFC 2-4]
vi) Risk of loss of rural livelihoods and income due to insufficient access to drinking and irrigation water and reduced agricultural productivity, particularly for farmers and pastoralists with minimal capital in semi-arid regions. [RFC 2 and 3]
vii) Risk of loss of marine and coastal ecosystems, biodiversity, and the ecosystem goods, functions, and services they provide for coastal livelihoods, especially for fishing communities in the tropics and the Arctic. [RFC 1, 2, and 4]
viii) Risk of loss of terrestrial and inland water ecosystems, biodiversity, and the ecosystem goods, functions, and services they provide for livelihoods. [RFC 1, 3, and 4]

To be clear, all of this is really bad. People are going to die. “Economic damage” sounds dry and abstract, but it means people going hungry and children dying of preventable diseases. The effects will fall substantially on the global poor, who have limited resources to help them cope. We can expect a climate refugee crisis.

It is also, notably, not human extinction.

Human extinction, if it were a likely outcome of climate change, would probably fall under reasons for concern #4 or #5 (although it’s still weird it didn’t get its own headlining concern). For this reason I will discuss #4 and #5 in more depth.

There is a low level of consensus about concern #4. If global warming is kept below 3 degrees Celsius, 20 to 30% of species are at risk of extinction– mostly specialist species who would have a far more difficult time adapting to climate change than humans would. Below 2.5 degrees Celsius, climate change will only cause a small reduction in gross world product; there is no consensus about the effects about 2.5 degrees Celsius, but they are expected to accelerate with increasing temperature. Human extinction is nowhere listed as a potential consequence of extreme levels of warming.

Concern #5 includes the following large-scale singular events:

  • Over centuries or millennia, the Greenland ice sheet and possibly the West Antartic ice sheet may deglaciate, leading to a five to ten meter rise in sea level.
  • The disappearance of the Arctic summer sea ice, which is likely reversible, although loss of biodiversity is not.
  • Irreversible changes in coral reef, Arctic, and Amazon ecosystems.
  • Two events described as “unlikely” or “very unlikely,” which include:
    • Accelerated carbon emissions from wetlands, permafrost, or ocean hydrates, which could cause a higher-than-predicted rate of global warming. I have not been able to find an estimate of how high the warming would be or what the effects would be.
    • Shutdown of the Atlantic meridional overturning circulation (AMOC), which would cause cooling in North America and Europe, increased extreme weather events, and (no matter what the Day After Tomorrow tells you) not human extinction

One concern I’ve often seen is an accelerated greenhouse effect turning us into Venus. However, Climate Feedback quotes Ken Caldeira, senior scientist at the Carnegie Institution for Science:

The Earth is not at risk of becoming like Venus. We have done climate model simulations in which all available fossil fuels were burned and the resulting CO2 released into the atmosphere. The planet warmed up about 10 °C in these simulations. This was enough to melt all of the ice sheets and produce 60 meters of sea-level rise, but in no such simulation does the Earth become anything like Venus.

Most of our climate models only extend to the relatively near future, such as 2100. There is a high degree of uncertainty about what will happen in the more distant future, with some exceptions, such as the melting of the Greenland ice sheet. It’s difficult to model things that are that far away. No one really knows what the world would look like in 2500 with three degrees of warming. But there’s also a lot of time in the next five hundred years to deploy other mitigation and adaptation solutions.

In conclusion, climate change will be very very bad. Lots of people will die. Many people– disproportionately the global poor– will go hungry, get sick or injured, not have access to clean water, or suffer from treatable or preventable illnesses. There will be many natural disasters. There will be global geopolitical instability, perhaps including wars and refugee crises. We will damage or lose many ecosystems that people value, such as coral reefs. The Amazon may become a grassland. But scientific consensus is that it will not result in human extinction or Earth becoming Venus.

GiveWell Top Charities Explained: Against Malaria Foundation



[This is the fourth post in a brief series explaining the current GiveWell top charities. You can get all the information in this post on GiveWell’s website, but my blog post is both shorter and less boring. In order to reward you for reading a whole blog post about a charity you already know about, I have included at the end the Most Interesting AMF Fact.]

The Against Malaria Foundation is one of the most iconic effective altruist charities. “Bednets”, to many people, are synonymous with “effective altruism.” With one year’s exception, AMF has consistently been a GiveWell top charity since 2009– not long after the term “effective altruism” was coined.

The Against Malaria Foundation provides long-lasting insecticide-treated bednets to partner organizations, which distribute the nets. Randomized controlled trials of insecticide-treated bednets find that insecticide-treated bednet distribution has the following benefits:

  • Reduces the rate of malaria and severe malaria episodes.
  • Reduces the rate of common complications of malaria, such as anemia, enlarged spleen, low birthweight, and placental malaria.
  • Improves the nutritional status of children.
  • Averts 5.53 deaths among children under 5 per 1000 children under 5 protected.
  • Prevents miscarriages.

The last bullet point is not included in GiveWell’s cost-effectiveness analysis. Preliminary results from a friend of mine suggest that it costs about a thousand dollars to prevent a fetal loss by donating to the Against Malaria Foundation.

it is believed that bednet distributions also reduce mortality among people over the age of five, mostly because it would be really weird if they didn’t. However, no RCTs have addressed this question.

It is believed based on studies of previous malaria eradication programs that reducing the prevalence of malaria in a country increases the income of people in that country, which means that people are less likely to go hungry, can get medical treatment when they’re sick, can buy televisions, and so on.

The studies were conducted of insecticide-treated bednet distribution programs, not of bednets specifically. Some people were in the treatment group of the study but didn’t put up bednets, and they were still counted as part of the statistics. That makes us think the research is more likely to apply to a program like AMF. However, it’s often much easier to have a really, really good bednet distribution program in a small study than it is to have a really, really good bednet distribution program that gives millions of people bednets. If fewer people use AMF’s bednets than used the bednets in the study, the effects will be smaller.

The bednet usage rates that AMF finds in its surveys are comparable to the bednet usage rates in the small-scale studies, and AMF similarly works in places with high rates of malaria. In general, AMF is a well-run charity. However, to the best of my knowledge, no research has been conducted on the health effects of AMF’s program specifically. It is conceivable that AMF is making some error that we don’t understand and does not have effects as large as the effects found in large-scale surveys.

There is one fact that is very commonly believed about the Against Malaria Foundation. Unfortunately, all the evidence shows that this fact is incorrect. For this reason, I will set the record straight.

AMF’s malaria nets are not usually used for fishing. AMF’s malaria nets are not usually used for fishingAMF’s malaria nets are not usually used for fishing. 

  • AMF’s malaria nets are not usually used for fishing.
  1. AMF’s malaria nets are not usually used for fishing.


Tell your friends and family. Shout it in the streetcorners. Educate your children about it. Tie it as symbols on your hands and bind it to your foreheads. Write it on the doorframes of your houses and on the gates. AMF’s malaria nets are generally not used for fishing.

How do we know this? AMF requires all its partner organizations to do followup surveys every six to nine months for two and a half years after the malaria nets are distributed. Outside of the Congo, after one year of use, about 80% to 90% of nets are properly hung. (In the Congo, nets decayed more quickly than expected.) Of course, over time, nets are more likely to break, so the usage rates two and a half years are lower– but that’s because they’re broken, not because they are used for fishing. The cost-effectiveness analyses for AMF incorporate the fact that not all nets are properly hung, and have done so long before anyone thought of the “what if malaria nets are used for fishing?” issue.

Of the ten to twenty percent of nets that are not hung up, many are not going to be used for fishing: they’re sold, or thrown out, or left in a corner because people can’t get it together to hang them up, or perhaps used for some other purpose. But it is possible some of them are, in fact, used for fishing. On this subject, Kelsey Piper writes for Vox:

What about harm to fisheries from people fishing with nets? Researchers have only recently started looking into this. No one has measured detrimental effects yet, though they could emerge later…

The insecticide in anti-malarial bednets also does not have negative effects on humans, because the dosages involved are so low. It’s unclear whether there are any harmful effects from fishing with nets. (And, it’s worth noting, there is one oft-forgotten positive effect from the use of bednets for fishing: People are fed.)

The insecticide-treated bednets issue shows the importance of the effective altruist approach to charities. AMF proactively checks whether the bednets are used as expected instead of assuming that they are. Therefore, if malaria nets were commonly used as fishing nets, we’d be able to find that out right away and account for it in our cost-effectiveness models. If we didn’t monitor bednet usage, it would be easy not to notice that. The “but AMF’s malaria nets are used for fishing!” argument– commonly deployed as a gotcha for effective altruists– actually shows why effective altruism is important.

AMF distributes nets for free. Some people object to distributing nets for free, because it puts local net salespeople out of business and it teaches people that they should get bednets for free. However, way more people will take a free bednet than a bednet that they have to pay even a little bit of money for, and GiveWell thinks that outweighs the effects on local net markets.

Neither fishing nor the fact that the nets are free is a real concern. However, there is a real concern about AMF: insecticide resistance. Insecticide resistance is very hard to quantify, but GiveWell’s best guess is that insecticide-treated bed nets are about a third less effective than they would be in the absence of resistance; this is still very very cost-effective. AMF is going to begin distributing nets that use a different chemical to which mosquitos have yet to develop resistance. GiveWell has not addressed the role of insecticide-treated bed nets in causing insecticide resistance.

Sometimes, AMF has talked to partner organizations about funding a distribution, but ultimately not done it. When they haven’t done so, another organization has usually stepped in to buy nets eventually, but it usually takes at least six months. In the intervening time, people aren’t covered. GiveWell’s cost-effectiveness model accounts for the fact that at least sometimes a different funder will buy the nets if AMF doesn’t. 

It is very very unclear what the Against Malaria Foundation’s room for more funding is. However, AMF has a good track record for scaling up and productively spending large amounts of money, and it would cost hundreds of millions more than anyone is spending on malaria nets to buy everyone who needs a malaria net a malaria net. So probably they will be able to use any sum of money that we can expect people would give them.

In conclusion, as promised, here is the best AMF fact. AMF’s CEO does not take a salary; they receive other pro bono work from volunteers. GiveWell’s model of the costs of an AMF net distribution includes the amount the CEO and other volunteers would be paid if they were paid. AMF, however, has apparently requested that GiveWell include the following caveat:

Comment from AMF: AMF would like all donors reading this to know that the costs included for the CEO and pro bono services are not actually incurred. Each of them is very happy to provide their services for free.

Why might you donate to the Against Malaria Foundation?

  • You care a lot about the deaths of children under five.
  • You think the deaths of fetuses matter as much as the deaths of children under five.
  • You want a program that is robustly good on a bunch of different axes: it makes people less sick and less likely to die and increases their income.
  • You want a program that definitely works and has very few negative side effects, even if it might be less cost-effective than other programs.
  • You grew up in a place with mosquitoes and have sworn eternal vengeance on the tiny blood-sucking monstrosities.

What Is Effective Altruism?



[Author’s note: I am absolutely confident I got this definition from somewhere else, but I’ve looked for it extensively and haven’t been able to find it, and I’d like to be able to reference it, so I’m writing it up. Sorry, original inventor of this definition, whom I have failed to credit.]

Definitions of effective altruism are often very vague. The Centre for Effective Altruism defines effective altruism as “using evidence and reason to figure out how to benefit others as much as possible, and taking action on that basis.” The Effective Altruism Foundation defines effective altruism as “a philosophy and a social movement which holds that actively helping others is of central moral importance, and approaches the choice of possible strategies in a rational and scientific way.” Various book titles define it as Doing Good Better or The Most Good You Can Do.

I’ve talked to people who are confused by these definitions. It seems like in principle feeding hungry people in America or sheltering stray cats could be done in a rational and scientific way, and they certainly involves actively helping others; some people are confused that effective altruists don’t tell them how to most effectively help stray cats or poor Americans. Other people believe that effective altruism is solely about donating to global health charities that have been shown to work in randomized controlled trials and are confused by the fact that many effective altruists are involved in causes with scanty or no peer-reviewed scientific backing.

I’d like to suggest a better definition. In many ways, effective altruism is a big tent: it is clearly not limited to a single cause or way of arguing. However, I think there is a distinctive effective altruism approach to doing good, which is worth defining.

Effective altruism is secular. It does not recommend charities that most effectively get people into Heaven, cause people to have a personal relationship with Jesus, or cause people to reach enlightenment, despite the many religious people that believe that these are more important ways to benefit others than preventing nuclear war or eradicating malaria.

Effective altruism is outcome-oriented. When you justify a course of action from an effective altruist point of view, you must explain why you believe this course of action will cause some specific good thing to go up or some specific bad thing to go down– how it will reduce deaths, make people healthier, improve education, prevent human extinction, or cause fewer animals to suffer torturous lives. You cannot justify the course of action by saying that it is what a virtuous person would do, or that there is some rule that says that everyone should do it, or that it respects human dignity, or that it seems like the sort of thing someone ought to be doing even if it has no effects whatsoever.

Effective altruism is maximizing. It is, as the book title says, about doing the most good you can do. An effective altruist approach does not involve listing off twenty things that we think pass a certain threshold for goodness. It involves saying what you think the single best thing is. Of course, there is uncertainty, so you might say “I don’t know which of these five things are best.” And some things might be better for one person than for another. If trying to be vegan will put you in the hospital, then obviously being vegan is not The Most Good You Can Do. If you’re an amazing political activist and a mediocre AI alignment researcher, then it might be best for you to be a political activist, even if it’s best for an amazing AI alignment researcher to be an AI alignment researcher.

Effective altruism is cause-impartial. Many people choose which cause they work on for reasons other than trying to have the most positive effect on the world. They choose a cause that they’re passionate about, or that they have a personal connection to, or that makes them feel warm and fuzzy feelings. They donate to a particular charity out of habit or because someone asked them to. Effective altruism, however, is impartial between causes: effective altruism recommends that people do whatever seems to be best, not whatever gives them the warmest and fuzziest feelings.

Effective altruism is egalitarian. Effective altruism values all people equally: that is, from the effective altruism perspective, saving the life of a baby in Africa is exactly as good as saving the life of a baby in America, which is exactly as good as saving the life of Ozy’s baby specifically. Effective altruism does not value some beings more and other beings less because they live in different places, or because one is cuter or more sympathetic than the other, or because one has a different skin tone than another. Despite some difficulties about how to justify it philosophically, effective altruism generally believes that future people are as important as present people. While there is controversy about to what extent nonhuman animals should be valued, effective altruism is not speciesist: if effective altruism should not value nonhuman animals, it is because they can’t feel pain, can’t suffer, are not conscious, or are incapable of having long-term preferences, not because of their species membership.

I have been careful throughout this post to say “effective altruism” rather than “effective altruists.” Certainly, it’s not an accident that effective altruists are typically atheists with consequentialist ethical systems. There’s a natural harmony between secular, outcome-oriented effective altruism and atheist consequentialism. If a person believes that converting people is so important that it’s a waste of time to feed bellies instead of souls, or that outcomes don’t matter at all, or that people in America are millions of times more important than people in Africa, they are unlikely to benefit much from effective altruism and can safely ignore our recommendations. But many people who do not fully agree with all the values of effective altruism can derive value from an effective altruism approach.

For example, you might rule out certain courses of action like killing people, even if they lead to the best outcomes. However, since Assassins Without Borders is not very likely to be recommended as a top charity any time soon, an outcome-oriented approach can still help you figure out your career and donation decisions. You might be religious but believe in an obligation to help people in this world rather than just the next; perhaps you split your effort and donations between religious and secular causes, and use effective altruism to guide your secular effort.

In fact, very very few effective altruists apply the effective altruism approach to every aspect of their lives. Professional effective altruists write a lot of fanfiction, which would be weird if they were trying to maximize the amount of good they’re doing with every moment. And I for one am willing to spend much more money to save the life of my baby than I am to save the life of some unrelated baby. Nevertheless, I find effective altruism very valuable in figuring out how to do the most good with the time, effort, and energy I’m willing to spend on that.

GiveWell Top Charities Explained: GiveDirectly



[This is the third post in a brief series explaining the current GiveWell top charities. You can get all the information in this post on GiveWell’s website, but my blog post is both shorter and less boring. In order to reward you for reading a whole blog post about a charity you already know about, I have included at the end the Most Interesting GiveDirectly Fact.]

Whoever said that you should buy warm fuzzies and utilons separately had never heard of GiveDirectly.

GiveDirectly gives money to people in the developing world, usually about $1000. This typically about doubles its recipients’ yearly income. You may see a more-or-less random sample of recipients’ responses to this program on GD Live. Recipients’ responses are unedited and only posted if they opt in to sharing. They may seem slightly overenthusiastic but imagine how you would feel if someone doubled your income for no reason. (I recommend only reading GD Live if you’re pretty sure you plan to donate to GiveDirectly; it has a known effect of causing people to be unable to resist the temptation to donate.)

Research on the effects of GiveDirectly’s cash transfers shows the following:

  • Households spent $51 more per month; about half of the money was spent on food.
  • Household assets increase by $463; most commonly, the money was spent on livestock, durable goods (particularly furniture), and savings.
  • 23% of recipients had an iron roof, compared to 16% of controls.
  • Households spend $13 more per month on business expenses, typically non-durable expenses on non-agricultural businesses.
  • Recipients spend $3 more per month on health expenses.
  • Spending on alcohol and tobacco did not increase.
  • Food security and sense of psychological well-being increased.
  • Business revenues increased by $15; profits did not increase, but that might be a short-term effect due to e.g. investments that have not yet paid off.

Also, one guy bought a guitar and used it to write this catchy song:

My life is GiveDirectly
My house is GiveDirectly
My phone is GiveDirectly
My job is GiveDirectly
My love is GiveDirectly

My life, Give Direct
My house, Give Direct
My farm, Give Direct
I love Give Direct

My life, Give Direct
My house, Give Direct
My job, Give Direct
I love Give Direct

While there is high uncertainty, GiveWell’s best guess is that GiveDirectly does not have significant negative effects on households that don’t receive money.

GiveDirectly is a very well-run charity. 99.7% of recipients receive all funds promised. While staff fraud has occurred in the past, GiveDirectly has responded promptly and taken more steps to prevent future fraud.

GiveDirectly is also known for its commitment to randomized controlled trials. A very high proportion of its recipients (although not 100%) are enrolled in a randomized controlled trial, such as the RCT on the macroeconomic effects of cash transfers or GiveDirectly’s basic income trial. (Oh yeah! GiveDirectly is totally doing a trial on whether basic income cost-effectively improves people’s lives!)

GiveDirectly’s room for more funding is huge, because of how easy the program is to scale. GiveDirectly alone could productively use hundreds of millions of dollars in funding– more than every other GiveWell top charity combined.

Many people support GiveDirectly not just because of its program but because of its challenge to the international aid sector. GiveDirectly asks, “if the thing you’re doing doesn’t work better than giving people cash, why the fuck aren’t you just giving them cash?” Of course, this is a very hard impact to measure, and it’s unclear if giving GiveDirectly more money would cause them to have more effect on the rest of the aid sector, compared to GiveDirectly existing at all. But anecdotally more funders are asking themselves “does this outperform cash?” and give-cash control groups have expanded in popularity.

Many other people support GiveDirectly because they care about autonomy. A lot of donors to the developing world are incredibly condescending: they buy a cow from Heifer International or a merry-go-round pump from PlayPumps or help build a school on their mission trip. Surely, however, if people in the developing world need cows or schools or merry-go-round water pumps, they can buy that themselves? Is there some reason to believe that we know better than people in the developing world just because we’re rich? By far the most popular purchase with a GiveDirectly cash transfer is an iron roof; have you ever seen a charity fundraising to buy iron roofs for people in Kenya? We don’t know what it’s like to be members of the global poor, because we’ve never been poor. The poor know better than we do what their needs are. It is respectful of their dignity as people to let them make this sort of choice.

So, GiveDirectly is great. Why don’t we all just donate there?

Well, GiveWell has this handy little chart where they calculate what you get for your dollar. It’s super-fake and you shouldn’t take it literally, but the effect is large enough that that doesn’t necessarily matter. And what it found was that the cost to achieve an outcome that is just as good as saving a five-year-old’s life, according to the median values of GiveWell staffers, is twenty-three thousand dollars.

Now, of course, that depends on your values, and I encourage you to put your own moral weights into the sheet instead of relying on the median of GiveWell staffers’ values, which is a terrible way to do ethics. But if you care about saving the lives of small children and/or don’t mind high levels of uncertainty, you will get more value for your money by donating to a different GiveWell top charity.

The problem with “do we know better than people in the developing world just because we’re rich?” is that the answer is “yeah, sometimes.” Very, very few Kenyans have access to Sci-Hub so that they can develop an informed opinion on whether deworming medicines will increase their children’s income twenty years from now. Few Ugandans can explain the connection between those vitamin A pills the health worker is handing out and their children dying of diarrhea. Of course, the same things are true for most people in the developed world, but there exist any people in the developed world who understand those things, and the rest of us can follow their donation recommendations.

People in general tend to undervalue preventative health care. People in Africa don’t buy malaria nets for the same reason you never use your gym membership. If it works, nothing happens: you don’t see the malaria or heart attack you didn’t get. Nothing disastrous will happen if you put off going to the gym or buying the malaria net till next week, and exercising is boring and if you buy the malaria net you won’t get to eat for two days, so you never get around to buying it. As an outsider, you can say “this is a known cognitive bias, I’m going to give you a free malaria net and then your children won’t die of malaria.” So charities other than GiveDirectly can be more cost-effective.

In conclusion, as promised, here is the Best GiveDirectly Fact:

GiveDirectly started enrolling recipients from Homa Bay county, Kenya in mid-2015. There, it encountered unexpectedly high rates of refusals from potential recipients; while refusal rates in Uganda and Siaya, Kenya have historically been low (around 5%), refusal rates in Homa Bay have been about 45%. GiveDirectly believes the refusals are due to widespread skepticism towards GiveDirectly’s program and rumors that GiveDirectly is associated with the devil…

November 2017 update: We requested data from GiveDirectly on refusal rates (and other metrics) for January to March 2017 for Kenya and Uganda and March to June 2017 for Rwanda. Refusal rates remained fairly high in Kenya, with 22% refusing to participate in the census and 68% of complaints submitted to GiveDirectly categorized as “program is evil/from the devil.”

Why might you donate to GiveDirectly?

  • You need a lot of warmfuzzies in order to motivate yourself to donate.
  • You think encouraging cash benchmarking is really important, and giving GiveDirectly more money will help that.
  • You want to encourage charities to do more RCTs on their programs by rewarding the charity that does that most enthusiastically.
  • You care about increasing people’s happiness and don’t care about saving the lives of small children, and prefer a certainty of a somewhat good outcome to a small chance of a very good outcome.
  • You believe, in principle, that we should let people make their own decisions about their lives.
  • You want an intervention that definitely has at least a small positive effect.
  • You have just looked at GDLive and are no longer responsible for your actions.

GiveWell Top Charities Explained: Helen Keller International



[This is the second post in a brief series explaining the current GiveWell top charities. You can get all the information in this post on GiveWell’s website, but my blog post is both shorter and less boring.]

Helen Keller International performs Vitamin A supplementation.

Vitamin A deficiency can cause stunting, anemia, blindness, more severe infections, and death. It is particularly harmful to pregnant or lactating people, infants, and children. People in developing countries who don’t eat much meat and don’t eat Vitamin-A-fortified food may suffer from deficiencies. (Vitamin A is also a nutrient of concern for vegans and vegetarians in the developed world, but if you have an ample and diverse diet of fruits and vegetables you probably don’t have to worry about it.) Luckily, your liver can store Vitamin A for several months; if you take a very high dose of Vitamin A once every six months, you won’t suffer from Vitamin A deficiency. It is recommended that children between 6 months and 5 years old get a supplement once every six months.

Helen Keller International provides technical assistance, advocacy, and funding. Technical assistance includes helping countries monitor how many children are getting Vitamin A supplements, running campaigns that educate parents about the importance of Vitamin A supplements, training health workers to give out supplements, and helping governments figure out why their vitamin A supplementation rates are so low and how they can fix them. Advocacy involves convincing governments that they should prioritize mass vitamin A supplementation. Helen Keller International also sometimes provides grants to governments to help them pay for vitamin A supplementation programs.

It is somewhat unclear whether vitamin A supplementation actually works to reduce mortality rates. Normally, this sort of thing is unclear because we don’t have any evidence about it. In the case of vitamin A supplementation, we have two pieces of really good evidence; they just point in opposite directions.

The Cochrane Collaboration, whom you may remember from the previous post as the people who aren’t sure whether flossing your teeth makes your teeth better, performed a meta-analysis that suggests that vitamin A supplementation reduces all-cause mortality by 24%, with a 95% confidence interval ranging from 17% to 31%. The Cochrane Collaboration primarily used studies that were conducted in the 1980s and 1990s.

Not long after the Cochrane Collaboration’s meta-analysis came out, we learned the results of the DEVTA trial. The DEVTA trial is the single largest randomized controlled trial ever conducted, with one million children participating. It estimated that Vitamin A supplementation reduces child mortality rates by 4% and could not rule out the possibility that it did not affect child mortality rates at all. You may notice that 4% is in fact much much smaller than 24%.

What the fuck is going on?

  • It might just be random chance. That’s pretty unlikely: the Cochrane Collaborations 95% confidence interval doesn’t overlap at all with DEVTA’s.
  • DEVTA might not have treated as high a percentage of the children in the study as claimed. DEVTA claims to have treated 86% of children, but some researchers are skeptical because DEVTA was done very cheaply. DEVTA seems to be using broadly reasonable strategies to get all children to take vitamin A supplements and to figure out how many children actually took it, but their strategies aren’t very well-documented and sometimes they didn’t implement them until halfway through the study. Nevertheless, the percentage of children treated in order to make ‘they didn’t treat enough kids’ plausible as an explanation is so much lower than the percentage of children claimed to have been treated that this is not a very plausible explanation.
  • DEVTA might have treated a population with less severe or prevalent vitamin A deficiency. However, the rate of vitamin A deficiency, severe vitamin A deficiency, and complications related to vitamin A deficiency is similar in DEVTA as it is in other studies. It’s more likely they underestimated vitamin A deficiency than that they overestimated it.
  • DEVTA’s population might be healthier than other populations. Vitamin A deficiency doesn’t generally kill children directly; it kills them indirectly, by making them more susceptible to infections. If those deaths are being prevented some other way (e.g. measles vaccianations, oral rehydration treatment), treating Vitamin A deficiency saves fewer children’s lives. DEVTA had a lower child mortality rate than most of the studies in the Cochrane review, and generally studies with a lower child mortality rate show a smaller effect from vitamin A supplementation. However, it’s unclear whether measles and diarrhea– the two biggest killers related to Vitamin A– were less common in DEVTA than in other studies.

GiveWell thinks the most likely explanation is the last one. That means that whether Vitamin A supplementation is cost-effective depends on not just how high the Vitamin A deficiency rates are but also how high the child mortality rate is.

The countries Helen Keller International works in typically have lower rates of vitamin A deficiency than in any study of the effects of vitamin A supplementation: they work in countries where 20% of preschool-aged children have vitamin A deficiency, compared to 59% in the Cochrane meta-analysis. Hellen Keller International works in countries where 12 children out of every 1000 die every year; previous studies have found an effect of vitamin A supplementation if more than 10 children out of every 1000 die every year.

However, there are a lot of limitations of this estimate. Helen Keller International typically works in regions, rather than in whole countries, which might have higher or lower child mortality rates than the country as a whole. It seems really unlikely that vitamin A supplementation doesn’t do anything below 10 children out of 1000 dying each year and then suddenly has a big effect as soon as you get to 10; it’s probably a smoother effect that’s harder to analyze. “Child mortality” is a statistic that includes a lot of different things. It’s unclear whether vitamin A supplementation helps with all infectious diseases or a subset, such as measles and diarrhea; it’s pretty clear that vitamin A supplementation has no effect on some other causes of child mortality, like car accidents. If a region has a high child mortality rate because there are a lot of car accidents, vitamin A supplementation might not do anything. More realistically, if vitamin A supplementation reduces deaths by causing children to be less likely to die if they get measles, then if a region has a low rate of measles, it won’t have a big effect from vitamin A supplementation, even if it has a high child mortality rate.

There are not likely to be any negative long-term side effects from vitamin A supplementation. In the short term, less than ten percent of children experience some sort of adverse side effect, such as headaches, nausea, vomiting, irritability, fever, or loose stools. Vitamin A supplementation does not cause vitamin A overdose or increase mortality when given alongside an inactivated vaccine.

Helen Keller International gives a relatively high percentage of target children vitamin A supplements (between 46% and 81%, depending on region).

GiveWell believes Helen Keller International’s grants cause vitamin A supplementation distributions that otherwise would not occur, but does not know whether its technical assistance helps countries to give vitamin A to children who otherwise wouldn’t receive vitamin A. For this reason, GiveWell’s analyses include only the effect of grantmaking, not the effect from technical assistance.

Helen Keller International needs $20.6 million over the next three years.

Vitamin A supplementation is only one program which Helen Keller International implements. GiveWell recommends donating to Vitamin A supplementation and does not recommend donating to their other programs.

One big area of uncertainty comes from the fact that Helen Keller International has been investigated in less detail than other top charities. In general, over time, GiveWell tends to become more uncertain about charities, learn more about their limitations, and have a higher cost-per-life-saved-equivalent number attached to the charity.

Why might you donate to Helen Keller International?

  • You want to save the lives of children under 6.
  • You want to donate to something that definitely won’t cause significant harm, even if it might not have an effect.
  • You’re optimistic about GiveWell’s further investigations finding that Helen Keller International is as effective as we thought, not less effective.
  • You think Helen Keller International’s technical assistance is more likely to be effective than GiveWell thinks it is.
  • You’re not too concerned about low rates of vitamin A deficiency or about the uncertainties associated with child mortality rates.