PSA: HIV PrEP

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Pre-exposure prophylaxis, or PrEP, is a way of preventing HIV. If you’re HIV-negative, you can take certain HIV medications before coming into contact with HIV, and it reduces the likelihood that you will contract HIV.

PrEP is very very effective. If you take 7 pills a week, your risk of contracting HIV goes down by 99%. That is, if you receive unprotected anal sex from an HIV-positive partner, you have a 1 in 100 chance of getting HIV. If you are on PrEP, you instead have a 1 in 1000 chance of getting HIV. If you use condoms, you have a 1 in 5000 chance of getting HIV.

Even if you miss a pill sometimes, PrEP can be very effective. If you take four pills a week, your risk goes down by 96%, and if you take only two pills a week, your risk goes down by 76%.

You have to take PrEP for a week for it to start working for anal sex, and three weeks for it to start working for vaginal sex. When you stop taking PrEP, you should continue taking it for at least four weeks after your last possible exposure to HIV.

PrEP has very few side effects and is considerably safer than, for example, the birth control pill. Some people report gastrointestinal issues in the first month of taking it (I personally experienced nausea for one day), but these side effects will go away after the first month. If you take PrEP, you may experience a small increase in serum creatinine, which is filtered by the kidneys. While PrEP has not been linked to loss of kidney function, your doctor will monitor your kidney function, and it might not be a good idea to take it if you have kidney issues. If you’re on PrEP, you will have to go to the doctor more often for blood tests. People have taken PrEP for up to five years without long-term health consequences.

PrEP is usually covered by insurance, and there are medication assistance programs to help high-risk people pay for it.

PrEP only protects against HIV, not other STIs or pregnancy.

You should consider being on PrEP if you have sex that puts you at a high risk of contracting HIV. Here are some people who should consider being on PrEP:

  • People who have sex for money, drugs, housing, etc. and their partners.
  • People who inject drugs and share needles.
  • People who have unprotected sex with people who are HIV-positive or whose status they are not sure of. (“I met him that night and he said he was clean” does not count as “sure of.”)
  • People who drink heavily or use drugs in a context where they might wind up having unprotected sex.
  • People who have recently contracted an STI.
  • People who have anonymous sex with men or trans people who have sex with men or trans people.

It can be easy to overestimate your risk of HIV. For example, if you are polyamorous, have sex within your extended polycule, use condoms reliably, have a gossipy enough polycule that you know the HIV status and condom use habits of random acquaintances*, and know that everyone you’re sleeping with uses condoms reliably and gets tested regularly and doesn’t have HIV, you’re pretty safe from HIV. I don’t think people should rush out and get PrEP without considering how likely it is that they will get HIV.

However, even if you aren’t at high risk of HIV, you may want to consider taking PrEP for peace of mind. If you regularly feel anxious about contracting HIV or are avoiding casual sex that would make you happy and fulfilled because of fear of HIV, PrEP might be a good decision for you even if you’re objectively at fairly low risk.

*This may be redundant with ‘is a polycule.’

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Incentives Matter

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This is a rule I’ve generally found useful for interpersonal interactions:

Consider the incentives you’re giving people. Behave in a way that rewards people for giving you things you want and punishes people for harming you, instead of the other way around.

For example, let’s say you want people to email you with your requests, so you can process them all at once and they don’t interrupt you. But when someone calls you on the phone, you handle the request immediately so you can get back to what you were doing. In this case, people who call you on the phone get their request handled faster than people who email you. A better policy would be to firmly inform people who call you that the appropriate way to contact you is through email, and that you will be happy to assist them as soon as they email you.

Or maybe you want a person you love to tell you when your behavior is hurting them, so you can stop. But every time they tell you that, you start crying and apologize a dozen times and beat yourself up for being such a terrible person and they have to spend two or three hours comforting you about the fact that you hurt them. Often, you get mad at them, because if they’re saying you hurt them they must be saying you’re bad, and you’re not bad, and it is very unfair of them to accuse you of being bad. They’re only going to bring up ways that you’re hurting them if it’s worth the cost of spending hours comforting you, and you might end up hurting them in lots of ways you don’t know about. A better approach would be to thank them for telling you and say that you’ll think about it, then do your processing with someone else where they can’t see it.

Or maybe you want your romantic partner to spend lots of time with you. But when they’re with you, you spend all of your time talking about how much you miss them when they’re gone, how jealous you are of all the time they spend with other people, how they have a moral obligation to spend more time with you than they’re currently spending, how miserable you are, and how much them not spending more time with you is ruining your entire life. A better approach would be to talk with them about their day.

Or maybe you would prefer that your child not have tantrums. But when they ask nicely for a cookie, you never give them a cookie. When they throw a tantrum, you give them a cookie every time in order to get them to shut up. A better approach would be to give them a cookie sometimes when they ask nicely for it and never give a cookie to a tantruming child.

In general, you should put yourself into other people’s shoes and figure out what’s the best way for them to get what they want, whether it’s a cookie, a pleasant afternoon, or a speedily fulfilled request. Some people are going to do the thing you want them to do, out of altruism or a desire to follow the rules or because they care about you. But lots of people are going to do the thing that helps them reach their own goals the best. So you’re more likely to get the things you want if getting you the things you want helps other people get the things they want.

This seems like a really simple rule but I think a lot of relationships would be improved by putting it into practice.

Assorted Book Reviews

Epic Measures: A book about the creation of the global burden of disease studies. The author thinks that he’s Michael Lewis but is not, so we have to put up with pages and pages of tedious “characterization” in order to “make the people involved feel real” when actually I just want them to get back to the part about how all the statistics are bad and Christopher Murray made them better.

Epic Measures brings home to me how difficult effective altruism would have been before relatively recently. Before the global burden of disease studies, for example:

  • There were at least nine different commonly used models for estimating life expectancy, which varied by as much as fifteen years.
  • If you added together the estimates of child deaths by various causes by the WHO groups that specialized in various illnesses, 30 million children died every year. (This excluded, for example, car accidents, which didn’t have a WHO group.) UN demographers, however, estimated 20 million children died every year.
    • In fact, just the estimated deaths from diarrhea, pneunomia, malaria, and measles outnumbered the estimated number of dead children.
  • If UN and World Bank estimators had no new information about life expectancy, they assumed that the life expectancy improved by two to three years every five years up to a life expectancy of 62.5, at which point it stopped improving.
  • The Demographic Yearbook sometimes used life expectancy estimates from governments and sometimes from the UN Population Division, which means that life expectancies sometimes rose or dropped by an entire decade from one year to another.
  • Countries that didn’t collect vital statistics or that didn’t like the vital statistics they collected often just made up their data.
  • Even countries that collected vital statistics had inconsistent ways of measuring it: for example, the percentage of French deaths due to cancer was 10% higher than it would have been if the reporting standards of the US were applied, which means it looked like French people were more likely than Americans to die of cancer when actually they were less likely.
  • Countries regularly recorded “garbage codes” as causes of death, which either made no medical sense (“senility,” which is not a thing people die of) or were so vague as to be useless (“brain trauma” instead of “car accident” or “fall”). In some cases, as many as 40% of a country’s official causes of death were garbage.
  • The number of people who died of malaria in Nigeria every year was five times the number of people who were reported to contract malaria every year, suggesting the estimate was a thousand times off.
  • For more than twenty years, it was believed the number of women who died annually from pregnancy or childbirth hadn’t changed. In reality, it had dropped by a third.

I literally have no idea how GiveWell would be able to work in that environment. (Well, actually, I do– it would be ACE.) I think an underexplored reason for effective altruism existing now, instead of earlier, is that only relatively recently have we had enough data to be able to say conclusively what the best global-poverty interventions are.

Best anecdote: North Korea complained that their country’s healthy life expectancy was wrong because “healthy life expectancy in North Korea is the same as life expectancy, because nobody is sick.”

Best reason to have complicated feelings about George W Bush: apparently in Uganda people were terrified when George W Bush left office because they were afraid Obama would defund PEPFAR, since it was a Bush project, and hundreds of thousands of people with HIV would die.

Pure: Definitely one of my favorite books about evangelical purity culture. Each chapter summarizes the experiences of a particular woman (or, in one case, a trans man) with evangelical purity culture; the author’s experiences are woven throughout. A thoughtful, nuanced exploration of the lifelong sexual trauma that evangelical purity culture can cause.

I particularly enjoyed Katie’s chapter. While older evangelical women “dating Jesus” is often mocked, Katie’s chapter sensitively explores how conceptualizing Jesus as the loving partner she otherwise doesn’t have empowers Katie to take care of herself and follow her passions. After all, Jesus loves her, and therefore Jesus wants her to take herself out on a dinner date with Him when she’s had a bad week and to go back to college to pursue a degree in science. Her chapter also includes the appalling declaration that she tries to separate masturbation from anything “dark and horrible,” such as imagining about people she finds attractive being with her, touching her, and saying things that make her excited. (Seriously. Man, fuck evangelical purity culture.)

Opening Up: A Guide To Creating and Sustaining Open Relationships: This book is fine, I guess, but I feel somewhat deceived. I bought it because I was informed it was a polyamory book. Whatever it is the people in this book are doing, it’s not any form of polyamory I recognize. For example, there’s this checklist where you and your partner can talk about what kinds of sexual partners they are forbidden to date (?!), which includes sections for gender, sexual orientation, D/s orientation, coupled status (?!), and appearance (?!?!). And then there’s a section about sex with a list of specific sex acts your partner can rule out you doing with other people.

Look, I’m not judging you or anything, but if one of your partners can say to you “I don’t want you to date any brunettes or eat any ass” and expect you not to laugh in their face, you are clearly doing a different thing than the thing I am doing and it is confusing to call them the same thing. If I wanted my husband to be able to decide who I had sex with I’d just be monogamous.

I am also extremely confused by this book’s insistence that “not allowed to fall in love with other people” is a reasonable agreement. I can imagine circumstances where this is the case– only seeing sex workers? only having one-night stands? grandfathering in a particular fuckbuddy you’ve been fucking for years and haven’t fallen in love with yet? monoromantic bisexual? aromantic person?– but in most situations it just seems impossible to enforce. When you go out on dates with people and have sex with them sometimes you are going to fall in love. That is how people work.

It’s Okay Not To Share: This is one of my favorite parenting books I’ve read so far!

If I had to sum it up in a single phrase, it would be “non-aggression principle parenting.” If a behavior hurts people or property, you might want to forbid it. (For a broad sense of “hurts people or property,” where the child themself is a person and “your parents’ ears hurt from all the screaming” or “your parent is really annoyed about having to clean up after your mess” counts as harm.) But if a behavior doesn’t hurt people or property– if it’s climbing trees, saying “I HATE the baby!”, refusing to share a toy, putting up a “no girls allowed” sign, running, swearing, poking dead birds with a stick, playing with toy guns, or crossdressing– you should almost always allow it.

One particularly insightful point was that if children don’t get practice resolving conflicts then they will be worse at resolving conflicts– just like with any other skill. Many parents want their children to be peaceful, so they interrupt at any sign of conflict and resolve the problem themselves. But that actually doesn’t teach your kid to be peaceful, any more than stopping your child every time they scribble on a piece of paper and drawing the tree for them teaches them art. If you want kids to be good at coming to a solution that works for everyone, you should let them practice resolving conflicts themselves (within reasonable limits), even if they’re bad at it at first

One thing that annoyed me in this book was all the unnecessary gender. Maybe I shouldn’t hold the gender against it, because it did have a chapter about how boys can wear dresses and be ballerinas if they want to, and I appreciate that. But they were continually like “it’s especially important to let boys run around, because boys tend to be more energetic than girls” or “it’s especially important to let boys do ‘big’ art projects, because boys tend to have worse fine motor skills than girls.” Why not just say “this is particularly important for energetic children” and leave the gender out of it? It’s not like there aren’t any energetic girls.

Legal Systems Very Different From Ours: Strongly recommended for any worldbuilder or person who wants to share interesting facts at parties. Legal Systems Very Different From Ours is an explanation of various historical legal systems and their unusual traits. A handful of interesting facts:

  • Among the Roma, violations of Roma law are sometimes punished by reporting the perpetrator to the gadje authorities for the crimes or welfare fraud everyone already knew the person was doing.
  • In classical Athens, you could search someone else’s house for your stolen property, but only if you did it naked.
  • In Imperial China, it was a criminal offense for a child to report to the authorities that their parent committed a crime, even if the parent is guilty.
  • In medieval Iceland, you could buy and sell the legal status of being a victim of a crime.
  • Maimonides wrote that a wife has a right to expect sex no more than once a week from a scholar, because “the study of Torah weakens their strength.”
  • In eighteenth-century England, criminals were sometimes transported to America as indentured servants; to earn money, the government chose to sell them to merchants. The government did not actually make a profit because of the number of young, old, alcoholic, female, etc. criminals they wound up holding indefinitely waiting for a merchant to pay for them.
  • The Comanche considered killing a man’s favorite horse to be murder.
  • In medieval Ireland, if a lord broke a contract, you were supposed to go on a hunger strike in front of his house; if a lord eats while someone is hunger-striking in front of his house, he owes double damages. For non-lords, you are supposed to break into the contract-breaker’s house with witnesses to complain about it, and the fourth time you are allowed to steal all of his cows.
  • Multiple feud systems don’t consider killing someone to be murder if you immediately confess to witnesses. (It is still a killing, which has a smaller penalty.)

Good to Go: An interesting and evidence-based review of the science behind exercise recovery. If you’re just interested in the advice, it is as follows:

  • Drink water when you’re thirsty and don’t when you’re not.
  • Take rest days; listen to your body about how much rest you need.
  • Get enough sleep.
  • Eat enough protein and calories, but don’t worry about eating within a particular window after your workout.
  • Do specialized “recovery” things if you enjoy them and they make you relax, but otherwise don’t bother. Anything that helps you relax will probably work equally well.

If you enjoy a trip around the world of pseudoscience, as I do, it’s a really fun and engaging read.

In My Culture

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I really liked this post by Duncan Sabien:

Because none of us quite have the same culture, after all. We all differ in different ways from the Basic Package—even those of us who’ve lived in the same towns, gone to the same schools, worked in the same industries, played the same sports, read the same books, watched the same shows—we’ve all got our own unique little takes, built up out of the odd quirks of our parents, tiny traumas and formative experiences, countless accumulated musings about how Things Could Be So Much Better If Everyone Would Just _________!

And so Your Culture, though it might match mine at a thousand different points, will also be noticeably different at a thousand others. You and I would found different churches, write different constitutions, build different schools and startups—

—and we would recognize different things as trespasses or offenses, and react to those trespasses and offenses in different ways.

And I thought I’d take the opportunity to describe what things are like in my culture. I’m mostly going to be addressing the same subjects Duncan addresses; later in the post I will address some things he doesn’t mention.

In my culture, although we wouldn’t use many of the words or the framing Duncan uses, we are conscious of the idea of a broader “context culture.” We are not only aware that other cultures do things differently and we should cooperate with them, but that these cultures often work well for their adherents. There’s a default assumption that people are different, and their needs are different, and if your needs are incompatible with mine you can’t be my friend but I still might wish you well.

Conversely, in my culture, there is little felt need to justify our norms to outsiders. Someone from another culture might say “that wouldn’t work for me” as a counterargument to our norms; this is likely to be met with a blank stare of incomprehension. Of course they don’t work for you. We didn’t design them to work for you. You should leave us alone to do our thing, and maybe you can find some other thing you like better somewhere else.

In my culture, it is assumed that people regularly fail to choose their most-preferred option from the list of options available. You will prefer X, and want to do X, and really intend to do X, and for some reason wind up instead doing Y. We don’t use the word “akrasia”, any more than you’d have a word for every action other than sitting in chairs. But we observe that while most people sit in chairs sometimes, and many people sit in chairs all day long, it is not at all uncommon to do something other than sit in a chair. Similarly, it is not at all uncommon to (for example), really prefer and want and intent that you go to bed at 10pm and instead stay up until 2am on Facebook.

It is important, therefore, in my culture, to distinguish between a person doing X because they actually want to do X, and a person doing X for some other reason. Of course, sometimes things actually have to get done; the baby’s diaper has to be changed regularly no matter what reasons you have for not changing the baby’s diaper. And sometimes people lie about what their preferences are, or self-deceive into believing they want to study Latin when in reality they want to write high-context fanfiction.

But it’s possible to distinguish between those things. And the right way to respond to a person not wanting to do something is different from the right way to respond to them wanting to do something and not doing it. The former can sometimes be changed by persuasion, giving people more information, or incentives, but often can’t be changed at all; you just have to accept that the person isn’t going to do the thing until they want to. Depending on what the problem specifically is, the latter can in theory be changed many different ways, from Facebook-blocking software to medication to making sure to get enough sleep to keeping tempting objects out of your house to reframing the way you think about things.

But sometimes the latter cannot be changed either. And even in that case we think it makes sense to treat them differently, in my culture. It can be frustrating to try your hardest to do something, and fail, and be told that that’s because you actually just wanted a different thing. We think “I wanted to but couldn’t because of my mental limitations” isn’t that much different from “I wanted to but failed because of my physical limitations.”

In my culture, we distinguish between an emotion being valid, an emotion being justified, and an emotion being effective.

A valid emotion is simply one that makes sense. All emotions are valid, because all emotions occur for reasons connected to particular situations, details of your history, thoughts and models you have of the world, and so on. Your emotions are trying to help you as best as they can, given what they “know” about the world, both from past experience and from the powerful optimization process of evolution. No emotion is stupid or dumb or wrong.

A justified emotion is one that in a certain sense “corresponds” to the situation that prompted it. If you respond to someone insulting you for no reason by cringing and apologizing, that’s valid; you have reasons to do that. But the justified response is anger. In general, among flourishing and self-actualized humans, people respond with anger to being insulted.

An effective emotion is one that gets you the thing you want in the situation. You’re stuck in traffic and you’re angry that you’re going to be late. This is a valid emotion– there are reasons for it– and it is a justifiable emotion– anger is a justifiable response when an important goal is frustrated. But it is not an effective emotion. Being angry will not cause the traffic to move any faster, and it might make you feel unhappy. If being angry causes you to drive more recklessly, it may even cause harm.

In my culture, as in Duncan’s, you can leave any conversation at any time. While there are blunt or rude or cruel ways to leave a conversation, you don’t owe anyone your time, attention, or energy on demand. Of course, there are obvious exceptions: if you’re the parent of a young child, for example, or someone has paid you to have the conversation. And there are relationships where you can expected to provide a certain amount of time, attention, or energy in general, even if you can’t be expected to provide it on any specific occasion.

Suicidality and other forms of mental health crisis are not one of the exceptions. If you are suicidal, people may choose to sit and talk with you about it, but you have no right to demand that they do.

In my culture, if I cover the check, you won’t pay me back, but it is expected that at some point you will cover the check for me, and it will all balance out. (Or not– maybe you’re broke, and covering the checks is just the cost of me spending time with you. That’s fine too.)

If you actually do want the check to be split, you should probably remind me; that way only one person has to remember the debt.

My culture tends to assume that people are generous but very forgetful.

In my culture, we try to recognize the ways that people communicate affection. It’s easy to miss that someone cares about you if you’re looking for them to express affection one way and the way they express affection is different. Sometimes it can cause hurt, if you are looking for affection expressed by invitations to things you like” and you aren’t getting any and assume you are not loved, when in reality your friend was attempting to express affection by reading your Tumblr and having thoughtful opinions about your posts.

So we make an effort to notice the ways that each individual person expresses care and affection within a particular relationship. They bring you a cookie when they go to the store to get snacks; they make a moodboard about your favorite character; they say affectionate words; they take your infant for an afternoon so you have some time to write; they stay up late to talk to you when you’re sad; they send you links to articles they think you’ll like, and they’re usually right; they read the books you recommend.

In my culture, it is always okay to ask verbally for consent for a hug. That doesn’t mean that you always will– sometimes you know someone’s cuddly, sometimes you can read their body language, sometimes you know each other well– but it’s unmarked to ask. We don’t notice or care whether you ask. If someone asks a lot, even when told that hugs are always fine, they might get teased lightly and affectionately about it, but it’s a quirk and doesn’t need to be changed.

If you’re touching someone for a while, it is also always okay to check in whether the cuddling is welcome, if you are uncertain.

My culture is, perhaps relatedly, very very cuddly. It is not at all uncommon in my culture to cuddle with platonic friends or friends of friends. While cuddling is sometimes a sign of flirting, it is often just an indicator of affection.

In my culture, if you randomly punch someone (even lightly, without causing damage) without prior consent, it is a major violation of social norms. You will be gossiped about and not invited to parties. People will passive-aggressively tell their toddlers about how YOU know that we do not hit but EVEN SOME ADULTS are confused about this. When your name comes up, people will say, “oh, isn’t that the guy who hits people?”

Of course, you may feel free to punch people if you have discussed this with them ahead of time and clarified that they are okay with it.

In my culture, if you want people to celebrate your birthday, you must announce “IT WILL BE MY BIRTHDAY SOON” several weeks ahead of time to give them a chance to prepare. If you fail to do this and your spouse forgets about your birthday and is like “isn’t your birthday coming up soon?” a week after it happens, this is a funny story and not a great offense. It isn’t even a funny story if it happens with your friend, it’s just normal.

In my culture, if you honk at people and there is not an immediate safety concern, you are an asshole and people will fantasize about fining you twenty dollars every time you do. More generally, my culture takes noise pollution very seriously; we’re opposed to car alarms, fireworks, and loud parties at unreasonable hours.

In my culture, there’s a strong norm that there are things we do not do. We don’t misgender anyone, no matter what. We don’t make fun of people’s names or appearances, no matter what. It’s always acceptable to say “hey, I think you’re being unfair, a more reasonable interpretation of that person’s words/actions is X,” no matter how many awful things that person has said or done.

It’s not that there aren’t any ways you can punish someone who is doing wrong. You can personally decide not to interact with them and encourage your friends to do the same. You can gossip; my culture is extremely gossipy, about good things as well as bad. You can criticize their behavior. In extreme situations, you can post a public callout post or even call the cops. But there is a certain baseline of respect everyone gets just because they’re a person, and you don’t lose that.

In my culture, people often say things behind other people’s back that they wouldn’t say to their face, but it’s a moral failing (however slight). You might phrase things more tactfully around the person, or avoid bringing it up unless directly asked, but you shouldn’t say someone’s dress looks nice and then make fun of it when they’re out of the room. You can either avoid making fun of the dress or say “eh, I don’t love the color on you” when they ask you about it.

In my culture, if someone makes an unusual claim about how their brains work– “actually, I’m two different people”, “I identify as a lizard”, “I can summon Loki into my brain”– there are a range of acceptable ways to respond to this claim. You can shrug. You can ask questions, as long as they’re polite and curious and the other person is willing to answer. You can say “cool!” You can say “what is the etiquette around people who are in some sense lizards?”

You are not permitted to mock them, or to ask questions if they don’t want to answer questions, or to condescendingly explain to them that people are not actually lizards, or to get offended about how People Think They’re Lizards Now, Tumblr Has Gone Too Far. If they ask you not to call them a human, or to use plural pronouns for them, or to switch names when they put on the necklace that indicates that they are a different person, then you should do that. Of course, they should also be understanding if you forget or if the thing they’re asking is something you’re just not capable of. If you absolutely can’t handle not calling someone a human, then you should avoid that person; clearly you are socially incompatible.

It’s okay to privately think they’re not having the experience they claim to be having. If they are a close personal friend or have signaled openness to such conversations, you might bring it up politely and respectfully. If they are not, you should leave them alone, because someone having weird beliefs but not bothering anyone is literally none of your business.

Why I’m An EA

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In January, over the past few years, I’ve sometimes written a post about why I’m an effective altruist. Sometimes that went along with the Giving What We Can pledge drive, but the GWWC pledge drive has been deemphasized as effective altruists have learned more about the best ways to do good. But I think January is still a good time to stop and reflect and think about why I’ve chosen the goals that I have.

My husband and I could have saved ten children with our donations this year.

We didn’t end up saving ten children, because we didn’t donate to the Malaria Consortium. Instead, we split our donations between Evidence Action and the Animal Welfare Fund, both of which have results that are harder to easily summarize.

But. We could have saved ten children this year, and we didn’t, because we thought we could outperform saving ten children’s lives.

“Ten” is an interesting number of children. It’s large, but it’s understandable. I’ve seen ten children in a particular location. It’s a small birthday party’s worth of kids. Not quite one a month.

It’s hard to think about hundreds or millions. When I try to think about millions of children, it turns out actually the whole time I was thinking about maybe six. But I can, in fact, wrap my brain around ten.

Next year, we’re aiming to donate fifteen percent of our income instead of ten; by coincidence, that means we would be able to save fifteen children instead of ten. Half a classroom. You’re a hero, if you rescue half a classroom from a fire.

And we can do that next year, and the year after that, and the year after that. My husband will get raises, so we can save more; the low-hanging fruit is (slowly, wonderfully) getting picked, so we can save fewer.

I won’t ever know her name. It’s impossible even in principle to know which person I saved. But somewhere out there in the world there’s a mother kissing her child’s forehead while she tucks them in at night, and if it weren’t for me she would never be able to kiss her child’s forehead again.

When I donated to GiveDirectly, I used to scroll down GiveDirectly Live and take credit for things. A woman got her own house instead of having to live with her abusive cowife, thanks to me. A family has a cow and their two children have milk, thanks to me. A man paid for a dowry and he could get married and they’re very happy together, thanks to me.

I am a very, very privileged person. My husband is a programmer, which makes me one of the richest people on Earth. I don’t mean to deny that. Saving ten lives a year is out of reach for the vast majority of people.

But… I think it’s an important thing to let people know that you don’t have to be a firefighter or a doctor or Spider-man to save a person’s life. The cost to save a person’s life is the same as the cost of a vacation, or a year of Starbucks coffees.

Effective altruists often talk about effective altruism as a sort of obligation, something you have to do or you’ll be a bad person. That isn’t what this post is about. I don’t think there’s anything you have to particularly do with this information. I think the act/omission distinction, or something close to it, is an important part of living sanely in the world. If you’d rather have the vacation, I’m not going to criticize you.

I just… in case you’re feeling like your life is meaningless or worthless, that no one would notice if you died, that you’re going to be born and work some bullshit job and watch a bunch of TV and never leave any mark on anything, that nothing you do matters, that there’s nothing you do that you can really be proud of…

If you make the average American household income and donate ten percent of it, your household can save three children’s lives a year.

Whenever that voice in my head that talks about how I’m a worthless stupid failure who doesn’t deserve to exist gets too loud, I count up the children I’ve saved.

I’m a worthless stupid failure and I’ve saved a dozen kids and nothing and no one will ever be able to take that away from me.

In terms of a purpose in life and a sense of accomplishment, you could do worse.

Bounty: Guide To Switching From Farmed Fish To Wild-Caught Fish

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Various effective altruists have suggested that avoiding farmed fish is one of the most important things you can do to reduce the amount of suffering caused by your diet. Fortunately, an almost perfect substitute for farmed fish exists: wild-caught fish. It is very unclear whether eating more wild-caught fish is good or bad for fish. Replacing a food that’s very bad with a food that might be good or might be bad seems like progress.

However, it does not seem like there are any guides for how best to replace one’s farmed fish consumption with wild-caught fish.

I am offering a bounty of up to $500 for a well-written, easy-to-understand guide to replacing farmed fish with wild-caught fish. Questions that might be addressed by this guide include:

  • Which, if any, species of fish are always farmed?
  • Which, if any, species of fish are always wild-caught?
  • How likely are farmed fish to be mislabeled as wild-caught? Are there heuristics to use to avoid mislabeled fish?
  • If you don’t know whether a fish is wild-caught or farmed, how do you figure it out?
  • How likely is a fish of unknown origin to be wild-caught? Farmed? What factors affect whether it is wild-caught or farmed?
  • What are the cheapest ways to buy wild-caught fish?
  • What are the best wild-caught substitutes for commonly eaten farmed fish?
  • Which fish oil pills, if any, use wild-caught fish?

The full $500 will be paid out for a complete, well-researched, well-copyedited, easy-to-understand guide that is ready to be given to interested reducetarians. Incomplete or poorly edited reports will receive a portion of the bounty depending on my judgment of their quality. Reports with factual errors or which are otherwise very low-quality will not receive any money.

People interested in the bounty are encouraged to email me at ozybrennan@gmail.com so I can connect them to other interested people, for coordination and to avoid duplication of work.

Open Thread: What’s The Second-Best Cause?

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I’ve recently read the book Epic Measures, about the global burden of disease studes. One person involved in the studies had a habit of asking people who said their intervention was the most important, “what intervention is the second most important?”

It was intended as a gotcha, but I think it’s actually a really interesting question that sheds a lot of light on cause prioritization, and I’ve got a lot out of thinking about it.

So: people who prioritize a single charity, intervention, cause, or broad area in which to work, what charity/intervention/cause/broad area in which to work is second-best, and why?

Link Post for January

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Rationality

“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.