Mountains Beyond Mountains (Tracy Kidder) and the case against cost effectiveness

Mountains Beyond Mountains is a biography of Paul Farmer, an American doctor who founded a small clinic in Haiti and ended up saving hundreds of thousands of lives, possibly millions.  But that’s at the end.  The beginning is spent with him  doing obviously suboptimal things like spending $5000/year per patient treating AIDS patients in a country where people were constantly dying of malnutrition and diarrhea (average cost to treat: <$30), while baiting me by bragging about how cost ineffective it was.  I was very angry at him for a while, until it dawned on me that getting angry at a man for distributing lifesaving drugs probably said more negative things about me than it did about him.  Plus he did maybe avert a worldwide epidemic of untreatable tuberculosis, so perhaps I should stop yelling at the CD player and figure out what his thinking was.

Let’s take tuberculosis.  At some point in the story (it’s frustratingly vague on years), Farmer’s friend brings him to Peru, which had what was widely considered the world’s best TB containment system (called DOTS).  The WHO held it up as what the rest of the world should aspire to.  DOTS did many things right, like ensuring a continuous supply of antibiotics to patients and monitoring them to ensure compliance (intermittent treatment breeds resistance).    On the other hand, the prescribed response to someone failing to get better on drugs (indicating their infection was resistant to them) was “give them all the same, plus one more.”  This is exactly the right thing to do, if what you want is to make sure the bacteria evolve resistance to the new drug without losing its existing resistance.  The protocol specifically banned testing to see which drugs a particular patient’s infection was susceptible to, because that is expensive and potentially difficult in the 3rd world.

The WHO ignored the possibility of drug resistant TB because it was considered an evolutionary dead end.  Resistance had to evolve anew in each patient, and rendered the infection noncontagious.  I don’t know what evidence they based this on, but  at best it was a case of incorrectly valuing evidence over reason.  At worst, it indicates a giant sentient TB cell has infiltrated the WHO and is writing policy.

Hello fellow humans. I sure do hate death and suffering.
Hello fellow humans. I sure do hate death and suffering.

If your evidence says a contagious disease spontaneously becomes completely noncontagious at a convenient moment, your first thought should be “who do I fire?” because obviously something went wrong in the study design or implementation. If you check everything out and it genuinely is noncontagious, your next thought should be “wow, we really lucked out having all this extra time to prepare before it inevitably becomes contagious again.”  At no point should it be “sweet, cross that off the list”, because while you are not looking it will redevelop virulence and everyone will die.

Farmer’s response to the ban on treating multiple drug resistant TB was to steal >$100,000 worth of medicine and tests from an American hospital to treat a handful of patients.  When caught, a donor bailed him out.

Or take cancer.  A young child with weird symptoms shows up at his clinic.  He drops a few thousand dollars on tests to determine the child had a rare form of cancer.  60-70% survival rate in the US, no chance in Haiti.  He convinced an American hospital to donate the care, but when the child becomes too ill to travel commercially he spends $20,000+ on medical transport.

Both of these went against standard measures of cost effectiveness, as did Farmer’s pioneering work treating AIDS patients in the 3rd world.  But let’s look at his results:

  1. The WHO’s “yeah, it’s probably fine” approach to drug resistant TB worked as well as you would think.  Farmer proves it is contagious, is treatable, and drives down the price of treatment (to the point it is $/DALY competitive with standard health interventions). He goes on to change the international standard for TB treatment and lead the effort in several countries. Book gives no numbers but I estimate 142,000 lives and counting, plus avoiding an epidemic that could cost 2 million lives/year.*
  2. Kid’s cancer is inoperable, he dies in the US.  American hospital agrees to take a few more cases each year.

In retrospect his actions in the TB case seem pretty damn effective.  But he didn’t set out to change the world.  He stole those drugs for the exact reason he flew that boy to the US: someone was dying in front of him and it made him sad.  It’s possible you couldn’t correct his answer in the cancer case without also “correcting” his answer in the TB case. And while someone more math driven could have launched the world changing anti-MDR TB campaign, they didn’t.  Farmer did, and we need to respect that.

Lots of people in the philanthropic space, including Farmer and most EAs, say that it’s unreasonable to expect perfect altruism from everyone.  People need to spend money on themselves to keep themselves happy and productive, and constant bean counting about “do the morale effects of name brand toilet paper make up for the kids I won’t be able to deworm?” is counterproductive.   You put aside money for charity, and you put aside money for you to enjoy life, and you make your choices.  What if we view Farmer’s need to save the life in front of him as a morale booster that enables our preferred work (averting world wide incurable TB pandemic), rather than the work itself?  By that measure,  $150,000 on a single kid’s cancer and 7 hours doing a house call for one patient in Haiti is a steal.  Given that I pay my cats more (in food and vet care) than what 1/6 of the world survives on, I do not have a lot of room to judge Paul Farmer’s “saving children from cancer” hobby.

Farmer himself raises this point, in a way.  It turns out that effective altruism did not invent the phrase “that’s not cost effective.”  Lots of people with a lot of power (e.g. the WHO) have been saying it for a long time.  From Farmer’s perspective, it seems to be used a lot more to justify not spending money, rather than spending it on a different thing.  He also rejects the framing of the comparison: cancer treatment may save fewer lives per dollar than diarrhea treatment but it saves way more per dollar than a doctor’s beach house, so how come it only gets compared to the former?  Those are fair points.

It’s not clear he could have redirected the money even if he wanted to.  Most of the care for the cancer patient was donated in kind; there was no cash he could redirect to a better cause (although that’s not true for the cost of the medivac).  No one gave him $100,000 to spend on TB treatment, he stole drugs and got bailed out.  It’s not clear the donor would have been as moved to rescue him if he stole $100,000 worth of cheap antibiotics.

In essence, I’m postulating that Farmer operated under the following constraints.

  • Evaluating cost effectiveness is emotionally costly even in the face of very good information.
  • Low quality information on effectiveness
  • Financial discipline was emotionally costly
  • Some money was available for treatments of less relative effectiveness but could not be moved to the most effective thing.  But the money was not clearly labeled “the best thing” and “for warm fuzzies only”, he had to guess in the face of low information.

Under those things, evaluating cost effectiveness could easily be actively harmful.  Judging by the results, I think he did better following his heart.

Doing The Most Effective Thing is great, and I think the EA movement is pushing the status quo in the right direction. But what Farmer is doing is working and I don’t want to mess with it.  At the same time, his statement that “saying you shouldn’t treat one person for cancer because you could treat 10 people for dysentery is valuing one life over another.” (paraphrased) is dangerously close to Heifer International’s “we can’t check how our programs compare to others, that would be experimenting on them and that would be wrong.” (paraphrased), which is dangerously close to Play Pump’s “fuck it, this seems right.” (paraphrased) as they rip out functional water pumps and replace them with junk.  So while Farmer is a strong argument against Effective Altruism as “the last social movement we will ever need” (because some people do the most good when they don’t compare what they’re doing to the counter-factuals), he’s not an argument against EA’s existence.  Someone has to run the numbers and shame Play Pump until they stop attacking Africans’ access to water.

It doesn't even make sense as a toy. The fun part of carousels is the coasting, not the wind up
It doesn’t even make sense as a toy. The fun part of carousels is the coasting, not the wind up

And just like you couldn’t improve Farmer by forcing to him do accounting, you can’t necessarily improve a given EA by making them sadder at the tragedy immediately in front of them.  EA is full of people who didn’t care about philanthropy until it had math and charts attached, or who find doing The Best Thing motivating.  We’re doing good work too. I understand why people fear doing the math on human suffering will make them less human, but that isn’t my experience.  I cry more now at heroism and sacrifice than I ever did as a child.

Ironically the one thing I was still angry at Farmer for at the end of the book was his most effective choice: neglecting his children in favor of treating patients and global health politics.  I could forgive it if he felt called to an emergency after the children were born, but he had kids knowing he would choose his work over them.  For me, no amount of lives saved can redeem that choice.  Maybe that is what he feels about letting that Haitian child die of cancer.

*This paper (PDF) estimates 142,000 deaths averted 2006-2015 by the program Farmer pioneered, and the program is still scaling up.    I estimate a drug resistant TB epidemic would cost a minimum 2.3 million lives/year (math below), although how likely that is to occur is a matter of opinion.  That’s ignoring his clinical work in Haiti, the long term effects of his pioneering HIV treatment in the 3rd world,the long term effects of his pioneering community-based interventions that increased treatment effectiveness,  infrastructure building in multiple countries, and refugee care.  I would love to give you numbers for those but neither Paul Farmer nor PIH believe in numbers, so the WHO evaluation of the TB program was the best I could do.

MATH

Untreated TB has a mortality rate of ~70%l

TB rates have been dropping since ~2002, but that’s due to aggressive
treatment. New infection rate held steady at ~150 people/100,000
from 1990-2002, so let’s use that as our baseline. With 7.3 billion people, that’s 11 million cases/year. 11 million * .7 chance of death = 7.7 million deaths. Per year. 25% of those are patients with AIDS who arguably wouldn’t live very long anyway, so conservatively we have ~5.7 million deaths. If I’m really generous and assume complete worldwide distribution of the TB vaccine (efficacy: 60%), that’s down to 2.3 million deaths. Per year.

For comparison, malaria causes about 0.5 million deaths/year.

Thanks to Julia Wise for recommending the book, Jai Dhyani and Ben Hoffman for comments on earlier versions, and Beth Crane for grammar patrol.

EA Book Roundup

In the span of a few months, three intro-to-effective-altruism books came out- Peter Singer’s The Most Good You Can Do, Nick Cooney’s How to be Great at Doing Good, and Will MacAskill’s Doing Good Better.  After reading all three, my preference order is: How to be Great… > Doing Good Better > The Most Good…, with fairly large gaps between the three.  I actively disliked reading The Most Good….  On the other hand, if you measured the impact each person has had on moving money to effective charities, the order is most certainly Peter Singer >> Will MacAskill > Nick Cooney.*  This leads me to believe my preferences are not wildly predictive and shouldn’t be given much weight.   But I think I understand why I like How to be Great… best, and that information might be useful.

In a nutshell: Peter Singer tells you what to do, Nick Cooney teaches you a way to think about the problem.**  In particular: I hate the argument from a drowning child.  It works by evoking a primitive instinct that is almost impossible to translate to rigorous analysis completely separate from the part of my brain that plans effective giving.   The same instinct that tells you to ruin your suit to save a child will tell you to skip a one time opportunity to earn billions of dollars for charity to save a child.  We like saving children.  Meanwhile, Nick Cooney’s book is about building up the skills so you can look at tough choices without blinking.  To me, this came off as simultaneously less judgmental of my faults and yet a stronger push for me to do better.

[I suspect high scrupulousness plays a role here- I constantly felt like Singer was saying I was a bad person because I wasn’t doing the most goodest thing, and it made me want to think about giving less.]

As EA-the-movement grows, I think it’s going to have to have very different inward and outward faces.  On one extreme you have the very core- doing or planning on doing direct work, the kind of hardcore earning to give that depends on social support, organizing the movement, or spreading ideas outside it.   On the other extreme you have people who are going to donate a modest amount to charity and are choosing based mostly on warm fuzzies, but are influenced by EA to donate more, or more effectively.  I picture this group as slightly less rigorous than my parents, who I have convinced to donate to several EA charities, and who have done good research on charities themselves, but also still give money to my dad’s extremely well endowed alma matter.  How to be Great… is for preparing people to be core.  The Most Good… is for motivating people on the very fringe.  I would place Doing Good Better between them, but much closer to The Most Good… If one of my friends wanted to know about EA, I’d give them Doing Good Better, on the theory that my friends are a lot like me.  If a stranger wanted to know more I’d probably point them to The Most Good…, based on empirical results (unless they were highly conscientious).  If you enjoy my blog I suspect you’re a How to be Great type- even if you don’t want to drink the EA koolaid, you probably like being taught more than being ordered.

*Singer had major influences on Bill Gates and Dustin Moskovitz (funder of GoodVentures) and after he’s done that there’s no point even counting the other people he’s influenced.  Will MacAskill cofounded 80,000 hours and Giving What We Can.  Nick Cooney runs some relatively small budget animal charities.

** If I had to pick a description for MacAskill’s approach it would be “descriptive”, but it doesn’t contrast with the other books as much as they do with themselves.   Peter Singer also spends a lot of time describing the effective altruism movement but I found a lot of it to be wrong.

Special Tax Status for Non-Profits?

Non-profits in America get several tax benefits:

  • Contributions to them can be deducted by donors.
  • They do not have to pay sales or property tax.
  • Exemption from corporate income tax

Should they?

There’s a number of problems with this.  One, it makes deciding what is and is not a non-profit really important.  I’m fine with government subsidies (which is what tax breaks are) to help poor people eat, but not for rich people’s entertainment.  Those two are easy to distinguish, but there’s a lot of room between homeless shelters and operas, and I’m uncomfortable with the government drawing the line. Or what about charities that have beliefs you find abhorrent?  Bob Jones University lost its tax-exempt status in 1983 due to its ban on interracial dating, and fear of a repeat apparently drives a lot of the religious objection to same sex marriage.  I think people who oppose interracial dating or same sex marriage are wrong and should be shamed, but I’m really uncomfortable having that much money riding on values judgments by the government.

The sales tax thing isn’t that big a deal, as witnessed by the fact that a lot of charities don’t even bother with it.  But property tax is.  It starves the tax base of municipalities with a large percentage of land occupied by non-profits.  It’s something of a problem in DC and an enormous one in some university towns, especially if the surrounding area is poor.  That’s hard to stomach when prestigious universities have endowments in the billions and a good chunk of their work is making the rich richer.  Lack of property taxes pushes charities to buy property when they would otherwise rent (which means it benefits only those charities with consistent funding), and to occupy more valuable real estate than they otherwise would.

I like that I get a tax deduction for my donations, and I’d probably donate less without that.  OTOH, it creates a distinct gap between “people organizing to do some good things” and Official Charity, which creates a barrier to entry.  It’s not a trivial barrier either- I’ve served in the leadership on both official (my old dojo) and unofficial (Seattle EA) charities.  Among other things, official recognition forces a fairly specific kind of hierarchy on you.   In Utopia of Rules, David Graeber talks about the strain his autonomous non-hierarchical collective experienced when someone had the gall to give them a car.  It ends with them destroying the car with a sledge hammer.

Now we see the violence inherent in the system.
Now we see the violence inherent in the system.

Removing the benefits of official incorporation would let more organizations find their natural structure, rather than a one size fits all government imposed one, and also lead to fewer car destruction parties.

My opinion on the corporate income tax is a post in and of itself, so let’s put that aside for now.  I think there’s a very good case for not exempting non-profits from property tax, and not making charitable contributions tax deductible.  I also think it would be extremely disruptive to abruptly switch, so we should ease over gradually, and the change should be revenue neutral.*

*People say I’m cynical but then I write things like “the government should raise this tax and lower another one so they get the same amount of money” so I don’t know what they’re talking about.

Links 8/28/15

My feeling on “awareness” as a charitable concept is that it should arise as a byproduct of something else (read: doing actual work), and if I see a charity promoting awareness I assume it’s a self aggrandizing waste of resources and they don’t really care about helping people.  This is very true about, say, the Susan G. Komen lighting up a record-setting number of buildings to raise awareness for breast cancer.  But it’s not always true.  This 99% invisible is about the original AIDS ribbon, which started at a time when HIV was excruciatingly taboo.  The ribbon advanced the ability of people to talk about AIDS, and in doing so accelerated the development of treatment options and increased the emotional support available to tens of thousands of dying people and those that cared for them.  Breast cancer was never as taboo as AIDS, but for a long time it was literally unspeakable in polite company.  Awareness was probably a good idea back then.

So I’m amending my position to “spreading awareness: a good idea if people will literally not talk about your issue.”

Yes, diet and exercise affect your weight.  But lab animals are fatter than their equivalents of 30 years ago despite provably identical genetics, diets, and activity levels.  I think it is time we consider the concept of an environmental cause.

It never occurred to me to wonder how hummingbirds got nectar out of flowers.  I was nonetheless delighted to learn they do so by way of grooved, spring loaded tongues. They also fly weird.  Good job hummingbirds.

Do you do your best work or feel your emotional best when you wake up hours before you want to?  Turns out children don’t either and if we want to keep up the pretense that school is about teaching them it needs to start later.

One criticism of Uber in Seattle is that they abandon people in the suburbs, because they don’t follow the law requiring taxis to send a certain number of cars to the suburbs even when the bars are getting out in the city and everyone wants a taxi.  Despite this, Uber actually serves the suburbs better than taxis.  They also maybe prevent DUIs.

The Argument Against Incrementalism.

Sometimes there are fights where one group says “iterative progress” and the other says “no, it’s all or nothing” (my interpretation).  For example, people that don’t like GiveDirectly because it reinforces capitalism, or whale treadmills because the whales need to be in the wild, or humaneness standards for farmed meat because it reinforces eating meat.

Twice now I’ve gone through airport security while they were in express mode, which means you get an x-ray rather than the pornoscanner, you can leave your shoes on your feet and your laptop in its bag, and there’s a k9 unit, which I assume is looking for bombs.  This is great because it’s faster and more convenient and spares me my usual protest groping*.  As an incrementalist, I should be happy about this, but I’m not.

My ultimate goal is not just “not get groped or irradiated”, it’s “stop spending billions of dollars to waste people’s time with absolutely zero compensating benefits”, and beyond that “not have a government for which this kind of toxicity is standard.”  However much I’m enjoying not taking my shoes off, this change does not get us any closer to the latter two goals.  I suspect this is what the [people I previously categorized as anti-incrementalist] felt about the incremental improvements I approved of: that they were harm mitigation at best but did not move them closer to their goals.  So I’m a lot more sympathetic to them now.

*I don’t know if the pornoscanners are actually dangerous or not, but I do know the TSA doesn’t know either and I will punish them for their decision however I can.

Review: The Hot Seat (Dan Shapiro)

Let me begin by describing something The Hot Seat does not do.  A while ago I read Never Say Die, about how society talks about old age.  Sometimes I would want to argue with its factual statements (“old women have no access to sex”), but feel immediately aversive.  Eventually I realized that this was because Never Say Die spent a long time deriding anyone who believed anything good about old-old age as delusional or mean.  I didn’t want to be delusional or mean, so even in the privacy of my own head I resisted arguing.  This is a bad tactic for finding out the truth.   You don’t win arguments by deriding people who oppose you, you win them with facts.  And the facts are that old people in nursing homes get a lot of STDs.*

A lot of business books do this too.  “Other people will tell all a company needs is a website and a mascot, but we’re not like that.  We think you should have a product.”  It’s not quite argument from bravery– more like argument against stupidity.  It often follows statements like “we won’t sugarcoat this” and “fancy new economy idiots/stodgy old economy losers believe…”.  The effect is to discourage critical thought about what they are telling you.

The Hot Seat does not do this, at all.  It gives you information- both legal rules and the unspoken ones, from funding to people management.  I think it would be useful for someone planning on starting their own company, but that wasn’t my use case.  I want to be an early employee at a start up, and want to be able to tell good start ups from bad.  Hot Seat isn’t a complete book for that, but it is a very strong foundation that will make it easier to assess if I’m getting good advice from other books.  It is also extraordinarily readable, to the point I would read it for fun.**

*When I went to look up the numbers I saw that they counted everyone above age 65 or even 50.  The book’s main thesis is that people take happy statements about the (upper class) young old and inappropriately apply them to the old old (80+).  So the author may not have even been wrong, but I don’t like the way she proved her point.

**Other books I read for fun:

But I don’t read finance for fun, so this is novel.

How Does Amazon Convince Anyone To Work For Them?

Amazon is in that club of employers (Google, Twitter, Facebook, Microsoft, etc), where working there functions as a stamp of quality.  Their employees are frequently cold called by recruiters working for other members of the club, middle tier companies, and start ups that cannot get enough people through their personal network.  Amazon pays very well relative to most jobs, even many programming jobs, but it does not pay as well as other members of the club.  The salary is just a little less than you’d make elsewhere, but equity and bonuses are backloaded such that many people are driven out before they receive the bulk of them.  The health insurance isn’t as good.  I realize paying for your own lunch is normal, but Amazon makes employees pay for a lot of things other companies offer for free, like ergonomic keyboards.  And then there’s the work environment.

How does Amazon maintain a talent pool equivalent to the other prestige club members while paying less?

This is anecdotal, but my friends at Amazon are much more likely to have come from unprestigious companies or schools than my friends at other club companies.  Working at Amazon doesn’t make them smarter, but it does provide widely-accepted proof of their intelligence that they didn’t have before, and can leverage into cushier jobs later.   In some ways Amazon’s reputation for chewing people up and spitting them out is a feature here, because leaving after 18 months raises 0 questions among other employers.

So my hypothesis is Amazon invests more in finding and vetting smart people who aren’t currently holding Official Smart Person Cards, and that part of employees’ compensation is getting that card.  In this way it’s like the US Armed Forces, which are grueling and don’t pay well but people tend to leave them with many more options than they started with.

I’m unconvinced this is a winning strategy.  Operational turnover is expensive, and bad working conditions decrease people’s productivity even when they’re well compensated.  But it does at least explain why it hasn’t collapsed already.

Links 8/21/15

A 3 part series in the New Yorker about Jehovah’s Witnesses and blood transfusions.  Summary: receiving blood is more dangerous than we think and outcomes would be better if we used various techniques to reduce the amount of donor blood patients needed (although they’d still need some).  These techniques were developed in part to treat Jehovah’s Witnesses.  This is why you tolerate weird and dumb.  Sometimes weird and dumb pushes the establishment to invent things that help you too.

Logical Journey of the Zoombinis is out on mobile.  11 year old me is so happy right now.

The New York Times published an article on how awful working for Amazon corporate is. This is one of those times the response is more damning than the accusation.  A lot of their complaints were anecdotal, sensationalized bullshit- every large company has an employee onboarding process where they say CUSTOMERS! a lot, no one expects it to actually affect you.  They left out things I’ve heard from friends that are more damning- e.g. they quote you compensation averaged over four years, but it’s back loaded and a good chunk of people don’t stay that long.  It’s Jeff Bezo’s response– “Even if it’s rare or isolated, our tolerance for any such lack of empathy needs to be zero”- that I think really demonstrates the problem, because it betrays exactly the kind of attitude that would lead to exactly the environment described in the New York Times article.  It’s punishing middle managers for not protecting him from the consequences of the culture he created.

The employee defenses betray the same lack of understanding of what the problem really is-  “During my 18 months at Amazon, I’ve never worked a single weekend when I didn’t want to.”, “Last year, during all-hands, a very high ranking Executive said, verbatim: Amazon used to burn a lot of people into the ground. This isn’t how we do things anymore”  (source).  These are the words of people with Stockholm Syndrome.

Dustin Moskovitz explains why long hours aren’t even helpful.

The Future Soon

I’ve officially given notice at work and notified my team. My current plan is to wrap up my project, do a webdev bootcamp to round out my skills, and get a job that actually makes a difference in the world (there are some options I’m extremely excited about, although nothing is done till it’s done). But if that is not the best plan, now would be the ideal time to that find out. So if you have any suggestions on any of the following, please let me know:

  • Companies with EA-compatible missions looking to hire remote programmers.  I have extensive test dev experience (meaning I write code, not run manual tests, and currently I don’t even write many test cases, it’s all designing and implementing tools) and will have webdev experience.
  • Books I should read.  I’ve been reading a lot of business and start up books with the goal of evaluating start ups, but if there’s another field you think I should look into let me know.
  • Bootcamps.  My qualifications were: online, large group and pair programming element, and free of macho bullshit that treats suffering and learning as equivalent, and that appears to have left me with one, but more would be great.
  • Supplemental classes or technologies I should learn
  • Cool people I should talk to.  I appear to have caught that case of “frequent trips to the bay area” that has been going around Seattle EA so in person is an option in either area, and of course there’s always the internet.
  • Projects that could benefit from a short-term/part-time programmer or writer/researcher (similar to this blog or what I did for Charity Science).
  • Off the wall careers I should research.

In Defense Of The Sunk Cost Fallacy

Dutch disease is the economic concept that if a country is too rich in one thing, especially a natural resource, every other sector of the economy will rot because all available money and talent will flow towards that sector.  Moreover, that sector dominates the exchange rate, making all other exports uncompetitive.*  It comes up in foreign development a lot because charitable aid can cause dutch disease: by paying what the funders would consider a “fair wage”, charities position themselves as by far the best employers in the area.  The best and the brightest African citizens end up chauffering foreigners rather than starting their own businesses, which keeps the society dependent on outside help.  Nothing good comes from having poverty as your chief export.

I posit that a similar process takes place in corporations.  Once they are making too much money off a few major things (Windows, Office, AdWords, SUVs), even an exceptionally profitable project in a small market is too small to notice.  Add in the risk of reputation damage and the fact that all projects have a certain amount of overhead regardless of size, and it makes perfect sense for large companies to discard projects a start up would kill for (RIP Reader).**

That’s a fine policy in moderation, but there are problems with applying it too early.  Namely, you never know what something is going to grow into.  Google search originally arose as a way to calculate impact for academic papers. The market for SUVs (and for that matter, cars) was 0 until someone created it.  If you insist on only going after projects that directly address an existing large market, the best you’ll ever be is a fast follower.***

Simultaneously, going from zero to an enormous, productive project is really, really hard (see: Fire Phone, Google+, Facebook’s not-an-operating-system).  Even if you have an end goal in mind, it often makes sense to start small and iterate.  Little Bets covers this in great detail.  And if you don’t have a signed card from G-d confirming your end goal is correct, progressing in small iterative steps gives you more information and more room to pivot.

More than one keynote at EA Global talked about the importance of picking the most important thing, and of being willing to switch if you find something better.  That’s obviously great in in some cases, but I worry that this hyperfocusing will cause the same problems for us that it does at large companies: a lack of room to surprise ourselves.  For example, take the post I did on interpretive labor.  I was really proud of that post.  I worked hard on it.  I had visions of it helping many people in their relationships.  But if you’d asked at the time, I would have predicted that the Most Effective use of my time was learning programming skills to increase my wage or increase my value in direct work, and that that post was an indulgence.   It never in my wildest dreams occurred to me it would be read by someone in a far better position than me to do something about existential risk and be useful to them in connecting two key groups that weren’t currently talking to each other, but apparently it did.  I’m not saying that I definitely saved us from papercliptopia, but it is technically possible that that post (along with millions of other flaps of butterfly wings) will make the marginal difference.  And I would never have even known it did so except the person in question reached out to me at EA Global.****

Intervention effectiveness may vary by several orders of magnitude, but if the confidence intervals are just as big it pays to add a little wiggle to your selection.  Moreover, constant project churn has its own cost: it’s better to finish the third best thing than have to two half finished attempts at different best things.  And you never know what a 3rd best project will teach you that will help an upcoming best project- most new technological innovations come from combining things from two different spheres (source), so hyperfocus will eventually cripple you.

In light of all that, I think we need to stop being quite so hard on the sunk cost fallacy.  No, you should not throw good money after bad, but constantly re-evaluating your choices is costly and (jujitsu flip) will not always be most efficient use of your resources.  In the absence of a signed piece of paper from G-d, biasing some of your effort towards things you enjoy and have comparative advantage in may in fact be the optimal strategy

Using your own efficiency against you

My hesitation is that I don’t know how far you can take this before it stops being effective altruism and starts being “feel smug and virtuous about doing whatever it is you already wanted to do”- a thing we’re already accused of doing.  Could someone please solve this and report back?  Thanks.

* The term comes from the Dutch economic crash following the discovery of natural gas in The Netherlands.  Current thought is that was not actually Dutch disease, but that renaming the phenomenon after some third world country currently being devastated by it would be mean.

*Simultaneously, developers have become worse predictors of the market in general. Used to be that nerds were the early adopters and if they loved it everyone would be using it in a year (e.g. gmail, smart phones).  As technology and particularly mobile advances, this is no longer true.  Nerds aren’t powerusers for tablets because we need laptops, but tablet poweruser is a powerful and predictive market.  Companies now force devs to experience the world like users (Facebook’s order to use Android) or just outright tell them what to do (Google+).  This makes their ideas inherently less valuable than they were.  I don’t blame companies for shifting to a more user-driven decision making process, but it does make things less fun.

**Which, to be fair, is Microsoft’s actual strategy

***It’s also possible it accomplished nothing, or makes it worse.  But the ceiling of effectiveness is higher than I ever imaged and the uncertainty only makes my point stronger.