Is Blood Donation Effective? (Yes)

Seattle is apparently not the only Effective Altruism group to talk about doing volunteering meetings, only to remember that the traits that make volunteering useful are almost antithetical to the traits that make it fun and doable to for a group on a drop-in basis.  I am kind of hoping that blood donation can bridge that gap.  So here’s my math on how effective donating blood is.  The Red Cross estimates a single donation can save three people, but what they mean is “a single donation can go to three different people.”  To get the actual value we need to see how many units of blood were donated and how many deaths they prevented.

The most recent data I could find was the 2011 National blood Collection and Utilization Survey Report (PDF), which couldn’t make it harder to do this kind of calculation if it tried.  They were extremely loose with what “unit” referred to, so I’m going to stick with the whole and red blood cell transfusions, so my numbers are consistent.  There were 15,721,000 units collected, of which 14,589,000 were deemed usable.  13,785,000 were used, of which 37,000 were directed to a specific patient, and 65,000 were self-donations, which are less effective for various reasons.  The collections numbers don’t call out general vs. specific donations and the numbers are small, so I’ll just use the total number used.  If some blood donations are also generating plasma and white cells in addition to the red blood cells counted here, that would only increase effectiveness.

A single donation is one pint.  Health and Human Services fails to define what they mean by unit, but it appears to mean “whatever you get from one donation after some filtering“, so let’s assume it’s 1:1.  The average recipient receives 2.75 units.  If you assume each person who received a transplant would otherwise die (supported by this sourceless FAQ), that means each donation saves ~1/3 of a life (discounting for donations that are rejected).  Using GiveWell’s $5,000/life number, that’s still equivalent to donating $1,667.   That is overstating the case, because some portion of recipients (I can’t find out how many) have diseases like sickle cell anemia that require chronic transfusions, and the fair thing is to count their lifetime transfusion count, not their per treatment count.  To get an upper bound I’ll use the Red Cross’s number that a car accident victim can use up to a 100 pints of blood, which means each donor saves 1% of that life, which is equivalent to $50 to an extremely effective charity.

But the question isn’t “what is the average value of donated blood?” but “what is the marginal value of your potential donation?”  I can’t find any direct numbers for this, but we have the following evidence:

  • Very little blood is thrown out.
  • People are spending lots of time and money developing artificial blood substitutes.  Despite this there are no generally accept substitutes for blood’s oxygen-carrying capacity.
  • The Red Cross spends a lot of time and money harassing people to donate.  They called my parents’ house for years after my one donation (I’m O-).
  • Some blood is able to reach the “too old” state, but then used to ill effect, indicating lumpy supply or demand.  Unless you can predict demand spikes you should use the average efficacy.  If you can predict demand spikes, there are probably more effective things to do with that power.

So I’m just going to use the average effectiveness as the marginal effectiveness for now.

What are the costs to the donor of donating?  The one time I donated it was high because I slept for the next two days.  If you’re my friend Elena who went into shock after donating, it cost you days and several thousand dollars in ER visits.  So it is probably not worth it for either of us to donate.  But for a typical person with no side effects, it’s plausibly useful.  If it’s replacing work time, then effectiveness depends on their hourly wage.  Multiple websites list the time to donate as 60-90 minutes, which translates to a minimum psuedowage of $33/hour and a maximum of $1667.  The average hourly American wage is $24/hour, although I would estimate the average wage of people earning to give as somewhat higher than that.  So that’s extremely plausible on its face.  But if the time isn’t coming out of work, and is made rewarding to the participant, blood donation is hugely effective.  This suggestions that an event that induced people to donate without replacing work would be effective, more so if it could be made into a positive experience.  So a blood donation event could be a huge win for an EA event.

[Side note: if you decide to do this yourself, I would recommend donating anywhere but the Red Cross if at all possible.  I’m going to try for Bloodworks NW, because if I get enough people they will send a truck and we can make it an actual party]

Bloody cupcakes
Do not GIS “blood donation party” with safesearch off

How Tests Improve Code Structure pt 2

I’ve always admired Test Driven Development and longed for it from afar, but never had a chance to use it until I was on my own project.  Most times when you crave something this intently it’s a let down, but no, this is every bit as fun as I thought it would be and more.  It’s so relaxing, and it takes so much less mental RAM.  I won’t go back to any other way.

I keep trying to explain why it is better and exactly how it made it obvious what I needed to do, but everything I write comes out boring and I don’t think it explained it anyway.  Let’s try an analogy.  You know how when you attempt a big cleaning project the middle looks worse than if you’d never started?  And if you misjudge your energy level it stays that way, and then gets worse because you’re still living your life?  Or maybe you misjudged the amount of space something required and your plan becomes unworkable, at which point you can improvise or revert?  That’s what regular coding feels like to me.  You don’t know if something’s working until it’s all working.

I’ve been cleaning up my apartment lately, including getting rid of things I don’t want and rearranging things I have so they are more accessible/easier to find/take less space.  And I am being very careful not to do that.  I pick tasks that can be done incrementally.  If I want to move things from cabinet A to cabinet B, things in cabinet B get moved to cabinet C first.  But cabinet C doesn’t have to be their permanent home, just a pareto improvement over the old one.  I have consolidated three dressers into 1 + some other storage bins.  I will probably rearrange those storage bins and the remaining dresser as I learn more about how the current arrangement works, but I was never going to be able to plan that out ahead of time anyway.    This way I never get stuck halfway through, out of energy or realizing my plan is unworkable.

That is what TDD feels like to me.  You might technically be writing and erasing a lot more code, but the mental effort is so much less.  Every step leaves you a little bit better off, and you can concentrate your efforts on one problem at a time.

I was really unimpressed with the android tutorials I saw.  I did Udacity’s, which is officially recommended by Google, but didn’t provide reference code or a way to check your project, so if something didn’t work you didn’t know where the error was. That’s bad enough when it’s a technology you’re well versed in, but with a new tech you don’t have any debugging tools.  It’s like trying to learn a foreign grammar by having it explained to you in its own language, when you don’t even have any vocabulary yet, except your brain hasn’t been crafted by millions of years of evolution to do it.  There are other tutorials, but most of them were written for the now-deprecated Eclipse IDE.  Translating from one IDE or build system is not a big deal when you’re familiar with at least one of them, but at the beginning you don’t even know what to Google.  That’s why you’re doing a tutorial. It’s even more fun with Android because it uses a bunch of very common Java tools but requires slightly different usage than everything else.

So what I actually did was do Udacity long enough to know how to make baby’s first project, come up with a concept that I was pretty sure I could subdivide into google-able problems, and then did so, one at a time.  I learned testing basically from scratch, because the two tutorials that covered it required me to know a ton of abstract android architecture, and none of it was explained well enough to mean anything unless you had already coded.  “Make minor changes until you understand the permutations” is how every programmer I know learns, and yet no class teaches this way.

All of which leads me to believe a test-driven tutorial could be really useful.  I’m picturing a project with a few very simple UI elements, and a series of commented out tests.  Users would uncomment the tests one at a time, in order.  The test would fail. The error message would be informative, maybe there would be a few suggestions for how to solve it.  Then they would research on their own until they found a solution.  They would know they had done it right because the test would be passing. Plus they’d learn testing tools at the same time, and those are extremely useful.  This may be my next project.

TDD got me all of the features I wanted in HungerTracker 0.2 except notifications.  I’m still poking at it, but notifications require a deep understanding of several concepts I’ve entirely ignored until now, and need several moving parts to work together to verify any of them.  So here’s version 0.2, which has a greatly improved button layout and a scrollable list that shows as many or as few entries as actually exist.

Review: Neanderthal Man

As a narrative about how science works, this is pretty strong.  I got it as part of my new policy of not reading emotionally intense books right before bed, and while it didn’t produce the post reading anxiety that, say, that book about slavery did, it was pretty exciting and pushed my bedtime back quite a bit.

The actual science, I’m not sure about.  He’s doing molecular biology without any background in basic bio, so he says things like “I didn’t know insects were animals.” on his first day as a zoology professor (he’s since realized his error) or “Can we really say they’re the same species just because they fertily interbreed.” in his book, on biology, that people paid him actual money to publish.  Yes, we can say that because that is exactly what species means.

I’m also a little confused by how they determined humans and neanderthals interbred.  It seems like they’re using the same data to calibrate the technique they’re using to sequence the DNA, the degradation rate of DNA, the contamination rate of the sample, when humans and neanderthals diverged, and when/how much they interbred.  He also doesn’t make a good distinction between when he’s talking about junk DNA (which is not subject to selection pressure, so is a pretty good molecular clock) and when he’s talking about genes (which is, and so it’s difficult to distinguish inheritance from the same source, interbreeding, and convergent evolution).

Lots of very smart people with much more information and training in this area than I have seem to be okay with his conclusions, so I assume this is one of those things where he is simplifying, and I know enough to know that he is missing something but not enough to fill in the gaps myself.  But if you are not in that uncanncy valley, it’s very well written and entertaining.

Being a cyborg proves more boring than anticipated.

Barack Obama recently announced doubling funding to fight antibiotic resistance, which would be more impressive if there wasn’t a significant step that cost the government nothing: ban use of antibiotics for livestock, which currently account for 80% of antibiotics produced.  Hell, taxing use of antibiotics in livestock would reduce the problem and generate revenue.  Representative Louise Slaughter has introduced a bill to (more or less) do this for five years running and it has gone absolutely no where.  So this feels a little like California introducing water restrictions on people while saying nothing about agricultural use, which coincidentally is 80% of their water use.

But maybe Obama’s new money will go to one of the lesser contributors towards antibiotic resistance: people who don’t finish their prescriptions.  Researchers are studying a new microchip that sends a signal when it is being digested.  They’re using it for severely mentally ill patients, who for various reasons sometimes have trouble staying on their meds (good luck to the first schizophrenic to explain to their new doctor that their old doctor tracked their medication by making them swallow computer chips), but what if we used them for antibiotics?

This isn’t a simple solution.  To have it do any good you have to either punish people for not finishing them (which is extremely hard on low income people) or pay them for finishing (hello terrible incentives).  People who split prescriptions are often trying to save themselves the doctor’s visit more than the cost of the medication itself, and this doesn’t address that.  But it seems like we ought to be able to do something with this.

How Tests Improve Code Structure pt 1

Hunger Tracker needs to persist data past the closing of the app.  Knowing nothing about Android I googled “android write to file” and used the first reasonable looking thing that came up.  This was sufficient to let me write to and read a file, which was good enough for a first try and powerful enough for me to release version 0.1.  But as I planned the next step I ran into problems.  The read function I found required me to specify the number of chars I wanted in advance.  I couldn’t spot the end of the file so I grabbed a fixed number of entries every time.  I could extract the data as strings but couldn’t figure out how to make a proper scrolling list (even though I’d done one in the Udacity tutorial).  Attempts at fixes felt muddled and high friction, which is usually a sign I’m afraid of losing data, either to a hard drive failure or to a introducing a bug and failing to detect it.

Step 1 in fixing this was setting up my github account so I had proper version control.  Step 2 was testing.  I spent a long while figuring how to properly test the kind of android class I was using (“android unit testing” being a surprisingly unhelpful search term), and then some basic tests of “The text fields that should be there, are they there?”.

The next step was to test the data storage.  But I couldn’t figure out how to unit test that.  If I tested whether the app was writing to the correct file I needed to look for the exact same file.  But that means updating the test every time I change the name of the file, which I didn’t want to do.  Plus seeing if the correct thing is written to it is ugly.  Tests should be atomic (meaning it doesn’t matter what order you run them in), but the file is persistent, meaning I either need to clear it every time or factor in what previous tests have done.  Plus I would have to shape the test around the exact storage format the app was using, but again that means making the test dependent on an implementation detail.  I could trigger writing and then reading and make sure the display element was correct, but that’s testing two different things and a unit test should only test one.

What I finally worked out was that the handling of persistent data was not actually a core function of HungerTracker’s MainActivity.  What I needed to do was separate out those functions into a separate class, and then use mock objects to make sure the expected calls were made.  E.g. instead of the app writing to a file and the test looking at the exact file and verifying the writing, the app calls the HungerTrackerWriter object.  The test swaps out the real HungerTrackerWriter with a fake one, and monitors that the expected call is made.  This leaves the HungerWriter proper tests blissfully unaware of the implementation details while still verifying that the app is doing what was expected.

[Technical details: somewhere I read that the android junit framework handled mocks easily. This was something of an exaggeration. It has built in mocking for a lot of Android specific classes, but nothing for user created classes. There are many well regarded Java mocking libraries, none of which provided comprehensive instructions that worked for me. Apparently they integrate weirdly with Android? My first round of mocking was hand-written, just so I could work on test code. I never did get the best regarded library, Mockito, working, but I eventually cobbled together a set of build instructions that made EasyMock work]

You might think that making that big a change in order to make something more testable is the tail wagging the dog, but as I was doing it something magic happened.  Those problems with reading exactly as many entries as there were and putting them in a list (as opposed to reading exactly 10 and dumping them in a string) were suddenly much easier to conceptualize.  What seemed so muddled when it was part of HungerTracker was suddenly easy to think about when it was part of HungerTrackerWriter.

If you are super curious, here is the code before the refactor, here is the code after, and here is the test code with mocks.

Prostaglandin, omega-3s, and health

My cat has lost weight since going on a special “I’m inbred and my kidneys don’t want to kidney” diet.  He’s also wheezing a lot.  My vet has recommended fish oil to get him some extra calories, and to fight the wheezing, if the wheezing is something something allergy something something prostaglandin.  She didn’t explain it very well, so I’m consulting with Dr. Internet.

Prostaglandins are lipids that send signals from a cell to itself or its close neighbors.  Prostaglandins take their name from the prostate gland, signifying the fact that they are produced and have effects in almost every tissue of the body.  This is what happens when you name things after the first place they’re discovered.  “Local signalling” covers a lot of ground, including constricting blood vessels, dilating blood vessels, inducing a fever, making you more sensitive to pain, digestive muscle contraction, digestive muscle relaxation, airway contraction, and airway relaxation.  So they could definitely either cause or cure my cat’s wheezing.

What about fish oil?  Prostaglandins are made from fats, but less so from omega-3 than any other fat, and their prostaglandins are less active than others.  Fish oil is rich in omega-3s, but it’s not the only source, as soylent has been working so diligently to demonstrate.  That’s an argument for swapping omega-6 for omega-3, but it doesn’t mean adding additional omega-3s will be any help.  What is an argument for straight up supplementation is that all fats are converted to prostaglandins by the same enzyme, which exists in limited quantities regardless of the amount of fat available.  Omega-3’s slow conversion rate effective blocks the conversion of the more inflammatory omega-6s.  So while I don’t see any reason fish oil would do better than other sources of omega-3s, this certainly seems like a plausible treatment with limited downsides.

Now is as good a time as any for a general omega-3 vs. omega-6 lesson.  3 and 6 are different in ways I can’t be bothered to look up because it doesn’t matter; your body absolutely needs both of these to survive.  Presumably we adapted, more or less, to whatever ratio was available in the evolutionary relevant time period.  Unfortunately 6s have a much longer half life than 3s before going rancid, and everything in our modern food system pushes this- olive oil bred for shelf life, cows are fed grains, which have more omega-6s than grown plants because they don’t want their seed energy going bad either.  The end result is that the intake ratio of omega-6:omega-3 is extremely different than what our bodies expect, and this causes various problems, like maybe prostaglandin-mediated allergies and inflammation (source).

Video Games for Good

Extra Credits is a video series on game design and the game industry.  It has interesting insights I don’t see elsewhere, but it is also… low density.  You could compress most episodes into a single written paragraph and lose nothing.  I tend to watch them when being told the same thing over and over with completely unnecessary accompanying graphics is calming, rather than annoying, which isn’t very often, so I only just caught this video on whether games can induce empathy.

If you are not in the mood to be reassuringly talked down to, they helpfully provide a summary:

Many studies have investigated whether or not there is a link between video games and violence, but few have looked at the bigger picture. What is the correlation between video games and empathy? Since games put us, as players, in the role of characters who are not ourselves, asking us to understand their situation and the problems that they face, they have the potential to teach us about how to empathize with others. While many gamers have anecdotal evidence about games that made them feel a character’s pain, there’s a disappointing lack of formal studies into that side of the question.

Examples: This War of Mine, Cart Life

I didn’t think anything of it until a week later at my Effective Altruism meetup, when we were discussing egalitarianism/maximization.  In a nutshell, EA believes that all lives are equally valuable, so if you can save two lives for $n each or one life for $2n, the most moral thing to do is to save the two lives.  Phrased that way I don’t understand how it’s at all controversial, but in practice it comes up against many people’s instinctive priorities.  For some, passing over a homeless person to give to GiveDirectly doesn’t just give them fewer warm-fuzzies, it feels actively immoral.  Someone at the meeting suggested it was a matter of empathy- people naturally feel more empathy the more often they see someone, or the more they have in common with them.

This is  of course obvious, which is why so many charities try to up the empathy you feel for their beneficiaries, by implying you’re helping a particular person when you’re not, or just sending a letter with a few heartwarming stories of all the injured dogs they’ve saved that year.*  They do it because it get donations, but it’s very hard not to slide into poverty porn. I find those examples really manipulative, but I loved the ability to choose out specific recipients when donating to Modest Needs so clearly I’m just as susceptible.

This is where I thought of that Extra Credits video.  What if instead of telling people how awful extreme poverty is, we gave them a video game demonstrating both the difficulties poor people faced and the resources they used?  Some things I would like to include:

  • Trade offs, trade offs, trade offs.  Do you invest in your child’s schooling or new farming equipment?
  • Bee Sting theory– demonstrating how it is easy to do the right long term thing when you have a few problems, but when too much is wrong sometimes palliatives are all you can manage.
  • The importance of social capital.  The poor (both in the US and the 3rd world) get a lot of criticism for spending so much on alcohol and ceremonies, but the fact is that that builds social relationships that can be crucial later on.  This doesn’t mean spending a lot on booze and parties is optimal, but that the change must come at a societal level.
  • How many well intentioned NGOs fail.  E.g. my continuing hate for the play pump.
  • Ideally you’d like to convey the scope of preventable deaths.  I don’t know how to do that respectfully.  You could do something like Shelter or The Oregon Trail, where you go in knowing some characters will die and the goal is to save as many as possible, but that seems a little horrifically callous.

I have several ideas for how to do this.  You could do the trade offs with a choice mechanism like that of Depression Quest or Long Live the Queen.  Soha Kareem has has apparently done some great work with video games to express her experience of microaggressions and sexual abuse.

EA strikes me as having a real comparative advantage when it comes to producing video games, relative to other charitable movements.  And by “real comparative advantage”, I mean “lots of programmers”.**  None are games programmers specifically, but it might be a skill worth picking up.

*Pro-tip for my local humane society: this may not work as well on cat owners as you were hoping.

**We were up to two non-programmers at the last meeting.  High five.

100% Food versus Soylent

I really, really wanted to like 100% food.  It has so much going for it- made of actual grown food, high protein variants, convenient portable single serve containers, shipping time measured in days rather than months… Unfortunately, it is inedible.

And if I’m saying inedible, it must be pretty bad.  I drink Soylent at room temperature, and for a long time didn’t bother mixing up the little protein clumps that formed (although once I realized how easy to clean my blender was, I did mix it).  As I write this I’m consuming my smoothie with a spoon because I put in too many chia seeds and it turned into a gel.  I cannot drink 100% food.  I ordered the six-variant mixer (chocolate/plain and regular/high protein/low carb), but I’ve only managed to try two (one low carb, one regular) and one of those was a mere pinch.  Extremely diluted the taste is tolerable, but still leaves this unbelievably gross oil aftertaste/film in your mouth.  I won’t drink it and you can’t make me.

The single serve containers were a disappointment too. There’s not enough room in them to really shake up the mix, so you end up with a lot of dry mix protected by a layer of wet mix.  So 100% food’s only real selling point is that it ships quickly.

I’m not 100% happy with Soylent.  I would really prefer fewer digestible carbs and more protein and fiber, but that’s addressable with some flax seeds and additional protein powder.  I would also love it if they shipped in < 3 months, and didn’t tell me they were going to ship a month before they did.  But it is better than starving to death, which is more than I can say for 100% food.

How effective is volunteering at a suicide hotline?

EDIT: 2023-05-10: I changed my thinking on this within a year or two of writing, and never updated because AFAIK no one was reading it. The post was linked to recently, so just in case: I don’t have better numbers than what I came up with here, but the overall rationale seems very similar to that of vegan leafletting, and I just don’t believe their numbers. I think people are in general likely to overestimate the effect of conversations they just had.

None of this means volunteering can’t be effective, or is worse than a given volunteer’s best alternative, but I don’t think “I felt helpful” is strong data.

Months ago my local EA group had a meeting around the concept of Effective Volunteering.  EA is not opposed to volunteering anymore than it it’s opposed to working directly for a cause, but it is more skeptical than the general population that this is the most effective way to help the world.  This doesn’t mean volunteering is bad, it can have all sorts of benefits outside of helping the world- building community, buffing one’s resume, and generally feeling good.  But if you want to justify volunteering on its helping-the-world merits, you have to compare it to the standard option of “work more, donate money.”

[I’m ignoring the argument that most people aren’t paid hourly because “learn skills to boost wages, donate excess” is an equally valid plan]

Based on the local discussion plus this post by Ben Kuhn, I propose that volunteering is most effective when some critical mass of the following are met:

  1. The product produced by volunteers is not the same as that produced by minimum wage workers (e.g. food kitchen volunteers are generally more cheerful than McDonalds workers)
  2. The volunteer has some comparative advantage in the task (e.g. pro bono work by lawyers)
  3. The activity does not take away from paid work (e.g.I have more hours in the week total than hours in the week I am capable of programming).

The problem is that 2 and 3 are often in conflict.  People’s comparative advantage tends to be used at work, either because that’s what led them to the work or they developed the talent there.  So it either has to be someone not capable of working regularly, or the person has to have two different comparative advantages.  I happen to think I fall into this category, because I’m very good at both programming and crisis chat counseling and they use entirely different parts of my brain.  And actually crisis chat makes a good play for having trait 1 as well: it’s heavy emotional work, and there are a lot more people capable of doing it 4 hours a week than 40.

Which got me thinking: how effective is crisis chat?  I’m fully prepared for the answer to be “not very”, it really seems like it’s on the less efficient side of things, but let’s run the numbers.

First step: how much does running a suicide hotline cost?  The first posting I found that listed a salary said $16.00/hour, and that’s for bilingual workers in an area with a cost of living 60% higher than the national average.  Let’s say $20/hour to include taxes, phones and computers, vacation time, etc.  GiveWell considers anything under $5,000 per life saved to be extremely cost effective, so to be competitive a hotline worker would have to save one life every 250 hours worked.  Statistics on chat line effectiveness are hard to come by because they’re anonymous by design, but I worked ~170 hours last year and I know for a fact I was 1/2 of a team that saved one life, and find it plausible that I saved more.  I work on the text line, which for various reasons is less likely to attract people who are imminently suicidal, so I suspect the phone line workers are more effective.  By this measure, suicide hotlines are competitive with GiveWell’s top charities.

The complication is that the hotline doesn’t do this alone.  I gave myself half a life because I called in a rescue for a phone worker who contacted me via chat, but that success depended on emergency workers finding the person and a mental hospital to take him in.  Malaria nets don’t work alone either (they can’t solve famine or war), but this seems more like evaluating the cost of the nets without the cost of employees to distribute them.  On the other hand, some percentage of chats may talk people out of suicide without requiring an active rescue.  If I help a person form a plan to keep themselves safe until the urge passes, that’s incredibly effective.

The other way to look at it is what would people pay for the service.  My gut feeling is that the service I provide is more valuable than anything the visitors could buy with $20*.  The most comparable services, therapy and psychiatric visits, start at $60/hour.  Crisis lines are not a substitute for psychiatry or counseling, but a marginal hour of chatting may be a reasonable substitute for an hour of either, given how much of their sessions is empathetic listening.    Even if hotline workers are not as effective at listening because they are lower status, that’s still substantial savings.  Plus we get a good chunk of people are uncomfortable talking to a real professional because they are so high status, but feel okay talking to us.  On the other hand, I’m pretty sure most of the bottom billion would take the $20, or even $2, over an hour talking with me.  Competitive within the sphere of 1st world interventions is not the same as competitive.

Still, that’s a much higher effectiveness rate than I was anticipating.  And it manages to hit all three of my criteria above (for people who are good at listening but don’t do it professionally), which is a pretty neat trick.  Unfortunately it does not work for Kuhn’s use case at all, since he was looking for things EAers could do as a group on an ad hoc basis.  I suspect this is not a coincidence.

*Testing this directly would be hard, since there’s nothing to stop someone who wants two hours of chatting to say they want five, but will accept two + $60.

Is Nicotine Harmful?

Tobacco is so definitely harmful  I’m not even going to cite a source for that statement.  But tobacco contains a lot more chemicals than just nicotine.  TobaccoHarmReduction.org says nicotine isn’t harmful, but TobaccoHarmReduction.org also says nicotine isn’t addictive, so I’m not giving them a lot of credit as a source.  Wikipedia also says pretty nice things about nicotine, but exactly how nice seems to depend on what day I check.  The page appears to be edited a lot, and sometimes claims it isn’t addictive.   So I’m going to fact check Wikipedia very carefully here.

Let’s get some basic things out of the way.  Nicotine is addictive to at least a certain percentage of the population. You can see that in science or in anyone you’ve ever watched try to quit smoking with and without the aid of nicotine supplements.  It is probably true that propensity to nicotine addiction varies in the population, and some people can try it a few times or even use regularly without becoming addicted, the same way opiates are insanely addictive to some people and I actively dislike them.  But most people with that propensity won’t ever start using tobacco because smoking is disgusting and if your brain doesn’t make you do it, you won’t.

Nicotine imitates choline in some but not all choline receptors (conveniently, the ones it affects are called nicotinic receptors).  Neurotransmitters are weird and powerful and we don’t fully understand them.  At best, nicotine could be in the same category as medications meant to treat depression, which have some costs and some benefits, all of which vary widely between individuals, and whether a given person is better off with or without it depends heavily on their exact mix of genetics and current environment.

Nicotine is poisonous in large enough quantities.  This is not necessarily damning: lots of things are poisonous in large doses including vitamin A, which has vitamin right in the name.

Which one will be your last?
Which one will be your last?

More to the point, nicotine is poisonous because it imitates choline, and in large doses completely borks that system.  This is not entirely dissimilar to the way SSRIs (commonly used as anti-depressants) can in large doses cause serotonin syndrome, and the same mechanism that causes that makes SSRIs incredibly useful for treating depression.*  Coincidentally, nicotine maybe also treats depression.

Nicotine promotes the growth of new blood vessels.  If you have just had an injury this could be good thing (although I found no data on nicotine specifically, and tobacco is definitely bad for recovery), but it also makes it easier for tumors to feed themselves, which is extremely bad.  It may also lead to hardening of existing blood vessels, which is pretty much always bad.

This may or may not be related to nicotine’s ability to temporarily raise blood pressure.  I would super like to tell you if or how they are related or at least if they are happening on the same time scale, but I could not find a primary source that measured the immediate cardiac of nicotine (as opposed to tobacco) with a sample size of more than 16. There are lots of secondary sources that say the increase in blood pressure/narrowing of capillaries is immediate, but they seem to be scare monger sites against nicotine use for harm reduction and don’t draw a strong distinction between tobacco and nicotine.  On its own this is worrisome only if it pushes your blood pressure to problematic levels, but if the process also leads to permanent hardening of blood vessels, it’s pretty concerning.

Nicotine also has some cognition boosting effects (even in people with Alzheimers)** similar to caffeine, appears to either partially treat schizophrenia or reduce the really awful side effects of anti-psychotic, and maybe Parkinson’s as well.

Based on this, I’m pretty confident that we should be investigating nicotine-derived treatments for a number of issues, and if I get Alzheimers or Parkinsons I will probably pick up a patch the next day.  But I still have serious concerns about its addictiveness that  would keep me from using it as an everyday cognition enhancer.  But I abstain from caffeine almost 100% of the time, so clearly I’m on the low side of risk tolerance in this area.

*Probably.  No one actually knows how SSRIs help.

**You remember last month when a study came out suggesting anti-cholinergics increased propensity for dementia, and I complained that they only studied drugs that affected muscarinic receptors, not nicotinic, so drugs inhibiting nicotinic receptors might be fine?  This would suggest I was wrong.