Tag: effectivealtruism

Open access journals

Scientific research is distributed in journals, a system which has a number of flaws, one of which is it is expensive.  Journals charge authors to publish their articles, readers to read the articles, and advertisers for space in the journals. This smells like bullshit before you know that both publication and access fees are often paid for out of government grants, with the second most popular source being “companies that want you to buy their product based on the publication.”  It’s why I’m often forced to work from abstracts, rather than full journal articles.  I can get the authors’ conclusions from abstracts, but they rarely contain enough information to evaluate the experimental methodology.  The US government has made various efforts at enforcing “open access” policies, which would force research funded by public money to be accessible to the public, but they’ve always been defanged.

The system persists because publishing is a prestige based system.  Scientists are most rewarded for publishing in the most respected journals (in biology that’s Cell, Nature, and Science), none of which are open access, and have no incentive to be as long as they are the first choice for scientists.  An individual scientist can make a principled stand and insist on publishing in open access journals, and I’ve known some who’ve done it.  After they get tenure. Before then, they can’t afford the risk that some committee member who still thinks the internet is a dump truck will take publishing in a less glamorous open access journal as a sign of failure.

But not all research is funded by the government or for-profit enterprises.  The Gates Foundation has just declared that any research they fund must be published under a creative commons license.   They also require the underlying data to be publicly available, which might be even more significant.  It’s not clear to me how this will play out: maybe a bunch of awesome Gates-funded research will be publicly available.  Maybe promising young academics will refuse to take Gates money (although given the relative availability of talented academics and money, they’re probably replaceable).  Maybe this will start a marginal revolution of ever higher prestige journals going open access, giving the public access to additional non-Gates research as well.

Either way, I think the Gates Foundation did a really good thing here, and I really want to see what happens.

Harm mitigation vs. cure

Scott Alexander has a very good post up about semantics and gender, which you should read in its entirety even though it is very long.  I have nothing to add to his main thesis, but there is a cute little anecdote about a woman with OCD whose life was nearly ruined by her fear she’d left the hair dryer plugged in, no matter how many times she checked it or how far she was from her house.  She was on the verge of living on SSDI for life despite trying every therapy and medication in the book.

Finally, a psychiatrist suggested she keep the hair dryer with her.  This transformed “checking if the hair dryer is unplugged” from a 40 minute task (to drive home and back) to a 2 second one.   The psychiatrists at the hospital were divided on this.  Scott doesn’t specify, but I assume the argument against was that you have to rip the problem out by its roots.  OCD is anxiety in search of a cause and if you assuage this one she’ll just find something new to worry about, and if you keep treating the symptoms she’ll end up loading her car with every appliance she owns every day.

This strain of thought is not baseless, and I think it’s important to keep in mind when developing population-level guidelines for treatment.  I also think that any doctor that argues that hairdryer therapy for this particular woman should be sent to a reeducation camp, because

  1. it worked, so shut up
  2. root-cause psychiatry and psychology had their shot.  They had in fact emptied an entire clip into the problem and had no more bullets.  At that point, unless something is actively and immediately harmful, they need to gracefully exit the field.

There’s also the matter that the problem was not just “she felt bad”, but also “she’s about to lose her job.”  Jobs are important.  They provide the money and health insurance that let you go to fancy psychiatrists that don’t believe in hair dryers.  Even if you’re independently wealthy, jobs are important psychologically and socially.  SSDI is oriented around the problems of factory workers who lost limbs, and really does not work well with people with high-variance mental disabilities, who can do some work some of the time but cannot function at the level society demands.   If hair dryer therapy does nothing more than buy you six more months before she experiences a negative shock from which it is very difficult to recover, that’s actually pretty good.

Even more than that, I think the psychiatrists are underestimating palliative care.  I absolutely do not think overcoming mental disorders is a matter of will power or wanting it enough, but I do believe that human brain and body are very good at repairing themselves, and that this implies that any non-traumatic disorder that persists must be in a self-reinforcing loop.  Chronic pain lowers your pain tolerance, worry that something will trigger a panic attack makes you anxious.  Pain and depression are mutually reinforcing.  Mental Illness saps your energy and cope and time, which makes it difficult to seek and follow through on treatment.  “Palliative” care like pain killers and anti-depressants give people energy they can use to heal, which is why oncologists sometimes prescribe them. For big scary things we don’t know how to cure, freeing up the patient’s own resources may be the most helpful thing we can do.

Meanwhile, my EA group is debating this article on charitable giving, which articulates something I’ve been trying to say for a long time, and not just about charities.  American capitalism is set up to encourage shooting the moon.  We’ve carried that over to charity, trying to find The One Simple Trick To End Poverty.  That is toxic on many levels: it doesn’t exist, we can’t measure finely enough to detect it, the most effective thing now is not going to be most effective thing after we’ve done it to death, finding things that work is a massive expense in its own right, and oh, poverty is a system of many millions of moving parts.  Waiting for the silver bullet is doomed and immoral, and perhaps a bit like refusing to let this patient adopt a hair dryer as her constant companion.  Yes, treating the root cause would be better, but it’s not on the table.

But that doesn’t mean we can stop doing RCTs and start firehosing money again.  It is tragically easy for aid to make things worse.  This is what the anti-hair dryerists were afraid of: that putting a salve on the symptoms will make the root problem, and thus eventually the symptoms, worse.  Possibly much worse.  Most people who gave food aid did it with the best of intentions: even the American agricorp executives who benefited probably convinced themselves this was a way of giving back .

So: you can’t tell people it’s cure or nothing, but you also have to be really careful with palliative care.  It’s even harder for charity, because you have to consider the externalities, not just the affect on the recipients.  This is one good argument for donating local, even if distant recipients are dramatically worse off: you will naturally get and give more feedback on a local charity’s effectiveness.  It’s also a very good argument for restricting yourself to charities that measure their effectiveness, almost independent of what the measurement says.  When we don’t know what to do, gathering new data is a good in and of itself.  And small pareto improvements may eventually free up the resources for societies to heal themselves.

Intro to EA/Giving What I Should

Update 11/19/14: I had the format of the pledge wrong.  Read Jonathan’s correction here, more comments on the bottom of this post.

People often ask me what EA is.  I tried describing it as “trying to make charity as effective as possible”, but that’s kind of implies that everyone not in EA is not doing that.  Like evidence based medicine, it’s either obviously correct or horribly mislabled.  I can say “we believe in randomized control trials”, but a lot of what I do in the local group is push for everything except RCTs.  And my favorite part of GiveWell is not their research into existing charities, although that is excellent for specific problems, but their deliberate seed funding of projects to find the best way to approach unsolved problems.  That they picked something I’m passionate about (criminal justice) is a bonus, but the principle would stand either way.  So I think that I will describe EA, or at least my interest in EA, as “generating and advertising the evidence for evidence based charity.”

Recently my EA group talked to Jonathan Courtney from Giving What We Can.  Giving What We Can has two functions: assessing charities, and taking and monitoring pledges individuals make to give 10% of their income.  On charity assesment, they’re basically Pepsi to GiveWell’s Coke.  They tend to agree with each other’s research but make slightly different recommendations based on differences in their beliefs about the future.*  GWWC also encourages people to register a pledge to donate 10% of their lifetime pre-tax income to what they (the pledger) believes to be the most effective charities for helping developing countries.   The pledge is not legally binding, and deliberately refers to lifetime income and not income in a given year (so you can consumption smooth), but they do ask people to log their giving, and perform audits of pledgers at the end of the year.

My EA group had a really great discussion about this, and my tentative opinion is:  it’s hard to fault them for what they’re doing, but I sure hope they’re an incremental step. GWWC’s main selling point, simplicity, is also an enormous limitation.

GWWC’s main goal is to head off decision paralysis by giving you a simple number.  A subset of this is giving people who feel equally guilty/anxious about retaining 2% and 45% of their earnings because even 2% is better than living in the Democratic Republic of the Congo, but really don’t want to live on 2% of their income so default to giving nothing.  Solving that problem is not insubstantial, and I give them credit for that.

The downside is that 10% is unlikely to be the best number for everyone.  If you’re childless, in perfect health, and earn $5 million a year for 40 years and have no extenuating circumstances, I think you should give more than 10%.  If you take a 50% paycut to work for a good cause**, I think you get to count all of it.  How does volunteering count?  How is that changed by whether it’s Effective Volunteering or Personal Satisfaction Volunteering?  What if you’re receiving a ton of charitable and government aid for your disabled child?

On the other side of it, I worry about the emphasis on money.  Lots of things require mass action that can’t be bought- like the Ferguson protests, or lobbying for net neutrality.  Western society has a personal connection deficit, and one of my big concerns with EA as a whole is that it commodifies altruism and in doing worsens the connection deficit.

Lastly, there is fear.  I have been out of work for five months due to dental work, and it could easily be another two months before I can start even part time work.  I was originally told my (astonishing) disability insurance (that I’m incredibly lucky to have) would cover at most a week of of that time, because “seriously, no one gets that much time for that small a problem”.  I eventually prevailed***- last week.  That’s 4.5 months without a paycheck, plus the immense cost of the dental and medical care I’ve received.  If I hadn’t had the money to wait that out- and to know I’d survive even if I was never paid- I would have had to handle it much differently, and I honestly don’t know how.  Beg from my parents (an option very few people have)?  Drug myself up to the gills so I could show up at the office, at the cost of, at best, a much longer recovery, and at worst never truly getting better?  Debt?  Forgo the physical therapy and IV nutrition, at the cost of, at best, a much longer recovery, and at worst never truly getting better? Even if I never actually had to do these things, just worrying about them would have been a huge tax on me when I had very little to spare.  At a gut level, I see this pledge as a threat to the sense of safety my savings gave me.

Proponents frequently counter with “It’s not legally binding, you can always withdraw.”  But I don’t want to take a pledge on the condition I don’t have to uphold it.  That seems wrong.

What I find a lot more appealing is a private consumption tax.  For every dollar I spend on things, or things excluding certain expenses, or all things after a certain amount of money, I have to donate.  This fits really well with how I donate now, which is often based on a need to restore balance.  I use the library a lot, so I give them some money.  When I got my shiny new job, I found a family on Modest Needs that needed money to move to a better job.  When I got expensive designer antibiotics for SIBO, for which even a diagnosis is a sign of privilege, I donated to a food bank.  After a lot of dental care I donated to families needing dental care on Modest Needs****.  When I’m feeling especially privileged about how my parents supported my education I donate to Treehouse, which is dedicated to giving foster kids the same support I had.  And when I just generally feel rich or need to use up my remaining employer match, I give to GiveDirectly*****.  These sound a lot like indulgences, but indulgences buy off the guilt from things you shouldn’t have done.  I don’t think anyone thinks I shouldn’t have access to the medical care or library books I do, the problem is that other people don’t have them.

These aren’t exactly consumption taxes.  Often what I give is based on what I didn’t have to pay because I have amazing insurance.  Actually, that feels really fair to me.  There’s an overwhelming amount of evidence that being well off is actually cheaper than being poor, in part for exactly the reasons I listed in the fear paragraph.  If my savings (that I was able to accrue due to an incredible amount of privilege) saved me a bunch of credit card debt, paying half of the hypothetical interest on that debt seems pretty fair, and avoids the “I’m punished for being successful.”  I’m not being punished, I’m just not getting to keep all the gains for something that was partially given to me out of luck.

Okay, so some sort of sharing of the benefits of privilege (for when I get things everyone deserves, but many people are denied), generally going to share that specific privilege with others, plus a consumption tax, because living in America is a privilege in ways I will never fully consciously comprehend.  Either a low general consumption tax, or a higher tax on luxuries.  This seems right.  I will need to figure out exact numbers and how I will calculate spending, but that is a practical problem.

*E.g. GiveWell no longer recommends giving to the Against Malaria Foundation because they already have a large stockpile they’re unable to move without lowering their ethical standards, GWWC recommends them because they believe a larger stockpile will serve as an incentive to make partners meet their ethical standards.  GiveWell doesn’t even advise against the AMF, they just believe there are three charities that are better.  Both sides sound plausible, and there’s no way to know who’s right without a control universe.

**And you’re doing it because you believe it’s the best way to help the world, not because it’s a better work environment.  There are EA charities devoted to this question.

***Despite a dentist so incompetent at paperwork I was beginning to suspect malice.

*****Although I haven’t for this round, possibly because none of the previous care actually helped

*****GiveDirectly ends up getting by far the most financial support but the least thought.

Update 11/19/14: it turns out the pledge is 10% every year, the year you earn it, not accumulated over time.  In defiance of all rationality, this makes me feel less anxious about it.  I need to give this more thought and then it probably gets it’s own full entry.

Rededication

When I started this blog, it was intended essentially as prep for a career as a psychiatric NP.  But let’s go further back.  When I was 12 a search for air conditioning at the national zoo led me to dedicate myself to become a behavioral biologist. I worked on the academia-research track for 10 years, until I realized academia was terrible (and also I didn’t get in to grad school).  I’d picked up a CS degree to facilitate the biology, and for lack of something better to do I jumped onto the programming track.  I found parts of it I loved to succeed at, but was never happy long term.*  After another company failed to make me happy, I decided the problem was me and started looking for a new track to jump to, which is how I got to psychiatry.

It’s only 10 months since I started the blog but almost exactly a year since I made that decision.  I spent five of those months not working, recovering from/prepping for dental surgery (and there are a few more months to come).  This was painful and I would have rather never had these problems, but the enforced break did give me some distance and some time to think.  Combined with my volunteer work and reading, this is what I’ve figured out:

  1. I really, really want to improve adolescent mental health.
  2. Psychiatrist, or any other mental health job, or any job at all, has its downsides.
  3. Programming is a rare and valuable skill it would be silly to just throw away.  Plus it really is fun when it works.
  4. I have gotten used to finding programming jobs by throwing a rock and waiting.  There’s a lot of them and I interview well.  But there is no plug and play position that uses my skills to accomplish the things I want to accomplish.
  5. So I will need to make my own.
  6. Beyond mental health, my goals are helping people take care of themselves.  I don’t want to detail a particular vitamin, I want to teach people how to research their own vitamins.  I definitely can’t do individual doctor recommendations, but I can help people evaluate their own doctors.

In parallel to this, I joined the local Effective Altruism discussion group back in April, and within six months rose to power/got conned into doing 1/3 of the organizational work.  I don’t know where I’m going with EA, which as a philosophy applies to anything but as a movement seems to have almost no overlap with the goals I’ve listed above.  EA’s big pushes have been in third world poverty (which I care about, but the only useful thing I have to give them is money), animal suffering (which our meeting made me care about enough to give up factory farmed animal products, but still doesn’t fit as a calling), and existential threats like meteors and malicious AI (which intellectually I think are important but I cannot bring myself to have an emotional response about).   EA is expanding, which is wonderful, but by design they work on a very large scale, and in some ways what I want to do is very small.  And yet, I think it is really important I keep doing it.  Even if it all it provides is a social group that thinks saving the world is a good and achievable, that is really valuable.  And I think it might be more than that.

So my plan for now is to see what I can do with the resources I have.  My primary job is having dental surgery, and that limits my moonlighting options.  But I can read, I write this, I can go to and organize EA events (even if I have to leave my own event early from pain and exhaustion).  I’ve done some work at crisis chat, and there was a brief window in which I was even able to program.*  I’m talking to a local charity that works at the intersection of childhood poverty and education about their best practices, and I’m hoping to turn that into a lesson about how to give when GiveWell doesn’t have the answer.  I have an idea for an Android app that looks pretty achievable but doesn’t exist yet, which I’m excited about.

Long term, I want to find a programming job on a project I care about, and I want to be in a position to design, not just implement.   Between that, EA, and my own projects I’m hopeful something awesome will emerge.  My thinking here is highly influenced by The Economy of Cities, which describes that new industries arise from small incremental changes and combinations in old ones.  I think that can work on a personal scale too.

The main implications for the blog are that video game posts will now be considered on topic, and I will stop feeling vaguely guilty for the low number of hard core medical posts.

*This window opened because my pain level was so much lower after the surgery.  It closed when the surgical incision in my gums failed to heal/my jaw bone started growing out through my gums, which is intensely painful.  But we had a good thing going for a week.

I Swallowed A Bug

Here are the arguments in favor of bug eating:
  1. Relative to traditional meats (chicken, cow, pig, sheep), bugs require many fewer resources. (This and all future comparisons will be done on a per unit edible protein basis, rather than per unit animal weight)
  2. Bugs have more trace nutrients and less fat.
  3. We care less about bug suffering than chordate suffering.  Possibly we don’t care at all.
Here are the arguments against bug eating:
  1. Bugs are gross.
Here is where 28 years of being unable to digest food becomes a super power.  Most food and essentially all protein sources strike me as gross.  So bugs aren’t that much worse than any other source, and I have a lot of practice overcoming disgust in order to eat.
My friend Brian held a bug eating night.  He explains the rationale and practicalities pretty well, so I’ll restrict myself to talking about my personal experience, which can be summed up as “a million times better than I thought it would be.”
For background: I’m trying to train myself to eat meat.  This quarter I’ve taken to cutting off slivers of salmon (for the omega-3s) and more recently duck (which is a wonderful combination of delicious when dead and malicious towards conspecifics while alive, which makes it feel a little more moral) and sauteing them until they’re charred through.  When I say slivers, I mean slivers.  I’ve been working on duck for a week and I eat at most two fingernail-clipping sized bits, prepared and eaten separately.  For salmon I might do as much as 1/2 the volume of my pinky. I have small hands.
I pre-committed to eating at least one cricket, but that was all.  The other bug was supposed to be waxworms, and waxworms are squishy.  I don’t do squishy even when it’s not bugs.  And I was going to be extremely proud of myself for just that one cricket.  Eating a new anything is a big deal for me, and it takes time to adjust.
When the moment came I ate several (along with some HCl pills), and walked away, supremely satisfied in myself for trying a new thing and not freaking out about it.  And then I started getting that itch to eat more, that means the thing in front of me has some trace nutrient I’m short on.    So I did.  And I asked for some to take home.
I got off easy on the waxworms because they were burnt so badly they ended up not serving them.  But there were mealworms.  Mealworms were served as taco fillings, but as it turns out I’d rather eat a bug than a taco (the variation in textures freaks me out).  Mealworms were wetter and more fibrous, so you had to chew them more (although don’t skimp on chewing crickets, catching a leg in your throat feels gross).  The had their own taste, which I didn’t care for at first but could probably grow to be okay with.  I think I like it better than chicken (aka bad tofu) and beef, but not as much as duck or pork, and by pork I mean bacon.
At the end of the night I had a slight stomach ache.  I’d brought HCl but no digestive enzymes, and my stomach was clearly struggling to keep up.  But I get that with all new foods and any significant amount of protein, so I don’t hold it against the bugs.
Some of ease of eating was undoubtedly the environment.  Brian, John, and their blogless roommates have a pre-existing tradition of communal meals that I love, and that makes eating easier.  it was also supremely gratifying to have other people share my attitude that the food in front of us was gross but we were going to eat it anyway.  Constantly being the only one that thinks that gets really lonely.  I flinched a little bit when I went to eat the cricket leftovers this morning.  But then I ate them, and it was fine.  Definitely better than duck, and duck is delicious.
Honestly, the biggest down side is that for all that bugs take many fewer resources than chordate meat, they are currently much more expensive.  One pound of edible cricket is ~$13/pound, which is as much as the grass fed free range humanely cuddled duck I get at the fancy grocery store.  I could probably grow them at home at essentially no cost, since they can live on food waste I would otherwise toss, but I’m not yet committed enough to deal with the noise.  But even at this price I plan on eating more bugs.

Book Review: The Child Catchers

I’ve used the words “calling” or “purpose” a few times on this blog now.  I’m not Christian, but I was raised in a Christian home in a Christian culture, and my concept of a calling is clearly steeped in that tradition.

So for me, reading The Child Catchers (Kathryn Joyce) was mostly a cautionary tale about letting a Call override the rest of your brain.  Step by step, Joyce takes you through how a large group of people who fervently believed they were doing not only the right thing, but the best thing, the thing they had been called by their God to do, destroyed the lives of countless children and ripped about whole societies.  Some of it came from privilege/White Man’s Burden beliefs, but some of it was just that they had bad or insufficient information.

On a practical level, non-foster-care adoption seems to have the trouble as the pharmaceutical industry: we wanted something (lifesaving medicine, care for abandoned children) but didn’t want to pay for it, so we handed the bill to the deepest pocket around (pharma companies, adoptive parents), and then we got mad when the system inevitably bent towards their point of view.  A lot of the problems in adoption stem from that most systems match a parent with a specific child and then start verifying if the child is available to be adopted.  Or the adoptive parents start picking up the mother’s expenses before birth.  The very impulse that will make these prospective parents good parents- the belief that this is their child– is incredibly destructive at this stage, and the fact that they’re required to invest a lot of money makes it worse.  It inevitably leads people to view searches for biological extended family as obstacles, or pressure a birth mother to “keep her word” and surrender the infant.  Even if they haven’t bonded with that specific child (which I would find worrying), they may not have the money to try again.  That’s just not fair.

Rwanda has chosen a different tactic.  International families go on a waiting list.  The Rwandan government checks all potentially eligible children, which involves looking for biological family who might take in the child and making sure the birth mother wasn’t coerced, or finding an unrelated local family that would like to adopt.  By the time an international adoptive family is contacted, the chances of something going wrong are minuscule.

Callings are important, but they need to be reality checked.  That might be my new Effective Altruism slogan.

Optimal hammering time

Last month I watched Home, a documentary about a charity offering homes to poor people (maybe just poor single mothers?) at a significant discount.  It focuses specifically on one woman who applied for help and the case worker assigned to her.   Watching it, I was struck by how much the case worker defined her goal as getting this woman this house, rather than helping her, or giving the house to the person to whom it would do the most good.   I thought it was a case of cargo cult, another friend described it as a cultural fixation on helping the poor by making them middle class rather than making being poor bearable.  Either way, it seemed to me like an example of misapplied charity.

Last week I started training to volunteer for a crisis hotline.  One of the things they drill into us is that most callers have a lot of problems we can’t solve.  We have very few tools:  occasionally we make referrals if they have certain  specific issues (e.g.  we’ll offer LGBTQ kids the number for the Trevor Project, or suggest they call 211 to get referrals to programs that could help their material problems), but mostly we listen.  That is what we do.  We are to apply that one tool as best we can.  If it helps, great.  If not, we end the conversation anyway.  There’s a weird tension between “Anything is a crisis if it feels like one to you.  We’re here to listen to anyone, any time, for any reason.”  and “Some people are just black holes, cut them off after 45 minutes.  But they can call back tomorrow.”

The only way I can justify this is by thinking “We have one tool.  It’s impossible to know if this tool is what this person needs.  Even when it is, there are diminishing returns to using the tool.  After 45 minutes, the marginal returns to further use are 0.  Therefore, treating everyone as receptive at minute 0 and no one as receptive at minute 45 is the optimal use of our time.”

I still think the case worker in the movie was pushing her tool too hard, and not listening when the person she was nominally trying to help brought up very reasonable concerns.  But I’m a lot more sympathetic to the myopia now.