Pros and Cons of boycotting paid Chat GPT 2023-03-18T08:50:48.753Z
Remote Health Centers In Uganda - a cost effective intervention? 2023-02-27T05:27:47.916Z
Should all RCTs now be Intervention X Vs. Cash Transfer? 2022-12-02T13:47:44.489Z


Comment by NickLaing on Comparing Health Interventions in Colombia and Nigeria: Which are More Effective and by How Much? · 2023-03-25T05:56:44.107Z · EA · GW

Great article really nice job!

I really like your table at the end, and I'd like to challenge a few of your estimates there. I think we ignore and underrate "hometown advantage" (to steal a sports phase). This is just my limited experience and weak intuition talking - it's very hard to put numbers on comparative advantage.

Part of the reason I think we ignore hometown advantage  that most EAs interested in global development live in such rich countries, that the multiplier for "targeting the most vulnerable" as you put it might be  so high, perhaps 50-100x for work outside their countr rather than 10x as in your case which makes hometown comparative advantages largely irrelevant. 

I love the way you put "8x multiplier" for Local network and credentials leading to a greater influence and leverage within the Colombian government. I agree with this strongly.

To that I would potentially add other multipliers for working in Columbia
- Ability to leverage language and deep cultural understanding to be more effective                       x 2
- Don't waste time understanding the local landscape (health system/ economy/politcal system) x 1.5
- Use local knowledge and networks to identify the most tractable/neglected issues                      x 1.5
- Happiness/contentment of being closer to home increasing productivity                                         x 1.5

You might also consider poorer countries around you (e.g. Bolivia) where you would retain some of these competitive advantages, while also being able to target more vulnerable populations.

A couple of other comments too

I think doing a masters or something abroad, then coming back and working in Columbia might be a good option. I don't see the connection between studying abroad and working in another country

Also I don't really understand your "Ability to choose the most effective organisations" multiplier in your chart. Why would this increase outside of Columbia? Also you could start your own ;).

Comment by NickLaing on Can we trust wellbeing surveys? A pilot study of comparability, linearity, and neutrality · 2023-03-23T12:41:43.756Z · EA · GW

Not only courtesy, but also future hope (which I think may be more important here).

Yeah it's really hard to test. I think validity of point estimates are pretty reasonable for wellbeing surveys and I agree with most of the reasoning on this post.

It's very had to test those biases ethically, but probably possible. Not in this kind of survey anyway.

The reasons he gave  for not being worried about those biases were not unreasonable, but based on flimsy evidence. Especially future hope bias which may not have been researched at all.

Comment by NickLaing on Estimation for sanity checks · 2023-03-23T02:28:26.416Z · EA · GW

Amazing I think this is a great (if fairly intuitive) concept, and I feel like this post might deserve more attention.

I think I do this quite a lot, but I haven't seen this crystallised so well before. I think we should all be sanity checking all the time.

I did have to sanity check one of your sanity checks though. Some "Neglected diseases" (as defined by the WHO) actually affect lots of people. E.g. Shistosomiasis infects something like 340 million people and might cause something like 2 million DALYs a year, which is hardly chicken feed ;)

Also am honoured (sort of) that you included my analysis of OneDay Health in your examples haha

Comment by NickLaing on My Objections to "We’re All Gonna Die with Eliezer Yudkowsky" · 2023-03-21T17:41:43.044Z · EA · GW

Thanks so much, this was unusually clearly written, with a small percentage of technicality a global health chump like me couldn't understand, but I still could understand most of it. Please write more!

My initial reaction is, let's assume you are right and Alignment is nowhere near as difficult as Yudkowsky claims.

This might not be relevant to your point that alignment might not be so hard, but it seemed like your arguments assume that the people making the AI are shooting for alignment, not misalignment. 

For example your comment As far as I can tell, the answer is: don't reward your AIs for taking bad actions.

What if someone does decide t reward it for that? Then do your optimistic arguments still hold? Maybe this is outside the scope of your points!


Comment by NickLaing on Cooperative or Competitive Altruism, and Antisocial Counterfactuals · 2023-03-20T19:33:54.643Z · EA · GW

I really like this, thanks!

Another point to perhaps add (not well formed thought) is that 2 groups may be doing the exact same thing with the exact same outcome (say 2 vaccine companies), but because they have such different funding sources and/or political influence  there remains enormous counterfactual good.

For example in Covid, many countries for political reasons almost "had" to have their own vaccine so they could produce the vaccine themselves and garner trust in the population. I would argue that none of America, China and Russia would have freely accepted each other's vaccines, so they had to research and produce their own even if it didn't make  economic sense. The counterfactual value was their not because the vaccine was "needed" in a perfect world, but because it was needed in the weird geopolitcal setup that happens to exist. If those countries hadn't invented and produced their own vaccines, there would have been huge resistance in importing one from another country. Even if it was allowed and promoted how many Americans would have accepted using sinovax?

OR 2 NGOs could do the same thing (e.g. giving out bednets), but have completely different sources of funding. One could be funded by USAID and the other by DIFID. It might be theoretically inefficient to have 2 NGOs doing the same thing, but in reality they do double the good and distribute twice  as many nets because their sources of income don't overlap at all.

The world is complicated

I didn't express this so well but I hope you get the jist....

Comment by NickLaing on EA for Christians 2023 Annual Conference | London, 14-15 April · 2023-03-20T18:57:27.423Z · EA · GW

This is fantastic! I will be there at the online academic workshop (as long as I remember)

Comment by NickLaing on Pros and Cons of boycotting paid Chat GPT · 2023-03-18T18:29:22.109Z · EA · GW

Gotcha thanks that makes sense.

Comment by NickLaing on Pros and Cons of boycotting paid Chat GPT · 2023-03-18T17:53:23.085Z · EA · GW

I love this thanks!

One thing, I don't understand how a boycott of one paid AI takes us out of the conversation. Why do we need the LLMs t help us double down on communication?

Do you mean we need to show people the LLMs dodgy mistakes to help our argument?

Comment by NickLaing on Pros and Cons of boycotting paid Chat GPT · 2023-03-18T09:42:26.955Z · EA · GW

Great points thanks so much, agree with almost all of it!

We've obviously had different experience of activists! I have a lot of activist friends, and my first instincts when I think of activists are people who

1. Understand the issue they are campaigning for extremely well, without  
2. Have a clear focus and goal that they want to achieve
2. Are beholden to their ideology yes but not to any political party because they know political tides change and becoming partisan won't help their cause

Although I definitely know a few who fit your instincts pretty well ;)

That's a really good point about the AI policy experts not being sure where to aim their efforts, so how would activists know where to aim theirs? Effective traditional activism needs clear targets and outcomes. A couple of points on the slightly more positive end supporting activism.

  1. At this early stage we are at where very few people are even aware of the potential of AI risk, could raising public awareness be a legitimate purpose to actvism? Obviously when most people are aware and on board with the risk, then you need the effectiveness at changing policy you discussed.
  2. AI activists might be more likely to be EA aligned, so optimistically more likely to be in that small percentage of more focused and successful activists?
Comment by NickLaing on Why I'm suss on wellbeing surveys · 2023-03-18T09:16:31.342Z · EA · GW

First I don't agree with your assumption that hunter gatherers might are likely their wellbeing the same as ours now. The best proxy we might have for "hunter gatherers" today is poorer, less developed countries. People in those  countries have on average have lower average wellbeing than richer countries. My assumption would be in the other direction, that hunter gatherers would most likely rate their wellbeing lower than we would today. 

I don't really understand your argument in this paragraph "Is the difference in WELLBYs significant enough to justify the hundreds of trillions of dollars and hours of effort and suffering (and negative WELLBYs) that have gone (and continue to go) into technological, economic and cultural development to give us our modern lives? 

The answer surely is a resounding yes! If the hunter gatherers rated their wellbeing lower than us and our wellbeing has improved, then surely all that effort into "technological economic and cultural development" is completely worth it!

Comment by NickLaing on Pros and Cons of boycotting paid Chat GPT · 2023-03-18T09:03:20.525Z · EA · GW

Wow that's a great point Sanjay I love it and agree! I've even thought about writing something about AI activism like "Does AI safety need activists as much as alignment researchers?" but its not my field. It's weird to me that there doesn't seem to already be a strong AI safety activist movement. I feel like the EA community supports activism fairly well, but perhaps a lot of the skills and personal characteristics of those working within the AI safety community don't lean in the activist direction? Don't know nearly enough about it to be honest.

Comment by NickLaing on Can we trust wellbeing surveys? A pilot study of comparability, linearity, and neutrality · 2023-03-18T07:24:52.049Z · EA · GW

Thanks for this, it is interesting and important.

I don't however think these issues with point estimates are biggest problem with wellbeing research, these issues are important yes for calibration, but a bigger problem is whether reported increases in wellbeing after an intervention are real or biased. I have said this before, apologies for being a stuck record.

These two biases which don't necessarily affect point estimates (like you discuss above) but affect before and after measurements...

  1. Demand/ courtesy bias. Giving higher wellbeing score after the intervention because you think that is what the researcher wants.

  2. "Future hope" bias. Giving higher scores after any intervention, thinking (often rationally and correctly) that the positive report will make you more likely to get other, even different types of help in future. This could be a huge problem in surveys among the poor but there's close to no research on it.

These might be hard to research and are undrafted, but I think it is important to try.

We should keep in mind though these two bias don't only affect wellbeing surveys, but to some degree any self reported survey, for example the majority of give directly's data.

Comment by NickLaing on Legal Assistance for Victims of AI · 2023-03-17T21:37:52.362Z · EA · GW

@Jason  seems in your area any thoughts?

Comment by NickLaing on Time Article Discussion - "Effective Altruist Leaders Were Repeatedly Warned About Sam Bankman-Fried Years Before FTX Collapsed" · 2023-03-17T06:39:18.172Z · EA · GW

@Jeff Kaufman  technically you might be right that even if board members were voted in and were responsible to members, they wouldn't have to disclose their information of explain their actions. 

But if you are voted in and therefore formally accountable to members, you are likely to both feel obligated to explain things like this, and also be motivated to explain important goings on to keep your support to ensure you have a mandate in the community to stay on the board.

Whether we agree or disagree with boards being more democratic (a different question) assuming a board is voted in it's hard to imagine they wouldn't be far more likely to publicly explain their actions and face questions. 

I'm also often confused by this common argument I see on the EA forums that people might not have time, or might consider other things more important than responding to critical governance issues or decision making - I remember this argument touted on the open phil thread. It seems a convenient excuse for not publicly responding to issues, which seems like a key function of any management body. There may be other good legal or confidentiality reasons not to respond, but I find the "workingother things" or "not enough time" reasoning weak. 

Comment by NickLaing on Shutting Down the Lightcone Offices · 2023-03-15T19:13:51.178Z · EA · GW

Wow thanks so much for the reply I didn't expect that much detail and appreciate it. Thought leaders curating their own fame and sacrificing things (including other people) for it is expected to some degree, but some of this is more extreme than I would expect for the average famous person.

Will see if anyone perhaps closer to Will will rebuff this at all. 

Thanks again.

Comment by NickLaing on Shutting Down the Lightcone Offices · 2023-03-15T13:02:15.320Z · EA · GW

Thanks Jeroen that's a fair point I think it was weird too.

 Even if the wrong book was plugged though, it doesn't feel like a net harm activity though, and surely doesn't negate his good writing and speaking? I'm sure we'll hear more!

Comment by NickLaing on Shutting Down the Lightcone Offices · 2023-03-15T05:28:28.342Z · EA · GW

Thanks so much for bringing this degree of honesty, openness and detail about a decision this big. As someone not deeply embroiled in the longtermist/rationalist world your uncertainty about whether you and others are doing net harm vs good on the AI alignment front is prett chilling. I'm looking forward to responses, hoping the picture is not quite as bleak as you paint!

One question on something I do know a little about  (which could be answered in a couple of sentances or even perhaps a link). What's your issue with Will Mckaskill as a public intellectual? I've watched Ted talks, heard him do interviews etc. and he seemed on shallow thought to be a good advocate for EA stuff in general.

Comment by NickLaing on Shutting Down the Lightcone Offices · 2023-03-15T05:27:34.939Z · EA · GW

Thanks so much for bringing this degree of honesty, openness and detail about a decision this big. As someone not deeply embroiled in the longtermist/rationalist world your uncertainty about whether you and others are doing net harm vs good on the AI alignment front is prett chilling. I'm looking forward to responses, hoping the picture is not quite as bleak as you paint!

One question on something I do know a little about  (which could be answered in a couple of sentances or even perhaps a link). What's your issue with Will Mckaskill as a public intellectual? I've watched Ted talks, heard him do interviews etc. and he seemed on shallow thought to be a good advocate for EA stuff in general.

Comment by NickLaing on [Linkpost] Scott Alexander reacts to OpenAI's latest post · 2023-03-14T11:29:55.984Z · EA · GW

100% agree. 

 I like the analogy with Exon mobil, I think it's helpful to keep that comparison in mind.

I mentioned before that I don't think companies that work on AI should have a significant voice in the AI discourse, at least in the EA sphere - we can't control the public discourse.

The primary purpose  (maybe 80% + of their purpose) of a company is to make money, plain and simple. The job of their PR people is to garner public support through whichever means necessary. Often that is by sounding as reasonable as possible. Their press releases, blogs, podcasts etc. should be treated at worst as dangerous propaganda, at best as biased and compromised arguments.

Why then do we engage with their arguments so seriously? There are so many contrasting opinions on AI safety even among neutral researches that are hard to understand and important to engage with, why would we throw compromised perspectives in the mix?

I lean towards using these kinds of blogs to understand the plans of AI companies and to understand the arguments we need to counter in the public sphere, not as reasonable well thought out opinions by neutral people.

Comment by NickLaing on Suggestion: A workable romantic non-escalation policy for EA community builders · 2023-03-09T12:44:17.827Z · EA · GW

Thanks Jeff

Again there needs to be nuance. Weekly events surely wouldn't be included, and like I said below I think maybe a speaker could be off limits for the duration of EAGx but then no restrictions afterwards? 

I don't think those are concrete reasons not to apply it, just scenarios where it should be handled differently from the OP's original scenario

I agree there are so many potential scenarios it would be hard to be fair and consistant.

Comment by NickLaing on How many QALYs equate to a typical human life? · 2023-03-09T12:30:27.437Z · EA · GW

First even though the way they are calculated can be very different, in theory at least  I think the DALY should just be opposite of a QALY, so QALYs gained = DALYs averted (in practise roughly) for a given intervention

Thanks so much, I had the same question for my OneDay Health cost-effectiveness post and was unsure what to do.d

  • In the "Doing good better" book they used I think 37.5 QALYs to a life but I'm not sure where they got that from (maybe using age discounting and like you say all life is not lived in good health?)
  • For my OneDay Health calculation to be conservative I used 82 as close to the "global maximum realistic" life expectancy, which is where you take the life expectancy from a country like Hong Kong or Japan and use that. Now it's around 88 I think? The idea is that if every human is valued equally, this is the maximum realistic life expectancy given the best diet, medical care and other factors available 
  • For DALY calculations now WHO uses 92, projecting out to 2050. "The loss function is based on the frontier national life expectancy projected for the year 2050 by the World Population Prospects 2012 (UN Population Division, 2013), with a life expectancy at birth of 92 years."

But with all that said I'm not very helpful as I don't have a clear answer for you ;). I could be wrong but I don't think there's a completely standard way of doing it.

Comment by NickLaing on Suggestion: A workable romantic non-escalation policy for EA community builders · 2023-03-08T19:18:39.828Z · EA · GW

Oh, I interpreted it as clearly 2, 90 percent confident ;).

Comment by NickLaing on Suggestion: A workable romantic non-escalation policy for EA community builders · 2023-03-08T19:02:48.794Z · EA · GW

Thanks Jeff what makes you less convinced about applying it directly? Im not sure you laid out your issues with it? 100 percent agree it's only one small rule which only applies in limited contexts and doesn't solve what's probably the biggest problem which you laid out (dangerous power differentials unrelated to events) but I think it could make a small positive difference at least.

Yes there would have to be nuance and I would suspect if you were a speaker on a panel this role wouldn't apply. Or maybe just no romantic stuff during the conference itself for people with less of a power differential?

Comment by NickLaing on Suggestion: A workable romantic non-escalation policy for EA community builders · 2023-03-08T18:56:07.457Z · EA · GW

If you just announced the policy at the start of the event, wouldn't that make it clear enough for everyone?

Something like ...

" Hey, we know the facilitators are amazing and some of you will fall in love with them during the event, but for safety and community reasons we are sorry to inform everyone that we have a rule that they are off limits for 3 months after this events, and you are off limits to them. Please don't flirt with them too much or ask them on a date. We know this is a bit weird but we think it's probably for the best."

That was my first crack at it, but you get the picture :D

Comment by NickLaing on Open Thread: January — March 2023 · 2023-03-07T12:32:28.807Z · EA · GW

Gotcha. It's true it's not immediately obvious from google or chatGPTx.

Comment by NickLaing on Open Thread: January — March 2023 · 2023-03-07T09:15:19.133Z · EA · GW

Thanks Emre - simple question what are his current views, I'm assuming from what you are saying he is still pro infanticide in rare circumstances soon after birth?

Comment by NickLaing on After launch. How are CE charities progressing? · 2023-03-06T14:54:51.506Z · EA · GW

Nice one. The success rate is quite phenomenal - especially how committed the founders are to bringing their concepts to fruition. Your biggest strength might be in selecting people even more than selecting causes.

My one slight issue with the data presentation is the use of "people reached" or "animals reached" as a  headline metric. To some extent I understand using it outside of EA circles as we know that the biggest numbers sound the most impressive, but I don't think it s a  impact measurement with integrity. Basically any org that does mass media will reach millions very fast which is great, but it doesn't necessarily translate to impact. 

Endless NGOs spend millions on fairly useless media messages here  - give me 10,000 dollars tomorrow in Uganda and I can reach 1 million people with whatever message you like - that's not an impact measurement, what matters is the result of that message - which looks to be great with CE orgs. What sets your orgs apart is that their approach is backed by evidence and is likely to lead to  real positive impact - not the fact that they can reach millions over the radio, anyone can do that!

Not the biggest deal, but I think within EA we can do better with our headline metrics.

Small question also, why no mention of Fortify Health, who I think are the CE org which has got the most funding to date and have done an amazing job?

Comment by NickLaing on Scoring forecasts from the 2016 “Expert Survey on Progress in AI” · 2023-03-06T14:43:48.627Z · EA · GW

Yeah I think an AI researcher working for a serious company who solved Angry birds might be fired for timewasting :D

Comment by NickLaing on Who Aligns the Alignment Researchers? · 2023-03-06T05:30:39.826Z · EA · GW

What makes you think that the average person rates saving humanity highly enough to make it worth doing alignment research rather than capabilities?   That seems like a pretty conservative statement from my experience. Most people I know would definitely take a small-moderate amount of extra money rather than doing more valuable work for humanity. Also building something could feel like more rewarding work than safety work as well.

Maybe I'm missing something, what do you think are the assumptions that that statement makes?

Comment by NickLaing on Comments on OpenAI's "Planning for AGI and beyond" · 2023-03-05T18:51:00.088Z · EA · GW

Thanks that's a good point. I hope though that they have less sway than independent people arguing in either direction. I would hope in the case of nuclear power and GMOs it would be independent advocates (academics, public, think thanks) arguing for it who convinced is rather than Monsanto and power plant manufacturers.

But I don't know those stories!

Comment by NickLaing on Animal welfare certified meat is not a stepping stone to meat reduction or abolition · 2023-03-05T09:08:39.490Z · EA · GW

Hey great post. I love hearing the different amazingly thought out positives from animal welfare activists with measured leanings towards welfarism or abolitionism.

A small point, I wonder if you might be able to add a coulple of simple tables to present the data. It's A little heavy to process just in text form thanks!

Comment by NickLaing on Comments on OpenAI's "Planning for AGI and beyond" · 2023-03-04T12:51:27.769Z · EA · GW

Not disqualify then from private discussions - of course they're needs to be loads of private discussions, but from prominent public discussions. Why is that intuitively dangerous?

I'm uncertain about this and keen to hear the counter arguments.

Its intuitive to me that People who are paid to develop something potentially dangerous as fast as possible (weapons manufacturers, tobacco, AI) should not be the ones at the forefront of public discussion nor the ones making decisions about what should be allowed and what not. They will be compromised and biased - the very value of what they do with their lives is at stake. they are likely to skew the discourse away from the rational

The ideal situation might be to have enough powerful AI programmers working on AI safety and governance independently of the companies, that they could lead the discourse and make the discussions.

I'm sure there are strong arguments against this and I'm keen to hear then.

Comment by NickLaing on Comments on OpenAI's "Planning for AGI and beyond" · 2023-03-04T03:54:11.489Z · EA · GW

Thanks so much for posting this! I find this rather scary just how blase he seems. The basic thesis of plowing on without worrying too much because the potential upside is so great doesn't seem like a well thought out, rational argument.

There are also a number of non specific pseudo inspirational comments that feel both our of touch with reality, and like they could be from a dystopian novel. Like

"the stakes (boundless downside and boundless upside) will hopefully unite all of us." And "we believe that the future of humanity should be determined by humanity" lol.

Part of me wonders whether working for a company on the cutting edge of AI development should almost disqualify you from being part of the public AI safety discourse. I believe that oil companies should have close to no sway in the climate change debate, and cigarette companies should have no say in cigarette regulation. Should we rather see AI progressors more like lobbyists when they are so compromised.

Comment by NickLaing on keller_scholl's Shortform · 2023-03-03T08:29:40.273Z · EA · GW

It's unfortunate if EA feels they have to block critical journalists from marquee events. Being open and transparent is a hugely valuable part of the EA movement, and even a mixed positive/negative press article is likely to be  net good for the movement - especially at the moment with all the negative press going on.

If a journalist is bent on writing criticism, they may well write criticism regardless of if we let them in to an event or not. The counterfactual of not accepting them could potentially make things worse long term too, if they double down and even use the rejection as a reason to criticise more severely.

One great thing to do could be to spend a lot of time making friends with and understanding journalists at the event.  Make them feel welcome and connected to people who are there, so perhaps they will be more empathetic and fair when they write their piece?

Or am I just being naive about journalists...

Comment by NickLaing on Remote Health Centers In Uganda - a cost effective intervention? · 2023-03-03T05:47:55.665Z · EA · GW

Thanks Annette those are amazing questions and comments wow!

Yes the government health centers have many problems including medications out of stock which I agree is an enormous problem We operate far from government though, and we're not in the business of fixing the government system right now - hundreds of other NGOs are trying as you know.

You are definitely right that there are other parts of the country with many healthcare black holes. we are already in eastern Uganda and moving into central soon with 5 health centers there at the moment. In western Uganda though there are not as many healthcare bleack holes. Government coverage is better. It's not to say there aren't areas in WEstern far from government - just not as many as in the North and East

The worst situation is actually in the North east, Karamajong and Pokot area, but the population there is so low and people so poor that our sustanable OneDay Health model wouldn't work there. Perhaps we could do an even more subsidised model there in future thogh because the healthcare situation really isn't good there..

Thanks so much for the comments amazing

Comment by NickLaing on Fighting without hope · 2023-03-01T19:03:23.333Z · EA · GW

I practise gratefulness. What are 10 things I'm grateful for this morning?

I pray

I meditate

I play some race for the galaxy with my wife

But  I don't really fit. I have the joys of working on the coal face of healthcare so I don't have so many of these issues. I have enormous respect (and sometimes even awe) of people like you who work hard towards distant and even low percentage goals. 

Maximum respect

Please keep working on them, so our rural communities here in Uganda will have a world which still exists in 50 years when we finally develop :).

Comment by NickLaing on Remote Health Centers In Uganda - a cost effective intervention? · 2023-03-01T18:50:30.328Z · EA · GW

Your paraphrasing is amazing (probably better than my original post). I just fear you know my brain a bit better than I do. Are you the first GAI?  I also don't feel like your analysis is that abstracted at all - your points seem quite concrete actually.

One small correction I might make is that most Ugandans who get malaria would get treatment, not just a few. We target the 5-10% of places which are really remote and getting treatment is difficult - that's what where here for.

It's an interesting idea to do "Badness of untreated malaria" x  "Chance the treatment was counterfactual". This is a cleaner method than what I did that's for sure. The first issue with this is that I'm not sure we have a clear data point for badness of untreated malaria (although I can look into this more). Obviously impossible to study now and we need to rely on older data. 

The chance of  treatment (yes or no) is counterfactual would be more realistic to find, but is very black and white when really there's a lot more too it than getting treatment or not.  Quality of care is important - but perhaps even more important like @Ray_Kennedy  pointed out is how quickly people get the treatment. Malaria is an exponentially replicating parasite, and hours can make a differece.

On your counterfactual adjustments (love it)

  • The most severe cases would be more likely to get treated yes (interesting point never thought of ths) - but as a counterpoint as already discussed early treatment is really important. Often (not always) severe malaria is a  direct result of inadequate, late or non-treatment.
  • Yes there's definitely the counterfactual of the government doing less because NGOs are doing the work. A given thing which should probably warrant a dscount with basically any NGO program! As a caveat here, the Ugandan government made the active decision to spend their resources upgrading current facilities rather than building more in remote places. In the last 10 years the government has opened 0 (or maybe 1) new health center in Northern Uganda. Also  of course like many other NGOs we have the dream that perhaps someday a government could see the value in our model and potentially take it over or roll out a version of their own. So this could be a tiny point in our favour (see my bias kicking in again...)
  • (Side note) Givewell seems quite rough on AMF on this front, positing a 50% chance that other funders would come in if they weren't there in some countries. This feels overconservative to me - what might well be happening is that Global Fund (or others) instead fund more nets in other places instead of working where AMF are working

The only comment I didn't really understand was the difference between where the vale comes from.

"My biggest uncertainty would be to what extent the value of ODH comes from [counterfactually averting deaths/saving lots of DALYs], vs [providing better quality of care, or more convenient treatment]."

I might well be missing something, but better quality of care and more "convenient" treatment (meaning people get earlier treatment) both avert deaths and save DALYs, just like getting treatment vs. not getting at all does. So doesn't it all play into the same value proposition?

Comment by NickLaing on Remote Health Centers In Uganda - a cost effective intervention? · 2023-03-01T12:33:50.049Z · EA · GW

Thanks Ray. I think it's really valuable for smaller orgs like us to try and calculate our potential impact even with all the flaws!

Yes you're exactly right with those 3 points driving our impact. I think improved quality (which includes common complete misdiagnosis in many settings) and timeliness might be nearly as important in driving impact as serving those who would have missed out on care completely. Its not like those who don't get treated are likely to die, the human body is an incredible thing -  without treatment we heal ourselves most of the time for most diseases, even malaria. Treatment Quality, prompt treatment and getting any treatment at all are all important impact factors

Sorry about the poor explanation - that's my bad I should have done better. The average DALYs incurred by a Ugandan with any given disease seemed the best measure available at this time, as it takes the average DALYs per person of whole spectrum of people who get that disease. From those who got no treatment at all to the majority who would get treatment. It's one of the few ways I could think of to get I'm very open to other ways of calculating DALYs averted per individual patient . At the time neither PSI or myself could think of a better one.

Measuring careseeking behaviour is a good thought, we have considered measuring this (we don't right now). One of the issues is that variability of malaria prevalence is so high that it can  confound the data. For example let's say the first year there's a high malaria season and they visit healthcare 8x a year, then the second year is low malaria and they only visit 4x. It looks like careseeking behaviour is worsening but it's just that there's ess malaria. Obviously we could try and control for this using regional malaria data but it ain't easy. Also how do we account for going to a drug shop and buying a few pills? Does that count as accessing healthcare? There is much depth to these things.

 Also decreased careseeking behaviour can even be the opposite, a sign of better health in the community. If an ODH health center had been doing good work treating patients well and the community is getting generally healthier, they will need to visit the facility less often. If people are treated poorly on the other hand the could end up coming back 5 times for the same condition. It's complicated that's for sure but I still think looking at healthseeking beahviour could have value!

I like your idea of 100%, 50% benefit etc and I might hit you up about that for futre analysis. We stlil run into that same problem though that we still need to decide what 100% benefit actually means in DALYs. We still need to pull that from somewhere - the problem described above that we currently use the GBD DALYs per person as  a proxy for. Our current approach kind of does take this into account in a blunt and flawed way, as the average patent in Uganda takes into account  whole spectrum of patient treatment  (High quality, late, not at all)

Yes saving money a big factor and I like your idea of modelling it perhaps using a givedirectly model. I even thought about trying to include those benefits in the analysis, but it seemed like a lot both to do and present all at once. WE should definitely do this soon!

Comment by NickLaing on Remote Health Centers In Uganda - a cost effective intervention? · 2023-03-01T05:50:45.865Z · EA · GW

Thanks Joel! Your community health worker question is a common one! I'm a big community health  worker fan, and the movement is even part of the inspiration for ODH. But there are a number of common misconceptions about what they  actually do

1) Community health workers might serve an area of 500 households (or more). Even the most active community health worker can't get around more than 50 housholds in a day  (and the data  shows the norm is more like 5-20 households).  When you have malaria or pneumonia, you need help in the first 24 hours of illness and the illness can often get very bad within 1-2 days. So in reality most people visit a VHT for treatment - the VHT doesn't visit them, it's just not possible. This myth of the VHT actively case finding most of their work is persistant though...

2) Community health workers are not  usually very cost effective. Monitoring them, supplying them and paying them to do a part time job works out as being surprisingly expensive. The orgs I've look at (Lastmile health and living goods) including all project costs seem to treat patients at between 4 and 10 dollars per patient (we are between $1-$2 depending on how you calculate), but it's hard to tell as I haven't seen these orgs release these numbers.

3)  Community health workers only usually treat kids under 5 for malaria, pneumonia and diarrhoea - it would be medically irresponsible to get them treating others as they have minimal training. They don't treate adults for malaria. Yes these childhood illnesses are the highest DALY burden conditions, but they still can't treat the majority of patients.

I'm not sure you mean by chronic issues? Community health workers rarely treat chronic conditions, they treat malaria, pneumonia and diarrhoea in under 5s and sometimes (rarely) provide antenatal care. Maybe in urban places they are involved in NCD care, but certainly not in remote rural placee

There are a lot of good reasons for community health workers t be doing part of this job. Filling the gap of lack of trained personal (like Uganda), health education and getting as much malaria treatment out there as possible. There are many RCTs proving their worth But we still need more cost effective solutions, and high quality universal helathcare in remote places.

Comment by NickLaing on Apply to attend EA conferences in Europe · 2023-02-28T17:38:47.136Z · EA · GW

Love it nice one! EA Cambridge was hugely influential for me a few years ago, although we didn't have a conference like this the year I was there.

But I must say if you really want warmth and light, come here to Uganda ;).

Comment by NickLaing on Help GiveDirectly beat "teach a man to fish" · 2023-02-28T07:32:44.507Z · EA · GW

Yeah I think the choice of incentive is really bad and even a little patronising, assuming we'd want to chat with someone from Givedirectly - surely Givedirectly deal in cash, stick to what you know ;)

Comment by NickLaing on Make RCTs cheaper: smaller treatment, bigger control groups · 2023-02-28T07:10:27.995Z · EA · GW

100% the original post stands, in any scenario we would want to optimise use of resources. I don't think JPAL/IPA is generally a funder though - they do the research themselves so they are the ones to convince ;).

Comment by NickLaing on Remote Health Centers In Uganda - a cost effective intervention? · 2023-02-28T05:06:51.324Z · EA · GW

Thanks so much Scott - is this the project you are working on?

I'll message you about this . There's a geomapping project I've never managed to get going along this line which I think could be hugely powerful, incorporating this kind of data and others such as distance to maternity centers, vaccination rates etc. to form an overall  "neglectedness map" that can help NGOs and government target the most neglected areas, rather than roll out projects fairly randomly.

Yes, I think there is immense value in looking for practical and cost efficient ways to provide universal primary healthcare, even if like you say we are not as cost-effective as hoped. Many seem have given up on solving the problem of proximal, comprehensive primary care in remote places. I feel like the hope is that community health workers can treat a proportion of the population in the meantime, while countries develop and urbanise to the point that this is no longer necessary- but that's a whole nother discussion

We need to be using more data based methods in OneDay health like this - this malaria map is pretty amazing I didn't know about it! We could definitely do a more accurate analysis using this - no question.

Also I'm going to check out your post from a week ago. I didn't see it at the time.


Comment by NickLaing on Help GiveDirectly beat "teach a man to fish" · 2023-02-27T20:27:10.973Z · EA · GW from the original givedirectly above - look down near the bottoom of the article. There are others too I'm pretty sure. Evidence is mixed on this one.

Comment by NickLaing on Help GiveDirectly beat "teach a man to fish" · 2023-02-27T19:40:57.811Z · EA · GW

You smashed it bro, love it :D :D :D 

Comment by NickLaing on Help GiveDirectly beat "teach a man to fish" · 2023-02-27T19:40:12.937Z · EA · GW

Yep evidence is mixed, but cash + skills (or financial training) in some studies has been more cost effective than cash alone. Not always giving the same cash equivalent in both arms (which is a shame), but estimating cost effectiveness from outcomes

Comment by NickLaing on Remote Health Centers In Uganda - a cost effective intervention? · 2023-02-27T19:31:03.726Z · EA · GW

Thanks so much for the comment and the questions. I really appreciate you reading this and thinking about it, especially given you are so engaged in longtermism stuff. Loved the skepitical braindump on existential risk from AI. 

Not Nitpicks at all

1) This is the biggest weakness in our calculation. We use the global burden of disease data, because it estimates the average DALY burden of everyone who gets a disease (say malaria) in Uganda whether they were treated early lateor not at all. OneDay Health centers treatthe people who previously had the worst healthcare access in Uganda, so we assume that our treatment could remove at least that nationwide average DALY burden. You couldargue that this still is likely to overestimate the benefit of treating patients, but you could argue the opposite direction too. Without RCT data I think this is the best we can do at the moment - I couldn't think of a better way to estimate the DALYs we might avert for each disease and also others in big orgs like PSI have used this approach before which is reassuring.

5km can seem like a short distance, but when you  or your child are sick it can be very difficult to walk that far. For what it's worth, the WHO uses this 5km threshold as a key accessibility indicator in countries like Uganda where walking is the only option for the vast majority of rural subsistance farmers. Also for context only 5-10% of Ugandans live in these healthcare black holes so the majority of people are in a better situation.

5km is only an indicator too - most of our patients live further than this from a government health center as well. It's also a very complicated ecosystem as many government health centers don't have enough medications so people have to buy the medication anyway even when you reach there. Distance isn't  the whole story, I simplified somewhat for this post

2) Subsidising transport would be (close to) impossible for a variety of reasons, mostly the first 2 I thnk

- How would you decide who to give the money to? Over the phone it would be impossible to know who was really sick and needed money. The system would  likely fall down pretty quickly as everyone claimed to be sick. I might be strawmanning  your proposed system though if so let me know! Give directly only works because they give unconditional money to most people in a given area.

- Many people in "Healthcare black holes" (only the most remote 5-10% of Uganda) don't have good access to phones or cellphone reception which would be necessary for any kind of transport program. 

- Motorbike transport means are not easily available in some of these areas (not the most important barrier, and motorbike accessibility is improving all the time).

Comment by NickLaing on Help GiveDirectly beat "teach a man to fish" · 2023-02-27T12:52:08.422Z · EA · GW

Thanks Madhav - you make some good points  hadn't thought about it that way!  There's even mixed evidence already that cash transfers + skills training might be just as good as cash itself so your point has current not only future evidence.

I think the media world moves so fast though that I doubt Givedirectly will damage future ideas through this campaign. 

Personally being in the development world the "teach a man to fish" mantra drives me crazy so I'm broadly in support of it getting dismantled even if it does hold some truth....

"Who cares if you give the fish, the fishing class, the rod or the boat - what matters is that it works"

This is Givedirectly crowdsourcing free advertising

Comment by NickLaing on Which movies have been most effective at expanding your moral circle? · 2023-02-26T07:03:13.761Z · EA · GW

I'm not sure about the level of EA congruence, but Lord of War helped me understand the effect of the small arms trade on people in sub-saharan Africa, which I didn't previously know about.

Comment by NickLaing on Make RCTs cheaper: smaller treatment, bigger control groups · 2023-02-26T06:51:13.686Z · EA · GW

Thanks Rory  - I think your general idea is good, and in some cases could be a good option!

I could be wrong, but from my experience working in the development world these 4 scenarios aren't really how RCTs generally happen. Usually there will be a partnership with a RCT running NGO  (like IPA) or a university department (J-PAL at MIT) where the partner organisation pays for and organise everything.

Sometimes scenario 4 could happen as part of a grant application