Some charities are thousands of times better than others

What do The American Cheese Society, Oxfam, and Homeopaths Without Borders have in common? The answer is that they’re all non-profit organisations.

 

‘Homeopaths Without Borders’ has provided ‘treatment’ and ‘education’ in a number of countries, including Haiti after the 2010 earthquake there. There is little reason to believe this intervention can be beneficial (beyond, perhaps, a placebo effect) and good reason to believe it may deter vulnerable people on the ground from seeking genuine medical attention if they believe homeopathy can somehow cure a range of deadly diseases such as cholera and malaria.

 

Hopefully most readers of this article are knowledgeable enough not to support such a charity. But some charities provide interventions that, on the face of it, sound like fantastic ideas. It’s only when you look at the details that the flaws emerge.

 

For example, Playpumps International were a charity that received millions of dollars from the US government, as well as celebrity backing, in order to help developing countries improve their access to clean water. The idea was simple: as children play on a merry-go-round they pump water from an underground water source into a storage tank.

 

Yet the pumps were criticised by other water charities for being far more expensive and complicated (and therefore harder to repair) than conventional pumps. To pump the amount of water that the charity claimed it could provide, it would require children to be ‘playing’ on them for 27 hours a day. Playpumps may well have diverted funds that could have been used to provide water for many more people.

 

Most charities probably don’t directly cause harm. But even amongst charities that support worthy causes, there are good reasons to favour certain charities over others. Why?

 

Firstly, some problems are more serious than others. Cancer is worse than the common cold. Being one of the 19,000 children who die every day from mostly preventable disease is worse than being an artisan American cheese manufacturer in need of promotion.

 

Secondly, some interventions simply cost more to achieve a similar outcome. This means that £1 given to one charity might do as much good as giving £1000 to another.

 

Giving What We Can point out that if you want to help blind people, you could spend $40,000 training a guide dog to help one person in the US or UK. Or, using the same money, you could cure more than 2,000 people of blindness by paying for surgeries to reverse the effects of trachoma in developing countries. There are similarly impressive differences in the cost-effectiveness of interventions to prevent the spread of HIV; education works out as much better value than anti-retroviral therapy.

 

This is the rationale behind the ‘effective altruism’ movement, which includes groups such as GiveWell and Giving What We Can (who have a chapter at the University of York). By researching charities to find those that provide the biggest impact for each donation, by ensuring that the charity’s work is backed up by independent evidence, and by demanding openness and transparency, we can support the interventions that help improve the world the most.

 

We should not merely seek out and support good charities: we should support the best.

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(article originally poster on The Yorker)

We Should Take Speciesism as Seriously as Other Prejudices

Racism, sexism and homophobia are three forms of discrimination that, one hopes, all readers of this blog will strongly oppose. Yet there is another form of discrimination that is increasingly recognised as being just as morally dubious as these three.

Speciesism means treating individuals differently solely on the basis of species membership. Just like skin colour, gender, and sexual orientation are not relevant characteristics when granting rights, neither is species membership.

This does not mean treating all individuals of all species identically.

But then, eliminating racism does not mean treating people identically; some ethnic groups are more likely to suffer from certain genetic diseases than others. Cystic fibrosis, Tay-Sachs disease and sickle-cell anaemia are more common in people of Caucasian, Ashkenazi Jew, and Afro-Caribbean ancestry respectively. It is not racist for doctors to take this into account when seeking a diagnosis.

Similarly, eliminating speciesism does not mean granting all animals exactly the same rights as humans. It wouldn’t be appropriate. Chickens aren’t going to get the vote or be able to buy alcohol or drive. What it does mean is that we should be consistent in treating individuals on the basis of morally relevant characteristics.

Clear examples of speciesism come in the form of how we treat pets versus how we treat farm animals. Why are we appalled when we hear of dogs and cats being subject to abuse, yet readily pay others to inflict abuse on animals such as pigs and cows, which have a similar level of intelligence and capacity to suffer? It is this cognitive capacity that surely matters, not whether an individual animal is a pig or a dog.

I can think of no justification for this inconsistency. If, as the evidence suggests, pets and farm animals are cognitively very similar, we must grant them similar rights. If it is wrong to harm a dog, then it is wrong to harm a pig. If you’re not willing to pay someone to breed and kill cats for you to eat, you should not be willing to pay farmers to breed and kill lambs.

Of course, some will eliminate this inconsistency by claiming they will happily abuse and eat cats and dogs. But how far are they willing to go for consistency? New born human babies are probably less cognitively developed than many farm animals. Perhaps they should be served for dinner.

Human babies do generally have greater cognitive potential than non-human animals. But does this matter? We don’t generally grant rights based on potential alone, but rather on potential that has been fulfilled. Children aren’t given the right to vote just because they will potentially be 18. Learner drivers aren’t given full driving licenses just because they may potentially pass the test. Furthermore, not all new born babies even have the potential to develop: they may have a terminal illness.

Is anyone actually willing to kill and inflict suffering on human babies in order to justify eating meat?

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(this article was originally posted on The Yorker)

Successes of international aid and effective development charities: global health

Does aid work? Some authors argue yes, and we should give more. Others argue that it has been ineffective, or even hindered development of poor countries. It’s clear that some charities are much more effective than others, and certain forms of government-financed aid can sometimes exacerbate corruption within a country. But there are also examples where aid seems to have been rather effective, particularly in the area of health. Here are some of its successes, along with some recommended charities to donate to if you want to contribute to ongoing achievements.

1. The Marshall Plan. 

No, this wasn’t a health-based aid project, and in terms of effectiveness this is probably the least empirically justified out of the whole list.  I provide it first because many opponents of aid in the UK seem to have forgotten how the UK and Europe as a whole were recipients of large amounts of aid not too long ago. After World War II, European countries benefitted from a substantial financial gift from the United States in order to rebuild their devastated infrastructure.

In today’s currency, a Marshall Plan would be worth more than $740bn.

2. Eradication of small pox.

Small pox used to kill millions of people every year. In the 1960s a plan was announced to provide sufficient vaccinations to completely eliminate the virus within a decade. It was successful; the last case of smallpox was in 1977. About a third of the funding was provided by ‘international assistance’.

3. Near-eradication of polio. 

Infection by poliovirus lead to the paralysis of tens of thousands of people each year in the early-mid 20th century.  In 1988 the World Health Organisation (WHO) resolved to eradicate polio worldwide. That year, there were an estimated 350,000 cases globally. By 2012 this had fallen to just a few hundred cases. The WHO is funded by governments of the United Nations. Members of the organisation Rotary International have also raised and donated huge sums (over $1bn) to help fund provision of the polio vaccine.

4. Near-eradication of Guinea-Worm disease.

Guinea-worm disease is caused by a parasitic worm caught by drinking contaminated water. Symptoms include “intense pain…fever, nausea, and vomiting. 

Unlike polio and smallpox, there is no vaccine. But the Carter Center, an NGO established by former US President Jimmy Carter, has helped almost completely eradicate it, working alongside the WHO, UNICEF and other groups to prevent contamination and infection:

“In 1986, the disease afflicted an estimated 3.5 million people a year in 21 countries in Africa and Asia. Today, thanks to the work of The Carter Center and its partners — including the countries themselves — the incidence of Guinea worm has been reduced by more than 99 percent….In 2012, there were 542 cases reported in South Sudan, Mali, Ethiopia, and Chad.”

5. Big decline in deaths and suffering from malaria.

Malaria causes illness in hundreds of millions of people each year, and kills thousands (mostly children) every day. But since 2000, these numbers have fallen by 25% globally, and 33% in Sub-Saharan Africa. Much of this is because of the mass-distribution and use of insecticide-treated bednets, which charity-evaluator GiveWell describe as ‘among the most cost-effective ways to save lives‘. These bednets have primarily been funded by the governments of wealthy nations via The Global Fund. The UK’s Department for International Development, for example, has funded tens of millions of nets.

-The Against Malaria Foundation. Private donations have also helped buy bednets. Bill Gates is a notable contributor to the Global Fund. For those of us who aren’t billionaires, the Against Malaria Foundation is a highly recommended charity that spends all of its donations on bednets. So far, over 475,000 people have donated more than $18m to buy more than 5 million nets, showing that everyone can make an important contribution. The Life You Can Save, GiveWell and Giving What We Can currently rate the AMF as the top charity to support for private donors; this means their work has demonstrated very high cost-effectiveness and high transparency/accountability. You can donate to them here.

6. Near-eradication of River Blindness (onchocerciasis) in West Africa. 

The OCP, a 30-year program lead by WHO and United Nations Development Program, ended in 2002 “after virtually stopping the transmission of the disease in the 11 West African countries covered by the program. This “reopened to farming 60 million acres of land once abandoned to the disease, and protected the sight of an estimated 30 million people at risk for blindness”.

A new program, the APOC, is now seeking to control and then eliminate it from the remaining endemic Africa countries over the next 2 decades. It is funded by a number of countries, including the UK and USA.

7.  Measles vaccination success

In 2011 around 158 000 people, many children, died of measles. But the World Health Organisation reports that, because of vaccination, there has been a 71% global decline of measles since 2000. This vaccination campaign has been supported by the WHO, UNICEF, the American Red Cross, and the United States Centers for Disease Control and Prevention.

Other vaccination campaigns include:

8. Hepatitis B

In China, hundreds of thousands of people die each year from the consequences of hepatitis B infection, in the form of liver cancer and cirrhosis. But the GAVI Alliance has worked alongside the Chinese government and co-funded over 25 million vaccines to newborns, signficantly reducing Hep B infection. Given the huge population of China, deaths from Hep B are still widespread, but the Chinese government is now working on expanding the program across the whole country.

9. Pneumonia

Pneumonia is a leading cause of childhood mortality, killing 18% of the 6.9 million under-5s that died in 2011. The type-b strain of the Haemophilus influenzae bacteria (Hib) is one the main causes of such pneumonia, along with Streptococcus pneumoniae, which it interacts with.

In the 1990s, only one low-income country offered the vaccine to Hib. GAVI, a partnership that promotes vaccinations, then campaigned and presented strong evidence as to the benefits of the vaccine. Governments responded: “By 2011, nearly all GAVI-eligible countries had introduced Hib vaccines with GAVI support, immunising a cumulative 124 million children and preventing an estimated 697,000 future deaths.”

10. pertussis (whooping cough), 11. pneumococcal disease/pneumonia, 12. rotavirus diarrhoea, 13. yellow fever

Vaccines/treatment of these have all been significantly funded by the GAVI Alliance, which is supported by government aid (including the UK) and private philanthropists. It raises funds by selling long-term bonds backed by donor governments, meaning money is immediately provided by investors in those bonds.

14. Reduction in burden of Schistosomiasis (and other parasitic worms)

Schistosomiasis is a parasitic worm estimated to kill up to 280,000 people due to organ damage, though it probably kills closer to 40,000. It also contributes to malnutrition and causes pain, fever and anaemia. Schistosomiasis is still widespread, infecting several hundred million people globally. But there is a cheap and effective treatment, and given the success of reducing the burden of other parasites such as guinea-worm disease (see above), it is plausible that the coming decades will see a large decline and perhaps eradication of schistomiasis and other tropical parasitic worms.

Deworming drugs cost around half a dollar (~£0.30) per person treated, according to GiveWell. Studies in Burkina Faso, Niger, Uganda, and Burundi by the Schistosomiasis Control Initiative (SCI) report significant declines in parasite prevalence and intensity after treatment with these drugs. There is also evidence from Kenya that deworming is by far the most cost-effective way to increase primary school attendance. In Rwanda, recent reports state that the prevalance of schistosomiasis infection has fallen by over 80%.

-The Schistomiasis Control Initiative, run from Imperial College London, has received significant funds from the Gates Foundation, as well as the US and UK governments. But private donations have also made important contributions. And for good reason; the SCI is another highly-recommended charity according to GiveWell and Giving What We Can, demonstrating its cost-effectiveness, commitment to transparency, and ability to properly use any additional funds it receives. You can donate to the SCI here.

But what about overpopulation?

A very common concern is that by reducing mortality, these efforts are simply contributing to overpopulation. There are two key points in response to this:

Firstly, as this World Bank article highlights, probably the biggest influence on fertility rates (how many children a woman has) is childhood mortality. If you reduce child mortality, adults have fewer children (see box 2 on page 11 of the article for a summary). And the wonderfully enthusiastic Hans Rosling presents this 3-minute video showing how fertility rates and childhood mortality rates have changed since the 1960s.

There are of course other important influences on fertility rates, including education and access to family planning/contraception, but childhood mortality appears to be more influential than each of these. But the second point is that these diseases don’t just kill: they often also cause serious physical weakness, mental exhaustion and disability. This makes it much harder for children to receive good education in the first place; children can’t access school or are unable to properly concentrate once there, or the teachers themselves have the same problem.

Continuing to reduce the burden of disease should therefore speed up a ‘demographic transition’ whereby fewer children are born in the first place.

Furthermore, these diseases impact the economy both in the short-term (seriously reducing the amount and quality of work that can be done) and in the long-term (i.e reducing quality of education and hence ability to grow businesses successfully when the children grow up).

The University of York’s RAG international charities: a good choice?

Background

Each year universities across the UK take part in RAG events. RAG is a ‘backronym’ of  ‘raising and giving’. Students engage in a range of activities and adventures in order to make as much money as they can for selected charities. Last year, the University of York RAG campaign raised a very impressive £80,000 which will be distributed to the charities selected by the student body.

This selection process initially involves charities applying to receive funding. The applications are then reduced to a short-list by the RAG team, before all students have the opportunity to vote for the charities they prefer from this short-list. This year, 2 local, 1 national, and 2 international charities were selected to receive funding.

I am skeptical about the process used to select these charities. And given the amount of money involved, having an adequate selection process could potentially be the difference between life and death for many people.

It’s understandable that the University wants to donate to local and national charities, as these are ones that will benefit the University’s standing in the local community, and will engage students on issues that may affect their own lives, or their friends and families. But when creating a short-list of international charities, clear and precise criteria must be used to ensure a worthy choice is presented to the students to select the winners from.

What Criteria Should We Use?

The first and most prominent criterion should be cost-effectiveness. As Giving What We Can point out, some charities can be as much as 1000 times as effective as others. So if RAG donated £100 to one charity, this could have as great an impact as donating £100,000 to another. Given that each charity can expect to receive £5-10k, it’s easy to see the importance of intelligent, targeted donations. Other important criteria for charities should be transparency and accountability (i.e. willing to share information about their expenditure ) and room for more funding. (i.e. actually have goals that can benefit from extra finances). These are the criteria used by GiveWell to rank the charities they review.

WaterAid and Medecins Sans Frontieres

This year’s international charities selected by the University of York are Water Aid and Medecins Sans Frontieres (MSF). So, how well do they meet the above criteria?

GiveWell has recommended MSF for their disaster-relief efforts. They are also described as being “unusually transparent”. However, despite this positive view of MSF, GiveWell do not consider them to be cost-effective overall, at least not compared to their top charities

GiveWell contacted WaterAid with the intent to thoroughly review them. However, they have now been ‘deprioritized‘. This means that subsequent investigations revealed the charity was unlikely to meet the criteria to be one of their top charities, possibly because WaterAid were unwilling/too slow in providing responses to their queries, or because they were unable to provide strong enough independent evidence of the effectiveness of their work.

Giving What We Can are also skeptical about the cost-effectiveness of water-related construction programs generally (building “boreholes, stand posts and dug wells, or infrastructure that improves sanitary conditions, such as sewerage, septic tanks and latrines”). They claim that “their cost-effectiveness has been estimated as less than a tenth that of some other ways of promoting health”. However, they are much more optimistic about programs that seek to improve behaviour regarding sanitation and hygiene. Perhaps WaterAid will eventually show that their work in this area is as cost-effectiveness as the top recommended charities. They do not yet appear to have done so.

Conclusion

Though WaterAid and MSF have undoubtedly made improvements to the living standards of a large number of people, the top-rated charities would likely have aided many more, and to a greater extent. Whilst the University of York international charity recipients of RAG aid should not be determined entirely by the criteria I have discussed in this article (York may have long-established links to particular communities or causes), such criteria must surely play a large part.

I would therefore encourage the RAG team to clearly publish the criteria they use, and the weightings for each one, in order to apply pressure onto charities to demonstrate their evidence of effectiveness, their accountability and their costs. Ultimately this will help us determine what form of charity works well and what doesn’t, and hence allow us to improve as many lives as possible.

The killing of police officers is not an act of ‘pure evil’, Mr Cameron.

Prime Minister David Cameron has described the murder of 2 policewomen today as an act of ‘pure evil’.

Clearly, he could do nothing other than seriously condemn the shootings. Yet whilst the use of the phrase ‘pure evil’ may solely be intended to demonstrate how seriously he takes the situation, it is also not particularly helpful.

Why? Because it encourages and promotes ‘good vs evil’, black-and-white thinking. It ignores any attempt at understanding why such crimes are committed, and how they can be prevented. After all, if someone is pure evil, then there is nothing that can be done to change their behaviour. Education and poverty reduction can’t combat pure evil. Only the mystical Forces of Good can.

But the reality is we know that crimes are committed for reasons. Lack of hope for the future, anger, depression, hatred. Even because of boredom and for personal pleasure. Committing murder because of boredom might sound like pure evil, but again, there will be deeper reasons as to why someone decides to relieve their boredom by killing, rather than seeking an alternative. Psychopathy/lack of empathy for others, for example. This in turn has genetic and environmental roots such as certain gene variants (e.g. the monoamine oxidase A gene) combined with serious neglect during childhood.

Dismissing even the worst perpetrators as ‘pure evil’ does not encourage people to think about the causes and reasons behind actions, and fails to acknowledge that behind every murderer there is a person, and behind every person, there is, in the right circumstances, a murderer.

Riding a horse is as dangerous as taking heroin

What’s wrong with the following argument?

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P1. In the UK, heroin is a Class A drug.

P2. Ecstasy is also a Class A drug.

P3. The classification of a drug represents the level of harm it causes to individuals and society.

P4. Horse riding causes at least as much harm as ecstasy.

C. Therefore, horse riding is as harmful as heroin.

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Suddenly, I have a new-found respect for Britain’s successful Olympic horse-dancing team. Who knew they were taking such risks?

The problem with the above argument is at premise 3.  The classification of a drug is supposed to represent the level of harm it causes, but in practice it doesn’t. Why not? Primarily because politicians ignore scientific evidence on drugs. They prefer to appear tough on drugs, in order to please the tabloids. The tabloids in turn significantly under-report deaths from drugs such as paracetemol (reporting approx 1 in every 250 deaths) compared to ones like ecstasy (reporting almost every single death).

This means the classification of a drug loses any value as a signal as to how harmful it is. You might as well take a Class A drug, because being Class A says nothing about how harmful it is.

Some people argue that no matter how harmful something is, as long as people are aware of the risks, then we should be allowed do whatever we want to our own bodies. This is a view I am sympathetic towards. However, as long as governments take the view that they should tell us what we can or cannot put in our bodies because of the harm it causes, at the very least they have a duty to ensure the law is consistent with such harm.

GM Crops: ban them, but only if you also want to ban peanuts…

…and milk and eggs and seeds and soy, wheat, fish, shellfish, fruits, vegetables.

Actually, ban any food with any non-human protein in. It all has the potential to cause a serious allergy. Whether it is genetically modified or not.

The ‘health risks’ argument that is used to oppose each and every GM crop is, for the most part, absurd. Yes, there is a small possibility of them causing health problems. I would be surprised if no one ever develops a health problem in response to consuming a GM food. But the point is that we must see this in the context of the health problems and risks of non-GM foods that we already widely consume on a daily basis and that already cause problems to a small number of people

Now, this is not to say that other factors associated with certain GM technologies can’t contribute to health problems. A commonly suspected factor is the use of pesticides and herbicides. The most famous example is Monsanto’s ‘Roundup’ weedkiller. By modifying crops to be resistant to Roundup, farmers can apply it in greater doses, knowing that it won’t harm the crop. There are debates over whether this has actually increased or decreased overall herbicide use (use of more ecologically harmful herbicides than Roundup may have actually fallen as a consequence) and whether Roundup can have detrimental health effects.

There is also a genuine issue about consumers being able to avoid GM products for known allergies. Say, for example, a gene for a peanut protein that causes allergic reactions in some people could be inserted into wheat. If products were adequately labelled, one would think that consumers could easily avoid wheat products that contained such a protein. The concern is that crops would cross-pollinate, meaning that even the wheat that was not modified with the hypothetical peanut protein could acquire it.

But all too often anti-GM protestors take concern about one particular crop, such as Monsanto’s GM soy, and use it to accuse all GM products of having similar issues. Creating a herbicide/pesticide resistant crop is only one type of genetic modification. And risks of cross-pollination are dependent on the species involved and its method of dispersing pollen, so should be considered on a case-by-case basis rather than supporting a blanket ban on GM. This is particularly true given some of the potential benefits of GM crops. Here are a few upcoming GM products that involve traits other than increased herbicide and pesticide resistance:

1. Golden Rice.

~200 million people suffer from vitamin A deficiency around the world, and each year hundreds of thousands of children are estimated to die or become blind because of it.  This rice is genetically modified to produce beta-carotene, which is converted to vitamin A in the body. The rice can provide a significant proportion of the recommended daily intake, possibly 100%. The genes that have been introduced come from a soil bacteria and from maize/corn.

Interestingly, the intellectual property rights involved in creating Golden Rice have been waived for subsistence farmers, meaning they can earn up to $10,000 without paying royalties for growing the rice.

2. Wheat with a peppermint gene.

Globally, pests cause huge damage to crops; with estimates of 25-40% loss for many common crops. In the UK, aphids would cause a loss of ~£100m without the use of pesticides. Recent trials are looking at whether GM wheat, with a gene from the peppermint plant inserted, could deter aphids, possibly resulting in reduced pesticide use. The gene leads to production of a pheromone that plants already use in the wild to deter aphids. It also attracts a natural predator of aphids to further reduce their impact. It won’t, however, result in mint-flavoured bread.

3. Drought-tolerant corn.

This year’s droughts across America led to the loss of huge amounts of corn. This GM drought-tolerant corn could help reduce future impact of droughts; though probably not when they are as severe as this year’s. Future versions may have improved tolerance.

On a similar theme, a flood-resistant form of rice has been developed using non-GM methods by hybridisation of different strains of rice.  Although not GM per se, it did use some clever genetic technology in order to cross the strains. And one of the developers of this rice hybrid believes that GM technology will “give us a lot of tools for further improving rice, that we do not have now….[it]will give us a way to do that much quicker and much easier”.

What about corporate control of food?

Finally, many anti-GM protestors are concerned about the monopoly/private control of biotechnology and IP patents. There are some genuine issues about this, but what I say to them is this: support state-funded research.

This ensures relevant information remains in the public domain and is available for any entrepreneur to use. More research being publicly funded means less likelihood of a particular discovery or technology being patented. And the more biotechnology companies there are, the less likely anyone of them will have a monopoly on the market and be able to dictate the terms of use. Just don’t oppose the technology as a whole, and remember to consider the likely costs of not using it.