[FoRK] Top 5 charitable opportunities

Stephen Williams sdw at lig.net
Sun Apr 24 17:52:38 PDT 2011

On 4/24/11 4:02 PM, Gordon Irlam wrote:
> This is intended to drive my giving over the next few years.
> Feedback is invited.

> I currently support #2 (pending final review), #3, and #5.  I would
> like to support the top opportunity, but I don't know how.
> thanks,
> gordon
> -------------------------------------------------------------------
> Charity done well can deliver huge societal benefits.  Charity done
> poorly is at best a waste of societal resources.
> The best charitable efforts are an amazing 100,000 times more
> effective than mediocre charitable efforts, and for this reason it is
> important to carefully consider where you give.  Such a wide range
> also means charitable effectiveness is far more important than whether
> a charity is tax deductable.
> What is the value placed on saving a life?  There are those who say
> you can't place a value on human life, but we place a value on life
> every day when we deny health care to those who can't afford health
> insurance.  To assess the charitable opportunities considered here we
> place the value of life at $2m.  Wikipedia places it at $3m.  Based on
> earning potential it might be closer to $1m.  The exact value doesn't
> matter to much, so long as we are in the right ball park.  It is good
> to be conservative in our calculations.

There are many ways to try to analyze this, all imperfect.  Value varies in various ways in time, place, and situation.  One major 
and obvious factor is age: It is obvious that a 99 year old is less worth saving than a newborn or teenager.  Mostly, you can use 
triage principles if you are, in effect, making tradeoffs between circumstances: Someone very sick with poor chances vs. prevention 
or easily cured problems.

> Are all lives considered equal, or are foreign lives worth less.  We
> say yes, all lives are equal, after all everyone is made from the same

Everyone is assumed to have the same potential, modulo the quality of their environment.  Different people have different arcs over 
time, for various reasons.  There are some valid reasons to differentiate, if we have to.  It should be avoided.

> flesh, blood, DNA, and dreams.  If you disagree with us you will get
> different rankings.
> With this in mind I present my giving guide.
> #1 HIV prevention for sex workers in countries where AIDS = death
> -----------------------------------------------------------------
> Each dollar invested yields $200,000 of societal value.
> ...

Reality-based prevention of sex workers in the first place would be nice, however most cultures are broken in this area.

> #2 Getting antibiotics out of animal feed
> -----------------------------------------
> Each dollar invested yields $130,000 of societal value.
> ...
> animal husbandry.  It also has a far more dangerous effect, it leads
> to the development of antibiotic resistance in bacteria.  This
> threatens to throw healthcare back to the days before penicillin.
> ...
> The true cost of antibiotic resistance is difficult to project, but it
> seems very conservative to assume a 50% chance of causing 10k
> deaths/year, going down to a 5% chance of 1m deaths/year.  For
> comparison a single existing antibiotic resistance bacteria, MRSA, is
> estimated by the CDC to have killed 100,000 people in the U.S. alone
> in 2002.
While an admirable goal, the payoff is likely to be much less.  It also doesn't factor in agriculture inefficiencies it would 
create, which means that it is likely a negative payoff overall.  Just because we fret about something doesn't mean we should 
actually change.

Where'd you get that number?  Wikipedia and the New York Times article linked says:
 > In the United States <https://secure.wikimedia.org/wikipedia/en/wiki/United_States>, the Centers for Disease Control and 
Prevention <https://secure.wikimedia.org/wikipedia/en/wiki/Centers_for_Disease_Control_and_Prevention> estimate that roughly 1.7 
million hospital-associated infections, from all types of microorganisms 
<https://secure.wikimedia.org/wikipedia/en/wiki/Microorganism>, including bacteria 
<https://secure.wikimedia.org/wikipedia/en/wiki/Bacteria>, combined, cause or contribute to 99,000 deaths each year.

That is for all types of infections, of which MRSA is just the most well-publicized.  Also, most of the MRSA numbers are from 2002 
or 2005, before it was much recognized or specifically handled.  What are the numbers for 2010?  Neither Wikipedia or the New York 
Times article mentioned animals or animal antibiotics once.  While it is a risk, it is not likely to be much of a problem and not 
likely to be causing much or any of our current problems.  For one thing, that path would only apply for organisms that are active 
for both cows and humans.

You could probably have a far larger effect through faster quarantine of sick people, encouraging less travel / meeting and more 
virtual meetings (Skype or higher quality methods).  Immediately switch to virtual schooling when a school has an outbreak, as 
schools probably account for over half of infections in the US.

You could also focus on changing healthcare: More smaller hospitals, more neighborhood clinics (retail medicine at the pharmacy for 
most things), better and faster diagnosis of virus vs. bacteria and type.

Most of these infection resistance problems come from giving people a lot of antibiotics.  And perhaps them sometimes not taking 
them properly.  It is important to knock out infections fast, but to try avoid resistance.  Some of that might be more aggressive 
practice, not less.  Perhaps everyone in a family should get the same antibiotics at the same time since it is usually likely they 
are all at various stages of infection.  Or similar strategies.

I just had a head and/or general infection that I didn't really notice until it migrated to my inner ear and I suddenly had 
equilibrium problems.  Then it progressed rapidly in just a few hours.  Waiting to get antibiotics would have been a stupid move, 
possibly leading to brain damage, etc.  I may not have received antibiotics easily as there was no strong fever etc., but luckily 
one eardrum was visibly out of normal.  4 hours after taking them, I started to feel better.

Besides reducing the incidence of infection and using antibiotics less, we need more research to understand, detect, and find new 
ways to combat infections.  We're on the path to assembling custom agents on the fly.

> Doing the math, the aggregate societal benefit of getting antibiotics
> out of animal feed is around $400b, giving $130,000 of societal value
> for every charitable dollar invested.
> #3 Lobbyists for the poor
> -------------------------
> Each dollar invested yields $60,000 of societal value.
> There are a number of charities working as lobbyist for the poor.
> Poverty is so much more prevalent, and each dollar spent overseas goes
> so much further than a dollar spent domestically, so our focus is on
> evaluating overseas focussed organizations: RESULTS, Jubilee, DATA,
> and Bread for the World.  Without their constant pressure the US
> humanitarian aid budget would be gutted.

Hopefully we can get more of the self-sufficiency tech and training out there.  OLPC type projects are great too as they get 
knowledge and modern culture out to the fringes in a pervasive way.  Look at the fractal revolution in the Middle East for the 
benefits of that.

> #4 STD treatment in low income countries
> ----------------------------------------
> Each dollar invested yields $40,000 of societal value.
> According to a study by the World Bank STD treatment programs in low
> income countries deliver around $40,000 of societal value through the
> prevention of death and disability.  Similar issues exist as with HIV
> prevention for sex workers in countries where AIDS = death, so we
> won't discuss this opportunity any further, except to say that once
> again targeted funding opportunities are limited.

Good.  Matching up already-HIV infected couples, an obvious strategy to reduce additional infections, would seem to be a low hanging 
fruit here.

> #5 OneWorld Health
> ------------------
> Each dollar invested yields $35,000 of societal value.

Cool.  Open source chemistry?

> OneWorld Health is a non-profit pharmaceutical research company that
> focuses on the diseases of the developing world.  Pharmaceutical
> research is a notoriously expensive and risky venture, and OneWorld
> health aren't immune from that risk.  If they can hit a home run
> however, something which they have failed to do to date, their impact
> could be huge.
> Their first product Paromomycin for treating the neglected disease
> Visceral leishmaniasis was scooped by the appearance of other new
> drugs for treating the same condition.  Still the low cost of
> Paromycin means it has some effect, and the value of each dollar
> invested in the Paromomycin project is still in the $70,000 range.
> Their second product synthetic Artemesinin is used for treating
> malaria.  Here unfortunately, they have been unable to get the cost of
> production down significantly below that of conventionally produced
> Artemesinin.  As such they have positioned themselves as providing a
> drug stockpile to buffer world demand, but it isn't clear how much
> societal value this adds.
> Their final product, anti-diarrheals is too early in the development
> pipeline to assess.
> Conclusions
> -----------
> Give wisely.  Some of the top rated opportunities deliver $100,000 or
> more of societal value for every charitable dollar invested, but they
> are other charitable opportunities which we didn't cover that are
> simply a waste of money.
> Four out of five opportunities were directly related to healthcare,
> other opportunities barely got a look in.  This is the way the world
> is.  Looking over the calculations, this is because life is extremely
> valuable, and anything that can be done to cheaply save a life, is
> money very well spent.  A different four out of five were
> opportunities focusing on low income countries.  This is because a
> dollar goes much further in such countries than it does here.  Perhaps
> Bill Gates is onto something in focusing his foundation on
> international health.
> Reviewing the top 5:
>      #1 HIV prevention for sex workers in countries where AIDS = death
>      #2 Getting antibiotics out of animal feed
>      #3 Lobbyists for the poor
>      #4 STD treatment in low income countries
>      #5 OneWorld Health
> For more detailed evaluations and full calculations on these and over
> 30 other opportunities that were considered: http://www.gricf.org/beguide


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