How much does the new deworming replication matter for Effective Altruists?

It doesn’t at all, as far as I can tell. As Calum points out, what matters is the systematic review of evidence not one study. And the new Cochrane systematic review doesn’t seem to have responded to the criticism from Duflo et al to their 2012 review, that it ignores quasi-experimental and long-term evidence on positive impacts of deworming (specifically Bleakley 2004, Ozier, and Baird et al).

A replication of the famous Miguel and Kremer deworming paper that launched the whole RCT in development economics movement, is published in the Journal of International Epidemiology today (along with comment from Hicks, Kremer, and Miguel, and reply from the replication authors), with coverage in the Guardian and by Ben Goldacre for Buzzfeed.

You may remember Berk Ozler's review of the draft of the replication paper back in January - concluding

"Bottom line: Based on what I have seen in the reanalysis study by DAHH and the response by HKM, my view of the original study is more or less unchanged."

You can probably expect to see more on the replication coming from @cblatts, which I’m not going to get into, but back in 2012, Givewell were convinced that the Cochrane review shoudn’t change their recommendation to donate to the Schistosomiasis Control Initiative or Deworm the World.

The ambiguity does make me a little queasy, and pushes me more in the direction of GiveDirectly (I see basically zero risk that giving $1000 to someone on a very low income can really be totally wasted, in the way that an ineffective drug could theoretically have zero impact).

The philanthro-nik manifesto

"We—the philanthro-niks—want more philanthropy to be strategic. Our fundamental challenge is this: that social change is hard and calls for slow thinking, but most donors will only think fast. It therefore falls to us to do the work that Thaler describes: get the evidence, and make it easy."

Caroline Fiennes in the SSIR

How to live well

Some interesting ideas from Alex Evans about the importance of building a movement

"Rich and I set out the need for a different theory of influence. Many of us who work in the fight for development, justice, and sustainability have I think been feeling the limits of theories of change that rely primarily on ‘insider lobbying’. We take that here as our starting point for asking what an alternative approach might look like: one that places much more emphasis on how we build new grassroots coalitions, transform values, and tell each other much deeper stories about where we are, how we got here, where we might choose to go next, and who we really are."

and then what those movements should do

We argue that it starts with the changes that all of us need to make in our own lives. This is partly because of the direct impact that such changes can have, of course, but we think the main issue here is something to do with the quality of intention that movements exemplify. Wherever movements not only demand but live out the change they want to see in the world, there’s a raw power there that can exert the kind of non-linear effect on politics that progressives so urgently want to see.

and from the full report

In practice, we think there are five areas that each of us needs to think about, which we describe in more detail below:

1. Live within our fair share of the world’s resources and environmental limits
2. Respond to poverty and inequality with radical generosity
3. Speak out prophetically
4. Use our power as a voter, a citizen and a consumer
5. Live restoratively and prioritise relationships

All of this is in a report for Christian Aid and supported by references to the bible rather than econ journals. Personally I’ve shifted somewhat from a Dawkins atheist to a de Botton atheist, and think there are important lessons here too for emerging secular congregations.

We can be (British) heroes

A reminder, whilst we are celebrating the 'British Schindler' Sir Nicolas Winton, who saved 669 mainly Jewish children from Czechoslovakia in 1939, that actually saving so many lives is entirely achievable for the average person in the modern world. Toby Ord, founder of Giving What We Can, has estimated that you can save a life for around $250. So to save 669 lives would cost you a little over £100,000, or spread over a 45 year career, £2,300 a year. Nicolas Winton has a knighthood, a statue at Prague railway station, Czechoslovakia’s highest honour (the Order of the White Lion), and a small planet named after him. 

60% discount on holiday giving

I've been frustrated this year about not really being able to give to GiveDirectly because they aren't registered in the UK and so are ineligible for Gift Aid (a 25% top-up donation by the government taken from your income tax payment).

I just discovered that this PROBLEM IS NOW SOLVED.

The new Giving What We Can Trust is eligible for Gift Aid, and they will pass on your money directly (plus gift aid) to the charity of your choice (as long as its either one of their recommended charities, or one of Givewell's recommended charities, which GiveDirectly is, though I'm guessing there is some additional bank charge for the trust to send money to GiveDirectly in the US?).

On top of this, Good Ventures (an awesome foundation financed by one of Facebook's co-founders) is offering a 100% match for any donations to GiveDirectly up to January 31st 2014.

So if you give £100 to the trust, this becomes £125 with gift aid, and £250 with the match (which is your 60% discount), which minus processing fees comes to around £225 directly in the hands of a family living in extreme poverty somewhere in rural Kenya, a pretty hefty chunk of cash when you're living on a dollar a day.

Big thanks to everyone at Give Directly, Give Well, Giving What We Can, Good Ventures, and Innovations for Poverty Action who have made this stunningly simple effective efficient way to make the world a slightly better place possible.

Merry Christmas!

Best charity in the world update

Depressing news from Givewell on the Against Malaria Foundation (AMF).

The good news: Givewell has directed $10m in the last 2 years to AMF. 

The bad news: This is a massive increase in scale for AMF, and they haven't yet managed to spend the money. This seems to be primarily because the transparency and accountability measures that help to make them such an attractive proposition for donors, also makes them a pretty unattractive proposition for implementers such as national governments. 

There's something about a sexy new NGO innovation which then runs into trouble when it tries to scale-up working through national government that sounds somehow familiar.

We shouldn't be too disheartened - this is hopefully just a set-back and the money will still eventually be spent. And it is still useful to model what good practice can look like even it is isn't replicated more widely immediately. But "room for more funding" - the capacity to implement at large scale, is clearly critical here. 

In the short-term this implies finding someone else to give your money to - your two best options seem to be Give Directly (tax deductible in the US) or the Schistosomiasis Control Initiative (tax deductible in both the US and UK, but with some concerns here) - neither of which seem to be entirely satisfactory for me as a UK-taxpayer. I'll wait for further comment from Givewell.

How you can literally give a whole family their entire annual income today for $1,000

Planet Money & This American Life have a really great new show on GiveDirectly.

What's best are the interviews with the recipients. It makes me feel very warm to imagine someone like Bernard Omondi in a remote village waking up one morning in slight disbelief to an SMS message containing $1,000 - his family's entire annual income - more cash than he has ever had at one time in his life - and that I sent him that.

A few things really struck me.

First, that even the recipients are sceptical about cash. Although they all explained how they themselves invested the money sensibly, they were quick to judge others in the village and explain how they had totally wasted theirs on booze. Perhaps this is a psychological thing and humans just have some kind of deep suspicion that everyone else is a bit of an idiot who needs taking care of? It reminds me of the surveys that show the overwhelming majority of drivers think that they are well above average (which is impossible). It's all the other road users who are idiots. Is that right? What is the relevant psychological bias? And what is the way of addressing this? The mounting evidence doesn't really seem to be doing the trick of convincing people.

Second, and related to that point, there seemed to be some surprise that many of the households had invested in a new metal roof. A chief criticism of someone who had "wasted" the transfer was "look at him, he still has a straw roof!" Now a metal roof which lasts for ten years actually turns out to be a great investment compared to a grass roof which needs constant costly maintenance. But I also wonder whether the fact that the transfer was explicitly targeted only on people with grass roofs had anything to do with people's choices? Might some people have got the new roof because they thought that's what the transfer was for?

Third, that "we are all poor around here." There are good reasons to think that selective-targeting of transfers can damage social relations. One of the recipients says "I've lost a few friends." Which could be important if you then later need to rely on those friends when you're in a tough spot. And so GiveDirectly are trying out a new model, identify a poor village and then give cash to everyone in the village, something that people asked for repeatedly when I spoke to recipients in Kenya and Eastern DRC.

Finally, there is an interview with a woman from Heifer International, which Chris Blattman comments on here (I think he actually goes a bit lightly on them). I actually think that sending a cow could be a great intervention, but it was just an embarrassing performance, which suggested that the organisation doesn't seem to believe at all that data can be informative about effectiveness, and doesn't seem to care at all about value for money (Heifer can't or won't even provide a per family cost for their programme, because "every family is different"). My money will keep going to the organisations interested in evidence and value for money. 

"Aren't you going to recycle that?"

I'm terrible about remembering to recycle. It's partly moving about so much and not keeping up with the different rules in each city. It's partly just laziness.

Andrea reprimanded me for forgetting last week, and after some debate I realised that though she was right about the recycling and my excuses were lame, I was annoyed about the reprimanding. Or rather interested - how and when did it became socially acceptable to reprimand people for forgetting to recycle, or for wasting food as the pope just did (by the way, it's great that this new pope is such a do-gooder, but wow is he a naive do-gooder for someone who has presumably been in the do-gooding business for... how many years?).

And why is it not socially acceptable to reprimand people for wasting money on crap they don't need when they could be giving it to charity and saving lives? Sure it's annoying, but so is being reprimanded about recycling.

In the UK at least I think a lot of this is our squeamishness about talking about money in general. As Kate Fox writes:

Our distaste for money-talk in everyday social life is well established: you never ask what someone earns, or disclose your own income; you never ask what price someone paid for anything, nor do you announce the cost of any of your own possessions. In social contexts, there is a sort of ‘internal logic’ to the money-talk taboo, in that it can be explained, to some extent, with reference to other basic ‘rules of Englishness’ to do with modesty, privacy, polite egalitarianism and other forms of hypocrisy.

But at the same time it is kind of nuts that there are such good giving opportunities out there to make the world a better place and we're not allowed to talk about them. In the UK only 39 percent of people give more than fifty pounds a year to charity (NPC 2013). Of those, the average amount for "mainstream" donors is £303 a year, for high-income donors £1,282 a year. Meanwhile, you could be saving a child's life for as little as £1500.

I have a bit of an advantage here because I'm from Yorkshire. As Kate explains:

There are pockets of stronger resistance to the money-talk taboo, particularly in Yorkshire, a county that prides itself on being forthright, blunt and plain-spoken, especially on matters that mincing, hesitant southerners find embarrassing, such as money.

Also it's much easier to type things into the internet ether than to actually say them to people in person. So consider this an annoying reprimand. We have the tools. We have efficient, low overhead, transparent, charities that have proven impact on poverty and child health. Excuses about waste and corruption just don't cut it any more. Aren't you going to recycle that?

Addendum:

I waste money on crap I don't need all the time, and it's annoying to be reminded of that. But is it bad to be reminded? Shouldn't I feel guilty? Andrea owes me some money, and so I'm making her give it to poor Kenyans via givedirectly.org instead of back to me, mostly just in order to annoy her or something. Which had instant positive results - she writes "excellent punishment actually. I started searching "bobbi brown cream eye shadow" and had to close it because the givedirectly page was open right next to it". How about that for a nudge - keeping a givedirectly tab open in your browser all the time?

This TED talk will probably save someone's life

Against Malaria Foundation

As part of my personal evidence-based living regime (ahem) I'm planning a £1,000 donation to the Against Malaria Foundation. It's at least partly selfish - one of the few ways that spending money can actually bring you happiness is by spending it on other people (can you tell how smug I feel writing this?). There has also been a lot of analysis into the effectiveness of buying bednets. Givewell estimate that the marginal cost of a net is $5.15, and that by buying enough of them, you can probably save a child's life for about $1,600 (or £1,000). I had been hesitating over a recent story about behavioural adaptation by mosquitoes to nets, but responses from Givewell and AMF have basically reassured me. Unless anyone has any other good objections?

Givewell:

our positive view on LLINs remains in place. There is strong evidence that LLINs reduce malaria and save lives and only preliminary/suggestive/mixed evidence that insecticide resistance may reduce their impact. In addition, it appears to us that the malaria control community has been devoting at least some attention and investigation to this issue for a long time, has developed a reasonable knowledge base (if one that has plenty of room to grow), and still recommends the use of LLINs regardless of the resistance situation. 

Indeed, the fact that we’re discussing this issue at all speaks to the extraordinarily and unusually strong evidence base (and supply of data) behind ITN distribution. For most aid interventions that donors can fund, the set of “things that could go wrong” is large and broad, and we have little evidence to address most of them, but when looking at LLIN distribution, the salient concerns are few and specific enough that the malaria control community is able to put substantial resources into specifically investigating them.

 And AMF:

Currently both issues - resistance to pyrethroids and changed time of biting - are not widespread. Currently LLINs remain highly effective in reducing the incidence of malaria.

 And why not, here's the Donation Page. 

Does deworming really work?

The latest Cochrane Collaboration review of the evidence on the impact of deworming on various outcomes has come out decidedly less than optimistic.

Here's a summary by the very smart Alexander Berger from Givewell, some discussion on the Public Library of Science blog including comment from one of the Cochrane authors and Alan Fenwick from SCI, and finally a rebuttal to the review's findings on schooling from IPA, JPAL, CEGA, Deworm the World, and the authors of the original Busia experiment on deworming.

I haven't spent enough time looking at the details to come to a strong opinion here, but one point made on the IPA blog seems evidently correct - random assignment should be enough to ensure pre-treatment balance between treatment and control. That is the whole point of random assignment. And  following the recent debacle of the medical journal the Lancet being forced to retract the key finding of a social-science-y study after some actual social scientists pointed out a mathematical error, combined with my disciplinary and professional loyalties, I'm inclined to go with the social scientists rather than the doctors on this one.


Update: Thoughts from David McKenzie

How to find an NGO to support

It is likely that bigger and more well-established agencies will be better able to answer these questions than smaller ones, though these do not have to be international agencies. This is an important observation as it suggests that bigger, more experienced, and more independent organizations with a greater range and depth of skills and deeper knowledge of the countries in which they are working are more likely to make wiser choices about how to deploy their funds than are smaller and newer agencies, which are often run and staffed by people with little development and country experience. It should be added that there are not only many competent nationally based poverty-focused organizations but that many of these have a better understanding of poverty and especially how it might be eradicated faster than do some international agencies. Also, it must not be thought that it is only the bigger agencies that do good development work: many smaller, especially locally based, agencies perform very valuable work. Additionally, a number of smaller agencies set up by people now living in the industrialized world but based on a deep understanding of the local communities in need—such as Send a Cow—continue to have a significant impact. The challenge is finding out about them.

Thoughts from Roger C. Riddell, a Non-Executive Director at Oxford Policy Management, writing in a special issue of  "Ethics and International Affairs" (HT: themonkeycage)

Millennium Villages: impact evaluation is almost besides the point

A lot has been said about evaluation and the impact of the Millennium Villages, most of which boils down to:

"What is the impact of the Millennium Village package of interventions on the area in question?"

The really depressing part though is that this is actually the least interesting question. Chances are that throwing in a whole bunch of extra inputs to a community will create some outputs, and some impact. The whole point of the Millennium Villages though is to provide a model for the rest of rural Africa to follow. The really interesting question is whether African governments have the desire and capability to manage a massive and complex scaling up of integrated service delivery across rural Africa.

A point which basically belongs to Bill Easterly.

Mr. Easterly argues that the Millennium approach would not work on a bigger scale because if expanded, “it immediately runs into the problems we’ve all been talking about: corruption, bad leadership, ethnic politics.” 

He said, “Sachs is essentially trying to create an island of success in a sea of failure, and maybe he’s done that, but it doesn’t address the sea of failure.” 

Mr. Easterly and others have criticized Mr. Sachs as not paying enough attention to bigger-picture issues like governance and corruption, which have stymied some of the best-intentioned and best-financed aid projects.

A proper randomised evaluation could give you a good estimate of the cost-effectiveness of the island. A difference-in-difference estimate could give you a slightly worse estimate. Doing a fake difference-in-difference with unreliable recall baselines, arbitrarily selected control villages, misrepresented results, and mathematical errors, will give you a pretty awful estimate. But either way, you are missing the main point, which is about scale and replication, and how that works.

How feasible would it really be to replicate something like this on a national level in Ghana? How exactly would it work? Do the  systems of accountability and capability exist at local levels to manage all of these projects? How would coordination and planning work between national ministries and their sectoral plans, and local level priorities?

The Millennium Village project seems to grasp vaguely at these issues but ultimately brush them under the table. From a MV project report:

Another challenge in some sites is insufficient capacity of local government to take full ownership of MV activities. This is manifested in unfulfilled pledges to perform mandated roles, unsatisfactory maintenance of infrastructure, and insufficient involvement of local elected officials. MV site teams are addressing these challenges by agreeing to jointly implement interventions targeted at improving the performance of sub‐district governments, increasing sensitization and engagement of local government officials, increasing joint monitoring of MV activities in communities, and developing training plans in technical, managerial, and planning skills for local government officials.

 Or : "we have no clue how to fix the systemic implementation challenges"

An anonymous aidworker writes on his blog Bottom-up thinking

I’ve noticed around here, normally sloth-like civil servants who won’t even sit in a meeting without a generous per diem rush around like lauded socialist workers striving manly (or womanly) in the name of their country when a bigwig is due to visit, working into the night and through weekends, all without any per diems...   

I fear all the achievements of the MVP will wash up against the great brick wall that is a change resistant bureaucracy.

None of this is to say that the situation is hopeless. It isn't. In particular there are elements of the Millennium Village package which are proven to be effective, cheap, and don't require complicated systems of governance and accountability. Namely distributing insecticide-treated bednets. Aid money can provide them easily, sustainability is less of a concern than other interventions, and you can buy them right now. Check out Givewell for a rigorous independent assessment (and recommendation) of the Against Malaria Foundation. Probably the single best way you could spend some money today. 

Kiva: A Gateway Drug?

It's pretty clear that "lending" money on Kiva is not the best way of giving to the poor. You aren't at all really lending to those individuals, but rather donating the interest you could have earned on your deposit to a microlending institution. And microlending institutions can raise their own money from deposits or capital markets, so you would be much better off donating to something more effective, such as buying bednets or deworming pills (see givewell.org's current recommendations, or the Proven Impact Fund).

The potential saving grace for me is Kiva as a development gateway drug. The story and personal connection is powerful. What if Kiva can get people hooked on development, who will then eventually find out more and graduate to doing something with bigger impact? I feel similarly about voluntourism. Would love to see any research on either of these topics.

Does succumbing to Kiva or voluntourism advertising have a causal impact on individual's attitudes and actions towards development, after the selection effect of those individuals being more likely to be interested in development in the first place?

Last minute donations

If you're into giving and tax deductibility and American, tomorrow is your last day (if you're not American or into giving - New Year resolution to save some lives?). I would highly recommend taking a look at Givewell's recommendations - hours of serious research into making your money go the furthest. 

Putting my money where my mouth is

I just made a donation to Give Directly. Given how much I have ranted about how great I think cash transfers are, it would be kind of rude not to.

I know it is very undignified and un-British of me to boast, but I believe in the power of social proof, and so I am going to do it anyway on the off chance that just one more person might be guilted into thinking about their own giving.

Besides all of that, I wanted to share this wonderful thank you message:

We will transfer your donation electronically to an impoverished household in Kenya. Your choice will give them choices: to pay school fees, buy food, get medical help, or repair their home, among others. 

Your donation is also a vote for a new vision of philanthropy - a vision that puts recipients in the driver's seat. Help us share that vision with your friends and family. Talk with them about what philanthropy could become and, if they're intrigued, send them our way. We'll be working to create the most efficient, transparent, and respectful way to give.