Early-Stage Medical Projects as an EA Focus

Epistemic Status: throwing an idea out for discussion

I think there’s a reasonable case to be made that medical research can count as an EA cause.

For the purposes of this post, I’m going to make some common assumptions: that you care at least to some degree about worldwide humanitarian benefit (e.g. human lives or QALYs saved) and are willing to compare causes on that basis.  You don’t have to be a strict utilitarian — I’m not.

Tractability and Scale

If you look at the Global Burden of Disease stats, you’ll find that what kills and disables people worldwide isn’t so much different than what kills and disables people in the developed world: cancer, heart disease, stroke, diabetes.  (If you look just at disability, depression and low back pain are big too.)

Yes, infectious disease is a big problem.  And yes, the most effective global charities have focused on infectious disease for good reason — we know how to prevent it fairly cheaply. Malaria incidence has dropped by 40% in the past 15 years, mostly thanks to insecticide-treated mosquito nets, provided by organizations like the Against Malaria Foundation.  This is a really impressive success.

But the rest of the DALY pie is taken up by diseases that we really don’t know how to cure yet.  There is no equivalent of a mosquito net for cancer. It seems reasonable that people who are concerned with “doing the most good” should at least look to see if there are “good buys” in the world of chronic noninfectious disease.

Room for Funding and Comparative Advantage

But don’t universities and pharma companies have biomedical research covered? What use is an individual donor or investor?

It would be the work of a much longer piece of writing to demonstrate rigorously that there’s bias in biomedical research, and I hope to get to that eventually. But, in rough outline, what I believe is that there are distorted incentives that favor elaborate, expensive treatments and slow research programs.  On the whole, researchers are rewarded for getting bigger grants, not smaller ones, and the fact that all healthcare is paid for by insurance means that normal market pressures to keep the cost of treatment down don’t operate properly.  By this reasoning, we should expect that there are underfunded-but-effective experimental medical treatments out there that fail to make it all the way through the pipeline. I’ve seen a few examples so far of early-stage research that could have major impact (organ regeneration is one) but risks stalling due to lack of a business model and lack of investment.

Then there are projects so ambitious that they’re not funded much because they’re not really on the mainstream radar.  Serious attempts at anti-aging research, like the SENS foundation, are surprisingly small in scale; they are crowdfunding a $30,000 experiment for repairing mitochondrial gene defects.  The Brain Preservation Foundation, which funds a prize aiming to cryopreserve a brain at high precision, has a grand total of 14 donors over $1000.  Bone marrow cryopreservation, as far as I know, is a technologically solved problem that could make bone marrow transplants much cheaper; but the project in question died for want of investment.

The best-studied, most evidence-based charities are good causes to promote confidently to the public or to large foundation donors.  But there still may be a place for high-risk, high-return, experimental stuff.  If you are unusually interested in doing your own background reading, and especially if you have a scientific background, then you have a comparative advantage in investigating and giving to (or investing in, or working on) projects small enough that most of the world doesn’t know about them, and that e.g. GiveWell hasn’t already thoroughly examined.  There’s an exploration-exploitation tradeoff, and it seems likely that not all the “exploration” of good causes has been done yet.

Next Steps

The next steps I’m taking in this vein are fairly modest; passive information-gathering of biomedical research news and biotech startup news, plus hopefully starting discussions among knowledgeable people, with the aim of finding out what’s out there and promising.  Small donations to organizations that look promising (I donated to SENS). I have a selfish as well as a humanitarian interest in medical research — it’s interesting to me and I would like myself and my loved ones to be healthy for as long as possible — so I’m not saying that everyone should devote time and effort into looking into this.  But it would be nice to see transformative medical research discussed as one of the options in the EA space.

An Extremely Personal Rant on Tolstoy

Epistemic status: not too serious. I’m making another attempt at blogging more casually.

If I were a humble person, I would not pick fights with great authors.  I would recognize that I am not an expert in literature, and that the literary canon has stood the test of time, and I would assume that I’m probably missing something if there’s a famous author I dislike.

I am not a humble person. I have issues with Tolstoy.

I don’t just, like George Orwell, have a problem with his later, utopian political writing, in which, for instance, he declared that the work of Shakespeare has no value. I don’t just have a problem with him raping his wife.  No, I have a problem with Anna Karenina.

Joyce praised Tolstoy’s fiction, “He is never dull, never stupid, never tired, never pedantic, never theatrical!”  This is true.  And I can see why Joyce, who hated sentimentality, found Tolstoy restful. The style of Anna Karenina is understated, clear, and ordinary, without excess drama.  It is “lifelike”, in the sense that it could easily be a story your friends told you about someone they knew; it is an act of expert attention to the mundane in social interaction and human psychology, in the same way that a Dutch still-life is an act of expert attention to the objects of everyday life.

The characters are all mildly despicable, and presented as such, with the authorial voice ironically pointing out where they self-deceive and rationalize.  Oblonsky is shallow, philandering, and a slave to convention; but he’s a rather generous friend.  Vronsky is a pure creature of machismo with almost no inner life; but he is a conscientious lover and responsible landowner. Karenin is self-righteous and pompous; but he is, on the whole, fairly reasonable to his wife.  Anna is flighty and utterly unreflective; but she is capable of some deep emotion and warmth.  We are not meant to hate these people, we are meant to pity their foibles, and consider their tragedies akin to ours.  It’s supposed to be “the human condition.”  But is it really the human condition to cheat on your spouse? To be pregnant and not plan ahead for the fact that you will eventually have a baby?  To let your source of income dwindle to nothing and have exactly no intention of doing anything about it?  Or is this just, perhaps, avoidable stupidity?

I’d contrast Anna Karenina with Middlemarch, which is also an ensemble-cast novel, also involves unhappy marriages, and is also a “novel of cognitive biases” in which the characters’ self-deceptions lead them to the brink of ruin.  But the characters in Middlemarch are, for the most part, basically sincere idealistic people who fool themselves into thinking their dreams are possible.  Reading it, I yearned for Dorothea and Tertius and Fred and Will to get their acts together — and they do, barely.  Middlemarch treats the theme of self-deception as though it is a human challenge, a serious problem that everyone must face, but that effort can sometimes overcome.

Anna Karenina‘s answer to the problem of self-deception is less appealing.  Levin, the author-insert character, has a realization at the end of the book: while all the time he has been doubting the existence of God and the purpose of life, he has been unconsciously living well — running his estate effectively, caring for his wife and child, upholding traditions.  The confusion and tragedy of the city people, he thinks, results from them trying to figure out how to live and screwing it up. If we all stopped overthinking things and imitated what we were taught in childhood, including religious belief, we’d make less of a mess.

It’s an ideology that places human thought and intention as bad.  Simplicity is good. Tradition is good. Faith is good. If you try to come up with your own damn fool ideas, you’ll ruin everything. Peasants are especially to be admired for their simplicity and faith — but we are carefully shown that Levin doesn’t treat them with any special respect and is quick to call them stupid, and sympathizes with the old-fashioned landowners who are nostalgic for the days of serfdom.  It’s not “peasants are human, just like aristocrats” — it’s “peasants are subhuman, and that’s AWESOME!”

The characters in Anna Karenina are extraordinarily unreflective.  There are no characters with a strong intellectual or artistic temperament; they are mostly “Sensing” rather than “Intuitive” types in the Myers-Briggs sense.  I rarely see the inner lives of such people; not only do I rarely meet them personally, but I rarely read about them, because it’s introspective people who are most likely to write personal narratives or explain their thought processes.  So it’s instructive, in a way, to see them in the daylight of Tolstoy’s prose.  And I feel that I ought to empathize with them.  I ought to be able to love them.  But I can’t, most of the time. The only exceptions are at the great occasions of life — Levin’s marriage, the birth of his child, the death of his brother, Anna’s meeting with her son.  These really are human universals, and as I share a species with these people, I can care for them and pity them.  But love, for me, requires some kind of recognition, and that just isn’t there…

Tolstoy is an eloquent defender of a worldview which is probably substantial enough to deserve attention. This simplicity thing, that goes with his voluntary poverty, his mistrust of modernity (note the role of trains!), his mistrust of thought. A horse or a dog can be good in a simple way, loyal and loving, and he wants humans to be good the way a horse or a dog is good.

For better or for worse, I can never, ever be good in that way; if I am to be good it will have to be a different way.

And I think that people really aren’t meant to be like horses or dogs, and you do them no favors when you treat them as such, even in the guise of admiration (see: the cruelty of Tolstoy’s personal life.)  Even at his best, even in his most celebrated novel, that cruelty comes through here and there.  It’s not actually okay.  Tolstoy is bad, and he should feel bad.