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.
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.