As someone who really admired George Monbiot as a teenager, I'm slightly surprised to hear him described as an effective altruist in spirit.

I admire his transparency and his willingness to change his mind, but he does strike me as someone quite committed to an ideology (generally a progressive one not too far from my own!) around issues like state intervention and ownership/delivery of public services. I'm also not convinced that rewilding is a promising or cost effective way of tackling the environmental issues which he (quite possibly rightly) prioritises so much. I'm not saying I don't think he is a good person, but I am saying it seems a stretch to think of him as an effective altruist in spirit. Do you know him personally?

I actually think the argument in his piece is pretty good as someone who works in one of the industries he is upset about. I can think of several friends, none of whom would consider themselves effective altruists, who have indeed followed the sort of path he outlines. All too often, people do not make differences from the inside.

I take your point that there are counterexamples where people do good from inside (I would hope to consider myself here, as someone donating 15%+ and triggering donations from colleagues worth around twice that last year) but as a general phenomenon his piece is pretty sound. A rebuttal would be difficult, but a response could go along the lines of "Not all City workers" or similar. Do you think this would still be valuable?

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I don't think there are any active proposals at the moment.

Pain is most definitely changeable, it's just very costly to do so. Lots of different medical, lifestyle and psychological therapies are tried. I think the best current solution for chronic pain is to have an interdisciplinary pain clinic that has physiotherapists, psychologists, doctors with an interest in pain medicine, some kind of medical or allied health folk with an interest in addiction medicine. And then you want to diagnose the type of pain, and give the minimum amount of opiods possible yet the maximum amount of pain relief. I've visited a bunch of these kinds of clinics as a medical student. All of this stuff is extremely costly, and still doesn't work very well, given the cost. It's not effective altruism. And this has been an active area of research for a long time. Hundreds of doctors in any country would class themselves as pain-specialists. There are pain-specialised-teams that visit patients in any major hospital. All of this is good, but it's far from a priority. What's interesting is that pain teams and pain specialists have emerged to a significant degree from the specialty of anaesthesia, who are really the original people who could reduce pain. If you want to look at where pain-reduction is cost-effective, it's getting the first anaesthetists. Having surgeries done with anaesthesia compared to without is terribly important, and it would seem critical to make sure that in areas of the developing world, basic operations can be safely performed, and local and general anaesthesia are available when required. Chronic pain could be of personal or selfish interest, but from a point of view of effectiveness, it's a disaster.

I think the problem is that a lot of pain is caused by being aware of the pain, and likewise a lot of mental ill-health is caused by ruminating about pain and suffering, so I think that if someone was going to work in this kind of area, it'd be very important for them to be a person who has very robust mental health themselves. The part that seems globally worrying is if people try to run awareness campaigns about the amount of pain, or writing pain reports, which could make worse-off more people who already have bad ruminations about these kinds of things.