Akhil

1179Joined Dec 2021

Comments
40

Hey Joel, great report- overall, I am also pretty excited about interventions for hypertension.  A couple of questions about your report:

  1. You decided to narrow down on sodium policy taxation advocacy- whilst I think this is probably one of the more appealing interventions in this space, I wonder whether you considered other interventions e.g. community salt substitution, which was looked into by Givewell and recently had a very large RCT conducted.
  2. The impact of sodium reduction extends beyond BP effects- Although the majority of the health effect of sodium reduction does seem to be through reducing BP, there are some other causal mechanisms that are suggested e.g. reducing oxidative stress, reducing sympathetic tone. I wonder whether you looked into/considered these
  3. The cost of advocacy- it seems like you have by and large taken the cost of quite a lean charity doing this. I wonder whether it would be worthwhile looking at organisations that have previously successfully helped advocate for taxation policy, and estimated their size/cost. I would imagine this might be a higher cost by several factors
  4. Are there good advocacy groups out there- I would be really interested to know whether there are highly effective organisations advocacy for sodium taxation policy already out there, that funders might be able to look int further + potentially fund!

A great report- thanks Joel!

High Impact Medicine and Probably good recently produced a report on medical careers that gives more in-depth consideration  to clinical careers  in low and middle income countries- you can check it out here: https://www.highimpactmedicine.org/our-research/medicalcareers

There is also an active High Impact Medicine community in Aus, with about 15 members and two fellowship cohorts currently running!

Yes, we would appreciate you sharing your working. We will also clarify that on the application form, thanks for asking :) 

Yeah great question! There were some similarities and differences from our normal research process

Similarities

  • We predominantly looked for ideas where there were good feedback loops to measure the impact of the charity and the good that it was doing
  • Our research process  largely worked and could be adapted to biosecurity as a cause area
  • We considered the potential of the negative impact of our ideas, and ideas where this was more likely were far less likely to pass through our research stages

Differences

  •  We had to very seriously consider information hazards in our idea, which is not a consideration we had given much weight on or considered at all for other cause areas
  • Had to rely a bit more on expert opinion and ‘lower’ quality forms of evidence like theoretic evidence, case studies
  • We had a lot more uncertainty about our cost-effectiveness analyses, since estimates vary a lot depending on priors about likelihood of future pandemics and how bad they could be; to an extent, these uncertainties were multiplicative, which made quantification particularly challenging
  • We had to coordinate and talk a lot more to EA biosecurity folk- the space is small and growing, and it was important to coordinate to make sure we were not duplicating something that was already happening in a way that might be harmful

We are happy to chat to anyone interested in biosecurity who might want to start a charity and wants to talk more about our research process and the ideas we are most excited about in this space

Given the uncertainty in the chronology of events and nature of how authorship and review occurred, would it have not made sense to reach out to Cremer and Kemp before posting this? It would make any commentary much less speculative and heated. If the OP has done this and not received a reply, they should make that clear (but my understanding is that this was not done, which imo is a significant oversight)

Hey Gavin, good question. My intuition is that:

  1.  The medications, at least while they are patented, are likely to be quite expensive and therefore unlikely to be super cost-effective.  I have some links in the article that go into estimating cost-effectiveness of GLP-1 agonists, and it doesn't look too exciting. That being said, if there was a way to make them cheaper by 2-3 orders of magnitude (not sure how feasible), maybe this picture changes.
  2. In addition,  I would worry that access to them (as with all medicines) does reduce how scalable an itervention it is.  
  3. Yeah,  I think that this is probably an area of pharma where the market has sufficient incentives and is vast, and don't think there is that much scope for and/or benefit of a new organisation, profit or non profit :)

Great post!

I think I would separate out two parts of this post

  • FMT and being an FMT donor as an effective way to do good
  • Being an FMT donor as a means of earning money, hopefully to give

On the first, I would be a lot more hesitant about some of the claims that are being made. The evidence for FMT is young, and relatively weak. I think it is far from being a potential treatment of a broad range of chronic diseases; FMT is currently approved for recurrent C. difficile infection in the UK. Things we do not know:

  • Is it helpful for other chronic diseases? If so, how much and is it cost-effective?
  • Can it be safely administered at home? You make the claim that donation and use of FMT can happen outside of the hospital setting; this is currently not recommended.
  •  Do we need super donors? There is a growing literature around the effectivneess of autologous FMT (use of your own stool for transplantation) may be as effective as a donation from someone else (one paper I am aware of, but I am sure there are many more). I would be hesitant in putting too much stock in one apprpoach early on in the R&D of this area.

On the second, I don't have strong opinions. I think it is worth more explicitly flagging that a super donor is quite a rare statistical occurrence, and that the activation energy and cost to be accepted and donate stool for the first time might not make net positive from a cost-effectiveness perspective ( I have not modelled this, but I wouldnt be surprised if this was the case

Yeah it is a little bit of a counter-inuitive presentation. 

Basically of vaccines low income countries did receive in 2021, they  averted 180 300 (171 400–188 900) deaths. 

If LIC had achieved the WHO target of 40% vaccination rate, they would have averted an additional 200 000 (187 900–211 900) deaths

200 000/ 180 300 = 111%

Great work. I think point 4 is really interesting:

4. Progress on the policy side is driving progress on the industry side and vice versa

I think this is perhaps applicable to other cause areas where a combination of industry and policy action might be helpful (e.g. corporate campaigns on cage-free chickens and policy change on the same, e.g. incentivising pandemic prevention investment). 

  1. How  easy/hard was it for you to understand the incentives of different stakeholders and map their relationships?
  2. Do you have any advice for others on how to approach this?
     
Load More