All of Alfredo Parra 🔸's Comments + Replies

Thanks for all this info! Keep it coming; I'm keeping track and plan to make good use of it. Get in touch if you'd like to discuss more. :)

Wishing you all the best! :)

Thanks for sharing your thoughts! While I'm obviously sad that you've updated negatively, this exchange has been very helpful for me to reflect on how to communicate my level of confidence in these treatments, especially given the little data we have from RCTs specifically. The total evidence still looks overall highly compelling to me (I wouldn't be working on this ~full time otherwise), but I'll work on improving my communication (and generating more scientific evidence).

The main thing I'd like to say is that I'm really not committed to psychedelics as a... (read more)

Clusterbusters, because torturous pain belongs to the past (especially if it can be easily prevented).

I understand it seems hard to believe! And yes, I'm motivated to support / advocate for RCTs and I'm developing various ideas with some collaborators (not just involving psychedelics). I agree that more data published in peer-reviewed journals is very much needed.

I still genuinely believe that the funding and legal barriers are very difficult to overcome (plus other barriers). A good resource on this topic is the book Psychedelic Outlaws (describing the history of psychedelic use and research for CH). This deep research by Claude may also provide useful co... (read more)

Why suspicious? The fact that DMT aborts cluster headaches is a pretty recent discovery. The word is just beginning to spread among sufferers. And there are very few researchers working on this topic, and very little funding generally, and it can be pretty difficult to get all the permissions needed to run trials using psychedelics. (I wouldn't be surprised if Schindler's group at Yale was running the DMT survey as a preliminary step to justify running a proper trial. Note that Schindler "is believed to be the only researcher in the United States studying psychedelics in headache disorders.")

Thanks for your comment!

It is true that published studies on psychedelics are few and small. Hopefully that will change but, currently, investment into cluster headache is minute relative to its severity and prevalence. 

There are no studies on DMT in particular (though one survey is being carried out at Yale). However, we've argued that the little evidence we have on DMT specifically should be taken very seriously (which is what motivates the Yale group).

In medicine you quickly learn that anectode is extremely unreliable and the average person is posi

Nice, can relate. Thanks for sharing.

Thanks so much for your comment and your support! :) And yes, we definitely want to engage with representatives at all levels, both ourselves as well as in a decentralized manner (e.g., by empowering patients and other volunteers to take action locally). Any efforts are welcome. Get in touch if you'd like to coordinate somehow or if you need any advice. :)

Thanks for the shoutout and for the vote! :)

I'm not convinced that the number of sufferers isas high as claimed. In 13 years as a doctor in Uganda and treating a few thousand patients, I've never seen a convincing case of cluster headache here.

This is indeed quite surprising! The relatively low prevalence and the lack of recognition of the disease / misdiagnosis may explain it to some extent, but zero patients in 13 years is still very surprising.

(Consider that even an average neurologist only ever sees a few dozen CH patients during their entire career. I... (read more)

Thanks for your answer! :)

 If so, why not generalise, and conclude you would avert 2^N h of pain of intensity 0.999^N instead of 1 h of pain of intensity 1?

I think the procedure might not be generalizable, for the following reason. I currently think that a moment of conscious experience corresponds to a specific configuration of the electromagnetic field. As such, it can undergo phase transitions, analogous to how water goes abruptly from liquid to gas at 100°C. Using the 1-dimensional quantity "temperature" can be useful in some contexts but is insuf... (read more)

As a panpsychist and suffering abolitionist, I'm one of the most sympathetic people in the world to the cause of reducing suffering even in the smallest beings. And yet, I do not want to see more research on how to increase the welfare of microorganisms on the margin (or at least not with EA resources).

I probably won't change your mind about meta ethics, but I strongly disagree with the aggregationist QALY approach to comparing the welfare of humans vs e.g. soil animals (e.g. here). I hope to write more about this at some point, but as an intuition pump, I... (read more)

Thanks so much for sharing these resources!!

Like many experts and institutions in global health, we use “disability-adjusted life years” (DALYs) as a way to measure the burden of a health condition. An intervention that improves health will thereby reduce DALYs.

It'd be awesome for OP to explore in parallel other cause areas and interventions that the DALY misses, such as less prevalent conditions inflicting very severe suffering. Otherwise, we risk neglecting those who are worst off.

I make this case in my paper "The Heavy Tail of Extreme Pain Exacerbates H... (read more)

Related video by Andrés Gómez Emilsson (@algekalipso): "The Case for DMT for Cluster Headaches: Practical Tips & Why It Deserves Urgent Scientific Attention"

I found it insightful to read your criticisms of the old website! And I really like the new website. Congrats on the launch! 🎉

This is helpful, thanks! (It would have come in handy for our kidney stone project, where we did something very similar!)

Thanks for the encouragement, Alistair! ❤️

Thank you, Cameron! You might be interested in the work of the Psychedelics & Pain Association.

Thanks a lot! I'll reach out again soon, once we launch our advocacy initiative (for which we're also gathering video testimonials :)).

Thanks for organizing this! :)

Minor thing, but this post says the week ends on October 19 while the banner on the Forum homepage says it ends on October 18. I assume it's fine to post on October 19?

Thank you for your feedback, Robert, and for your commitment to reducing suffering! I'll stay tuned!

Thanks, Vasco!

Would you still believe this under expectational total hedonistic utilitarianism?

Someone who is fully bought into expectational total hedonistic utilitarianism and nothing else would probably not agree with that conclusion, no. (I don't endorse such a form of utilitarianism. My views align much more closely to something like xNU+.)

I do, however, hope that people across the ethical spectrum can acknowledge that we could be doing much more to relieve extreme suffering without necessarily making significant compromises elsewhere. We already mana... (read more)

All testimonials we've heard about DMT are crazy. Some people report being able to abort 100% of their attacks with low doses and no apparent loss of effectiveness with continued use. Here's a relevant interview: DMT for Cluster Headaches: Aborting and Preventing Extreme Pain with Tryptamines and Other Methods

Dr. Emmanuelle Schindler at Yale (top expert in psychedelics for cluster headache) is planning to run a survey on DMT usage. (We're helping her fundraise, so anyone reading this with $150k to spare, let me know. :))

>1.7 million views in 7 days! B-A-N-A-N-A-S!

Depopulation is Bad

I remain unconviced by the arguments in the book (based on this post). My main disagreement is that it assumes that the main downside of a larger population is climate change (which I don't think it is), and then goes on to focus exclusively on all the great things we could have with more people. Perhaps not surprisingly, I think this debate is not complete without bringing up the problem of extreme suffering:

More Good is Better. It’s better if there is more good in the world, other things being equal, and worse if there is less. That in

Thanks! I think we probably agree much more than your comment suggests. I wholeheartedly agree with this, for example:

But better still would be "I would like more examples of what these budget numbers mean for our day to day operations" or "expert consensus is that people will pay more attention if you sound excited when you give a presentation". 

Those are the kinds of indisputable facts that I think should be used instead of judgments (no one can dispute that you would like more examples for the budget).

I think there's a caricature version of NVC in ... (read more)

Nice, thanks for sharing this! I'd been thinking about this topic for a while. It seems like something for the EA Forum team to invest some resources into (maybe they already are).

Thanks! With "such as," I meant "among others." I agree that "makes me sad" wouldn't do the job here, but I think the other examples I mentioned would, no? ("I disagree", "I doubt", etc., which aren't really feelings but they're still not judgments).

(Very much agree with the "Featured in" point!)

I'd love to talk to people broadly interested in ways to reduce the burden of extreme suffering in humans, which I think is weirdly neglected in EA. The vast majority of global health & wellbeing work is based on DALY/QALY calculations (and, to a lesser extent, WELLBY), which I believe fail to capture the most severe forms of suffering. There's so much low-hanging fruit in this space, starting with just cataloguing the largest sources of extreme human suffering globally.

I'm eager to talk to potential collaborators, donors, and really anyone interested ... (read more)

Thank you so much, Wladimir! I admire the work that you and your team at the Welfare Footprint Institute are doing, so this means a lot coming from you!

Thank you so much, Dee! There might be a way for you to help—I'll get in touch in the coming weeks! :)

Thanks so much for your comment and your willingness to support these efforts! I'd be happy to chat and brainstorm ways for you to contribute. Just get in touch anytime (e.g. DM me here on the Forum). 🙂

In case it helps, I enhanced the audio of Rob Burbea's jhana retreat, which you can find here. :)

Thanks for reading and for your comment, Derek!

there doesn't seem to be any obvious mechanism for general quantum level truths to exert the kinds of very targeted influences that would be necessary for them to explain our beliefs about consciousness

I think it will turn out that the mechanism will not be obvious, mainly because quantum mechanics and fundamental physics more broadly are extraordinarily complex (and I expect that understanding consciousness will be just as difficult as understanding, say, quantum field theory). But, that being said, I do thin... (read more)

Thanks so much for your thoughtful and detailed comment, Mitchell! It seems like we're roughly on the same page regarding the various constraints that a successful theory of consciousness should meet, as well as the class of approaches that seem most promising. Let me just share some immediate reactions I had while reading your comment. :)

The problem with entanglement is that it potentially gives you too much unity

Potentially, yes (though my understanding of entanglement is limited). On the other hand, as Atai has pointed out, "most binding-appreciators st... (read more)

Really cool report! Thank you and congrats on publishing it. :)

I'd love to see an analogous report tackling preventable severe suffering (i.e., beyond preventable deaths). There's a wonderful case report from Uganda's efforts to provide universal palliative care (see this short documentary). A good starting point could be the Lancet Commission report "Alleviating the access abyss in palliative care and pain relief".

In addition if they are sentient, then I would estimate their experience of pain might be between 1x and 1,000x less important than that of an individual human.

This is the reason why I agree that there's a non-negligible chance that insect suffering is "only" moderately important, though I think the chance is higher than "small-ish" (despite the fact that I think insects are 100% conscious/sentient). I come at it from a non-materialist physicalist stance on consciousness, assuming that suffering is (super roughly) proportional to the energy of the electrom... (read more)

I assume it's the one I linked in my original post? Catherine announced it was discontinued. :/

Should the EA Forum facilitate donation swaps? 🤔 Judging from the number of upvotes on this recent swap ask and the fact that the old donation swap platform has retired, maybe there's some unmet demand here? I myself would like to swap donations later this year. Maybe even a low-effort solution (like an open thread) could go a long way?

My experience from the church is the salary doesn't correlate will with likelihood of donating, although it does of course correlate with donating larger amounts of money.

Yes, though I thought maybe among EAs there would be some correlation. 🤷

I think I was assuming people working in highly paid AI jobs were donating larger percentages of their income, but I haven't seen data in either direction?

Yeah, me neither (which, again, is probably true; just not in my circles).

Am I wrong that EAs working in AI (safety, policy, etc.) and who are now earning really well (easily top 1%) are less likely to donate to charity?

At least in my circles, I get the strong impression that this is the case, which I find kind of baffling (and a bit upsetting, honestly). I have some just-so stories for why this might be the case, but I'd rather hear others' impressions, especially if they contradict mine (I might be falling prey to confirmation bias here since the prior should be that salary correlates positively with likelihood of donating among EAs regardless of sector).

Sharing this talk I gave in London last week titled "The Heavy Tail of Valence: New Strategies to Quantify and Reduce Extreme Suffering" covering aspects of these two EA Forum posts:

• Quantifying the Global Burden of Extreme Pain from Cluster Headaches
• The Quest for a Stone-Free World: Chanca Piedra (Phyllanthus niruri) as an Acute and Prophylactic Treatment for Kidney Stones and Their Associated Extreme Negative Valence

I welcome feedback! 🙂

Oh god that's a huge preview. OK.

Thanks for writing this! Coincidentally, my talk "The Heavy Tail of Valence: New Strategies to Quantify and Reduce Extreme Suffering" just went online a couple of hours ago. I thought you might like it ☺️ 

Thanks, Hasan! :)

Obviously I want to be cautious about making such a recommendation. 😅 But I'm confident enough in our data (pointing at chanca piedra being safer than e.g. melatonin) that I myself take 500mg once a week, but mostly because (a) that was the default recommended dosage on the bottle I got, and (b) I thought taking it daily would be an overkill given that I think I'm at very low risk. But I could see the rationale for taking it daily for one month per year, as you suggest. Or maybe doing both?

Thanks, Henry. Your care, as a doctor, for people's wellbeing shines through! We'd also hate to learn that this herb causes e.g. delayed, severe side effects. We hope this question can be settled for good asap given the scope and severity of the suffering involved here!

We start our post acknowledging that online reviews are not usually a reliable source of information concerning medical matters. So we asked ourselves: if there was a statistically significant signal, how could we possibly find it? This is what motivated us to:

• Compare reviews across three di

I really appreciate your feedback and your questions! 🙏

I'd love to reply in detail but it would take me a while. 😅 But maybe two quick points:

1. On observer independence: The main challenge that computational functionalism faces (IMO) is that there's no principled way to say "THIS is the (observer-independent) system I posit to be conscious" because algorithms, simulations, etc. don't have clearly-defined boundaries. It's up to us (as conscious agents) to arbitrarily determine those boundaries, so anything goes! The section "Is simulation an intrinsic prope

Thanks for your questions, Joseph!

Would it be easier to convince lots of people to buy and consume chanca piedra than to convince lots of people to drink an extra liter of water each day? Any thoughts comparing the relative impact and tractability of these two paths? I’m particularly thinking of patient compliance and of the fad/popularity of large water bottles in recent years.

We've also been wondering about that. I drink a lot of water myself but I tend to forget how much of a hassle it can be for a lot of people who are not used to drinking much water. ... (read more)

Thank you for your feedback, Henry! :)

We'd absolutely love there to be RCTs and definitely encourage larger studies to be run (as mentioned in the Final Recommendations section). It seems like such low-hanging fruit. And one of the main motivations behind this project is that it becomes exactly that incentive needed to get those studies running.

At the same time, it could be years until a large RCT is run. Given the rising incidence of kidney stones worldwide, it seems like asking people to drink more water and eat low-oxalate foods isn't cutting it. 

W... (read more)