Director of Research at PAISRI
So I remain unconvinced that there's a specific longtermist case for democracy, but I think there is a longtermist case for some kind of context in which longtermist work can happen.
What I have in mind is I'm not sure democracy or liberal democracy is necessary to work on longtermist cause areas, but liberal democracy is creating an environment in which this work can get done. So there's an interesting question, then: what are the feature of liberal democracy that enable longtermist work?
I ask this because I'm not sure that, for example, democracy is necessary to work on improving the longterm future, however it's also clear that something about liberal democracy has allowed people to start doing work towards bettering the longterm future, so it must have some features we care about for that purpose. Maybe it is the case that electing the government is the key feature that matters, but I don't see an obvious causal chain there between the two, which makes me wonder what the features are that do matter that we'd want to ensure are preserved if we want people to be able to work on making the longterm future better, even if it means having a government that is not what we'd consider to be democratic.
Maybe another way to put my comment is that this post feels like it's taking for granted that liberal democracy is good for longtermism so we want to figure out what it is about liberal democracy that makes it good, but I'd say it slightly differently: longtermism has been fostered within liberal democracies, so this means there must be something about liberal democracies that matters, but this doesn't imply that longtermism requires liberal democracy, so we should cast a wider net and look at features of specific liberal democracies where longtermist work is flourishing without presupposing that it's somehow connected to the system of government (for example, maybe it's just that liberal democracies are rich and have lots of extra money to spend on "hobby" interests like longtermism, and any sufficiently rich society, no matter the government, would be able to foster longtermism; I don't know, but that's the kind of question that seems to me worth exploring).
As best I can tell you don't seem to address the main reasons most organizations don't choose to outsource:
You could of course hand-wave here and try to say that since you propose an EA-oriented agency to serve EA orgs this would be less of an issue, but I'm skeptical since if such a model worked I'd expect, for example, not not have ever had a job at a startup and instead have worked for a large firm that specialized in providing tech services to startups. Given that there's a lot of money at stake in startups, it's worth considering, for example, if these sorts of challenges will cause your plan to remain unappealing in reality, since the continue with the example most startups that succeed have in-house tech, not outsourced.
I think the obvious challenge here is how to be more inclusive in the ways you suggest without destroying the thing that makes EA valuable. The trouble as I see it is that you only have 4-5 words to explain an idea to most people, and I'm not sure you can cram the level of nuance you're advocating for into that for EA.
This question on the EA Facebook group got some especially not EA answers. This seems not great given many people possibly first interact with EA via Facebook. I tend to ignore this group and maybe others do the same, but if this post is representative then we probably need to put more effort in there to make sure comments are moderated or replied to so it's at least clear who is speaking with an EA perspective and who isn't.
You want more good and less bad in the world? Would it be better if we had a little more good and a little less bad? If so, then we should care about the efficiency of our efforts to make the world better.
*note that I of course here mean something like efficiency that includes Pareto efficiency, not the narrow notion of efficiency we use everyday; you could also say "effective" but you asked for why giving should be effective, and we can ground effectiveness in Pareto efficiency across all dimensions we care about
I've been pretty skeptical that mental health is something EAs should focus on. One thing I see lacking in this report (apologies if it's there and I didn't find it) seems to be a way of comparing it to alternatives, since I don't think that mental health is a source of suffering for people is in question, but whether it's compares favorably to other issues.
For example I'd love something like QALY analysis on mental health that would allow us to compare it to other cause areas more directly.
Having lived with someone who suffered chronic kidney stones, at least within the US, a huge problem in recent years has been the over-reaction to the so-called opioid crisis. The result has been a decreased willingness to actually treat what we might call chronic acute pain, like the kind that comes from kidney stones.
This is a somewhat technical distinction I'm making here. Kidney stone pain is acute in that it has a clear cause that can be remediated. However if someone produces kidney stones chronically (let's say at least one a month), they are chronically in acute pain. This creates a problem because standard treatment protocols for chronic pain don't always work because this is a continuous level of pain above what's normally experienced by chronic pain sufferers, perhaps with the exception of migraines. But since migraine pain is best treated with non-opioid drugs, they don't run into the same problems as chronic kidney stone sufferers do who need repeated access to opioids to deal with pain that can break through maintenance pain medications.
The result is people left in agony who suffer from chronic kidney stones that are resistant to treatment because of restrictions on opioid drug use in the name of curbing abuse. To make matters worse, treatment can become a catch-22: chronic pain doctors won't treat such pain because it's "acute" and at some point other doctors will stop wanting to treat repeated kidney stones because they are "chronic". The incentives are aligned perfectly to get doctors to not treat these patients since they can risk losing their license for improperly prescribing opioids. It doesn't matter if it's valid, all that matters is that it looks suspicious in a database, and doctors would rather avoid that attention than risk it to treat patients (but of course not all doctors are like this, just that there's a lot of them who follow the incentives rather than work against them in the name of patient care).
Regarding the difference in prevalence between chronic pain in men and women, there's a tendency, at least within the US medical system, to dismiss women's pain more often than men. A good example of this is pain resulting for endometriosis, which is often dismissed or downplayed by doctors as "just bad period cramps" rather than a serious source of chronic pain. So too for many other sources of pain unique to women.
I don't have a source, but my experience is that most of this seems to be due to a variant of the typical mind fallacy: male doctors and some female doctors have never experienced similar pain and so fail to appreciate its severity and sympathize with it less on the margin, being more likely to recommend more conservative treatment rather than more aggressively try to remediate the pain.
My model is the that the global angle is kind of boring: the drug war was pushed by the US, and I expect if the US ends it then other nations will either follow their example or at least drift in random directions with the US no longer imposing the drug war on them by threat of trade penalties.
I think this starts to get at questions of tractability, i.e. how neglected is this contingent on tractability (and vice versa). In my mind this is one of the big challenges of any kind of policy work where there's already a decent number of folks in the space: you have to have reasonably high confidence that you can do better than everyone else is doing now (and not just that you have an idea for how to do better, but like can actually succeed in executing better) in order for it to cross the bar of a sufficiently effective intervention (in expectation) to be worth working on.