All of JamesSnowden's Comments + Replies

Announcing the launch of the Happier Lives Institute

On (1)

>people inflate their self-reports scores generally when they are being given treatment?

Yup, that's what I meant.

>Is there one or more studies you can point me to so I can read up on this, or is this a hypothetical concern?

I'm afraid I don't know this literature on blinding very well but a couple of pointers:

(i) StrongMinds notes "social desirability bias" as a major limitation of their Phase Two impact evaluation, and suggest collecting objective measures to supplement their analysis:

"Develop the means to negate ... (read more)

Announcing the launch of the Happier Lives Institute

Excited to see your work progressing Michael!

I thought it might be useful to highlight a couple of questions I personally find interesting and didn't see on your research agenda. I don't think these are the most important questions, but I haven't seen them discussed before and they seem relevant to your work.

Writing this quickly so sorry if any of it's unclear. Not necessarily expecting an answer in the short term; just wanted to flag the questions.

(1) How should self-reporting bias affect our best guess of the effect size of therapy-ba... (read more)

Hello James, Thanks for these. I remember we discussed (1) a while back but I'm afraid I don't really remember the details anymore. To check, what exactly is the bias you have in mind - that people inflate their self-reports scores generally when they are being given treatment? Is there one or more studies you can point me to so I can read up on this, or is this a hypothetical concern? I don't think I understand what you're getting at with (2): are you asking what we infer if some intervention increases consumption but doesn't increase self-reported life satisfaction in a scenario S but does in other scenarios? That sounds like a normal case where we get contradictory evidence. Let me know if I've missed something here. I'm not sure what you mean by this. Are you asking what the evidence is on what the causes and correlated of life satisfaction is? Dolan et al 2008 [] have a much cited paper on this.

I would deprioritise looking at BasicNeeds (in favour of StrongMinds). They use a franchised model and aren't able to provide financials for all their franchisees. This makes it very difficult to estimate cost-effectiveness for the organisation as a whole.

The GWWC research page is out of date (it was written before StrongMinds' internal RCT was released) and I would now recommend StrongMinds above BasicNeeds on the basis of greater levels of transparency, and focus on cost-effectiveness.

Very interesting you say this. I recently suggested to Basic Needs' CEO that he get in contact with GW and hopefully this will lead to BN focusing more on cost-effectiveness and transparency. Did you and I not discuss the Strong Mind's RCT ages ago? I thought we agreed it was too good to be true and we really wanted to see something independent, but maybe I misremember/was talking to someone else. If it's the case the best evidence for mental health in the developing world is an internal RCT that shows 1. how far behind mental health is and 2. the urgent need for a better evidence base.
Some Thoughts on Public Discourse

Thanks Holden. This seems reasonable.

A high impact foundation recently (and helpfully) sent me their grant writeups, which are a treasure trove of useful information. I asked them if I could post them here and was (perhaps naively) surprised that they declined.

They made many of the same points as you re: the limited usefulness of broad feedback, potential reputation damage, and (given their small staff size) cost of responding. Instead, they share their writeups with a select group of likeminded foundations.

I still think it would be much better if they mad... (read more)

The Giving What We Can Pledge: self-determination vs. self-binding

I agree this seems relevant.

One slight complication is that donors to GWWC might expect a small proportion of people to renege on the pledge.

Estimating the Value of Mobile Money

It seems like you're assuming that the GiveDirectly money would have gone only to the M-Pesa-access side of the (natural) experiment, but they categorized areas based on whether they had M-Pesa access in 2008-2010, not 2012-2014 when access was much higher.

Ah yes - that kind of invalidates what I was trying to do here.

I didn't notice that GiveWell had an estimate for this, and checking now I still don't see it. Where's this estimate from?

It came from the old GiveWell cost-effectiveness analysis excel sheet (2015). "Medians - cell V14". Act... (read more)

Estimating the Value of Mobile Money

Thanks for this Jeff - a very informative post.

The study doesn't appear to control for cash transfers received through access to M-Pesa. I was thinking about how much of the 0.012 increase in ln(consumption) was due to GiveDirectly cash transfers.

Back of the envelope:

  • M-Pesa access raises ln(consumption) by 0.012 for 45% of population (c.20m people).
  • 0.012 * 20m = 234,000 unit increases in ln(consumption)

  • GiveDirectly gave c.$9.5m in cash transfers between 2012-14 to people with access to M-Pesa. [1]

  • GiveWell estimate each $ to GiveDirectly raises ln(c
... (read more)
0Jeff Kaufman6y
Good point! I hadn't thought about this at all. GiveDirectly's cash transfers were very large, enough that $9.5m would go to 33k people ($288/person). The population was 43M, so 1 in 1300 people received money from GiveDirectly. Their sample size is just 1593, so you expect 0-2 GiveDirectly recipients. I think they should be pretty visible in the data? Might be worth writing to the authors. It seems like you're assuming that the GiveDirectly money would have gone only to the M-Pesa-access side of the (natural) experiment, but they categorized areas based on whether they had M-Pesa access in 2008-2010, not 2012-2014 when access was much higher. I didn't notice that GiveWell had an estimate for this, and checking now I still don't see it. Where's this estimate from? (In my post I just took their average amount transferred, figured out what effect that had on the average recipient's income, and then discounted by .8 for GiveDirectly's overhead.)
Is not giving to X-risk or far future orgs for reasons of risk aversion selfish?

I agree. Although some forms of personal insurance are also rational. Eg health insurance in the US because the downside of not having it is so bad. But don't insure your toaster.

Is not giving to X-risk or far future orgs for reasons of risk aversion selfish?

I agree that dmu over crop yields is perfectly rational. I mean a slightly different thing. Risk aversion over utilities. Which is why people fail the Allais pradadox. Rational choice theory is dominated by expected utility theory (exceptions Buchak, McClennen) which suggests risk aversion over utilities is irrational. Risk aversion over utilities seems pertinent here because most moral views don't have dmu of people's lives.

I think that this discussion really comes from the larger discussion about the degree to which we should consider rational choice theory (RCT) to be a normative, as opposed to a positive, theory (for a good overview of the history of this debate, I would highly suggest this article [] by Wade Hands, especially the example on page 9). As someone with an economics background, I very heavily skew toward seeing it as a positive theory (which is why I pushed back against your statement about economists' view of risk aversion). In my original reply I wasn't very specific about what I was saying, so hopefully this will help clarify where I'm coming from! I just want to say that I agree that rational choice theory (RCT) is dominated by expected utility (EU) theory. However, I disagree with your portrayal of risk aversion. In particular, I agree that risk aversion over expected utility is irrational - but my reasoning for saying this is very different. From an economic standpoint, risk aversion over utils is, by its very definition, irrational. When you define 'rational' to mean 'that which maximizes expected utility' (as it is defined in EU and RCT models), then of course being risk averse over utils is irrational - under this framework, risk neutrality over utils is a necessary pre-requisite for the model to work at all. This is why, in cases where risk aversion is important (such as the yield example), expected utility calculations take risk aversion into account when calculating the utils associated with each situation - thus making risk aversion over the utils themselves redundant. Put in a slightly different way, we need to remember that utils do not exist - they are an artifact of our modeling efforts. Risk neutrality over utils is a necessary assumption of RCT in order to develop models that accurately describe decision-making (since RCT was developed as a positive theory). Because of this, the phrase 'risk
Is not giving to X-risk or far future orgs for reasons of risk aversion selfish?

In normative decision theory, risk aversion means a very specific thing. It means using a different aggregating function from expected utility maximisation to combine the value of disjunctive states.

Rather than multiplying the realised utility in each state by the probability of that state occurring, these models apply a non-linear weighting to each of the states which depends on the global properties of the lottery, not just what happens in that state.

Most philosophers and economists agree risk aversion over utilities is irrational because it violates the... (read more)

I just want to push back against your statement that "economists believe that risk aversion is irrational". In development economics in particular, risk aversion is often seen as a perfectly rational approach to life, especially in cases where the risk is irreversible. To explain this, I just want to quickly point out that, from an economic standpoint, there's no correct formal way of measuring risk aversion among utils. Utility is an ordinal, not cardinal, measure []. Risk aversion is something that is applied to real measures, like crop yields, in order to better estimate people's revealed preferences - in essence, risk aversion is a way of taking utility into account when measuring non-utility values. So, to put this in context, let's say you are a subsistence farmer, and have an expected yield of X from growing Sorghum or a tuber, and you know that you'll always roughly get a yield X (since Sorghum and many tubers are crazily resilient), but now someone offers you an 'improved Maize' growth package that will get you an expected yield of 2X, but there's a 10% chance that you're crops will fail completely. A rational person at the poverty line should always choose the Sorghum/tuber. This is because that 10% chance of a failed crop is much, much worse than could be revealed by expected yield - you could starve, have to sell productive assets, etc. Risk aversion is a way of formalizing the thought process behind this perfectly rational decision. If we could measure expected utility in a cardinal way, we would just do that, and get the correct answer without using risk aversion - but because we can't measure it cardinally, we have to use risk aversion to account for things like this. As a last fun point, risk aversion can also be used to formalize the idea of diminishing marginal utility without using cardinal utility functions, which is one of the many ways that we're able to 'prove' that diminishing marginal
New version of

We wanted to differentiate the website slightly from the eaglobal site while maintaining brand coherency so went for a slightly different shade of blue which feels a bit 'calmer'.

Not wedded to it though and may change back. Which do you prefer?

New version of

Thanks Ian - agreed it doesn't look fantastic at the moment. We embedded it on the website at the last moment and it screwed with the formatting. We'll be working to improve how it looks over the next couple of weeks.

Philanthropy Advisory Fellowship: Mental Health in Sub-Saharan Africa

Thanks Austen. This is really helpful feedback.

  1. Yes I agree. This is important but very hard to quantify. Of course the causal relationship goes both ways (poor physical health poor mental health) but it's probable that mental health disorders have worse downstream effects than most physical health problems (economic productivity, stigma, impact on carers, physical health). We tried to capture these qualitatively at the beginning of the report but could have been clearer that they weren't included in the cost-effectiveness calculations.

  2. Thanks - this is

... (read more)
Philanthropy Advisory Fellowship: Mental Health in Sub-Saharan Africa

Eric - this is so great! Coincidentally, CEA has also been working on a very similar report which was completed last week. It's here:

I've shot you an email. We should definitely discuss our conclusions.

Very good report, James. I have a few comments: 1. The DALYs calculated for mental health don't factor in the huge effect that mental health has on physical health [] . This may be laboursome to estimate, but should at least be considered. And you mentioned that people with MNS issues are often treated horrendously by their family/society, but that also hasn't been factored into the DALY cost estimate. An MNS disorder with a 0.4 DALY could really have a 0.9 DALY when you factor in mistreatment. I realize this is probably impossible to do, but it important to recognize that socialization side effects have huge impacts on DALYS. 2. Sri Lanka pesticide ban cost per DALY: $1000 is pretty high. Eddleston estimated it at $2 per YLL using the actual costs of running Sri Lanka's pesticide regulation department. That figure doesn't even factor in savings in health care costs. Also, Sri Lanka and other countries have only banned a few HHPs. A total ban of HHPs could yield drastically different cost estimates. I should note that only a fraction of pesticides are classified as highly hazardous. A total HHP ban still leaves farmers with lots of choices to buy pesticides, in addition to non-chemical forms of pest control. 3. No choice for donating to advocate for pesticide bans: Later this year, I expect that the Global Initiative for Pesticide Poisoning Prevention will begin our anti-HHP campaign. It takes a long time to do the initial steps of receiving charity status and input from all the experts in the field. 4. Room for more funding for a program like StrongMinds doesn't make sense because it can be scaled up to LMIC around the world. 5. I don't understand what the mental health charities have to do with children. Do StrongMinds and BasicNeeds treat children?
Is effective altruism overlooking human happiness and mental health? I argue it is.

1) Ah yes - thanks for pointing out. Probably has limited external validity for the strongminds model though (which is psychosocial treatment alone for most patients delivered by community health workers, with only the most serious cases referred to clinics for medication). The numbers come from the Chisholm (2015) WHO-CHOICE model.

2) Analysis is here

[This is quick and dirty but gives a rough indication of cost-effe... (read more)

Hi James! Your comments to this blog post are very much appreciated - thank you for contributing. We are a group of students at Oxford University doing a research project where we are trying to find the most effective charity to donate to (see []. We are currently looking into StrongMinds, and found your helpful cost-effectiveness model. If we may ask, we were wondering if possibly you have a more up-to-date / complete version of the same? And possibly also ask which inputs you received from StrongMinds vs. inputs estimated (and if so, how those estimates were made)? Completely understandable if you don't have time to answer all questions, but truly any feedback from you at all would be greatly appreciated. Please do let us know. Many many thanks!
1) Yeah, I never thought the numbers were that robust. More good measurement needed! 2) Thanks for this, will check this out soon. 3) Thanks 4). By being 10-18 times worse than we think, I mean anxiety/depression may cause about 10-18 more suffering than people expect them compared to other health conditions. This is from the the Dolan and Metcalfe paper: they show people are prepared to trade off 15% of life to remove 'some difficulty walking' and 'moderate anxiety or depression', but that people with 'moderate anxiety or depression' report 10x the reduction in life satisfaction that those with 'some difficulty walking' do, and 18x reduction in terms of daily effect (their measure for what we might call 'happiness'). In other words, the average person imagines walking with a limp would be bad as moderate depression (as inferred from trade offs), but actually the depression would be much worse for their happiness than the limp. This is explained by the focusing illusion and the non-adaptation stuff. If you look at the other numbers in the Dolan and Metcalfe paper, they show 'self care' and 'usual activities' are equally over-rated when people the trade-offs compared to how much they effect happiness. In terms of weighting, my thought is that if we constructed well-being adjusted life years (WELBYs) depression would be 10-ish times worse than walking with a limb, but this would be rescaled. So if depression has a WELBY weight of 0.8 (e.g. 1 year with depression is worth 0.2 years of happy life), then minor mobility issues have a WELBY weight of 0.08 or something. I would not suggest all cases of mental health should be understood as being many times worse than death! I don't think I implied that anyway, but I would clarify that in future. The overall thought is more like: daily life with depression is quite bad in terms of happiness, health conditions which don't cause depression (or pain) at all (or for very long) are probably not nearly as bad as we imagin
Is effective altruism overlooking human happiness and mental health? I argue it is.

Just to add to this. Acute schizophrenia is one of the worst health conditions on GBD13 DALY weightings (c.0.8). Severe depression is also one of the worst (c.0.65).


So Michael - I agree it's very possible that mental health disorders are underweighted by DALY weightings because of the focusing illusion. But they are actually weighted quite highly at the moment. 10 years with severe depression is worth approximately 3.5 years of healthy life.

yes, it's interesting that schizophrenia tops the list anyway, although this could be the case in virtue of the face it stops you from leading a normal life part of the disability (this being based on the EQ-5D), rather than because severe schiozophrenics are less happy than severely depressed people. although they are weighted highly, that doesn't stop them from being underweighted. Given the way DALYs are constructed - measuring health, not happiness; using preferences, not adaptation - it's conceptually very hard to see how mental health conditions can't be underweighted in terms of happiness. Unless and until we measure people's experiences of various diseases we really won't know. My guess is that depression could be the most comparatively underweighted health state: if you can function normally, but you're just really sad, you might do pretty well on an EQ-5D metric because you're only doing badly in 1 of 5 criteria, and that's the criteria most linked to happiness. As an aside, do you know how the GBD project takes episode duration into account? Or is it just a measure of intensity?
Is effective altruism overlooking human happiness and mental health? I argue it is.

Hi Michael! As I said before, congrats on an interesting paper.

A few points on this comment:

1) DCP3 didn't have any cost-effectiveness figures for the StrongMinds intervention (interpersonal group therapy). Is the $1,000/DALY figure you mention related to primary care advice on alcohol use?

2) I'm currently writing a piece on mental health for a HNW donor and tried to model c-e of StrongMinds. I got c.$650/DALY reducing to $400/DALY as intervention scales. The biggest uncertainty in this estimate is the long term effects of psychosocial treatment as hardly ... (read more)

Hello James. in reply: 1) check figure 3 on p1681 of DCP3. The box says "Depression: episodic treatment in primary care with (generic) antidepressant medication and psychosocial treatment" at the box implies it's between $1000/DALY and $10,000/DALY. I'm not sure exactly where those numbers came from. Have I misread that? 2) I'd be really keen to see your calculations and how you're putting it all together! 3) Can you point out where in their spreadsheet they specify that? I've just spent 20 minutes looking through it and am a bit lost. My estimate is then likely a miscalculation - thanks for pointing that out! What I should have done is use YLD figures for malaria and depression, and then transformed the disability rating using subjective well-being numbers. Then I'd need to say something about the badness of losing a life. I think this indicates the perils of using DALY numbers...
Why effective altruism used to be like evidence-based medicine. But isn’t anymore

Thank you all for some great responses and apologies for my VERY late reply. This post was intended to 'test an idea/provoke a response' and there's some really good discussion here.

Why effective altruism used to be like evidence-based medicine. But isn’t anymore


Thank you for your very informative response. I must admit that my knowledge of EBM is much more limited than yours and is primarily Wikipedia-based.

The lines which particularly led me to believe that EBM favoured formal approaches rather than doctors' intuitions were:

"Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can ... (read more)

Sorry for being slow to reply James. The methods of EBM do absolutely favour formal approaches and concrete results. However - and partly because of some of the pitfalls you describe - it's relatively common to find you have no high quality evidence that specifically applies to inform your decision. It is also relatively common to find poor quality evidence (such as a badly constructed trial, or very confounded cohort studies). If those constitute the best-available evidence, a strict reading of the phrase 'to greatest extent possible, decisions and policies should be based on evidence' would imply that decisions should be founded on that dubious evidence. However in practice I think most doctors who are committed to EBM would not change their practice on the basis of a bad trial. Regarding tradeoffs between maximising expected good and certainty of results (which I guess is maximising the minimum you achieve), I agree that's a point where people come down on different sides. I don't think it strictly divides causes (because as you say, one can lean to maximising expected utility within the global poverty), though the overlap between those who favour maximising expectation and those think existential risk is the best cause to focus on is probably high. I think this is actually going to be a topic of panel discussion at EA Global Oxford if you're going?
Why effective altruism used to be like evidence-based medicine. But isn’t anymore

Thanks both for thoughtful replies and links.

I agree that it may be counterproductive to divide people who are answering the same questions into different camps and, on re-reading, that is how my post may come across. My more limited intention was to provide a (crude) framework through which we might be able to understand the disagreement.

I guess I had always interpreted (perhaps falsely) EA as making a stronger claim than 'we should be more reasonable when deciding how to do good'. In particular I feel that there used to be more of a focus on 'hard' rathe... (read more)