Joel Tan (CEARCH)

Founder @ CEARCH
352Joined Aug 2022
exploratory-altruism.org/

Bio

Founder of the Centre for Exploratory Altruism Research (CEARCH), a Charity Entrepreneurship-incubated organization doing cause prioritization research.

Once a civil servant, and then a consultant specializing in political, economic and policy research. Recovering PPEist who overdosed on meta-ethics.

Sequences
1

CEARCH: Research Methodology & Results

Comments
25

Topic Contributions
1

Thanks for the comment above on presentation, Jason - will keep that in mind!

On the issue of pricing - I think this you/MHR make good points here, and it did slip my mind that the US market (for which we have the most data) is unrepresentative (e.g. we certainly wouldn't want to use US insulin prices if we were examining diabetes interventions!).

My quick sense is that adjusting for this (as well as any bulk buying discount) puts the naive headline estimate into the GiveWell ballpark, but not enough to warrant deeper research if your expectation that further research is likely to cause estimated cost-effectiveness to drop even further anyway - as is the typically the experience of researchers (e.g. I think Eric Hausen had a good talk on this).

Hi Michael,

The spreadsheet/CEA is here and is also linked at the very top of the post ("Considering the... etc").

Apologies for any lack of clarity in my write up - that's right, the intervention itself is providing training and the actual SSRIs to clinics (in LMICs).

(1) & (2) The Cochrane reviews/GBD results (e.g. https://www.bmj.com/content/346/bmj.f1325 on sodium/hypertension and https://jamanetwork.com/journals/jama/fullarticle/2596292 on hypertension/DALYs) and the scientific consensus more generally seems fairly compelling to be, and while I wouldn't rule out all this being wrong (e.g. the saturated fat issue), it seems fairly reasonable/prudent to deprioritize research into this area of uncertainty relative to others.

(3) Taxation is highly effective, because if affects massive numbers of people are low to no additional counterfactual cost. CEAs that I've run myself (or that Charity Entrepreneurship has done) on tobacco/alcohol taxation, plus the extremely strong underlying epidemiological/economic research on the price elasticity of demand for tobacco/alcohol, all reinforces this point.

I'm fairly sympathetic to the freedom of choice argument. Quick calculations I've done on this area suggest that under fairly plausible moral weights of freedom to smoke/drink etc, (a) it's welfare negative to legally ban alcohol/smoking (even leaving aside the black market effects and assuming these taxes work perfectly, which of course they won't); however (b) aggressive taxes while keeping the product legal generally pass the cost-benefit analysis test. See CEARCH's evaluative framework for our treatment of moral weights for freedom, or examples of BOTECs/CEAs where tax policies are evaluated based on both health and freedom considerations.

Definitely agreed that more advanced modelling has to take into account substitution into sugar - I believe an empirical study in NZ found substitution into sugar, while others found the fat/salt/sugar correlation in food to be high enough that it's actually benefit. Will take a far closer look at this at the deeper research stages!

Agreed that the linear vs non-linear issue is a major outstanding issue. My rough sense now is that you capture more of the benefits at higher levels of blood pressure (less so at lower levels/for healthier people) - so diminishing returns - but in general I don't have a good answer and it's something I'll have to get a better sense of via expert interviews. 

Thanks for the feedback!

(1) My understanding is that literal packs/shakers of salt sold in supermarkets would not be exempt from the sodium tax. But that raises more dramatic political problems (e.g. at a $0.3 per mg tax, that increases a 500g packet of salt by 100x), and I presume the per mg tax on literal raw salt would have to be far lower. In general, I do agree that substitution with home food is a worry, though there will also be frictions (i.e. not perfect substitutes because of the social element, time needed to cook, etc).

(2) I'm not sure if this is a significant concern - it depends on your frame of reference, and one could easily argue the opposite (e.g. more aggressive sin taxes normalizes them/shifts the overton window, so even if the extreme version gets rejected, people see the more conventional ones like on tobacco and alcohol as reasonable by comparison). In general, I'm not sure if we have strong reason to believe one way or another.

(3) I think I'm fairly deferential to the scientific consensus in this area, which seems strong - it's something I'll definitely look more closely into via expert intervews.

(4) & (5) Generally, direct delivery (whether of medication or general checkups/treatments) is a lot more expensive due to (a) actually requiring ongoing resources, and (b) counterfactual costliness, for an EA charity. I agree that they could be promising, but in the context of a shallow review I made the call to focus on what seemed to be the most impactful solution - I could be wrong!

It seems the scientific consensus, and Cochrane reviews/meta-analysis of RCTs(e.g. https://www.bmj.com/content/346/bmj.f1325) are supportive. I wouldn't rule out the possibility that sodium isn't as harmful as health authorities think it is (c.f. the whole fracas over saturated fat vs sugar), but I guess I don't see this as a serious worry or something that demands more research given the current evidence/expert opinion and limited research time.

Hi Akhil! Hope you're enjoying your new role!

(1) I didn't look at community salt substitution at any real depth. My quick prioritization on tractable solutions (definitely the weakest part of the 5-day shallow research process) was that policy intervention via a tax would be more effective than direct delivery (including providing communities with free salt substitutes). And with GiveWell also less optimistic on this issue, there doesn't seem to be a strong case for re-examination.

(2) Didn't look at the other positive effects - will look to incorporate these in deeper research reports, as well as with the negative side effects (especially on how poorer families are likely to be affected - it's going to be the thorniest part of the political case for sodium taxes)

(3) Good point! Will be looking to re-examine the costing, by talking to experts and orgs (especially WASSH) in the area, especially since the topline cost-effectiveness number is so sensitive to this. I think it's very possible that my view is overly influenced by the implicit understanding that this will be an EA organization running on CE-style leanness, but I was also encouraged by the fact that WASSH didn't have a monster budget or anything.

(4) The Thai Low Salt Network seems to be on the verge of success, and WASSH seemed successful in getting supermarkets to reduce product sodium content, but salt taxes are rare enough, and I don't believe there  will be many organizations (unlike for sugar) that have a strong track record here.  Will definitely be doing a deeper dive on this - unfortunately, deeper case analysis (let along talking to experts) is just really hard to do within the 1-week shallow research stage

Hi Bruce, thanks for the comments!

On (1): Will definitely be looking to examine the counterfactual policy passage issue more explicitly, in deeper research rounds - but one view is that this is already automatically factored in by any analysis (like the rough one here) of how age-standardized DALYs lost per capita will evolve in the future based on past trends (since any chance in sodium consumption due to policy reasons will show up in both prevalence/severity of hypertension and hence in these age-standardized DALYs).

Any advice on how counterfactual policy passage should be incorporated would be welcome! The way I've done it in the past (and what the way CE does it, I believe) is case study analysis (look at past instances, and calculate country-years of policy passage against total country-years, or something like that), but it's not always wholly satisfactory.

On (2): You're right that this may be too optimistic! My assessment here is based partly on my understanding of the work of CE policy charities (LEEP/PEN/Good Policies), researching and planning out a potential tobacco taxation charity in the recent CE incubation programme (went with CEARCH in the end), and also my past work in government/policy consulting. I have moderate confidence in the view that conditional on there being interest from policymakers, you can work your way up to cabinet ministers within a year in a LMIC and get a yes/no answer by then. I also have high confidence in the view that if the government is not interested, you get the feedback from lower level civil servants long before that, allowing you to pivot accordingly. All this is premised on a high willingness to ignore sunk costs and pivot quickly, and excludes implementation time (folding that into the next year of operations, as you juggle both advising the persuaded government and lobbying the next country)

I'll recalibrate this as I get more expert advice (and also update on the more recent work of CE policy charities, including Mathias Bonde's aid policy organization).

On the catastrophic collapse issue - no, didn't look at that! It wouldn't change the headline cost-effectiveness that much, but it might depend on your views on astronomical waste.

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