I do see that as a string argument, but i still think drugs should only go to market legally when both safety and efficacy has been proven in well enough powered RCTs. The risk to the medical profession and the reputation of the drug production industry is just too high to allow any less i think. There's no reason a fast tracked RCT couldn't get this sorted in a year and that seems like a reasonable way forward.

The RCT should also be vs. triplets and not vs. placebo. I'm not sure why the previous small trials were not done vs. standard best practice, that seems odd to me?

 If I was sitting in the FDA reviewing this i would still be pretty nervous about making an exception.

Interesting take, very American centric though, while China has about as many self driving cars on the road as the US, more companies in the game and faster scale up plans. With less extreme regulation why would Chinese makers not accelerate The takeoff here, and even maybe take over like they are with electric cars?

point 2 is actually a really good point. pumping s 20l Jerry can with a borehole takes at least 2 minutes even accounting for transfer times between Jerry cams etc. Asuming 12 hours of continuous pumping 6am to 6pm (unrealistic) that would mean 30x12 20 litre Jerry cans a day which is about 360 jerry cans. People often do use under 20 liters a day on average despite WHO recommendations (we do even lol) but i would say 500 people might  be the absolute limit that a borehole could realistically fully serve? And even that feels quite unrealistic.

I've also NEVER seen a borehole that heavily used here in UgAnda, but it might be possible in other places?

 my math could be a bit wrong but I've never thought about it like that before, thanks @Mihkel Viires 🔹 .

EDIT on googling, it seems that standard boreholes are usually designed to serve communities of 200 to 300 people usually with up to 500 a stretch in some cases. Stacks up with our thoughts here!

Comments like this @Alfredo Parra 🔸  "There's no doubt in my mind that psychedelics help many patients enormously, and at low doses for most patients. " and this @Curran Janssens "This is not a placebo effect." have updated me a little against the clusterfree initiative and this treatment specifically. This is not a good scientific approach, and mirrors language from patient lobby groups I've seen that often turns out to be incorrect or at least grossly overstated

This could still be placebo effect. After being a practising doctor for many years, I've experienced the power of the brain so many times. I've seen conversion disorder here in Uganda multiple times that's so extreme that when someone is poked with a sharp needle (and bleed) in multiple places there is zero pain reaction. Obviously we thought there was something serious going on in these cases but every time it turned out to be a strong psychological effect.

I agree with @Henry Howard🔸 , this probably shouldn't be legal yet. I wouldn't call the evidence "strong" yet until we get a well powered RCT vs. the best pain relief options currently available. "Trial or it didn't happen" as henry says is super important here, and this needs happen before any treatment becomes an encouraged, widespread norm.

If the effect is really as strong as claimed, you wouldn't even need 100 patients for an RCT. Perhaps clusterfree could even make this happen faster

Thanks I've updated my post i think i was wrong here. I think you're a little optimistic with your 7 figures comments (earning a salary over a million dollars is no joke) but your point stands!

After @RobertM's comment below it seems i was wrong here and yes the GiveWell top team is pretty darn powerful thanks Robert (I just disagree voted myself which was fun!) I stand by the second paragraph 😊.

I would guess this might be true for a small proportion of these people,  but i would personally guess that most of the top in 10 GiveWell employees would not be able to earn 200k plus very easily in the private sector. 

We're not "hassling anyone for making too much money" here, I don't think anyone in this discussion begrudges any be GiveWell employee their salary. We're just discussing whether it's actually the best idea to have salaries this high in jobs like this, which is a complicated question.

Wow those GiveWell salaries seem high from the perspective of someone running a non profit. Its hard to wrap my head around, after running an org that raised less than any of those individual salaries in yearly donations for the first 5 years of our operation.

Of course this doesn't mean those high salaries are necessarily bad, but when you're sitting here in northern Uganda it feels like another world that's for sure. I might comment more on this later 

I agree @Vasco Grilo🔸 in principle, although I really doubt this is a strong consideration for very many workers, even at aligned places like GiveWell. I think few give away large proportions of their salary.