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NickLaing

Country Director @ OneDay Health
8619 karmaJoined Working (6-15 years)Gulu, Ugandaonedayhealth.org

Bio

Participation
1

I'm a doctor working towards the dream that every human will have access to high quality healthcare.  I'm a medic and director of OneDay Health, which has launched 35 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community  in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.

How I can help others

Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda 
Global health knowledge
 

Comments
1170

FWIW I think a clear mistake is the poor communication here. That the most obvious and serious potential community impacts have been missed and the tone is poor. If this had been presented in a way that it looked like the most serious potential downsides were considered, I would both feel better about it and be more confident that 80k has done a deep SWAT analysis here rather than the really basic framing of the post which is more like...

"AI risk is really bad and urgent let's go all in"

This makes the decision seem not only insensitive but also poorly thought through which in sure is not the case. I imagine the chief concerns of the commenters were discussed at the highest level.

I'm assuming there are comms people at 80k and it surprises me that this would slip through like this.

Clueless, although there are bound to be outliers and exceptions even if we don't understand why.

I'm a little sad and confused about this.

First I think it's a bit insensitive that a huge leading org like this would write such a significant post with almost no recognition that this decision is likely to hurt and alienate some people. It's unfortunate that the post is written in a warm and upbeat tone yet is largely bereft of emotional intelligence and recognition of potential harms of this decision. I'm sure this is unintentional but it still feels tone deaf. Why not acknowledge the potential emotional and community significance of this decision, and be a bit more humble in general? Something like...

"We realise this decision could be seen as sidelining the importance of many people's work and could hurt or confuse some people. We encourage you to keep working on what you believe is most important and we realize even after much painstaking thought we're still quite likely to be wrong here.'

I also struggle to understand how this is the best strategy as an onramp for people to EA - assuming that is still part of the purpose of 80k. Yes there are other orgs which do career advising and direction, but that are still minnows compared with you. Even if you're sole goal is to get as many people into AI work as possible, I think you coud well achieve that better through helping people understand worldview diversification and helping them make up their own mind, while keeping of course a heavy focus on AI safety and clearly having that as your no 1 cause.

It could also feel like kick in the teeth to the huge numbers of people who are committed to EA principles, working in animal welfare and global health and  who are skeptical about the value AI safety work for a range of reasons whether its EAs sketchy record to date, tractability or just very different AGI timelines. Again a bit more humility might have have softened the blow here.

Why not just keep AI Safety as your main cause area while still having some diversification at least? I get that you're making a bet, but I think it's an unnecessary one, both for the togetherness and growth of the EA community in general and possibly even if your sole metric is attracting more good people to work on making the AI trajectory better

You also put many of us in a potentially awkward position of disagreeing with the position one of the top 3 or so EA orgs, a position I haven't been in before. If anyone asked me a week ago what I thought of 80,000 hours, I would say something like, "they're a great organization who helps you think about how to do the most good possible with your life. Personally I think they have a bit too much focus on AI risk but they are an incredible resource for anyone thinking about what to do with their future so check them out"

Now I'm not sure what I'll say but it's hard not to be honest and say I disagree with 80ks sole focus on AI and point people somewhere else, which doesn't feel great for the "big EA tent" or bolstering "EA as an idea"

Despite all this yes you might be right that sidelining many people and their work and risking splintering the community on some level might be worth it for the good of AI safety, but boy is that some bet to make.

I think James's did is really important and shows the potential good if a radical flank 

Traditionally though movements and organizing was often around issues which has decent public support already and wasnt necessarily that radical. The civil rights movement and the HIV medicine campaigners directly moved the elites towards their goal, and didn't just move the needle on public opinion for the better like the radical flank can

Do you think "Most of these required community organising and protest as at least part of the process to achieve the concrete change." is that strong a statement? There is a pretty strong correlation between protest/organising and these changes. Elite consense is clearly very important, but I think that the voice of the masses can move the elite to consensus so there's some chicken and egg there. Also to mention a few cases here where I don't think elite consensus was strong at the time of change and their hand's were perhaps forced...

- Access to free HIV treatment (This I'm pretty sure of)
- Civil rights movement
- Women's suffrage

I do find this a tricky issue to keep a scout mindset on here on the forum, as I find EAs in general are unusually against protest and organising compared to other communities I am a part of. My feeling is this is largely because the nature of many EAs is more to be into research, debate and policy rather than social roles like organising and protest.

What makes you think it is overstated? I think its a tricky counterfactual question with a lot of room for conjecture.... 

I honestly think you have the most important factors so don't feel obligated, but this nature paper is not bad https://www.nature.com/articles/s41467-018-07357-w

Nice one David! Mo has done as great job explaining here do I won't add too much. 

To reiterate the costs of overheads are built into all that estimations, so I don't think you need to worry about that as a separate issue. 

I love your intuition on family planning, and there are some great Organizations like FEM. And Lafiya Nigeria which have solid first effectiveness analysis showing they in probably have similar cost t effectiveness to other to charities, spend very little on overhead and help women in Northern Nigeria to take control of their family's future and improve women's health. 

I love the way you are thinking and all the great on your donation journey.

My 2 cents, from decent quality second hand information, yes! Tamaika is a  legitimate charity that is doing fantastic work treating malnutrition cost-effectively.

I'll also piggyback off this great question and @JustinGraham's fantastic response below and point out there are many smaller orgs that have performed their own cost-effectiveness analysis (Introducing Lafiya Nigeria, Tamaika etc.) and judge ourselves to be cost-effective compared to top  GiveWell orgs - without having the direct RCTs on the exact work we do to be able to qualify for GiveWell's top charity list, nor necessarily having external bodies assess us. (Rethink did an analysis for Lafiya). I would think almost all CE charities will have an analysis along these lines performed in the first few years of operation, and some that weren't judged to be cost-effective might be shut down.

Unfortunately like @JustinGraham says, doing direct RCTs on the life-saving evfect of our work might be close-to-impossible now either for ethical reasons, or because the size of study needed these days to detect mortalty differences is very large, so studies powered for mortality have become rare. This is largely because far less kids die than in the past  - which is great. This doesn't mean though that we can't do high quality research on proxy measures though (for us at OneDay Health quality of care and healthcare access) which we are currently doing in collaboration with top universities.

I'm co-founder of OneDay Health and we've done a cost-effectiveness analysis which might put us between $800 and $1800 per life saved. Early stage analysis (and self performed) analysiss though often grossly overestimates cost-effectiveness, so this cost-effectiveness would likely be hugely reduced if others or GiveWell did their own analysis.
 

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