Researcher @ Founders Pledge
52Joined Jun 2022


Oral healthcare in LMIC is a promising new cause area: Founders Pledge (Medium Investigation)

Hi Christian,

Thanks for this comment, I am happy someone drew attention to this!

I did check out various papers (such as the one you linked, and some other papers proposing a link between fluoride exposure and adhd). I didn't find them convincing enough to add in a non-monetary cost to fluoride (bear in mind that I also left out various potential net-benefits, such as increased attendance at school and work). 

To give a bit more detail (because I think this important), I found that the evidence linking fluoride to neurological outcomes was pretty low quality. I could only mainly find ecological studies, where i judge the risk of confounds to be very high- plus other issues that make me suspicious such as exclusion of outliers (without clear justification). That being said, I do think it's important to be cognisant of these theories, even if the available evidence is poor— I quite like this review, which basically argues that low to adequate levels of fluoride don't appear to be associated with any neurological conditions, but there is 'low level' evidence that they are at high concentrations.

To me, this gets at the point that fluoride should only be used in communities that have low levels of fluoride already— apart the speculation about neurological disorders, we know that fluoride can cause fluorosis  (weakening of tooth enamel) in levels with high levels of fluoride. I have put the 'costs' of fluoride at zero, but have highlighted in the report that I think these kinds of interventions should only be used in area with low fluoride (for instance, not areas with high levels of groundwater fluoride). In areas with high fluoride, I agree with you that there might be 'costs' to be accounted for .

Totally agree with you on the point about trust! I quite like the salt/ milk interventions since they are more 'opt in' than water fluoridation (aka you could just buy the other salt/ milk), as well as being more practical in areas with lower levels of piped water access. I'd hope that this would mean less pushback.

Oral healthcare in LMIC is a promising new cause area: Founders Pledge (Medium Investigation)

Yep! I do think flossing is good, but I suspect it's less impactful/ helpful than fluoride (especially fluoride added to water/ milk/ salt).

Thanks! I didn't especially look into tongue scraping, but I'll check it out a bit more. My general sense would be that it would be tricky to persuade people to do regularly, in comparison to something 'automatic' like fluoridated salt.

Oral healthcare in LMIC is a promising new cause area: Founders Pledge (Medium Investigation)

Hey Christian, thanks for your comment! I totally agree that ML has great potential for diagnosis (in dentistry but also within the field of medical care more broadly– e.g. I was reading about this grant from Gates the other day, it's a diagnostic ultrasound for maternal conditions). Caveat that I'm not sure that the average person would trust an ML diagnosis over a 'real person' diagnosis (at least, not yet), and I think it would be a while until roll-out in an LMIC type context. Nonetheless, I think this is a promising area which I want to check out in more detail.

Within the field of oral health though, I think that investing in preventative treatment is currently more promising than diagnostics/ curative treatment: i.e. while I think that training up local dentists may be cost-effective, it seems a little borderline. However, preventative treatment (aka fluoride) seems to be extremely cost-effective, and we already know how to do it. This is mainly because salt and milk fluoridation appear to work and are insanely cheap—that's where my $2 WELLBY/ $9 DALY figures are coming from.

The importance of getting digital consciousness right

'The structure of academia rewards people for developing one theory and sticking to it. There are few academic incentives for reaching a consensus or even hashing out the relative probabilities of different views.'

I agree with this, but I just wanted to link out to a new paradigm that I think gets good traction against this problem  (and also highlights some ongoing consciousness research). This is being funded by the Templeton Foundation (a large philanthropic science funder), and essentially they've got leading advocates of two leading consciousness theories (global workspace theory and integrated information theory; see here) to go head-to-head in a kind of structured adversarial experiment. That is, they've together developed a series of experiments, and together agreed beforehand that 'if the results go [x] way, this supports [x] theory'. Afaik, the results haven't been published yet.

Disclaimer that in a previous life I was a comparative psychologist, so I am nerdily interested in consciousness.  But I do think that there is a tension between taking a strong view that AI is not conscious/ will not be conscious for a long time, versus assuming that animals with very different brain structures do have conscious experience. (A debate that I have seen play out in comparative cognition research, e.g. are animals all using 'chinese room' type computations). Perhaps that will turn out to be justified (e.g. maybe consciousness is an inherent property of living systems, and not of non-living ones), but I am a little skeptical that it's that simple.

New cause area: Violence against women and girls

Hi Akhil, I really like this report: thank you for writing it up here!

Something that I think could additionally add to the impact of VAWG (although clearly difficult to estimate/ maybe not worth it for a shallow dive) is the somewhat cascading/ generational nature of domestic violence and associated trauma– e.g. that if you experience more Adverse Childhood Experiences,  your children are also more at risk for ACEs, etc.

It also has struck me before that social norms about VAWG/ intimate partner violence vary strongly across regions. I  think social norms are very powerful; do you know of any charities aiming to shift social norms regarding VAWG/ intimate partner violence?  (E.g. I'm thinking along the lines of narrative stories over the radio, but there may be other alternatives in this area).