Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.
You can view our June 2019 open thread here.
Comments
I have recently read Melinda Gates’ book “The Moment of Lift” and have been reflecting on her belief that “contraceptives are the greatest life-saving, poverty-ending, woman-empowering innovation ever created”, among many other issues she raises. I wonder if GiveWell has reviewed some of the NGO’s she recommends such as BRAC, Tostan, or the Community Empowerment Lab, among others. I’m also curious about your feelings about donating to the Gates Philanthropy Partners “Empowerment & Opportunity Fund”. Thank you so much for all of your dedicated and life-saving work.
Hi Bill, thanks for your message! We have not reviewed the organizations you’ve mentioned for their work in contraceptives and/or family planning. (We had initially researched BRAC for all their programs; the review page can be found here, but please note it is likely to be out-of-date). We have worked on an investigation of family planning groups, though we haven’t yet published it. Here are some related links on our website:
Unfortunately, we haven’t researched the Gates Philanthropy Partners’ “Empowerment & Opportunity Fund,” so we don’t have a sense of how cost-effective the programs it funds are or what its funding needs look like.
Any thoughts on the recent update to the Cochrane review on mass deworming, including six new trials since the 2015 edition, but reaching the same conclusion: “Public health programmes to regularly treat all children with deworming drugs do not appear to improve height, haemoglobin, cognition, school performance, or mortality.”
As more evidence accumulates, GiveWell’s position that possibly there are some possibly some spectacular later-life financial benefits of deworming though an unclear mechanism looks increasingly odd. You might also have noticed that even the advocates of mass deworming (see for example Pullan et al, Lancet, 2019) now generally make no direct mention of individual benefits of deworming, but rather talk about WHO eradication goals. So GiveWell is rather out on a limb in agreeing with those that hypothesise these possible later-life benefits.
How many negative trials of mass deworming impacts do you need to see to make a re-evaluation of your recommendations ?
Link here
or https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000371.pub7/full?highlightAbstract=withdrawn%7Cdeworming%7Cdeworm
Alex,
Thanks for your engagement with our work. A few points of clarification and response.
Our position on deworming
– We agree it’s unlikely there are very large later-life financial benefits of deworming (e.g. the estimated ~14% increases in earnings from Baird et al), due in part to a prior that such effects would be unlikely, and in part because of the lack of clear evidence for a mechanism. We discount the headline results of Baird et al heavily to account for that. Instead, we believe that there is some chance of relatively small impacts on earnings on a large number of infected children. (more in this blog post)
– We continue to believe deworming is (in expectation) a highly cost-effective intervention in areas with high worm burdens, based largely on our estimate that it costs under $1 for each child dewormed in most settings in which our charities operate (source).
– Unfortunately, this leaves us in a difficult position as the minimum effect size of interest is small and difficult to detect (or falsify). We’ve funded work to try to falsify our conclusions but have not found an opportunity to support research that could realistically falsify our view. That includes longer term follow-ups to Baird et al, and a scoping grant to assess whether other RCTs might be amenable to long term follow-up to estimate the effects of different interventions on long run income.
– Given the difficulty of definitively proving or falsifying the case for deworming, our recommendation necessarily relies on difficult judgment calls. We’re uncertain about those judgement calls and know we might be wrong, but they represent our best guess of what to take away from the accumulated body of evidence (that mass deworming has, in expectation, a small effect on long run income and is very cheap to administer). We’ve strived to be open and transparent about that (see here and here).
The studies you mention
We haven’t reviewed Pullan et al or the 2019 updated Cochrane review in depth, but we have read through them. They don’t currently change our conclusions, and we don’t expect that they will once we review them more thoroughly (though we plan to do that in the future). That’s because:
-In the 2019 Cochrane review, the mean estimate of weight gain appears to have increased slightly, and the null effect of height gain appears to be slightly more precisely estimated than in the previous version, which we don’t think is likely to be a substantial negative update on balance.
-The Pullan et al. study appears to be a comparison of different delivery platforms for combination deworming, rather than an evaluation of deworming itself.
I have read some of the blog posts with respect to Heiffer and “donor illusion” with interest. To some extent, they make sense to me. What I don’t understand is why the Givewell web site pops up on top in my Google search. Normally, one has to pay Google to come up on top of the search results, right? Why is the entry labeled as an ad? I thought we are looking at a blog with a objective discussion of Charity options. Is Givewell some sort of Metacharity that does charitable work by analyzing other charities while, maybe, having the same business models and structures as the charities it rates? Just trying to figure out what is really going on here…
Hi Wolfhard,
GiveWell is a nonprofit dedicated to finding outstanding giving opportunities and sharing the full details of our analysis. Our aim is to direct funding to excellent charities. Last year, we estimate that donors gave a combined ~$140 million to the charities we recommend, as a result of our research.
Donors can support our recommended charities through GiveWell. We don’t take any percentage of those donations to support our own operations.
GiveWell’s work is funded by donors who proactively opt to support our operations, selecting the option to provide us with “unrestricted funding” when donating. Among other things, our unrestricted funding enables us to hire and pay research staff that help us identify and evaluate excellent giving opportunities. We also use this funding to share our work with donors who might be interested in using it to guide their giving, and to help us direct funding to groups that we believe will use it effectively (our top charities). As part of that work, we do run advertisements (such as these podcast ads).
Additional information about our mission and how we are funded is available here. I hope this helps!
Hi Catherine,
thanks for your response and the multiple links. After reading some more material on your web site about Heiffer (my charity of choice for years), my impression of them is not as good as it used to be. It is somewhat sobering to see that in 2009 Heiffer did not meet either of your two criteria you set for a recommendation. Yes, it is one thing to receive photos of happy families who have animals from Heiffer, and another thing to know that Heiffer does not seem to have a way to independently prove success, at least in your analysis. More home work to do for me.
Thanks for what looks like serious work and open yet civilized discussions! Yet, your top list seems quite narrow for my taste, and it contains several deworming projects, which lack flair to the casual observer. It’s disheartening to see how few charities spend money responsibly while being able to prove success.
Best regards, donation to be made, soon,
Wolfhard Homma
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