I understand that a lot of you have been sitting on the edge of your seats, wondering when GiveWell is going to recommend an organization for fighting diarrheal illness. Your wait is over.

My research on diarrhea began as an interest in the cause of “water.” It’s a very popular cause, and a very marketable one: hard to argue with the idea of giving people water. In my research, the first thing I learned was that the main problem of “water” is lack of clean water (not lack of access to water entirely), and that the main thing contaminating the water is fecal material. And the main problem caused by this, in turn, is diarrhea so severe it can actually lead to death by dehydration.

But the problem goes well beyond water. People lack access to adequate sanitation facilities, as well as sanitation education. Fecal matter gets everywhere (their hands, their food, and their water), and all of this contributes to the death toll of diarrhea.

Even though there are a few cost-effective strategies for reducing diarrheal illness, most of the organizations with which I spoke focused on expensive approaches, something that both former Secretary of the Treasury Paul O’Neill and I find confusing and frustrating. Part of the issue may be that focusing on clean water is more marketable–but less cost-effective–than focusing on the root problem, diarrhea.

But then, I investigated Population Services International. PSI is a large ($260 million budget last year) organization focused on basic health issues in the developing world. To reduce diarrheal illness, they offer Oral Rehydration Therapy (ORT) and water purification at point-of use. Uniquely, instead of distributing the products for free, they sell them through local vendors allowing them to recoup some of their production costs and reduce distribution costs. We estimate that PSI’s ORT program saves lives at less than $50/life. Holden’s made a big deal about numbers like this before (he did grossly understate ORT’s cost at 5c/life), but $50/life is hard to process. $50 … per … life. Jeez.

Along with its focus on the most cost-effective strategies, I’m a big fan of PSI’s evaluation approach – they keep careful records of exactly how much ORT and water-purification solution they distribute and have a research department devoted to evaluating PSI’s work.

Now, PSI isn’t perfect. It didn’t give me a detailed breakdown of its total budget – its diarrheal illness programs only make up about 2.5% – and it doesn’t comprehensively or systematically evaluate each program. Also, it’s been relatively difficult to get information from PSI, even after I made a reasonable donation.

Right now, I’m working on the review, which should be up on GiveWell in the next week.

So, I gave around $9000 ($5000-$6000 actual cost, factoring in taxes) to charity this year. Was it enough? I’ll be the first to admit that wasn’t all I could afford to give. It was as much as I wanted to.

And you know what else I’ll admit? Earlier in the year, when the baseball playoffs came around, I went to four games, spending a total of $400 on tickets alone. According to me, that means I let two children die of malaria so I could watch the Yankees lose in person. Those of you of certain philosophical persuasions could even say I killed two children. Adjusting for taxes, I killed three.

It’s an unnerving thought. But if I wrote that I’m losing sleep over it, I’d be lying. I’m not. I spend more time than most people thinking about the horrible problems in the world, but in an hour and a half what I’m going to be thinking about is how awesome it is when 300-pound men injure each other for my entertainment. And even when I am thinking about the horrible problems in the world, I generally don’t feel that terrible or sad and I definitely don’t cry (which some people consider to be the ultimate sign of an effective charity agent). Honestly, the main feeling I have is excitement that I can do something about them.

If you think that makes me a terrible person, and you’re either (a) giving away every penny you have or (b) staying up all night to jam needles into your eye because you feel so bad, well, cool. If you’re one of the remaining 99.99999% of people who values yourself way above others, I imagine that what I’m saying rings true.

I want to help others, but I have no interest in being a saint or Zell Kravinsky. I’ve got some disposable income, and I spend it on things that feel worth it. Improving the world is one of those things. Others include baseball, beer, and steak dinners. I wouldn’t fault you for doing the same. Just remember: you don’t have to give away everything to give away a lot.

All right! Some of those Christmas bonuses Elie talked about are going to charity, after all! This is awesome–not only are those Wall Street dudes super rich, but they’re super smart too, right? I bet they’re all thinking really carefully about how to accomplish the most good, and focusing on evidence and accountability, like these guys and this guy.

Or, they’re giving to whoever invites them to the coolest parties. One of the two.

I’m not trying to hate on the United Jewish Federation of New York. I know practically nothing about them (their website didn’t help … but I digress). But what percentage of the $21.5 million this party raised from Wall Street–accounting for about 1/7 their annual budget–would have come in if they hadn’t held an awesome casino party? And does this make any sense?

When it comes to evaluating charities, there is a common obsession with making sure your money goes “directly” to the cause, as opposed to overhead and administration costs. I think this is silly and I’ll discuss it more sometime soon … but hey … if you begrudge a charity every penny that it spends on salaries and infrastructure, how do you feel about their throwing an enormous gala to get you in the giving mood? Wouldn’t it be better to save them a little cash by sitting down yourself and figuring out where to give?

The issue, it seems to me, is that many people think of giving the same way they think of eating broccoli: they feel obligated to, they know they should, but they’d rather not. So charities, smartly, treat them like 5-year-olds: they try to trick them into it. If there were millions of dollars riding on getting some kid to eat his broccoli, the wisest move would probably be to get one of those chocolate-covering machines and douse the stuff until it’s unrecognizable.

This phenomenon isn’t the charities’ fault, it’s the donors. And it means that where the money goes has way less to do with who’s accomplishing the most good than with who does the best fundraising and party-throwing.

But a funny thing happens as you grow up. You realize broccoli isn’t half bad. With a little garlic, it can be flat delicious. Seriously, try it if you don’t believe me. And it’s especially good when you’ve had more than enough chocolate for the moment and you’re feeling just a little sick.

You also start to appreciate the fact that chocolate-covered broccoli is, by any measure, pretty gross.

(Just realized that talking about medicine and sugar would have made more sense as a metaphor here. Screw it, “broccoli” is a funny word and I’m sticking with it.)

OK, maybe I got a little carried away in my last post, as Elie is more than happy to point out. I’ve been screaming about “low prices,” when the truth is that curing an obstetric fistula or cleft can be worth the extra $-per-person for a variety of reasons.

Something you’ll see a lot of on this blog is me ranting/raving/foaming at the mouth about the cause of the day, even if it isn’t my personal favorite. That’s because I think there are a lot of great causes that might appeal to different people, and I want to promote all the good ones. But something that’s very important–and that I think most people don’t do nearly enough of–is deciding between the many good things you can do with your money.

I think it’s crazy to make 10 small donations when you could make 1-2 big ones. None of your small donations will solve the problems they’re attacking (i.e., there will still be plenty of the problem left), so why not spend all the money on the most important one? Plus, big donations get you attention: they give you the opportunity to tell a nonprofit what you do and don’t like, and have them listen. The most important reason to concentrate your giving, though, is exactly the reason that most people don’t want to: it forces you to make hard decisions. And that forces you to raise the stakes, learn more, and think harder. And that leads to better decisions and totally sweet websites.

So, after raving about the great deals on malaria and cleft and diarrhea and fistula like a kid in a (nightmarish) candy store, let me put my 2006 giving decisions front and center. There are a lot of great places to give. These are the ones I determined (based on about .01% of the information I wish I had) to be the best.

$5000 to New Visions for Public Schools. As cheap as it is to save lives in Africa, I see improving U.S. education as the most difficult and important problem of all. This country is rolling in it. It should be a utopia, for crying out loud, and it isn’t close. Poorer countries are eventually going to be this wealthy, but unless we figure out how to promote true equality of opportunity, that wealth isn’t going to translate into what it should. And New Visions has the most promising approach I’ve seen in this area: go straight at the public schools (eliminating the selection bias of charters), and go at them with extreme systematicity and rigor. Read the review for details.

$2000 to Interplast. Cleft was the cause I specialized in researching over the last few months, so this was partly a relationship-building donation. But I also think corrective surgery is the cheapest and most concrete way I’ve seen to convert a full life of misery to a much more reasonable (if still poverty-stricken) one. There’s a good chance I’ll change my mind as I learn more about fistula, child slavery, etc., but this is what I’m confident in for now.

$1000 to the Children’s Aid Society, also promoting equality of opportunity in the U.S., though in a very different way from New Visions. They’ve received my biggest donations in the past; they’re good (though New Visions now excites me more); and I want to maintain a relationship because they could be great if they did a better job tracking their activities and results.

$256 each to four smaller causes: two with personal connections, one as a thank-you to Alliance for Smiles for being open and helpful (though I ultimately went with Interplast), plus alma mater.

And that’s it. $9000 in tax-deductible donations (so between $5000 and $6000 of actual money). I could have protected people from malaria, helped fight global warming, fed the hungry, saved the children, or even bought some books for affluent communities. I chose to support two organizations trying to break down inner-city obstacles to opportunity, and one correcting deformities for those who can’t afford it. And I’ll be the first to admit that I didn’t give every penny I have. So, how did I do? For my take, tune in next time. For yours, post a comment.

I think in numbers. I’ve always thought in numbers. When I think about charity, my first instinct is to think of how to save the most lives with the fewest dollars. So Holden’s argument that malaria and diarrhea are “cheaper” than obstetric fistula–in a “dollars per person” sense–has obvious appeal.

But then, I think about women who have fistula. I keep thinking about a young teenage girl who has to live alone, whom no one will be near, whose life is effectively torture. I imagine that that girl is someone I know, and then, I can’t believe that the only thing preventing this girl from living a normal, happy life is something in the ballpark of $1000 (generally cited lower, but we’ve learned to take cited numbers with a large grain of salt). $1,000 is a lot of money, but it seems incredibly small when it’s the difference between someone suffering as those with fistula do and not having to suffer. And I’m not sure this is because I’m being emotional as opposed to rational. I think there’s a reasonable philosophical perspective that says we should try to improve lives (fistula, inner-city education, etc.) as opposed to merely trying to prevent death.

We haven’t researched fistula much yet, but a couple things strike me. First, many of the preventable diseases that kill people in the developing world (like malaria and diarrhea) largely affect children. Since fistula affects girls who have already reached their early teenage years, girls who are helped are largely safe from the main preventable diseases that kill people in Africa. On the other hand, providing a family with bednets does prevent malaria, but those very same people are susceptible to other dieases (diarrhea, for instance). Narrowly, this means that the cost of really saving a life is understated for diseases like malaria and diarrhea, where solving one problem still leaves a person exposed to a host of others. More broadly, I’m concerned about the kinds of lives we are saving. If fistula is literally the only thing keeping a girl from a relatively normal (if poor) life, while diarrhea is one of many debilitating problems for the people it affects, we may be accomplishing more by attacking fistula–even at a higher price tag.

My buddy Elie, a member of the GiveWell project and a passionate diarrhea guy, is trying to get you excited about the idea of saving lives for about $1000 a pop (see below). Hey, it is a good deal, and I agree with his take that repairing someone’s fistula is pretty comparable to saving her life. Why settle for pretty comparable, though? How much would you have to pay to literally stop a child from dying?

Turns out, the answer is less. Way less. For your real charity bargain shopping, go on down to Africa, especially the regions afflicted by malaria. According to this study, “About six lives can be saved each year for every 1000 children protected with insecticide-treated nets.” Insecticide-treated nets can be had through Nothing But Nets for a whopping $10 each (transportation and distribution included), and they last 3-5 years and generally cover 2 people each … which means buying 500 nets (for $5000) can cover 1000 children and save let’s say 24 lives over 4 years … which comes out to ~$200 per life saved.

Hang on. This is crazy. Let me say that again.

$200 to save a freaking life.

But that’s not all. The weirdest thing about Elie’s high-priced offer is that he’s forgetting about his own favorite cause, fatal diarrhea. This is one we don’t understand as well, largely because the organizations we’ve seen in this area don’t seem as careful about tracking their results. So I can’t give you an exact dollar figure … but I can tell you that an ORT, a tiny packet of nutrients that a child can swallow and ensure that he survives his bout of diarrhea, costs … wait for it …

5 cents.

There’s a word for this, friends. It’s called a bargain. We’re all familiar with the idea as it applies to junk: if someone cuts prices enough, you’re usually in, even if we’re talking about a DVD of Deuce Bigalow, European Gigolo. (Admit it, you smiled just now. No, I’m not proud.)

Well, it just so happens that this is your lucky day! Cause thanks to a combination of global disparities in wealth, ineffectively distributed charity, and horrible disease epidemics, SAVING LIVES HAS NEVER BEEN CHEAPER! WE’RE PRACTICALLY GIVING THESE THINGS AWAY!! ACT NOW BEFORE IT’S TOO LATE!

(And hopefully, this sale won’t last much longer.)