BenHoffman comments on Where should anti-paternalists donate? - Effective Altruism Forum

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Comment author: BenHoffman 05 May 2017 09:08:45AM 5 points [-]

Consider paternalism as a proxy for model error rather than an intrinsic dispreference. We should wonder whether maybe the things we do to people are more likely to cause hidden harm or lack supposed benefits, than things they do for examples.

Deworming is an especially stark example. The mass drug administration program is to go to schools and force all the children, whether sick or healthy, to swallow giant poisonous pills that give them bellyaches, because we hope killing the worms in this way buys big life outcome improvements. GiveWell estimates the effect at about 1.5% of what studies say, but EV is still high. This could involve a lot of unnecessary harm too via unnecessary treatments.

By contrast, the less paternalistic Living Goods (a recent GiveWell "standout charity") sells deworming pills (at or near cost) so we should expect better targeting to kids sick with worms, and repeat business is more likely if the pills seem helpful.

I wrote a bit about this here: http://benjaminrosshoffman.com/effective-altruism-not-no-brainer/

Comment author: Halstead 05 May 2017 12:05:26PM *  2 points [-]

I agree that there might be instrumental concerns about paternalistic interventions, especially where we have limited information about how recipients act. However, these concerns do not always seem to be decisive about the effectiveness of interventions in terms of producing welfare. e.g. mandatory childhood vaccination is highly cost-effective notwithstanding its paternalism; same goes for tobacco taxes, mandatory seatbelt legislation, etc. When you look back at the most successful public health interventions, they have been at least as paternalistic as bednets and deworming - smallpox eradication, ORT, micronutrient foritification etc.

This shows that paternalism isn't that reliable a marker of lack of effectiveness. Wrt deworming, the issue seems to stem from features particular to deworming, rather than the fact that it is paternalistic.

Comment author: BenHoffman 05 May 2017 03:42:53PM 1 point [-]

You're assuming the premise here a bit - that the data collected don't leave out important negative outcomes. In the particular cases you mentioned (tobacco taxes, mandatory seatbelt legislation, smallpox eradication, ORT, micronutrient foritification) my sense is that in most cases the benefits have been very strong, strong enough to outweigh a skeptical prior on paternalist interventions. But that doesn't show that we shouldn't have the skeptical prior in the first place. Seeing Like A State shows some failures, we should think of those too.

Comment author: Halstead 05 May 2017 05:08:02PM 1 point [-]

I think I agree with maybe having a sceptical prior for paternalistic interventions, but I'm unsure about how strong such a prior would be. The information on what has worked in the past would determine the prior I should have when assessing a new intervention. If I looked at all past public health interventions and paternalism was not correlated at all with quality of outcome, even correcting for reasonable unknown side-effects, then it seems like I should give paternalism very little weight when assessing a new intervention. My examples were a bit cherry-picked, but they do show that if you look at the tail of the distribution of interventions in terms of impact, they tend to be paternalistic.

However, I suspect there is something of a correlation between paternalism and outcomes: I suspect nearly all or all of the ineffectual/harmful interventions have been paternalistic - playpump etc. This is borne out by the fact that GD is better than most other anti-poverty interventions. Then you have to take in the risk of hidden costs/harms, as you say.

But there are also factors pushing the other way - e.g. biases about spending on personal health, positive externalities etc - that counterbalance a presumption against paternalism.

Comment author: BenHoffman 05 May 2017 08:45:53PM *  1 point [-]

But there are also factors pushing the other way - e.g. biases about spending on personal health, positive externalities etc - that counterbalance a presumption against paternalism.

It's not obvious to me that the "near" bias about one's own health is generically worse than our "far" bias about what to do about the health of people far away. For instance, we might have a bias towards action that's not shared by, e.g., the children who feel sick after their worm chemo, or getting bit by mosquitos through their supposedly mosquito-proof bednets. (I'm not sure how bad either of these problems are relative to the benefits, and that's the problem - we really don't know. I'll note that Living Goods does sell some deworming pills, so at least some people in poor countries think it's in their interest to take them.)

It's also not obvious that positive externalities are generically more likely with paternalistic interventions. For instance, in a recent Reddit AMA, GiveDirectly basic income recipients reported that there was much less social conflict in their community once people started receiving basic income - they started imposing fewer costs on each other once they were more secure in meeting their basic needs.

It does seem to me like each of these considerations - if it points in the right direction for any given comparison - could contribute to overcoming the paternalism objection.

Comment author: BenHoffman 05 May 2017 08:33:59PM *  1 point [-]

It sounds like we might be coming close to agreement. The main thing I think is important here, is taking seriously the notion that paternalism is evidence about the other things we care about, and thus an important instrumental proxy goal, not just something we have intrinsic preferences about. More generally the thing I'm pushing back against is treating every moral consideration as though it were purely an intrinsic value to be weighed against other intrinsic values.

I see people with a broadly utilitarian outlook doing this a lot, perhaps because people from other moral perspectives don't have a lot of practice grounding their moral intuitions in a way that is persuasive to utilitarians. Autonomy in particular is something where we need to distinguish purely intrinsic considerations (e.g. factory farmed animals are unhappy because they have little physical autonomy) from instrumental pragmatic considerations (e.g. interventions that give poor people more autonomy preserve information by letting them use local knowledge that we do not have, while paternalistic interventions overwrite local information).

Thus, we should think about requiring higher impact for paternalism interventions as building in a margin for error, not just outweighing the anti-paternalism intuition. If a paternalistic intervention has strong evidence of a large benefit, it makes sense to describe it as overcoming the paternalism objection, but not rebutting it - we should still be skeptical relative to a nonpaternalistic intervention with the same evidence, it's just that sometimes we should intervene anyway.

Comment author: Halstead 06 May 2017 10:21:55AM *  0 points [-]

Yes I'm not sure I disagree with much of what you have said.

I don't want my argument to be taken to show that we should ignore paternalism as a potentially important instrumental factor. Showing the implicaitons of paternalism as a non-instrumentally important goal does not show anything about the instrumental importance of paternalism. Paternalism might not count in favour of GD as an non-instrumental goal, but count in favour of it as an instrumental goal.

It's important to separate these two types of concern. I do think some people would have the non-instrumental justification in mind, so it's important to get clear on that.

Comment author: DonyChristie 07 May 2017 01:30:31AM *  0 points [-]

'Do No Harm - on Problem Solving and Design' talks about fixer solutions vs. solver solutions. Its key points:

  • When solving a problem, are you looking for a fix or are you looking for the cause?
  • For a complex system to be resilient, it must (in any practical sense) be comprised of a collection of simpler, resilient parts.
  • The aim of a resilient part is to normalize (make consistent) the things that matter, and to minimize (dampen or hide) the things that don't.
  • If you can't solve an existing problem, how do you know you aren't causing more?
  • Resilience invariably relies upon feedback loops, and so the variables involved must be free to move through some critical range or the feedback is broken and the resilience is lost.

Its concluding paragraph:

The bottom line is: there is no escaping the need to make best effort to understand the whys and wherefores. To skip this and go straight for the fix is not humbly admitting the system is too complex to understand, it is arrogantly assuming we understand it well enough to fix it without breaking it. The humble thing to do is less, not more--to respect the difficulty in keeping any complex system stable, and the degree to which doing so relies upon a best effort by, and freedom of, each component to self-regulate.

Highly recommended read! :D