Comment author: MichaelPlant 17 August 2017 01:53:57PM 4 points [-]

This is sort of a meta-comment, but there's loads of important stuff here, each of which could have it's own thread. Could I suggest someone (else), organises a (small) conference to discuss some of these things?

I've got quite a few things to add on the ITN framework but nothing I can say in a few words. Relatedly, I've also been working on a method for 'cause search' - a ways of finding all the big causes in a given domain - which is the step before cause prio, but that's not something I can write out succinctly either (yet, anyway).

Comment author: John_Maxwell_IV 16 August 2017 08:16:44AM *  3 points [-]

it's a relevantly different problem from that of under-prescription in the developing world

Seems like it could potentially be pretty relevant if "optimal" levels of prescription tend to slide towards heroin epidemics, or something like that.

this is already a huge document

That's fair. I guess I mainly wanted to ensure that you spent some time thinking about this before actually working on DPR.

[Rant incoming]

I am generally frustrated with EAs for not brainstorming how their projects might backfire. In my view, the sign of a given intervention is much more important than the tractability/cost-effectiveness, and it seems like you devoted more space to the second two. Sign uncertainty should be high by default.

I am also frustrated by the fact that I feel like in this particular case, the 'EA way' of thinking about things is actually worse than the way the average American voter thinks about them. Like, if I proposed to an average American voter that we should legalize all drugs, they would probably immediately say something like "well what about the heroin epidemic", and this seems like a completely valid point to bring up! I'm frustrated that EA has somehow caused us to focus on issues like tractability, cost-effectiveness, and neglectedness instead of addressing the issue of whether we should do the darn thing in the first place. And this is a mistake that the average American voter does not make.

This is also related to another thought pattern I see in EA where it seems like people consider EA to be some kind of magical fairy dust that creates effective interventions. Like, I'm sure many gallons of ink have been spent writing about the optimal drug policy and I don't see you making a serious attempt to either summarize the existing literature or contribute something new (e.g. "here is why drugs were made illegal, here's why the thinking is flawed"--cc Chesterton's Fence--"here's a new drug policy that gets us the benefits of the old policy without the costs"). And even if you were doing either of those things, that still doesn't necessarily constitute a basis for action. I might as well randomly choose one of the many memos that have been written over the years and implement the drug policy suggested by that memo. There's no magical fairy dust in the EA forum that makes your memo better than all the other memos that have been written.

That said, you should not take this objection personally because like I said, it is a beef I have with EA culture in general. This series is fine as a pointer to the topic, and you probably just meant to indicate "hey, EAs should be paying more attention to this", so my rant is probably unjustified.

In part 3 I note it's an open question as to whether decriminalisation, legalisation (or even the status quo) is the right response to heroine.

Could you point to the specific passage you're referring to?

As a final pragmatic note, I think if you actually wanted to work on DPR, solving the heroin epidemic could be a good first step to doing that, because that would create room to maneuver politically for legalization reforms.

Comment author: MichaelPlant 16 August 2017 10:26:33AM *  2 points [-]

Thanks for the comment, although I largely feel you're accusing me/us of things I'm not guilty of. (note: Lee wrote the pain section but we both did editing, so I'm unsure whether to use 'I' or 'we' here)

What I see this series of post as doing is suggesting DPR to the EA world as a cause worth taking seriously. I don't insist on particular policy suggestions. I haven't made my mind up and others are free to draw their own conclusions.

One issue we highlight is the lack of pain medication in part A of the world, whilst noting there is too much in part B, but that we wont talk about B. That doesn't seem unreasonable to do in an essay limited in scope, unless it's obvious changing the situation in A would obviously lead to it becoming like B. It's not obvious (although we can argue about it) so we left it out. Indeed, given the use of psychedelics to treat addiciton (see footnote 27), you might think that part of DPR is important because you worry about the opiate crisis.

Further, as I claim in part 1, there are multiple arguments for different types of DPR. So it's not sufficient to claim one part would backfire to say we shouldn't be interested in any of it. There are lots of ways we could do DPR, and you could change everything else whilst leaving opiates unchanged. By analogy, seems that I'm saying something like "X will reduce crimes apart from murders" and you're replying "but you should think about stopping murders" which strikes me as irrelevant.

Here's the quote where I mentioned this in part 3:

Perhaps we should legalise all those drugs up to and including cannabis on the graph of harms I used earlier, but no further. This would mean legalising everything apart from amphetamines, cocaine and heroin (and presumably keeping tobacco and alcohol legal too) [note: graph now added; must have been lost in transmission]

I'm slightly unsure how to response to your point about original analysis, which feels unhelpfully personal. In section 2.1 above I say why drugs have been made illegal, but I didn't want to get stuck into that because I took the real objective to be explaining why DPR might do good. I also suggest a range of policies (in part 3) and how they each solve different parts of the problems. I'm not claiming to be the first to write about DPR. What I thought was missing was an analysis that brings all the different arguments together, as I also discuss in part 3, and, further, brings it to the attention to EA. If you already know lots about DPR the argumentative pay-off only comes in part 4 where I explain why this might be more cost-effective that causes EAs already support. If I'd just written part 4 you (or others) would be justified in complaining I hadn't made the case!

Finally, FWIW, I think the largest ammount of value from DPR would come from tackling mental health with new methods, and that doesn't have the obvious backfire worries. I'm not really sure how to think about the heroin epidemic, nor do I see it as necessary for me to provide an answer. If you happen to have a solution to the opiate crisis and can give me a cost-effectiveness model, then I can build that in to what I do have. I'm not expecting you to have a solution, nor I think I need one to be able to deal with other parts of the topic.

Comment author: Halstead 15 August 2017 01:58:48PM 1 point [-]

He's saying that the value of the global cereal market alone is $2tr, which exceeds the value of the wholesale drugs market, contra what you say in your piece.

Comment author: MichaelPlant 15 August 2017 02:58:38PM 0 points [-]

Okay. So the source I found was probably wrong. I can't see how this has any significance on the argument, so it would have been more useful to say "this isn't important for the argument, but just so you know ... "

Comment author: Denkenberger 15 August 2017 02:04:44AM *  1 point [-]

According to 2005 data, production was valued at $13 billion, the wholesale industry priced at $94 billion and retail estimated to be worth $332 billion. The wholesale valuation for the drugs market is higher than the global equivalent for cereals, wine, beer, coffee, and tobacco combined.

I couldn't see the full report from your link, but global grain (cereal) production is around 2.2 billion tons per year. Wholesale price fluctuates, but it is around $1/kg, so ~$2 trillion per year. This is more than an order of magnitude bigger than your illicit drug wholesale value.

Comment author: MichaelPlant 15 August 2017 10:48:28AM 0 points [-]

Sorry, I don't see what your point is. Could you expand?

Comment author: John_Maxwell_IV 14 August 2017 10:00:26PM 0 points [-]

No discussion of the US heroin epidemic?

Comment author: MichaelPlant 14 August 2017 10:37:03PM 1 point [-]

We say we're not going to discuss it: it's a relevantly different problem from that of under-prescription in the developing world and this is already a huge document. We don't have particular suggestions for the US epidemic but everything else we say still stands. In part 3 I note it's an open question as to whether decriminalisation, legalisation (or even the status quo) is the right response to heroine.

Do you have a suggestion?

Comment author: MikeJohnson 14 August 2017 02:53:09PM 2 points [-]

Hi Michael,

This is fantastic work, thanks for all the effort and thought that went into these posts. Your overall case seems solid to me-- or at minimum, I think yours is 'the argument to beat'.

One thought that I had while reading:

Drug policy reform may also allow us to better understand current pain medications and develop new treatments and uses. Your focus here is on decriminalizing existing drugs such as psilocybin, opioids, and MDMA, because you believe (with substantial evidence) that these drugs have nontrivial therapeutic potential, despite their sometimes substantial drawbacks. This seems reasonable, especially in the case of drugs with fairly benign risk profiles (e.g. psilocybin).

I do worry about some of the long-term side-effects associated with certain drugs, however, and it seems to me an interesting 'unknown unknown' here is if it's possible to develop new substances, or novel brain stimulation modalities, that allow us access to the upsides of such drugs, without suffering from the downsides.

E.g., in the case of MDMA, the not-uncommon long-term effects of chronic use include heightened anxiety & cognitive impairment, which seem very serious. But at the same time, there doesn't seem to be any 'law of the universe' mandating that the pleasant feelings of love & trust elicited by MDMA that are so therapeutically useful for PTSD must be unavoidably linked to brain damage.

I'm not completely sure how this observation interacts with your arguments, but I suspect it generally supports your case, since decriminalization could lower barriers for research into even better & safer options. Quite possibly, this could be one of the major reasons why decriminalization could lead to a better future.

On the other hand, the sword of innovation cuts both ways, as there seem to be a lot of very dangerous, toxic variants of drugs coming from overseas labs that are even less safe than current options (Fentanyl, Captagon, etc). Perhaps this is a case of "Banning dangerous substances as a precautionary principle can have perverse effects if it causes people to take a more dangerous drugs instead," and decriminalization would help mitigate this phenomenon. But I must admit to some uncertainty & worry here as to second-order effects.

Anyway, I think this is worth pursuing further. OpenPhil might be interested? I think probably Nick Beckstead might be a good contact there.

Comment author: MichaelPlant 14 August 2017 03:57:17PM *  0 points [-]

Hello, and thanks!

I agree with you there isn't any law of the universe here, although, for whatever reasons, many people actually do seem to believe drugs that make you feel good now must make you feel bad later, and the later badness is at least equal to the goodness experience. Maybe this is borne out by people's experiences of hangovers, not sure. But yeah, there's no obvious reason for this to be true. If there is, we should look for a neurological and evolutionary explanation.

Nor does it seem it is true: i'm fairly confident the odd pint increases my well-being overall and than i've taken painkillers that have removed unhappiness without making me feel worse again later.

On precautionary principles, my thought is we should look at the evidence before collapsing into a moral panic. It's not like we're uncertain about fentanyl's safety, we know it's pretty potent (used to be an elephant tranquiliser, etc.). And we should consider the counterfactuals, too. I don't have a line on exactly what should be legalised and i think it's worth thinking through.

I hadn't occurred to me to pitch this directly of OPP. My plan was to put it up here so others could see if/where I'd gone wrong as the first step.

Comment author: [deleted] 13 August 2017 08:29:56AM *  5 points [-]

Thanks for this impressive series of posts, Michael!

In the body text you write:

As far as I’m aware, there are no cost-effectiveness estimates comparing near-term causes like Give Directly and AMF to far-future ones, so I don’t know how much better X-risk charities are supposed to be.

But then you acknowledge in footnote 7 that there do exist such models. Michael Dickens' model is one example, and so are the models we developed during the Oxford Prioritisation Project, which you can tweak to your liking. Since not everyone may read the footnote, one thing you might do would be to amend the body text.

In a Part 2, you outline Six Ways DPR Could Do Good, yet your quantitative model only seems to take into account the first of these, improved treatment for mental health. Do you think it's the biggest effect? Or was it the easiest to model? Do you have plans to model other ways DPR could do good?

Assume the research caused by the rescheduling reveals ways to increase the happiness of each of these 10m people by 0.1 for a single year.

Does this assume that every single person suffering from depression or anxiety in the UK will adopt the new treatment? That seems unlikely. One way to get at this might be to look at current adoption rates of existing medication like SSRIs. These may be lower than adoption rates for new drugs would be, because SSRIs are less effective, but should give an interesting base rate.

You assume a 0.1 change. How does this relate to the studies on psilocybin you cite in part 2? For instance, you might look at how to translate changes on the QIDS (Quick Inventory of Depressive Symptomatology) scale into changes in HALYs. We did something very similar in our model of StrongMinds. In particular Konstantin and Lovisa wrote:

StrongMinds measures impact on the 27-point, linear PHQ-9 scale. To convert PHQ-9 impact to DALYs averted, Global Burden of Disease DALY-weighting of most severe depression (0.658) was divided by PHQ-9 points-weighting of most severe depression (27) to render 0.024 DALYs averted per PHQ-9 point reduced.

Finally, with regard to the £166m figure. It would be useful to get an order of magnitude estimate of the cost of past campaigns to achieve this kind of policy change, and their rate of success. A quick google scholar search throws up: Advancing the Empirical Research on Lobbying, Figueiredo and Richter, a literature review.

I want to stress that although my comment focused on areas of possible improvement in your post, I strongly support your doing this work and I think it's good. Good luck!

Comment author: MichaelPlant 13 August 2017 10:29:26AM *  1 point [-]

Hello Thomas,

no cost-effectiveness estimates comparing near-term causes

On reflection, I should state 'there's only one model' rather than 'there are none' but mention one in the footnote. I guess I meant, which is still true, "there are no models I known how to use"...

ix Ways DPR Could Do Good, yet your quantitative model only seems to take into account the first of these, improved treatment for mental health.

I think the mental health effect is the biggest, it's also the easiest to think about because I know what the numbers are - it would take me a long time to assess the happiness impact of DPR caused by reducing crime (how much happiness does a crime remove? how many are there around the world? how many of those are attributable to drugs? etc...). I don't plan to do any further modelling as I need to get back to my thesis and the detail of DPR now looks like it will be outside it. FWIW, I think the mental health impact of DPR is about 80% of it's value, but when I asked Lee the same question (before telling him my view) I think he said it was about 30% (we were potentially using different moral philosophies).

Does this assume that every single person suffering from depression or anxiety in the UK will adopt the new treatment?

Yeah, I'm not clear on this. It's probably unreasonable to assume everyone would get/use the new treatment, although that's what I initially thought. I take the 0.1 as the (mean) average change across all those could be treated.

You assume a 0.1 change

I just guessed the number based on (a) the happiness impact of removing depression via other methods and (b) my qualitative sense from reading the studies of how much more effective psychedelics seems to be than alternatives. If there's a cardinal scale I can use that shows how much better psychedelics are that would be great, but I didn't dig through because doing something like what Lovisa and Konstantin did didn't occur to me.

with regard to the £166m figure. It would be useful to get an order of magnitude estimate of the cost of past campaigns

I agree it would be good to do this. I looked into this a bit but couldn't find anything useful on the cost-effectiveness of lobbying (I skimmed your paper too; it doesn't really bear on the question at hand). It's also a long way from my area of expertise and thought I was better to share what I had rather that wait until I'd found time to dig into this (which may not happen for months). If anyone read this and wanted to have a go, I'd be very grateful.

FWIW, two more things, 1) I think £166m figure is conservative and the real figure is closer to £10.5bn.

2) This is compared to AMF. As I note above and have argued elsewhere, you would have you to hold a particular, implausible philosophical view to believe AMF is as cost-effective as I stated; I was being generous to my imagined critics. A more realistic comparison is probably Basic Needs, which I say above is about 3x less cost-effective than AMF on AMF's unbelievable numbers, So really we should multiply the ammount we would spend on a DPR campaign by three to get something like £560m (conservative) or £35bn (optimistic).

Comment author: Jiwoon 12 August 2017 06:38:47PM 3 points [-]

In one study, 12 of 15 smokers (i.e. 80%) quit tobacco after 2-3 does of psilocybin (i.e. biological tests showed they had not smoked in 6 months); to the best of my knowledge, this result is unheard of in addiction treatment.[34]

Although the sample size was very small (15), if psilocybin was effective for tobacco cessation, it seems it will have potential to "save" 7 million people/year.

Recently, I wrote an article on the distribution of E-cigarettes for smoking cessation, but psilocybin seems more effective than e-cigs, and possibly more cost-effective than AMF, or other GW-recommended charities.

Also, psilocybin might be a substance that may be good to start DPR campaign, as we have a very good reason (tobacco cessation) to do DPR on that substance.

Comment author: MichaelPlant 12 August 2017 06:43:31PM 2 points [-]

I hadn't made that link, but yes, that could be an additional reason to get excited about DPR.


High Time For Drug Policy Reform. Part 4/4: Estimating Cost-Effectiveness vs Other Causes; What EA Should Do Next

This is the fourth of four posts on DPR. In this part I provide some simplistic but illustrative cost-effectiveness estimates comparing an imaginary campaign for DPR against current interventions for poverty, physical health and mental health; I also consider what EAs should do next. Links to the articles in this series: Part... Read More

High Time For Drug Policy Reform. Part 3/4: Policy Suggestions, Tractability and Neglectedess

This is the third of four posts on DPR. In this part I look at what a better approach to drug policy might be and then discuss how neglected and tractable this problem is as cause area of EAs to work on. Links to the articles in this series: Part 1  (1,800... Read More

View more: Prev | Next