Comment author: drwahl 05 April 2017 05:24:40PM *  4 points [-]

I've done a little work on this, using techniques from modern portfolio theory, and uncertainty estimates from GiveWell and ACE to generate optimal charity portfolios. See here for a background post, and here for my 2016 update.

Comment author: Phil_Thomas 11 April 2017 03:31:09AM *  2 points [-]

That’s interesting! I worked on something similar, but it only allows for normal distributions and requires pre-calculated returns and variances. Using the GiveWell estimates to create your own probability distributions is an interesting idea -- I spent some time looking through sources like the DCP2 and Copenhagen Consensus data but couldn’t find a source that did a good job of quantifying their uncertainty (although DCP2 does at least include the spread of their point estimates that I used for an analysis here ).

One thing I wondered about while working on this was whether it made sense to choose the tangency portfolio, or just keep moving up the risk curve to the portfolio with the highest expected value (In the end, I think this would mean just putting all your money in the single charity with the highest expected value). I guess the answer depends on how much risk an individual wants to take with their donations, so a nice feature of this approach is that it allows people to select a portfolio according to their risk preference. Overall, this seems like a good way to communicate the tradeoffs involved in philanthropy.

Comment author: MichaelPlant 30 June 2016 03:25:28PM *  0 points [-]

Phil,

this is all really helpful. thanks for the links to the other pieces of research and to a couple of eCBT companies I hadn't heard of yet. Also interesting to see that the challenge is substantially behavioural.

I do hope this outcome is inevitable too, and I hope I can speed it along, rather than uselessly duplicating the work of others.

Comment author: Phil_Thomas 30 June 2016 08:27:46PM 1 point [-]

Yeah I think “inevitable” might be an overstatement, but there do seem to be some pretty promising companies in the area of cCBT for depression right now.

I know less about the apps focused on happiness. Their completion rates might be closer to those of open online courses (~7% on average) because the users might be more motivated. I think building a support community around the app could be important, maybe with users coaching each other? Duplication of effort isn’t necessarily a bad thing at this point because a lot of different approaches are needed to find the right combination of technology/content/support.

Comment author: Ben_Kuhn 22 June 2016 06:57:03PM *  7 points [-]

[Has anyone from GiveWell looked into mental health interventions? I couldn't find an intervention report on their website but I'd be interested to know whether they have any informal take on it.]

At first blush this is pretty intriguing, especially the following points:

  • Apparently, people's prediction about how bad depression would be compared to, e.g., severe pain is off by a factor of about 10, because hedonic adaptation applies to severe pain but not to depression. This biases DALY burden and cost-effectiveness statistics against mental health interventions.* (EDIT: not sure I buy this anymore; the "established" psych research is more questionable than I thought. See convo with Lila below.)
  • Note that despite this bias, unipolar depressive disorders incur the 9th biggest DALY burden of any disease according to the Global Burden of Disease 2012 update.
  • Most developing countries spend ~nothing on mental health and there is only one large charity working on it.

Other things this makes me wonder:

  • Where (geographically/demographically) is the DALY burden of depression/unhappiness concentrated? This would seem to have strong implications for where work should be focused. E.g., anti-depression smartphone apps developed in the US are unlikely to transfer well to India.
  • What is the actual effect size of CBT run "in the wild" via a scalable delivery mechanism like an app? How much of depression can we expect it to mitigate? Is the main problem to solve here finding a good intervention, or distributing it (i.e. getting people to use the CBT app or whatever)?
  • Have other (non-depression-related) interventions aimed directly at developed-world quality of life been tested? For instance, people notoriously neglect the effect of having a long daily commute on their happiness, and I suspect something similar applies to exercise and to food quality (at least, it does for me).

BTW, one note on the paper: you remark that "[a billionaire] should also run randomised controlled trials to assess how much happiness is increased by anti-poverty and anti-malarial interventions"--in fact, you can achieve a lower bound on the happiness increase of anti-malarial interventions because the main mechanism by which they reduce DALY burden (at least in GiveWell's cost-effectiveness analysis) is by reducing mortality. Unlike severe pain, one cannot hedonically adapt to being dead, so anti-malarial interventions (and other mortality-reducing interventions) should have less of the 10x bias than e.g. cash transfers.

*I'm not incredibly confident in this argument; determining the actual quality of life burden here seems like a pretty subtle measurement problem of which I'd love to see a more thorough treatment than the paper provides, since it's really the crux of the quantitative argument.

Comment author: Phil_Thomas 29 June 2016 10:15:34PM 2 points [-]

What is the actual effect size of CBT run "in the wild" via a scalable delivery mechanism like an app? How much of depression can we expect it to mitigate? Is the main problem to solve here finding a good intervention, or distributing it (i.e. getting people to use the CBT app or whatever)?

From what I can tell, the problem is more with outreach and retention than with effectiveness. Most of what I've read shows that computer based cognitive behavioral therapy (cCBT) is as effective as in-person CBT for anxiety and depression in the context of a RCT. But "in the wild", rates of adherence drop considerably, with estimates of 0.5% and 1% completion in the only two published studies I could find [1,2].

If your server time and ongoing development costs are low enough, though, cCBT could still be a cost effective approach despite poor retention. This assumes that those that fail to complete the training aren’t harmed, but evidence seems to suggest that even partial completion is helpful [1,2]. Note that in study [1], about 15.6% completed 2 or more of the 5 modules, so a larger portion of people at least partially complete the training. I haven’t done a $/DALY estimate, but it would be fairly easy to come up with one with the results from study [1].

[1] A Comparison of Changes in Anxiety and Depression Symptoms of Spontaneous Users and Trial Participants of a Cognitive Behavior Therapy Website. http://www.jmir.org/2004/4/e46/

[2] Usage and Longitudinal Effectiveness of a Web-Based Self-Help Cognitive Behavioral Therapy Program for Panic Disorder. http://www.jmir.org/2005/1/e7/

Comment author: Phil_Thomas 29 June 2016 09:50:53PM *  5 points [-]

I’m glad to see some discussion of this topic here, I think it could be a pretty effective area for EAs to work. I have a few comments specifically related to electronic delivery of therapy. I’ve been following the area for awhile, although most of what I’ve read is in the context of anxiety and depression treatment so it might not be applicable to interventions focused on general happiness.

cCBT is as effective as in-person CBT for anxiety and depression in the context of a RCT. But when you change over to open access therapies, rates of adherence drop considerably, with estimates of 0.5% and 1% completion in the only two published studies I could find [1,2]. If your server time and ongoing development costs are low enough, though, cCBT could still be a cost effective approach despite poor retention. This assumes that those that fail to complete the training aren’t harmed, but evidence seems to suggest that even partial completion is helpful [1,2]. Note that in study [1], about 15.6% completed 2 or more of the 5 modules, so a larger portion of people at least partially complete the training. I haven’t done a $/DALY estimate, but it would be fairly easy to come up with one with the results from study [1].

One promising approach to improve retention is to offer health coaches, which interact with cCBT users and help them stay on track to completion. This would be more expensive, but could be a middle ground between cCBT and in-person therapy. Ginger.io is one startup using this approach, and I’m excited to see how things go for them. They offer cCBT, health coaches, and psychologists via video conferencing if needed. This approach could make it pretty seamless for those with mental illness to seek help. There are a few clinical trials testing their technology here, but I can’t find any results yet.

For a good overview of some of the other emerging startups in this space, see this article. It’s especially encouraging to see people with very strong academic credentials founding or on the boards of these startups, which suggests there is fairly good scientific support for the approach. If you want to read more of the literature, the faculty profiles at Australia National University e-health group and cbits at Northwestern are good place to start. ANU’s moodGYM has been around since 2001, so it has been tested in a number of RCTs.

How could effective altruists help in this area?

Now that a number of promising cCBT companies exist, their outcomes might be inevitable. But EAs could still help the therapies spread more quickly, fund RCTs to verify or improve effectiveness, or work directly for these research groups/companies. On the regulatory side, each state in the US has different licensing processes for mental health professionals, which prevents them from video conferencing with patients in other states. Relaxing this barrier would be especially helpful for rural patients. Getting a cCBT approved for Medicare/Medicaid in the US would also be a step forward, but I would think that stronger randomized evidence would be needed before that would happen. One interesting side note is that the UK, Australia, Denmark and Sweden found the evidence strong enough to approve cCBT years ago, so maybe the problem is that nobody has lobbied hard enough in the US?

[1] A Comparison of Changes in Anxiety and Depression Symptoms of Spontaneous Users and Trial Participants of a Cognitive Behavior Therapy Website. http://www.jmir.org/2004/4/e46/

[2] Usage and Longitudinal Effectiveness of a Web-Based Self-Help Cognitive Behavioral Therapy Program for Panic Disorder. http://www.jmir.org/2005/1/e7/

[3] The Law of Attrition. http://www.jmir.org/2005/1/e11/

[4] Adherence in Internet Interventions for Anxiety and Depression: Systematic Review. http://www.jmir.org/2009/2/e13/

Comment author: Marcus_A_Davis 07 April 2015 02:16:19AM *  4 points [-]

As someone currently in the process of learning programming here are a few thoughts on my attempt at learning two of the bolded languages, Java and Ruby:

I'm currently working through The Odin Project, which has a backend focus on Ruby, and I'd highly recommend it. I'd also recommend Peter's guide to TOP which I've found very useful which includes some time estimates, some additional resources and some things to learn after you complete TOP. Perhaps the biggest plus to TOP for me is giving projects of the correct difficulty at the correct time so that they are challenging but doable. Another of the biggest benefits of TOP is the sheer scope of the resources already collected for you. Also Ruby is far more intuitive than Java.

Before starting TOP I started learning programming by attempting to learn Java on my own without much structure. However, going on my own I'd often spend time attempting to track down a good explanation for topics. There was also the issue of not knowing what was a logical path to take to learning and I think I took some major false steps. The resource I found most beneficial during that time were probably the free courses at Cave of Programming which covered a wide range of topics but had the huge downside of being somewhat dated video tutorials. Other than that I didn't find lots of free resources to help learning Java but there are some pretty cheap stuff on Udemy and a subscription to Lynda could be a good investment as well.

Of course, a huge caveat, I am a sample size of one who had no experience at all with programming before starting with Java. People with different backgrounds may have very different experiences.

Comment author: Phil_Thomas 15 May 2015 06:15:56PM 1 point [-]

Epicodus put their entire Ruby/Rails program online for free here. I don't know enough to judge the quality, but it might be useful.

Comment author: John_Maxwell_IV 12 April 2015 08:49:38PM 2 points [-]

Less Wrong thread. I still advocate learning Python; it's an OK or good choice for almost anything you'd want to program, and I think its simplicity and readability mean that it will give you the best conceptual foundation out of anything out there. I listed a bunch of resources on learning Python in this post. They're a bit deeper and more conceptual than the resources you'll see on learning Ruby, which is a good thing because it will differentiate you from all the Ruby web development types and give you the opportunity of becoming a backend developer, which has higher salaries and barriers to entry (and is a better fit for someone who has more of a traditional math/engineering mind since it's less forgiving of mistakes and has more challenging mathy engineering problems). If you're sure frontend web development is all you want to do or you have some cool frontend thing you're inspired to make, I guess JavaScript is fine.

Comment author: Phil_Thomas 13 April 2015 12:59:52AM 1 point [-]

I have also found Python to be very useful. I learned through Udacity's Intro to Computer Science course, which was really user friendly.

In response to March Open Thread
Comment author: Phil_Thomas 01 April 2015 07:56:18PM 2 points [-]

I just came across an interesting set of short, user friendly videos describing how QALYs are derived using the standard gamble or time tradeoff techniques. They mainly focus on applications in the US healthcare system, but I think they could be useful for anyone trying to communicate the ideas of cost effectiveness research.

Determining utilities using the standard gamble and time tradeoff techniques

Calculating QALYs, and applying them to the healthcare system

They're written by Aaron Carroll, who regularly writes for the NYTimes, and blogs at The Incidental Economist. Their blog outlines the general concept behind EA here, so maybe they'd be open to consulting with an EA group? In general, I think healthcare economists have really interesting viewpoints to add to this movement.

Comment author: Giles 03 February 2015 02:07:13PM 1 point [-]

some of the Gates Foundation work is higher impact than GiveWell top charities

Hasn't GiveWell also said that large orgs tend to do so many different things that some end up being effective and others not? Does this criticism apply to the Gates Foundation?

Comment author: Phil_Thomas 04 February 2015 07:19:16AM 0 points [-]

I think GiveWell was initially much more critical of the Gates Foundation than they are today. Perhaps this is because during the OPP they found that what Gates does is (1) very difficult and that (2) Gates (or other foundations/govs) had already funded many of the most promising opportunities.

It's probably best to evaluate the GF like a venture capitalist rather than on a project by project basis.

Comment author: Owen_Cotton-Barratt 03 February 2015 10:22:35AM 4 points [-]

I think there's a real question here and it is plausible that large donors do better.

I will point out that if it's correct that there are better returns from scale the conclusion probably isn't that small donors are best giving to charities like the GiveWell recommendations while large donors can do better. Instead small donors would be best getting to a position where their money acts like that of large donors.

Here are three possible mechanisms for that: (i) Give money to large donors, such as the Gates foundation; (ii) Coordinate with others, pooling money so that many small donors act as a single large donor; (iii) Gamble, exchanging certainty of a small donation for a small probability of a large donation.

Comment author: Phil_Thomas 04 February 2015 06:30:03AM 0 points [-]

I'm especially interested in coordinating with others, something like a crowdfunding site with prescreened projects would be great.

Otherwise, gambling's cool too :)

Comment author: Phil_Thomas 19 December 2014 05:47:41PM 0 points [-]

There was an interesting interview with Dean Karlan from Innovations for Poverty Action on PBS. Some excerpts:

Dean Karlan: I divide my thinking into short-run and long-run. For the long-run, I want to invest. I want to think about how we get better information, better evidence [for what we give], because we need to help future children, not just today’s children. In fact, there are many more children in the future than today so I put more money into the long-run. And for that, I support Innovations for Poverty Action which is doing research to figure out what works and what doesn’t.

But, I also do care about the short-run. So I also look at some of the things that we do have strong evidence on — where there have been really good tests to show that an idea works, and here’s a charity that’s doing it, so let’s support it.

This year there are three charities that stood out in the work that I was doing with my family, trying to think through what to support. One is called Trickle Up, which works a lot in West Africa and Latin America. A second is Seva Mandir which does work in India.

And a third is Evidence Action, an organization just started a year ago that is strictly committed to scaling up ideas that have been shown to work using randomized trials. They are doing two things right now. One is a de-worming program. This is a school-based de-worming program. De-worming, as in children who have intestinal worms, which gives them a distended belly and makes them lethargic and sick and not able to go to school. Taking a pill has been shown not only to improve their school attendance, but 10 years later, improve their income.

A second is a chlorine dispenser. . .

There are also some interesting findings on savings and crop insurance instruments that they discuss:

So, the striking insight was that it’s not that people weren’t credit constrained, but they were very risk-constrained, and there was a lot of under-investment going on simply because of risk. And this suggests that a scaled-up micro-insurance product that helps people absorb rainfall risk would be a very successful thing.

The host seems convinced at the end, and decided to donate 10% to Dean's suggested charities.

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