I agree with you in humans, but who knows how these degrees of pain might work in animals? I think with these degrees of uncertainty in animals it's not unreasonable to have smaller multipliers

Not my area, but a well written concise post, with great explanation. How right you are I do not know (Not my area again) but I appreciate clear arguments that can easily be engaged with.

As giving season is here, lets do our best to not fall into this trap. I don't agree this problem is the norm, but I've seen it both in myself and others.

"Perhaps the most overrated virtue in our list of shoddy virtues is that of giving. Giving builds up the ego of the giver, makes him superior and higher and larger than the receiver. Nearly always, giving is a selfish pleasure, and in many cases it is a downright destructive and evil thing. 

One has only to remember some of our wolfish financiers who spend two-thirds of their lives clawing fortunes out of the guts of society and the latter third pushing it back. It is not enough to suppose that their philanthropy is a kind of frightened restitution, or that their natures change when they have enough. Such a nature never has enough and natures do not change that readily. I think that the impulse is the same in both cases.

 For giving can bring the same sense of superiority as getting does, and philanthropy may be another kind of spiritual avarice."

Steinbeck -The Log from the Sea of Cortez

 

I'm pretty confused about this.

It looks like the CEA has TBA's giving TXA at homebirths, which accounts for a good chunk of the benefit at homebirths, yet above your reply said "Our piece does not propose supplying TBAs,"

Trying to figure out what's going on here exactly.

Thanks Akhil. I completely agree with your high level summary of the situation (quoted below). The sentiment of your summary wasn't how I read the article, and I don't think would be the message most people would get from it. After re-reading I still think its very bullish about autoinjectors specifically.

"At a high level, our piece does not say autoinjectors are the only answer or even the most cost-effective answer. It says that a ready-to-use intramuscular (IM) format removes one specific and important barrier (the need to site an intravenous (IV) line and run an infusion), and that a pull mechanism such as a prize or an advance market commitment could bring that format to market. We do not claim it is more cost-effective than stocking the drug or training midwives; we do not recommend autoinjectors over prefilled syringes; we do not recommend an AMC over other market-shaping mechanisms.


On 1

“Availability is improving fast, and fastest at the facilities you say the device will not reach.” 

I agree availability is improving fast, but is still a massive problem and needs a LOT of work. Like you said only 3 in 4 countries even having the drug on their essential medical list (a first step) and PPH guidelines shows how new the treatment is. Your official adoption examples only begin in 2022 or later. TXA treatment is a new thing, and TXA is still not in most facilties where women deliver.
 
One 2024 Study which only looked at big hospitals showed that  In Ghana, 8/9 hospitals said they had TXA, but staff could only show them where it was in 5 of those. In Uganda 5/7 hospitals they had TXA yet none could even find it for the researchers. Since 2024 stocking has improved but I'm not sure that level faciltiies even stock it routinely yet in Kenya and Uganda. I don't think we yet "now have TXA in the building" nearly to the extent you think.

On the specific points.

On 2

I don't think my comment "We can't give TXA into the muscle yet" is "categorically false" in LMICs at least. From what you've presented I agree we are further along than I thought in confirming that IM works great, but TXA is still only given IM in clinical trials, and apart from one niche paramedic approval in England, it still isn't approved for use anywhere in LMICs. Given this I still don't think that its safe right now to write 'TXA does not have to be delivered by IV” in a public article focused on LMICs.

On 3. 

Your reply here says "The argument is ready-to-use intramuscular format versus drawing up and running a ten-minute intravenous infusion." which I agree with, but I think a straightforward read of your article pushes autoinjectors and pre-filled syringes more than regular IM  which we draw from a vial - so I don't think its fair to say I strawman your article. This is what you say

"Autoinjectors could close this gap. TXA does not have to be delivered by IV; a trial has found intramuscular TXA reached therapeutic levels in the blood within minutes and achieved bioavailability close to that of intravenous administration. This means it could be given via prefilled syringes in two 5 mL injections, or — with further engineering to concentrate the formulation — as a single autoinjector. Both are technically feasible, and an autoinjector would allow a wider range of people — lower-cadre health workers, birth attendants, family members — to administer it. "

On 4

I think you've perhaps misunderstood that homebirth in Africa means no skilled attendant in perhaps 90% of cases. But on the other hand your CEA contains the right numbers? You say "Our piece does not propose supplying TBAs, nothing in our argument depends on unattended home birth". But your piec does propose supplying TBAs with an autoinjector for TXA,

"an autoinjector would allow a wider range of people — lower-cadre health workers, birth attendants, family members — to administer it.  

Its hard to discuss these contradictory statements. 

On 5

Outside of Sub-Saharan Africa in higher income countries, I do think there's a strong case for autoinjectors. They seem to have medically trained first responders which could realistically use an autoinjector.

In Sub-Saharan Africa, 80%+ of the time, when an accident happens nobody medical will see a patient before they reach a hospital so in our context we sould talking about non-medical strangers administiring injection. While trying to refute that non-medical strangers dont' give injections, none of your examples of autoinjection use involved non-medical strangers. They are all administers by medically trained people, or they are friends/family, or they are not injections (naloxone).

It seems to me that AI was involved here in just generating a bunch of examples which didn't actually refute my point at all - but I can't be sure of that.

On 6

"You may be right that the device is third in the queue. That is an ordering argument, not a dead end."  Perhaps I think this order more important than you do, in what work we should prioritise. I think often we do need to see if problems are largely solved after nailing step 1 and 2 before we prematurely invest a lot of money in step 3. Other issues might arise along the way But I think your argument is fair that it can be good to work on different problems at once.

My point "time isn't really of the essence" is to saying that if facilities have antivenom, staff feel better using it and people don't waste hours going to a tradition healer, 6 hours is long enough that we can manage antivenom pretty well with health system we have. Two of your 2  preconditions for autoinjectors being useful at the start of the article was "minutes matter", and "no clinician within reach". When 6 hours is usually fast enough, with antivenom there's a strong argument with antivenom that both of those conditions are not met.

You also didn't mention my point that it would be impractical and prohibitavely expensive to have to give 10+ autoinjections as would be the case with antivenom treatment, which I think is quite a big barrier to autoinjection for antivenom

Overall I think we agree on a lot and I think many of the points you make in the reply soften. It does seem though that you were trying to refute every single point I made even when I think my point was strong and the refutation is pretty weak. 

I doubt you meant it this way, but this comment came across as a personal attack and I'm compelled to reply immediately. You said"The woman bleeding after a home birth two hours from a facility, whom you set aside after noting that a third of births still happen at home, has a real problem." My life's work is trying to find solutions for real problems like this one - as is yours which I respect greatly. Neither of us set her aside. Comments like this where someone with a tech-solution from afar derides someone working on the same problem on the ground is the kind of thing which can give Effective Altruism a bad name.

But to reply to that claim, my solution is that the mainstream public health response to encourage and help her get to a facility to deliver (as I stated). I don't think you propose any solution for her anywhere here though. You say "Our piece does not propose supplying TBAs, nothing in our argument depends on unattended home birth". But in this case your agument does depend on unattendend home birth. 90% of those third of home births you speak of have no skilled attendant to give the TXA. A homebirth in Sub-saharan Africa usually means a TBA or nothing. So what is your solution then?

How much does it cost to offset the suffering an average diet causes to farmed animals?

The lives of a billion nematodes that would have suffered on that factory-farmed land.

@Vasco Grilo🔸 couldn't resist ;).


In all seriousness its an interesting question and I appreciate this wee write-up. Of your 2 questions "How much money is needed to help each type of farmed animal affected by the diet about as much as the diet harms it? Or how much money is needed to decrease the suffering of farmed animals as much as the diet increases it, regardless of which animals benefit?" I would only consider the first question strict offsetting. I think given that offsetting is already a controversial approach which some people disagree is valid, going one step removed and not offsetting the actual direct problem you are causing is perhaps too much of a stretch, and personally I wouldn't be OK with making that equivalency

When you offset carbon, its the same type of carbon being pulled out of the air that you put in, like for like. When you offset biodiversity, you pay (in theory) to restore/protect an equivalent habitat somewhere else. I think preventing suffering in shrimp to allay your conscience from causing pig suffering is something similar, but distinct. 

This might be a straw man, but I would feel OK (ish) about supporting a charity that improved the welfare of miners in the DRC to allay my moral burden of the rare earth metals in my phone, but I wouldn't feel right "offsetting" that suffering I caused to miners by eating less meat and reducing the equivalent amount of chicken suffering - if you get my drift.

This is just my opinion btw, not any kind of standard practise. I may well also be flat wrong, I often am when it comes to moral philosophy.

I agree that different people might be trying to do different things, and I appreciate you outlining the costs of both, but I would rather not call the second question "offsetting"

Still though 80,000 hours could have produced these videos directly from the 80,000 hours account without going AI only. It seems to me a strawman that you would have had to make these videos form a separate platform.