
I mostly believe in Worms - apsec112
http://blog.givewell.org/2016/12/06/why-i-mostly-believe-in-worms/
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Isamu
I like that the GiveWell website has an "Our Mistakes" section right up in
their main navigation bar. It does a lot to inspire a feeling of transparency,
which is a big issue for non-profits. I think more of them would do well to
take the issue of transparency more seriously, and if they are reluctant to be
transparent, they should take some time to consider whether it is for truly
good reasons.

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imagist
I think GiveWell does a great job at determining where we get the best bang
for our buck when it comes to aid, but at a more fundamental level, I don't
think I'm in a position to tell someone else what they need. That's
condescending and I'll never have the whole picture. That's why I give to
GiveDirectly--I think people should be able to determine how they are helped.

Deworming programs might help kids the most, but then that money goes to a
(likely American) pharmaceutical company and the benefit is over.

In contrast, give someone money and a lot of that money will stay in their
community. Maybe the iron roof they buy provides them a smaller benefit than
deworming, but the guy who makes and installs the iron roof can now buy a cow
from his neighbor, who can now buy seed for next year's crops. Maybe
eventually the money allows someone to get deworming medication for their
kids, but now that money had benefited a bunch of people in the community
first.

It's hard to collect data on this kind of stuff (although GiveDirectly is
collecting a lot of data). But I think we need to recognize that the only
reason we collect data is to control outcomes, and we're not really helping
people if we don't allow them control over their own lives.

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notahacker
If we're doing fair comparisons, the gift to a single family that allowed them
to buy the iron roof could have dewormed 200-1000 children and at least some
of those funds pass into the hands of local administrators spending in the
local economy. I also doubt the profit margin for an East African roof
installer buys him a cow, and it may not even be as much as the local thatcher
stands to lose from no longer being required to undertake as many biennal
rethatching projects. (Estimating all the side effects of a programme is
really quite tricky)

I don't buy the argument that deworming doesn't really help people because
they weren't offered the choice of buying the equivalent value of cigarettes
instead. Just because a person freely chooses to do something doesn't mean it
helps them, and vice versa. Donors and aid agencies' systematic biases in
favour of things that don't work particularly well (this, not "control" is the
real reason for all the data collection attempts) is certainly worth worrying
about, but that can't be fairly assessed without realising that recipients
also have systematic biases in favour of things that don't work or against
things that do too. There's a reason why countries where the average person
has a lot of disposable income spend _even more_ as a proportion of income on
publicly subsidised healthcare programmes.

Edit: This shouldn't be interpreted as a particular criticism of GiveDirectly,
if the idea of making a fairly big difference to a small number of randomly-
selected very poor Kenyan people appeals to you.

~~~
Veedrac
The mention of cigarette spending is an extremely dangerous strawman, largely
because for some reason people actually believe it. There's fairly strong
evidence that there is no increase in tobacco or alcohol spending[1][2] with
direct cash transfers to the extremely poor. These stereotypes are frequently
used to argue against charity or welfare to the needy, and I can only consider
this line of argument to be harmful.

This is not to take away from the rest of your point, but I would appreciate
it if you chose a different comparison next time.

[1] [https://www.givedirectly.org/research-at-give-
directly](https://www.givedirectly.org/research-at-give-directly) [2]
[https://www.givedirectly.org/research-on-cash-
transfers](https://www.givedirectly.org/research-on-cash-transfers)

~~~
notahacker
Appreciate the sentiment, but it was actually a quite deliberate comparison
because (i) the very poor in developing countries where cigarettes are very
cheap often have a cigarette budget which comes _before_ investment and
improved nutrition (ii) I'm well aware that despite the startling prevalence
of smoking amongst poor men, increased tobacco use isn't a significant factor
in studies of how poor people spend donor cash.

(i) pretty much underlines my point about the things people choose to spend
their money on not necessarily being what's best for them. And in the short
term it's not an inexplicable phenomenon because cheap tobacco probably does
provide more pain and stress relief than slightly better nutrition.

(ii) is partly because surveys like those you've posted accurately represent
people tending not alter their habits of smoking cheap cigarettes (or frowning
on tobacco) after receiving a sudden windfall; there's a limit to how much one
can smoke and stockpiling makes no sense when for people who don't even have a
waterproof roof. But it's also because poor people are smart enough to realise
that people quizzing them on their lifestyle and unexpected windfalls from
foreign donors aren't unrelated, and the natural response is to tailor
responses to what they think the foreign donors want to hear, resulting in any
increases in spending on cigarettes and alcohol (whilst likely low relative to
increases in spending on roofs or microbusiness investments anyway) being
systematically underreported.

~~~
glomph
Do you have any evidence for systematic underreporting? One could just as
easily say that the members of control groups (who do not receive cash) would
have a reason to underreport their spending on things that are not approved of
in order to receive more potential money in the future.

Also the research presented by GiveDirectly also includes studies of people
where the cash is not from the same people as the surveys (for example state
funded benefit programs that have clear and universal criteria unrelated to
spending or consumption.) In those cases again there is reason to expect the
underreporting to be similar across both groups that get cash and those that
do not currently.

~~~
notahacker
> One could just as easily say that the members of control groups (who do not
> receive cash) would have a reason to underreport their spending on things
> that are not approved of in order to receive more potential money in the
> future

This apparently happening with control groups _in the same villages as cash
transfer recipients_ is actually some of the most persuasive evidence response
biases exist in the surveys. According to various RCTs, when their neighbours
start getting money, women are less likely to report their husbands beating
them. On the other hand, they're also less likely to report being satisfied
with their life. There are [just about] plausible mechanisms for how spillover
effects from donations could cause those behavioural/satisfaction changes
amongst non-recipients in a neighbourhood, but _recipients thought they were
less likely to receive money if they reported domestic violence or said they
were satisfied with their life_ is the most Ockham's-razor satisfying one.
(It's also likely part of the reason why _recipients_ seem surprisingly
unlikely to report increased satisfaction from life after receiving life-
changing sums despite positive changes in almost every measurable area.)

Response biases are difficult enough to eliminate in social science surveys
when participants have no reason to suspect a sum greater than their average
annual income may hinge on their answers.

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barney54
What I love about this analysis how it tries to deal with conflicting
information. The author is very explicit with the problems of the Worms study,
but still trusts it. This is real life decisonmaking.

There are few easy answers, especially in complex systems. The best we can do
is put the evidence out there and make our best guess.

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PaulHoule
It reminds me of the time we had too many homo saps and cattus rattuses in the
house and we got tired of seeing worms on the carpets and gave all the mammals
a round of Pyrantel.

CDC estimates (not alt-health loonies) that 10% of people in the U.S. have
some worms.

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lkbm
Where are you getting that number from? I can find stats on individual types
of parasites on the CDC site, but not worms in general.

I am seeing 13.9% with Toxocara antibodies[0], so past exposure. That's fun.

[0]
[https://www.cdc.gov/parasites/toxocariasis/gen_info/faqs.htm...](https://www.cdc.gov/parasites/toxocariasis/gen_info/faqs.html)

