Thanks for sharing your perspective and experiences here! I think it's really valuable for EAs with first-hand experience to write about these issues, and I'm really sorry you went through such a difficult time. You might be interested to read this piece I wrote last year about EA and disability based on my own experiences. It includes some discussion of HALYs, though that's focused more on the history and perception of HALYs rather than the issues you touched on. 

Reading your piece, I very much agree with you that the current methods of constructing HALY weights generally have methodological issues and would greatly benefit from more focus on actual experiences of people in the health states in question. I also agree that the naive application of HALYs as units of utility or “goodness” can lead to some very dark places (especially in light of the methodological concerns you mentioned, it frustrates me that EAs often slip into using DALYs as units of utility when the post-2010 weights are specifically intended to only be a measure of health status). 

I have a slightly different perspective on a couple of the other issues you mention, and I’d be curious to talk more with you about these. 

First, I think that the existence of difficult tradeoffs is inevitable as long as resources are limited, and moving to HALY alternatives won't necessarily eliminate these challenges. For example, one of the articles you quote mentions NICE guidelines about drugs for dementia. I would really, really like better medications to exist, but my (admittedly not very in-depth) understanding of the field is that the drugs are quite expensive and don't do much to improve symptoms or alter the course of the disease. As long we have limited healthcare resources, it’s not clear that there’s an alternate weighting strategy that would justifiably recommend allocating limited resources to buying these medications rather than spending on other health interventions that work better. Here, it seems like the problem is much more the paucity of options and limited resources than the particular weighting scheme. 

Another item is the role of HALYs in perpetuating healthcare inequalities. I do agree that there is absolutely a straightforward way in which this is true, but I’ve come to think there’s some more complexity here than I at least initially thought. HALY maximization in some situations encourages improving the wellbeing of people with chronic illnesses/disabilities over extending the lives of able-bodied people. For example, the 2021 GBD disability weights give post-viral chronic fatigue syndromes a weight of 0.22. A policymaker trying solely to maximize DALYs averted would, if such a treatment were available for the same cost, choose to invest in curing five people of post-viral chronic fatigue over saving one fully healthy person’s life (if all the individuals were the same age). I absolutely agree that ME/CFS is underfunded overall, and that there is probably a role for HALYs in that underfunding (in particular, the 2021 GBD disability weights only include values for a small number of recognized post-viral chronic fatigue syndromes, so policymakers may not be able justify investments in broader ME/CFS research/treatment in terms of HALY benefits). I just think the overall picture here is a bit complicated. 

The last item is the existence of states worse than death. I very much agree that deciding at a population level that certain people’s lives are worse than death, then making policy on that basis, can lead to very dark and wrong places. However, I really do think that some people in some cases experience states worse than death, both from my own experiences and from the testimonies of others. In my own life, I have had experiences that were bad enough that I absolutely would have traded off shortening my own life to avoid them (for example, I would have been happy to lose a week of healthy life to avoid the worst moments of a shoulder dislocation). More broadly, I do think we should listen to ill or disabled individuals such as Gloria Taylor who’ve described their own conditions as worse than death and advocated for the right to access medical assistance in dying. I think it would be wrong to say that for individuals who describe their lived experience as worse than death and express a desire to access medical assistance in dying, they have not benefited by being able to fulfill their desire. And moreover, not having a weighting scheme that allows for states worse than death I think risks underemphasizing the suffering involved for certain people in cases of extreme pain. As a result, I worry that such a scheme could lead to underprioritizing interventions that improve quality of life and alleviate pain in favor of interventions that save lives. Again, I think it’s absolutely wrong to decide based on population-level statistics that an individual person’s life is worse for them than death, but I think there’s a balance to walk here and I worry that it’s as bad or worse to not listen when people describe their lived experiences as worse than death based on their own values. 

Thanks again for writing your piece. I hope these thoughts are useful!

RP is currently #1. EA Animal Welfare Fund is currently #2, and I don't think it the kinds of work it funds are necessarily things OP won't fund.

I think this is only partially true. Since RP gets significant funding from OP, my understanding based on their communications is that they tend to often use unrestricted funding specifically in areas that can't get funding for from OP. And similarly, AWF has specifically highlighted funding areas that OP won't as one of their top areas. 

Thank you Sjir and Aidan for this excellent work! I think it's quite valuable for community epistemics to have someone doing this kind of high-quality meta-evaluation. And it seems like your dialogue with ACE has been very productive. 

Selfishly as somone who makes a number of donations in the animal welfare space, I'm also excited by the possibility of some more top animal charities becoming supported programs on the donation platform :) 

Thanks Vasco. After thinking about the numbers myself, I agree that allowing for states worse than death can't on its own do a lot to make the numbers comparable between GiveWell and SWP. I do actually think it would move the numbers more than you're accounting for there, both because the deaths prevented by GiveWell top charities might involve more than 7.5 minutes of excruciating pain and because GiveWell top charities prevent a lot of morbidity among people who end up surviving (and I think they're significantly underweighting the value of this, e.g. clean water interventions prevent about 6 person-years of being sick with waterbone illnesses for everyone person who dies, and I would significantly prefer to be in a dreamless sleep than be conscious with a severe enteric infection.^[1] But the DALY weight for severe diarrheal illness is 0.247, implying 3/4ths the wellbeing^[2] of being fully healthy). But this is at most going to change the cost-effectiveness of GiveWell top charities by a factor of 2, not 4 OOMs.

As for the 10000x difference in weights between disabling and excruciating pain, I have to admit I'm pretty confused here. On the one hand, it strikes me as fundamentally implausible that suffocating is 10000x worse than dying of heatstroke. On the other hand, some of my intuitions do lean towards not being willing to endure e.g. burning to death for almost anything else. I'll need to spend some time reviewing the literature before I try and make further sense of how to best make these tradeoffs.

Thanks again for all your work and engagement here, I think it's genuinely quite valuable to be having these conversations!

1. ^{^}

   I took some notes on my willingness to make these tradeoffs when I was recently sick with norovirus and am hoping to write a short post on this soon!  

2. ^{^}

   DALY weights are a measure of health status, not wellbeing, but that hasn't stopped anyone from using them as a unit of wellbeing

I also ranked Arthropoda first! I'm quite bullish on the value of information in the animal welfare space, and think that on the current margin they would do extremely valuable work. 

Though I've made some comments that disagree with some of Vasco's specific numbers, I agree that SWP is extraordinarily effective and ranked them a close second after Arthropoda!

(Crossposted from twitter)

While I'm a big fan of SWP and have donated to them myself, I am skeptical of claims like

 This makes [SWP] around 30 times better at reducing suffering and promoting well-being than the highly effective animal charities focused on chicken welfare which themselves are hundreds or thousands of times more effective than the best charities helping humans.

I greatly appreciate @Vasco Grilo🔸 for writing up his analysis, but I don't think that most people would agree with some of the assumptions made in it regarding pain intensity:

For air asphyxiation: time in disabling pain equal to the maximum time during which shrimp can remain alive of 30 min, although Aaron noted he and his colleagues have seen some alive for 6 h; time in excruciating pain as a fraction of that in disabling pain equal to that of ice slurry (0.126 h); time in hurtful pain as a fraction of that in disabling pain equal to that of ice slurry (0.00633 h); and time in annoying pain as a fraction of that in hurtful pain equal to that of ice slurry (0 h).

[...]

• Annoying pain is 10 % as intense as fully healthy life.
• Hurtful pain is as intense as fully healthy life.
• Disabling pain is 10 times as intense as fully healthy life.
• Excruciating pain is 100 k times as intense as fully healthy life.
• RP’s median welfare range of shrimps of 0.031.

My assumptions for the pain intensities imply each of the following individually neutralise 1 day of fully healthy life:

• 10 days (= 1/0.1) of annoying pain.
• 1 day of hurtful pain.
• 2.40 h (= 24/10) of disabling pain.
• 0.864 s (= 24*60^2/(100*10^3)) of excruciating pain.

Vasco estimates that asphyxiating shrimp experience about 7.5 minutes of excruciating pain, and weights this as 10000x worse than disabling pain, which is the maximum pain experienced by a chicken during a keel bone fracture or death from heat exhaustion (in the data used to generate the THL numbers). Moreover, the data he relies on for the cost effectiveness of GiveWell top charities does not allow for the existence of states worse than death. This means that he's estimating that the pain experienced during asphyxiation is 100000x the worst pain prevented by GiveWell. This seems highly implausible to me. Surely dying of malaria or diarrheal disease involves some pain that is within 100000x the intensity of suffocation (and indeed WFP estimates that sepsis in a chicken involves excruciating pain, so I would expect that sepsis in a human does as well).

None of this is to say that SWP is ineffective, merely that the cost-effectiveness ratios compared to other EA top charities citied here seem overly high to me. 

Congrats, Sjir!

Thanks for looking at this Vasco, it's always great to see others doing this kind of cost-effectiveness analysis. 

Your results indicate a substantially higher direct cost-effectiveness for SWP relative to the analysis I did last year. From looking at your methodology, I believe our primary difference comes from a difference in weighting the relative badness of different levels of pain. I used the same numbers as a 2023 RP report which weighted excruciating pain as 33 times worse than hurtful pain, while your weights put excruciating pain at 100000x worse than hurtful pain. 

I've updated towards thinking 33x is probably at least an order of magnitude too low (and more recent RP reports have used weights in the vicinity of 600x), but I would personally be skeptical of 100000x. 

Of course much of SWP's impact is through creating systemic change, so I don't want to over-emphasize the importance of these direct impact CEAs, as valuable as they are.

Great list (and thanks for the shoutout)! 

I would add @Laura Duffy's How Can Risk Aversion Affect Your Cause Prioritization? post