A Medical Perspective on Effective Altruism
‘Effective altruism’ as a philosophical and social movement has spread slowly around the developed world since the 2000s. This movement has touched the lives of millions of the most underprivileged and impoverished people on earth, yet by all its merits still avoids catching the eye of governments, companies and the average taxpayer. Doctors shoulder a moral burden as leaders in society, and that is an opportunity for us to lead not only with our skills and expertise, but also with empathy and reason both locally and globally, to improve the health of those less fortunate the world over. I believe this can be achieved through the ideals of Effective Altruism.
The most basic interpretation of Effective Altruism is ‘How can good be done the most efficiently’ or alternatively it can be described as ‘the project of using evidence and reason to figure out how to benefit others as much as possible, and taking action on that basis’.1 Many philosophers have debated the virtues and tact of Effective Altruism, Melbourne Born Philosopher and current Professor of Bioethics at Princeton University, Professor Peter Singer, is prominent among them. Signer originally wrote his most notable piece on Effective Altruism ‘The Life You Can Save’ over a decade ago, and the core premise he implores us to consider is this:
‘A life is a life no matter where that life lives. A human being over there is no less valuable than a human being over here.’
Which he follows with a series of introspective questions:
‘What am I doing as a human being on planet Earth to help the less fortunate’?
‘Can I perhaps do a little bit more’?
‘If so, how’?2
The answer, unsurprisingly, is in Effective Altruism.
The World Bank defines extreme poverty as having insufficient income to meet the most basic human needs for food, water, shelter, clothing, healthcare, sanitation and education. The percentage of the world’s population that lives below the extreme poverty line (less than $1.90USD per day) is currently ~700 million. Qualitative studies have elucidated what the daily life for someone living in such poverty is like:
‘You are short of food for all or part of the year, only eating 1 meal per day, often having to choose between stealing your child’s hunger or your own and sometimes being able to do neither; You can’t save money, when your child falls ill you can easily be trapped in crippling debts to moneylenders with high interest rates seeking a remedy, and medical care often requires days of travel by foot; You can’t afford to send your kids to school, or they have to be taken out if the harvest is poor; You live in an unstable house you have to replace after every few years or if the weather is severe; and you have no nearby source of safe drinking water’.3
Objectively reading the above description we know that one living in such circumstances is in a place of constant struggle and suffering just to keep themselves and their children alive. Sadly, this struggle often ends in failure and death, the life expectancy and child (<5yo) mortality rate of people living in the poorest countries is as low as <55yo and 1 in 13 respectively, while in Australia it is >82yo and 1 in 263. In fact, at least 5.4 million children die every year of easily preventable poverty related causes.3 But what can we do? In Australia we sit comfortably in peace and prosperity with money and time to burn on our leisure, we are so far removed from these people and their plight. What if you could be convinced that perhaps just some of that time and money could be devoted to alleviating their hardship, illness and suffering? Perhaps even less than you would suspect.
Below is a list of charities recommended by The Life You Can Save for their efficiency and impact:
The Fred Hollows Foundation – founded in 1992 by Australian Ophthalmologist Dr Fred Hollows to help treat and cure preventable blindness, the Fred Hollows Foundation originally provided treatment in remote Australian Indigenous communities, but now operates in 25 countries and has restored vision in >2.5 million people. It currently costs as little as $35 to restore sight through inexpensive cataract surgery.
Fistula Foundation – Obstetric fistula is one of the most serious and debilitating childbirth injuries, causing severe incontinence (often of bladder and bowel), pain, infertility and often social ostracization in >50000 women per year. Usually preventable in developed nations with delivery via C-section, obstetric fistula is also repairable by way of corrective surgery, which costs an estimated $970 including rehabilitation. Fistula foundation currently provides 8000 surgeries per year and has capacity to deliver many more with further funding.
Against Malaria Foundation – every year ~200 million people become infected with Malaria and ~435 thousand die, of which 60% are children under 5. Against Malaria Foundation distributes insecticide nets proven to prevent the transmission of Malaria. At a cost of $2.80 each net can protect 2 people for up to 3 years.
Other examples of what a donation of just $50USD could achieve:
- Evidence Action – through their Deworm the World program protect 100 children from parasitic worm infections which cause cancers, spleen damage and anaemia – or through their Dispensers for Safe Water program provide safe drinking water to 40 community members for 1 year.
- Iodine Global Network – Provide a years supply of iodised salt for 500 people preventing brain damage.
- Population Services International – provide disease prevention averting 2 years of sickness and disability as well as maternal health and family planning services.
- One Acre Fund – supply a family of 6 agricultural resources to increase production and profits by 50% in a single season.
- Living Goods – supply a community health worker to reach 30 people providing basic healthcare services and referrals, considerably reducing the child mortality rate7.
- Project Healthy Children – Provide food-based micronutrient fortification to 100 people for 1 year, preventing the consequences of malnutrition.
- Oxfam – train local law leaders in sexual violence laws and international women’s rights legislation, or contribute to a whole host of other interventions including targeted disaster relief and governmental support for policy and infrastructure development.
- GiveDirectly – Provide $44USD directly to the extreme poor, which has been robustly proven to increase the recipients assets, food security, access to education and healthcare.
The benefit of organisations such as The Life You Can Save and Givewell is that they take the guess work out of charitable giving, you can be confident that the charities they recommend are doing high yield impactful work with transparency, as they have teams of researchers who have elucidated this for each recommended charity. It is clear that even with meagre donations to the above charities, you can have a very substantial impact on the lives of the less fortunate, which each in their own way has potential to have long lasting flow on effects to the rest of those communities and societies, with eventual global repercussions. Effective altruism does not encourage you to donate all of your money and earthly belongings to achieve it’s ideal. In fact, Singer indicates that a donation of just $130USD from those with sufficient affluence would end extreme poverty.9 But for practicality and equity proposes he proposes a sliding scale, imploring us to Take the pledge by donating at least as little as 1% of annual income for those who earn >$55000AUD and as much as 13% for those who earn >$1 million AUD (up to 50% for the super-rich). If this were to be adhered to it would raise funds of >$1 trillion USD, 15 times the best estimate of what is required to close the poverty gap, with negligible impact to donor quality of life.10
The impact of adhering to the ideals of Effective Altruism financially should not be underestimated. It is relevant for every taxpayer but arguably more for those with greater affluence. Particularly when earning more than $85000 per year puts you in the top 1% richest of the world’s population.11 As medical professionals we are in a privileged position where we can contribute to these causes not only with our future affluence financially, but also with our time using the skills and expertise given to us in our training.
Médecins Sans Frontières (Doctors without Borders) is the leading humanitarian organisation providing medical services on the frontline of extreme poverty and humanitarian crises. MSF provides doctors opportunities to work in environments where medical care is often absent or lacking expertise, where medical interventions can have the ability to save lives, improve health outcomes and increase the wellbeing of whole communities and societies.12 Doctors who have done work for MSF often report the liberation of being able to practice ‘pure’ clinical medicine, making diagnoses and choosing interventions with limited resources as well as needing to endure less bureaucracy and non-clinical obligations. The work is also much more hands on, helping develop practical skills, and oftentimes the impact you are having on the lives of your patients is more visible than in the western medical context.
A question which often arises when considering the benefits of working for a humanitarian aid organisation such as MSF is whether it is worthwhile from a cost-benefit perspective. Consider that with the income of an Australian medical professional you could donate sufficient amounts to alleviate substantially more suffering than what you could possibly achieve with your own hands and clinical skillset, and perhaps fund the training of many local healthcare officers, which could contribute more to the ongoing health outcomes of those health systems and the populations they serve. This, however, is where I believe the research Effective Altruism relies on currently falls short of painting a comprehensive picture of how we as medical professionals can contribute perhaps most. Outcomes of research can paint a binary or simplistic picture of these issues, and while it is of high importance that charitable organisations are accountable and shown to have traceable, cost-effective impacts, there are broader societal and intergenerational implications for the programs that humanitarian organisations run which are not currently well elucidated by research (though it should be noted that there is research occurring in this space, see In-house charity evaluation - The Life You Can Save for details).
I had the privilege of having a thorough conversation with Dr Claire Fotheringham, a medical advisor for obstetrics and gynaecology with MSF Australia and New Zealand, about the impact a medical professional working with MSF can have. A primary focus of MSF is to build the capacity of fragile and fledgling health systems through collaboration and education, with the aim of developing the independence of those health systems in the long term. Doctors play a vital role not only in providing lifesaving and disability alleviating healthcare in these settings, but also educating the local health professionals around them.13 Whilst on her first assignment with MSF in Sierra Leone Claire worked extensively in a 205-bed women’s and children’s hospital which had just 1 qualified paediatrician. Evidently, there is no doctor who could possibly treat 205 patients per day, so along with their clinical role managing more complex presentations, they influenced the decisions made about the healthcare of patients in the hospital through the education of other local health officers and the promotion of evidence-based treatment guidelines.
Furthermore, a key belief MSF holds at its core is advocacy and ‘témoignage’, which translates to ‘to witness and give testimony’, founded on its roots in journalism. MSF is a firmly neutral organisation, though it has been well known for speaking out against abuses and bringing intolerable situations into the public eye to gain political and societal support for the most vulnerable on our planet.14 This is of course highly pertinent in conflict zones but is also transferrable to other programs MSF has been involved with. An example of this is antiretroviral therapy programs provided in Malawi, a country with one of the highest rates of (particularly mother to infant transmitted) HIV and one of its most deadly complications, cervical cancer. At the time this may have not been an obviously cost-effective means of providing aid, but what these programs did to break stigma on a societal level as well as prevent HIV along with its associated disability and mortality has permanent and compounding repercussions for the people of Malawi and their future prosperity.
Another important component of MSFs work is its dedication to research and innovation.15 Tuberculosis kills millions of people every year due to the drug resistance of the bacteria along with the difficulties of adhering to complex long term medication regimes. MSF is on the front line of programs delivering life saving medications to those infected by TB, including those with multi-drug resistant TB. Doctors servicing programs in South Africa, Belarus and Uzbekistan have been responsible for the development of new treatment regimens to maximise efficacy, minimise toxicity and reduce the course of treatment for those with the infectious disease using newly developed TB medications.16
The examples given above undoubtedly have substantial ripple effects on the health and wellbeing outcomes for many more people than those health professionals interact with directly, though they are examples of good which are inherently difficult to predict, measure and quantify. I would argue based on this that the contribution that can be made as a doctor working for a humanitarian organisation such as MSF is highly fruitful, and does align with the ideals of effective altruism, despite the current lack of firmly quantifiable evidence for this.
As alluded to, there are other ways in which doctors can adhere to the ideals of Effective Altruism using their time. Medical research in the modern era has substantially progressed the life expectancy and quality of life for people the world over, pursuing a career including research will contribute to this trajectory.17 Consider the development of the smallpox vaccine – this breakthrough in medical research can certainly be attributed to the prevention of millions of deaths, not to mention the emotional turmoil and societal consequences associated with the disability survivors experienced.18 It is therefore pertinent to consider what research is worth pursuing in our modern context. If a new TB drug which is capable of killing the bacteria quickly and effectively was developed, it would certainly save millions of lives and alleviate immense suffering and hardship, primarily in developing countries.19
Often accompanied with progress made by medical research is the challenge of rolling it out. This is where doctors can wield significant influence with their ability to advocate, educate and advise on public health issues.20 The eradication of smallpox was only possible due to the devotion of the World Health Organisation (directed primarily by doctors) to rollout an extensive global vaccination program, without this coordinated effort smallpox would likely still circulate and kills thousands of people around the world today despite the presence of a highly effective vaccine.18
Since first being introduced to Effective Altruism I have felt a renewed sense of purpose in the direction I intend to take my career. I believe this can be the same for anyone, regardless of their profession or specialty. Adhering to the ideals of Effective Altruism has the potential to give you the ability to have impact far beyond what you may previously have believed possible. I implore you to give careful consideration to how you choose to conduct your future professional lives as doctors and encourage you to seek an understanding of how you can conduct yourself in a way that is both providing immense benefit to those less fortunate in the world while also being highly fulfilling for you. Perhaps you will find they come in tandem.
Visit The Life You Can Save - Best Charities for Effective Giving for more examples of how little it can take to have a significant and traceable impact on the lives of the less fortunate, which each in their own way has potential to have long lasting flow on effects to the rest of those communities and societies, with eventual global repercussions. If you would like more information about Effective Altruism, please see the following resources:
- Peter Singer: The why and how of effective altruism TED – A good introduction to Effective Altruism including some of Singer’s strong philosophical and logical arguments, as well as methods to begin contributing.
- https://open.spotify.com/show/0F8sUBdcUbGVUPMcTYIW2a?si=ad038d786c024604 – A podcast version of The Life You Can Save which can be listened to in just over 7hrs. Free wherever you get your podcasts.
- Interview with Dr Claire Fotheringham from MSF.mp4 – See my conversation with Dr Claire Fotheringham here.
- https://open.spotify.com/show/3Nj24X6DCN10WxQwTsFGAi?si=3f2e32e3a5f04477 – Everyday Emergency – a podcast from Doctors without Borders (MSF). Listen to some of the inspirational stories from the health workers on the frontline of MSFs programs, free wherever you get your podcasts. I would recommend Episode 01 – The First 24hr Shift (Emergency Hysterectomy during an Ebola outbreak), Episode 02 – Saving Lives Amidst Chaos (Emergency care and retrieval for gunshot trauma), Episode 06 – Precious Child (delivering babies in South Sudan)
- Effective Altruism Medicine - Investing Your Time & High Impact Medicine – Websites for medical students and doctors who have an interest in Effective Altruism. They discuss further the role doctors have in research, advocacy and public policy which can align well with effective altruism. They also give insight into the perspectives and experiences of doctors who adhere to Effective Altruism in their professional lives.
Bibliography:
1. MacAskill, William (January 2017). "Effective altruism: introduction". Essays in Philosophy. 18 (1): eP1580:1–5. doi:10.7710/1526-0569.1580. ISSN 1526-0569
2. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) Foreword. New York: Random House
3. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) CH01 - Introduction. New York: Random House
4. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) CH03 - Common Objections to Giving. New York: Random House
5. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) CH04 - Why Don’t We Give More? New York: Random House
6. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) CH05 - Creating a Culture of Giving. New York: Random House
7. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) CH06 - How Much Does it Cost to Save a Life? New York: Random House
8. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) CH07 - Improving Aid. New York: Random House
9. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) CH09 - Asking Too Much? New York: Random House
10. Singer, Peter (2009). The life you can save: acting now to end world poverty: (Audiobook) Ch10 - A Realistic Standard. New York: Random House
11. How Rich Am I? World Income Percentile Calculator: Global Rich List. (2022). Retrieved 30 June 2022, from https://howrichami.givingwhatwecan.org/how-rich-am-i
12. How we work. (2022). Retrieved 30 June 2022, from https://msf.org.au/how-we-work
13. MSF Academy for Healthcare | MSF. (2022). Retrieved 30 June 2022, from https://www.msf.org/academy
14. Advocacy and témoignage. (2022). Retrieved 30 June 2022, from https://msf.org.au/advocacy-and-t%C3%A9moignage
15. MSF research and innovation. (2022). Retrieved 30 June 2022, from https://msf.org.uk/msf-research-and-innovation
16. TB PRACTECAL. (2022). Retrieved 30 June 2022, from https://msf.org.uk/tb-practecal
17. Todd, B. (2022). Can one person make a difference?. Retrieved 29 June 2022, from https://forum.effectivealtruism.org/s/YCa8BRQoxKbmf5CJb/p/hk9Xh6xK5j3SQmkcn
18. Smallpox. (2022). Retrieved 29 June 2022, from https://www.who.int/health-topics/smallpox#tab=tab_1
19. Tuberculosis (TB). (2022). Retrieved 29 June 2022, from https://www.who.int/news-room/fact-sheets/detail/tuberculosis
20. Effective Altruism Medicine - Investing Your Time. (2022). Retrieved 29 June 2022, from https://www.ea-med.com/investing-your-time