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Today's episode of Rationally Speaking is brought to you by give well, charities very widely and how effective they are and it's hard for a donor to tell the difference. Give well, spends thousands of hours each year researching which charities do the most good with your money visit give. Well, rationally speaking, to get a short list of the charities they've found with the best evidence behind them. The recommendations are free to use and give well, does not take a cut of your donation.


Also, if you're a first time donor, your donation will be matched up to two hundred and fifty dollars. Donate now through give weblogs rationally speaking. Welcome to, rationally speaking, the podcast, where we explore the borderlands between reason and nonsense. I'm your host, Julia Galef, and my guest today is Angus Deaton. He is a professor of economics at Princeton who won the Nobel Prize in economics in 2015. You may have seen his name in the media most recently because he and his colleague and wife and case at Princeton wrote a very widely discussed paper on the alarming rise in the US of deaths of despair, which is their term for deaths from drug abuse, alcohol abuse and suicide.


That paper came out a few years ago, but just this year they published a book on the topic titled Deaths of Despair and the Future of Capitalism. So that is the first thing that I wanted to speak to Angus about. Why are depths of despair increasing and how do we know? Then the second half of the episode is about a topic that's especially close to my heart. Effective altruism, which is the movement based on using logic and evidence to figure out how to do the most good.


And a few years ago, Angus wrote an essay that was pretty critical of effective altruism. And so, of course, I couldn't resist the opportunity to talk to him about it. So those are the two halves of this episode. And then at the end, I spent a few minutes talking about my reaction to the arguments that Angus made.


So let's jump in. Here is Angus Deaton on deaths of despair as we enter the conversation. He's giving the background context that for most of the 20th century, people were living longer and longer, at least until depths of despair started to take off. We really have data starting in the 1930s when all the states started collecting information on this, we can project beyond that, but it's pretty clear that throughout the 20th century, mortality rates were falling at almost all ages and life expectancy was rising.


There are interruptions in that, the most obvious of which is the last pandemic at the end of the First World War, the influenza pandemic. But until you know, the turn of the century, we've got the sort of steady progress. What was causing the progress was different at different times, but nevertheless, life expectancy kept going up. We're living longer and a great benefit to mankind.


And so what you and and Case discovered is that those trends begin to change around 1999, 2000.


Yeah, in the late 90s. And it's clear that that steady progress just sort of comes to a pretty shuddering halt.


And we have to be a little bit careful here because, you know, mortality and life expectancy are not the same thing. Mortality is age specific. You know, their deaths at five or deaths at 55. And, you know, they can all behave a little differently. But what we discovered was initially in the age group, Midlife 45 and 54, that the study progress over the past century had just come to a halt. It was going up in some years or just study and other years.


But the steady progress that we'd seen for the century before really just stopped. And the most remarkable thing was that when we did that for other countries, other countries had been sharing this mortality decline about two percent a year. And they didn't stop. They went straight on. So the US just left the herd. It became egregious, to use the word in its technical sense.


What is the technical sense of egregious? I don't know. Outside the flock. Outside the flock.


I think the word flock, the flock to Grex Syriacs is Latin for a flock. So egregious means you're outside the flock, whether sheep or birds.


But what I will be using that in a sentence as soon as possible. So.


So you attribute this sudden halt in progress on falling mortality rates to something you call depths of despair. Could you describe what that entails? Like what are you defining as a death of despair?


Well, let me back up a little bit. OK, so we discovered that this great benefit to mankind, it stop giving benefits. The first thing we wanted to know was, you know, what causes of death are making this happen? And we discovered this accidentally while looking at suicide. So we knew suicides at midlife were rising quite rapidly. And then we looked for the other things that were rising rapidly. And what we found were deaths from alcoholic liver disease and also deaths from drug overdoses.


So those were the two most rapidly rising causes of death. And we thought, oh, wow, look at these things, or at least I think it was. And who thought of the term talking to a journalist that all three of these deaths, whether deaths from alcoholic liver disease or deaths from drug overdose or suicides, were self-inflicted in some ways, as she likes to put it there sometimes fast, kill yourself quickly or kill yourself slowly. But it's not like an infectious disease or a virus or it's not like a failure of the medical system.


It's sort of self-inflicted. Now, just to the question here is attributing this. And in a comment that was posted very shortly after our paper was published, the Dartmouth researchers, Miyahara and Skinner pointed out that the upturn would not have happened except for what was happening to mortality from cardiovascular disease. So mortality from heart disease had been the big thing that had been driving down mortality in the 1970s, since the 1970s, and basically it had stopped and was beginning to turn around.


So, you know, that was not a rapidly rising, but it's a very big item. And the fact that it had been declining for so long and that stopped declining was a big, important part of the story as to why deficits stopped falling.


And the story about. Causes of death, of despair that I had absorbed from when it was first in the media several years ago and which I bet many of my listeners also have in their heads, is an economic story that's around the U.S. and especially rural areas.


Wages have been stagnating. People are losing their jobs. Cost of health care are going up and so on. And so people are struggling economically more than they used to. And this is what's driving them to drink and to drugs.


But in your book, you kind of explicitly say this is not what you see as the main culprits for deaths of despair. That's right.


Almost OK, right.


I mean, well, in the book, what we talk about is a long, slow process in which, you know, wages are going down, jobs are getting less good. The good jobs that people used to have have turned into not very good jobs. They don't belong to unions anymore. And that this fuel for the working class that used to be so important has really been choked off to the point where the working class is really struggling. And that's a long, slow process.


When we talked about that, people wanted to say, well, there's a recession is not going to cause lots of despair. And the answer is, well, no. And in fact, there's a graph in our book and even in our Brookings paper, which was twenty seventeen, which show that if you look at the Great Recession in 2008, which was the biggest recession since the Great Depression and up until now, you know, depths of despair rising before the Great Recession, they were rising during the Great Recession and they were rising after the Great Recession.


And you just can't see any point at which the Great Recession has any effect on those deaths at all. So, you know, we don't want to tie this, you know, so when you said it's tied to economic factors. That's right. But there's a difference between the way, but not directly and not on a day to day or month to month basis, like over the business cycle. And we're talking about a long term sort of gutting of the working class.


There's something very important we haven't talked about, though, and that is that these debts of despair are only happening to people who don't have a four year college degree. Right. And that's a very important part of this story because, you know, if it was just the drug epidemic, why would you pick those people out if it was suicide? You know, um, again, suicide is usually higher among more educated people, and that's the opposite of what's happening now.


So there's really something else going on which is very important.


OK, so we we covered the fact that economic conditions are an indirect cause of death, of despair. But we didn't talk about what you're you're a leading candidate for.


The direct cause was.


Well, let's let's I'm a bit worried about indirect cause. I mean, I think of the failures in the labor market as being a sort of fundamental the deepest cause, if you like. But, you know, I don't like this the way causal language tends to be used in the sense that there is a cause or there's things along the causal chain. But what happened here is, you know, as the labor market disintegrated, lots of other bad things happened.


So unions went away. Social structures begin to fall apart. You know, Bob Putnam's guy who is bowling alone, was bowling alone in a union hall. Now, he's not bowling at all, has no union anymore. People don't go to church.


All of this is people that obey their marriages are coming apart, which is not true for people who have a B.A., people who have a B.A., you know, stay married and marriage rates are falling among people without a B.A. And what's more is the huge rise in pain, all sorts of pain, you know, face pain, neck pain, sciatic pain, back pain. You listed it. And it's all the reports of that are going up and up and up among less educated people, something that's not happening in other other rich countries in Europe, for example.


So there's this unwinding catastrophe. Now, if you tell me what is it that made me think it was a good idea to hit the bottle or what was it that made a good idea to think drugs? Well, the proximate cause might have been my back pain. You know, the proximate cause would be I don't have any friends anymore. People report they have trouble socializing. But way back at the root of that is what's happening in the labor market and the pulling out the props for a good working class life for people who don't have a four year degree.


You know, there's one additional Democrat. Qualifier to who gets death of despair that we haven't talked about yet, in addition to level of education and that is race, that it's not just noncollege educated people in general, but noncollege educated whites in particular, who are seeing this rise in death of despair as opposed to minorities. Right.


But that's even more complicated because, you know, when we first started doing this work, which was, you know, in the summer of 2013, what was very noticeable was that these types of despair were only among white people, men and women who do not have a four year degree. And blacks were doing just fine or not really. You have to be very careful how I say this, but blacks have always had higher mortality rates than whites. But the mortality rates of blacks have been falling for quite a long time and were continuing to fall.


So the mortality gap between whites and blacks was narrowing, which is a very welcome thing. But a lot of it was narrowing because more whites were dying rather than and that was also an improvement among blacks. So when we first wrote about it, these depths of despair were just not happening to blacks at all. Two aspects to that. One is that if you go back to the 60s and 70s, there was an episode when the inner cities, you know, really disintegrated when the first wave of globalization came and when there was a terrible episode of African-American poverty or flight from the cities of what a time was called, you know, cultural problems with the Negro family, you know, to quote Daniel Patrick, Patrick Moynihan.


And so that episode, which was seen at the time as being sort of a one off thing that had happened to the African-American community is very similar, not perfectly similar, but very similar to what was happening to whites after the mid 90s. So it was like the the hard things that happen to blacks in the 60s and 70s were now happening to less educated whites. And, you know, that's a very uncomfortable parallel because it suggests that, you know, there's some feature of capitalism which is shedding the least skilled workers first.


It's also true that the cultural critics from the right have used exactly the same rhetoric about, you know, white loss of virtue this time around, that they used the black loss of virtue and the earlier episode.


Well, at least they're consistent, I guess. A small comfort.


Yeah, except the story doesn't work so well now because. Well, you know, I always thought it was peculiar to the peculiar blacks. Why is it happening? Right. White. And it's pretty clear that, you know, we've seen this falling labor force participation at the same time that wages have been falling for less educated whites. And that's got to be that's not a pulling back of supply. That's got to be a failure of demand. But, you know, the other part about the black story is that we didn't know this when we were writing because it hadn't happened yet.


But after 2013, black mortality started to rise, too. And most people, including us, attribute that to the spread of fentanyl into the inner cities. And so, you know, blacks and whites, less educated whites, began to share the same tracks after that.


Well, I wanted to ask about the racial gap in depths of despair because it wasn't clear to me whether your theory can account for that gap.


Well, so, you know, the factors that you've been pointing to that reduced meaning in people's lives and that are kind of the main cause of death, of despair are things like.


The loss of good jobs for people without college educations and related metrics like the decline in labor force participation, the decline in unionization and some other metrics of of like strong communities and social ties, all of those things, as far as I've seen, apply just as much to minorities as they do to whites.


And yet we've only seen this strong rise in death of despair, at least until more recent years among whites and not minorities.


Well, except we've seen the black deaths already. So in some sense, you wouldn't gone through that.


But your theory wouldn't predict that as those causes of death, of despair continue to mount, we wouldn't see more death of despair in the last 20 years.


Well, we are not. I mean, so I mean among blacks and no, we are not since 2013.


And it turned out just to be delayed. But in some sense, you could say, well, you know, the shakeout for African-Americans already happened. And so they were sort of exempt for a while until you got this thing among whites.


But there are other factors exempt because they already, you know, that their jobs had already been destroyed. Presumably, if it gets worse, then. Yeah, no, absolutely. But there are other things happening in the white community which were not happening in the black community. And I think what well, a lot of people have written about that.


But there's this sense of which the loss of white privilege is very important. And, you know, the people who do the ethnographic work, you know, when they interview people, when they talk to what's bothering people, a lot of what's bothering people as they feel they're being left behind, their jobs are being taken away by black people, that the privilege they used to have. And as many people have said, well, you know, if you've had this privilege for so long and you've been sort of unconscious of it, then when it's taken away, the removal of a privilege looks more like oppression than just the removal of a long term privilege.


So I think that's been a very important thing, too. I also think that in spite of what's happened this year and, you know, what's happened this year is long overdue. There's been a huge change in attitudes towards race in the United States. And I think that's been hugely beneficial to African-Americans at a time when sort of the opposite is happening to whites or they see it as the opposite happening.


I see.


So the theory is that there are a number of destructive forces that were affecting both whites and minorities, like the hollowing out of the job market for people without college education and a decline in marriage rates and a decline in unionization and other sources of meaning for people.


Yes, but that this didn't result in a spike in death of despair among minorities the way it did among whites, because, A, they kind of already had that spike in like two decades ago.


And so they were exempt in a sense. And B, they had countervailing forces such as a, you know, long term fall in discrimination. I think that's protected them from you.




I wouldn't I wouldn't say they're exempt, though. Maybe I did say that. But you can amend it.


You can always amend your comments on this podcast. Well, I think a lot of what had happened was at the end of the crack epidemic, the African-American communities decided that had enough of drugs and were much less susceptible for a while. And some of the stories of fentanyl is that at the end of the crack epidemic, there were a fairly large number of people in inner cities who were regular users of heroin or cocaine, but stable users. I mean, no one really knows those numbers, but there are a number suggesting that even before any of this started, there were, you know, more than a million Americans using heroin on a regular basis.


And the story is the fentanyl got into the supply.


So illegal, you know, dealers who were illegally dealing heroin and cocaine were putting fentanyl into the supply in order to make it more powerful. And so sometimes people would die because they didn't know what they were using. Yeah. I wanted to ask about the chronic pain issue that you mentioned, because as I was reading your book, I was I think I was like a third of the way through and it suddenly hit me.




I bet chronic pain is the cause of death, of despair.


And and this theory was very appealing to me because it just seemed to fit the data so cleanly, because chronic pain has been increasing significantly for the last two decades, which is the same time frame as death of despair. And the biggest predictors of having chronic pain are being rural, white and noncollege educated, which are also the strongest factors predicting who experiences death of despair, you know, and also there is like a pretty clear causal connection between being in a lot of pain and, you know, turning to alcohol or drugs or so or suicide.


Yeah. And, you know, you do devote a chapter to chronic pain. But unless I'm misreading you, your interpretation was different from mine in your read. Pain is kind of downstream of, you know, the loss of meaning factors that we talked about, like loss of good jobs, loss of, you know, decline in marriage rates, declining unionization, things like that.


But I guess I'm just it wasn't clear to me why your model wouldn't simply be chronic. Pain is like the main goal you're supposed to being.


You still have to explain where the chronic pain comes from. And there's no chronic pain among people who don't have a B.A. or sorry, no chronic pain, no rise in chronic pain among people who do have a B.A. And there's no rise in chronic pain among Europeans. We have a paper just a couple of weeks ago in the Proceedings of the National Academy of Sciences showing that. So I'm quite sympathetic to what you say. I think that pain is a big factor in driving people to depths of despair.


So that's part of the causal story. But you still have to tell a story where the pain is coming from.


And yeah, I mean, it's true.


I don't have a good story to explain that and certainly not about why it would be, you know, specifically a larger rise among whites than minorities that, you know, that is surprising and confusing.


It just seems like having I think there's been quite an upsurge in pain among blacks to we don't have a book, but that since when I think around the same period, we haven't looked at that very carefully. But I don't think in the pain measures there's such a big difference between blacks and whites, I think which would which would go nicely with your story about the labor market in recent years, because we tend to think of the labor market not directly, you know, because working in McDonalds is not going to give you more pain than working on an assembly line.


The working as Amazon warehouse might. Well, but it's we think of it and that's why we quote the neuroscience literature, where lots of people are thinking that being excluded can be a source of, you know, things like lower back pain. But it's all very mysterious. No one really knows what's driving that. Some people think the drugs are driving it.


Well, I guess it could be that I'm mistaken about the racial component to chronic pain. I was pretty sure I had read that it was a the rise was much stronger among whites than among blacks.


But assuming that I'm right about that, it OK, you might be right. I'm not being definitive about that.


Well, neither am I. So. Well, just provisionally imagine I'm right for the moment.


If that were the case, then it seems like if you add this additional piece to your model where there's this underlying cause of the chronic pain stemming from, you know, loss of meaning, but the elements of loss of meaning are not differentially bad for whites as opposed to blacks. And so it just seems like it makes the model more complicated and it fits the data less well than just the simple, well, complicated model.


So all those fit the data are better than less common. No, no.


I think this one the data works just because I mean, am I wrong? Because the, you know, things like falling marriage rates and an employment to population ratio and unionization, etc. apply to both whites and blacks and Hispanics. But we only see the rise in chronic pain and death of despair among whites.


I don't know all these things because a lot of the things we look at in the book about coming apart at home and coming apart at work, we know those things are true for whites without a college degree, have worked through them in detail for the black community or the Hispanics. But remember, I do think this thing is very important. You know, the that we're treating African-Americans are treated better than they used to be.


I mean, there's a Gallup statistic we caught in there about, you know, how almost the whole population.


Intermarriage was immoral and bad and shouldn't happen, and then within 25 years, I switch the other way some more recent work we've been doing. If you have a B.A., whether you're black or white, matters much less than whether you have the B.A. or not. Yeah. So it's still true that blacks with B.A. have lower life expectancy than whites with a B.A. But that gap is tiny compared with the gaps between whites who do and do not have a B.A. or blacks who do and do not have a B.A..


So, you know, and Bob Putnam has written about this, too. There's a sense in which these racial differences are being in part replaced by education or class differences. If you think of class in terms of education.


Yeah, well, that actually reminds me of another question I had, which is if more people are going to college over time than could it be that if we're looking at the group of noncollege educated people over time, that's actually a different group of people as we go through the years with a smaller group of people who are, you know, maybe less, you know, like, yeah, that's true.


Whatever caused people to go to college, the people who are left out of the college educated pool by 2010 are, you know, worse on those measures than than noncollege educated people were on average in 1980.


That's right. And I'm sure there's some such effect. But remember, it brings down it makes health worse for the more educated to become.


Well, if you have fewer people not going to college. Right. Right. Than the people who are not going to college are a more negatively selected, which is the word we tend to use in the profession.


Right. You know, they're less healthier, maybe less smart or whatever, whatever you'd like to think.


But then those people who were in that group have now moved up into the educated group and they were not so healthy before and they're still not so healthy.


So it brings down both groups. All right. It's what sometimes is that the Will Rogers, the fact that, you know, if you transfer the smartest person at Harvard to Princeton, the IQ in both places goes down.


Oh, that the Princeton joke. I guess that's an important piece of context for the joke.


Well, I. I've got it the wrong way. Right. But I mean, if you have to play two sets of people, you know, one of whom is, you know, faster or smarter or whatever you like than the other, and you move people from the left good to the good group.


Right. It brings down both groups.


So if it's a it's like a well-known paradox whose name I'm forgetting, I think it's called the Will Rogers paradox, but I'm not sure. Yeah, yeah, yeah. It's one of those things. So, yeah, it doesn't explain the expanding gap quite as well. But I mean, I'm we're not resistant to that interpretation. The first group we looked at, which was the midlife whites. If you look between 1990 and twenty fifteen, I think we were looking then there was very little difference in the fraction of them that had a college degree.


But more broadly, that has been increasing over time, not as fast as you might think, given how much you get rewarded for having a college degree. Um, but I'm sure there's some such effect. But if you look at, for instance, life expectancy for people without a B.A. or life expectancy at 25, because at birth you can tell whether they have a B.A. or not. Right. Then what happened was that Rose until about 2010 and then it started going down and it's been going down ever since.


Right. And it's a bit hard to explain that sharp curvature by a steady increase in the fraction of people going to college. But I'm sure someone very clever could tell that story. But I just wanted to come back to your paint story because I don't think I mean, I think this marriage thing, you know, in the book we talk about Sarah Kleinhenz work on fragile families, for instance, and how, you know, marriage rates have gone down, but people are still shacking up with each other and having kids.


And then those are fragile relationships which sort of move on. So you could get people like a guy in his 50s who might have had three sets of kids, but he doesn't know any of them. Um, and I think when you get to your 50s, for me, that would make me quite prone to alcohol or suicide, that sort of thing, you know, because a lot of the things that are good for your life and late middle age and middle age are from having had a stable family life.


And, you know, and not having that is likely to engender pain, too. So I think Daniel Patrick Moynihan used the term a tangle of pathologies. And you're looking for simple causal effects in here, I don't think it's terribly productive, but it's not so surprising that these lives would lead to more pain and then for more pain to more suicide, more drugs or alcohol.


I mean, I I'm I'm very sympathetic to the idea that the world, the real world is, in fact, very complicated and messy. And any any theory that's just, you know, has one simple cause is going to be pretty wrong. But at the same time, I'm also worried about this problem of, you know, adding epicycles to the theories where, you know, if the if the theory doesn't quite fit the data, then you can always add an explanation for why.


Well, we you know, we didn't see the rise in this group because there was this other countervailing factor. And and those explanations may be true. It just feels like this.


You can kind of infinitely fool yourself because, you know, I agree with out, but I think we have a pretty simple story here, which is, you know, a labor market disintegration and then through marriage and through pain towards all these other things. And then I think you do have to overlay on this the the withdrawal of white privilege. Yeah.


I mean, that is definitely one of the the asymmetric by race factors. I agree that. Yeah. So, I mean, I guess it just sounds like you're you're less concerned about mismatches in timing and and across races than I am.


Does that make sense? Like it had seemed to me that there were a lot of mismatches between factors that your theory should have predicted would cause a rise in minorities as well, but didn't find factors that would have you know, we would have expected to cause a rise in deaths of despair earlier, but didn't. But it sounds like you these mismatches seem kind of small to you in the grand scheme of things.


Well, I mean, you have power, but has Hispanics, which is the one that people usually do talk about and say, you can't explain Hispanics, but, you know, Hispanics are clearly very different. I mean, Hispanics have they're healthier than whites by quite a lot. But, yeah, no, people do get upset about that. So and, you know, I'm not upset. I'm happy for them.


But some people call it the Hispanic paradox. And, you know, a lot of Hispanics are immigrants. And, you know, to us, this makes perfect sense in our story because, you know, these are not you know, when you think of whites, they're doing worse than their parents did for Hispanics. That's just not true at all, you know, because a lot of them weren't here in 1970 to see what the old world used to be like.


So far, I also think that works. OK. One of the things that's interesting is that, you know, during the covid epidemic, Hispanics are being hurt at higher rates than they ought to be, along with blacks. And in Britain, which is interesting, where blacks and other minorities, as they call them, they had better health than whites in Britain before covid, but now have worse. So it seems that the blacks and other minority ethnicities in Britain are rather like Hispanics here.


So it's it's the immigrant factor that the the types of people who immigrate to a country are going to be, on average, more well protected.


Yes. The common factor, I mean, well, they're not as deeply affected by this disintegration of a class that which they didn't used to belong there. Also, there's a huge amount of health selection on immigration to, um, you know, that more healthy people are more likely to immigrate.


Yes. Yeah. So they may be coming from countries where there's high infant mortality. But, you know, if you immigrate to the United States from Nigeria, for instance, you obviously didn't die as an infant. So you got through that part of it. And those people tend to be very ambitious, very, you know, well put together, do very well.


All right. Well, let's move on now, OK?


The other thing I was itching to talk to you about, which is effective altruism, and I don't know if I made this clear, actually, but I'm I'm a big fan of effective altruism. I've been involved with various effective activist organizations over the years.


And so, like any good, effective altruists, I was very excited to see a critique of effective altruism that you had written a few years ago in the Boston Review.


OK, 2015, it was titled The Logic of Effective Altruism.


Does this do you remember this? I mean, I'm sure you write many things, which is why I didn't assume you remember.


But I can, you know, remind you of what you said so that I can ask you about it.


So it was a response to I guess it was kind of like a symposium. And you were responding directly to Peter Singer. Right. But you you were talking more broadly about effective altruism and and critiquing the kind of give. Well, style of health people, which is, you know, funding, funding charities who do things like distributing antimalarial bed nets or or deworming or sometimes doing cash transfers, some of the top charities that give all recommend.


So just to dive into one of the first criticisms that you made, it sounded like. From your perspective, a big problem with the give well approach is that it casts poor people, the recipients of the charity, and kind of a passive role that they're they're not asked if they want to participate in effective altruism. And in fact, you write that polls by Gallup and Afrobarometer suggest that they're the poor people in Africa. Their priorities lie elsewhere. So I was I was just curious for you to elaborate on that and possibly you don't remember the details of the polls.


But if you do, I'd be curious, is it is your view that people in places like Africa aren't interested in the kinds of interventions that give all offers, like, you know, and I don't think I know I'm sure they're interested in antimalarial bed nets.


So just to back off a little bit, OK? I have no objection to altruism at all.


And I also think that I spend a lot of my life studying that. There are a lot of people around the world living in very dire poverty. And I also agree with the proposition that we have an obligation to do what we can to help those people. And I think I dealt with this more fully in the last chapter of my previous book, The Great Escape. About the problem of foreign aid or aid, yes. Yeah, exactly. So I have no problem with altruism.


It's the effectiveness. But I have and when I listen to Peter, you know, talking about how easy it is to do these things, and the only thing that people have been doing wrong before was they weren't doing randomized control trials, that they do randomized controlled trials, then we can find out what works. And to me, that's just nonsense. And I don't think randomized control trials are capable of doing that. I don't like the way Jeff well uses them.


But what you said is more fundamental, that I think giving aid in other countries from outside is almost always a mistake.


And are you talking about aid to governments or are you talking about also aid to individuals?


But I mean, there's not a sharp distinction, as you might think there. And that's because one of the analogies I'd like to give is suppose that you're living somewhere and someone moves in next door and this person who moves in next door, who has a wife who lives with him, is someone really detestable. And he treats his wife like a slave and, you know, gives her just enough to eat, makes her life totally miserable and sort of behaves to her.


Like Borat likes to tell you, the Kazakhs behave to the Roman church has actually called for Kazakhstan.


Apparently it's been celebrating recently.


I heard they decided to lean into it and they're certainly not very nice. So a guy like Borat moves in next year with his wife and he hasn't learned that Kazakhstan has changed it. It's, you know, tune. Then the question is, you would really like to help this woman who's truly miserable. And you ask yourself, OK, I have a randomized controlled trial that shows when I give women money, they do better. Well, do you think it would be a good idea to give this woman money?


Well, of course not, because her husband would just say thank you very much and take it right now. You might be able to do better by giving him money, which is the opposite of what the effective altruists like to say. You know, the husband is like the government here. Oh, yeah, right. Because the government, you know, has control over its people. And so if you give any significantly large sums to poor people, you know, it's just one more source of revenue for the government because the government is in business of extracting and exploiting from its own people.


You know, they're not trying to help them. If they were trying to help them, the women wouldn't be miserable in the first place and these people would not be supporters. So, I mean, a lot of the problems and a lot of those countries is, you know, government that is dictatorial, extractive and is is basically plundering its own people. And the danger of giving aid to either the people or the country is you make that worse, not better.


And is that you're saying that that happens even in the case of, say, giving out antimalarial bedmates or how would that happen?


Well, the antiplatelet I mean, I've always argued the health side of this is, you know, probably less subject to this critique. But, you know, the government is providing health services anyway. And, you know, you're only going to have, um, you know, you're only going to have healthy society and healthy, good health system in those countries. If there's a if the government provides it and if there's a consensus by the people that they want to provide it.


So the big problem with providing health services from outside is that they make the indigenous health services much worse.


And is that a conjecture that sounds very plausible, or is that something we have evidence of?


I think there's plenty of evidence of it over the years because there's always been this this debate and the in the global health community between these external innovations where people parachute in and, you know, inject people or maybe give them bad. That's so the bed that some sort of intermediate case. I mean, give vaccine vaccines to kids, for instance. So they fly in on helicopters with the help of the local people.


And they do this an external intervention over a relatively short period of time. And, you know, maybe they help, you know, clean up a swamp or, you know, things like that.


The antimalarial campaigns after the Second World War were temporarily very effective, but and none of those countries has outside. Funds, I think, ever been able to provide a functioning health service with, you know, good maternal child and maternal care, I mean, this sort of thing? Yes.


Are you saying then that we shouldn't try to do these to save lives in the present with vaccines and bed nets and so on until we can figure out the underlying answer?


Oh, so you're saying that these I think the vaccine, they just didn't solve the problem?


Well, they solved the big problem. I mean, and that, you know, life expectancy went up by leaps and bounds in poor countries after the Second World War, largely because of these external interventions. And so we credit those with lot. But, you know, if you're trying to provide health care and remember, providing health care is incredibly difficult or really bad in this country, you know, let alone in countries that just don't have the resources we do.


And so it's a very difficult problem. But I think interventions from the outside of providing clinics and manning clinics and so on are likely to have unmeasured side effects. And those side effects are never taken into account in the randomized control trials either.


And it seems likely to you that the side effects would be bad enough, that it would kind of outweigh the good done by the lives saved from the vaccine.


Well, we could colonialized those countries. I would say we could reach colonialized some of those countries and do them. Well, no, but we can give them health services. I mean, that's what Paul Romer and I used to argue. He was going to get the Canadian government to set up a sort of part of Honduras as a separate country and basically, you know, make people do what was good for them.


But OK, that I'm not signing my name to that plan. To be clear, I don't think that's like falls under the EEA. Effective altruists umbrella of.


But you see, with effective let's focus on effective. You have to find out what is actually effective. You have to do a much more serious job of looking at the, you know, what happens. And that's why in my book, The Great Escape, what I argue for is that there's a huge number of things that we could do to help those people. Right. For instance, how about the arms trade? You know, I mean, when I talked to Peter Singer, you say, why don't you ever say anything about the arms treaty said, well, that's too hard.


Well, maybe. But, you know, if Peter and all the other effective altruists were to go to Canberra or go to Washington or go to London and go to the cities where they have some standing to speak and speak up against the arms trade, then I think we do a lot more good than, you know, digging wells in the south.


I see. So your your view is that it's it's not that effective. Altoist interventions don't do good.


You just think that we could do more good if if the people attracted to effective altruism would turn to, you know, political influence and activism. Is that.


Well, that's true, but it's more specific than that. I think Jagdish Bhagwati was the first to use the phrase. He said, I believe in giving help for Africa, not help in Africa.


What is help for Africa consist of trade policy, for instance, you know, making it easier for African countries to sell their goods here, you know, not putting punitive patents on drugs. There's a whole lot of things that the secret is not to go in there with money which will screw up the equilibrium between, you know, between the government and the government. You're not going to get developed unless you're not going to get development, unless there's a government that voluntarily raises money from his people and uses them to use to benefit them.


Most aid from the outside will severely, severely interfere with that. There are lots of countries in Africa where more than 100 percent of government revenues coming from abroad. There's no accountability that our own citizens and effective altruists that works well.


The thing that's still unclear to me is whether, you know, I don't really disagree with your picture of aid in general, but it seems to me that the, you know, specific targeted interventions that effective altruists tend to favour.


Were they you know, they don't have the the baggage attached and the problems that you're talking about that apply to, you know, most aid over time.


I guess it's just hard for me to see how giving out antimalarial bed nets is really that damaging, even if we could be doing more.


Well, I'm not I'm not against giving out antimalarial, but not so I'm you know, I've read some work and talked to some people who are skeptical about the long run effectiveness of those. But that's not the point. I mean, I'm all for giving a vaccine. I'm not against facts, Ed. That's exactly the question, like whether those like those are the interventions that maybe it wasn't clear. Those are the interventions that I was meaning to ask about where you live.


A different you know, if you read if you read the global public health literature, especially on the left, they've always been against those sort of innovations. Because they say we have to build health systems in countries so as to look after maternal and child health. OK, well, maybe we should talk now about your critique of randomized controlled trials or Arktos, because that type of evidence is one of the big things that effective altruists like give well, base their judgments on their judgments about how to help people.


And you've pretty famously written about why our seats aren't so trustworthy. So I would have thought, like before reading your op ed, I would have thought you would actually approve of the way give while uses our seats. So let me describe to you the way I see them using our assets. And you can tell me if you actually do approve or not.


So give us a view.


Is that most I mean, I can't officially speak for them, but my perception of their view is that most research is pretty flawed, including the vast majority of randomized controlled trials, but that occasionally you can have enough assets that are well done in enough different contexts that are looking at, you know, lots of different outcome measures with a large enough effect size that at that point you can be pretty confident that there's a real benefit there. You're making my hair stop.


Well, let me finish that or maybe I'll make it worth so, you know, you can't be 100 percent sure. But if you have a lot of different assets in different contexts, but large effect sizes, then you can be, you know, probably confident enough to act on that.


And so the small selection of charities that give all recommends in their website are the the exceptions to the rule. They're the cases where you give all things OK. In this case, there are you know, there actually is enough evidence that we feel comfortable recommending, you know, that people act on it, even though that is usually not the case. So. Is that I mean, maybe the way I misconstrued your view is that you don't think you can ever do that as whereas in Gimbel's case, they think you can sometimes occasionally do that.


Is that.


Well, I'm sure you can sometimes occasionally do it, but your language drives what we expect. Well, for instance, you know, replication tells you nothing.


Now, think of all the white swans that were in the world before the first Black Swan turned up. Read about Bertrand Russell's chicken. What doesn't it you know you know, Bertrand Russell's chicken.


Is that the the chicken that thought or turkey? Was it a turkey? No.


Well, it was in the poorer days, people only had chickens.


OK, well, that's what I was thinking of the right example, at least the right fowl. But, you know, I mean, the point is the chicken here's the farmer coming every day and realizes after three or four hundred applications that every time the chicken hears the footsteps, it's going to get fed and gets very happy every time it eats the footsteps until Christmas, even when the farmer wrings his neck. And the moral of that story, which I think maybe I can paraphrase Bertrand Russell's words, you know, a deeper understanding of the nature of the world would have been useful to the chicken under these circumstances.


The point is, replication doesn't tell you anything.


So even if you like, even if you did a thousand Arktos in tons of different countries and every time you found that, you know, cash transfers increase people's consumption made them happier, you still you would claim that you you haven't learned anything because you can never be sure that in the one case that you'd find.


That's right. That's right.


So we just told me why unless you could tell me why it's happening, you know, I don't need a randomized control trial to tell me that if people get better off, they get happier.


Well, actually, I mean, that's a lot of what it takes on cash transfer.


And certainly I thought that actually wasn't an open question where it seems very common sense, but we've done research on it. It wasn't like obviously going to turn out to be true because.


Yeah, I don't think so. I mean, I think those are on cash transfers are really silly. So you.


Oh, you think they're silly because you think it's obvious the cash transfers do make people better off.


So. Well, I'd be prepared to work on that and work on that basis.


But none of those experiments are ever include the people who are going to have to pay for the cash transfer, which people the people are going to have to pay for them.


Sorry, rich people. Are those, though, that. Well, if people are talking about cash transfers in America, which was an issue in the election, for example, taxpayers have to fund those.


I mean, this was what I was describing is just a charity where, you know, donors give money and then the charity gives out that money in cash.


But we're going around in circles here. But I mean, the problem is that, you know, in some environments that's going to make people better off. In other environments, it's thought and you're not going to get it, that by doing replications of randomized control trials because, you know, some governments, they let people enjoy the money and other places. They won't let them join the money and lots of other contingencies that are not taken into account. So you have to have a basic structure mechanism of what you think is going on here.


I'm not against air traffic control trials, but this idea that if you do them often enough, like the graduation experiment, that somehow it always works is is really preposterous, both logically and in practice. And then you use the term effect sizes effect sizes as a completely disreputable statistical concept. Why is that?


Because you're not interested in the effect size, the effect size is to do with the Standaert, no, it's how big an effect it has on people.


Wait, how is that not right? When I say it affects size, I meant to refer to things like how big is the mean effect on people's life expectancy if you know not the effects?


And that's the effect. Size is a is what you just talked about, divided by some sort of standard deviation, which anyway, I mean, I could give you lots of literature to read on that, but these people are using effect size all the time because they want to compare things across countries and you can't compare things across countries if they're in different currencies and if they're in different places. So they use effect sizes and effects sizes robs the whole thing of meaning.


I mean, you do a training program for people, a training program for dogs.


You could look at the effects like, well, I don't know which what what the people you're complaining about are doing. But I, I imagine if you're testing out the civic intervention, like, you know, giving out antimalarial bedmates, the cases in different countries or different regions aren't going to be identical. But it's still pretty similar what you're doing from one region to the other. You're giving out bed nets.


And so I don't agree because all the side effects, which are the things we're talking about, are going to be different in each case. And also, you know, just to take a case that, you know, we know what reduces poverty, which makes people better off. It's schoolteacher's, it's malaria...


How do we know that?


Oh, come on.


I'm sorry, that was not a rhetorical or troll question.


Really? I don't know, I don't know how you get out of bed in the morning. How do you know that that when you stand up you wont fall over? I mean, there's been no experiments on that. There's never been an experiment on an aspirin. Have you ever taken an aspirin?


Sorry, you think that increasing the number of schoolteachers or paying them better or some intervention on schoolteachers causes people to be better off that that that claim is as obvious as gravity?


It's pretty it's pretty obvious, but that's not the point I'm trying to make. The point I'm trying to make is if you send a bunch of people who do experiments, you know, students from M.I.T. or wherever you do experiments in these countries, then and I don't know if you know about the graduation program, but the graduation program is regarded as one of the great stars in the firmament of this thing. And, you know, they say they've got the same effect sizes.


Could you just summarise person?


You should read the paper that Nancy Cartwright and I wrote in Social Science.


No, I mean, that's a great website. If you wouldn't mind just giving the quick summary for my listeners. The graduation program is a program and a bunch of different countries in which people are given some capital in the form of guinea pigs or chickens or sheep or something. They're also given advice on how to farm and then they're revisited. Maybe they're given some money. I forget exactly the details. And then you come back after a year or two years and see whether they're better off, you know, whether they're earning more money, whether their enterprise is working and so on.


So the idea is to try and get people over the hump, which otherwise is keeping them trapped in a poverty trap.


And they got pretty positive results in all but a couple of countries. And so they put a great weight on their application. They do the standardized effect size, which I think is nonsense. But the point there is the question is not whether those things can work. You know, we sort of pretty sure that these things can work. The question is whether governments, civil servants or government employees, you know, working on all the usual constraints of employing workers and all the incentives that go with that can actually do that.


And that comes to the crux of the matter, really. It's really whether the countries can do this for themselves, because if we can develop general methods, you know, things that look like they're sort of promising, then local people have to adapt them for themselves. So this takes us back to where you started, which is this question. You know, we're going to use local knowledge. We got to let you know we can send blueprints to places they can look at and say, this is interesting.


Maybe this would work in our context if we adopted this. And that, to me makes sense. I'm just not persuaded by any number of randomized control trials as they usually run at like.


So I wanted to share a few of my takeaways and updates from my conversation with Angus, and of course, he's not here to respond right now. So, you know, it's possible I'm misunderstanding or mischaracterizing him somehow. So just keep that in mind with that caveat. My reaction to the second half of our conversation about effective altruism was. You know, I went into this call assuming that Angus's problem with effective altruism was basically that first he's focusing on the problems with foreign aid and he doesn't realize that that is not what IA's are talking about.


And second, that he's focused on the danger of trusting randomized control trials too blindly. And he doesn't realize that IA's agree with that. And they have a pretty high bar for how good the evidence has to be in order to have confidence in a given intervention. So that was my expectation of his view. But in fact, from our conversation, I was surprised to learn that his view seems to be not that we need to use our assets more carefully, but rather that we should be we're better off relying on our common sense intuitions about how to reduce poverty, which to me just seems not reliable enough.


You know, our common sense intuitions are often wrong, and I think we have to test them with data with Arktos. And then I guess my other big disagreement with Angus in that part of the conversation was something like. You know, I felt like he was basically holding charity to a very high bar of evidence where you can never be positive that you're a well-intentioned intervention, like giving people bed nets to save them from malaria isn't going to somehow have a negative side effect you couldn't anticipate.


And if you could never be positive, then you know you shouldn't do it. And, you know, you can do a thousand studies that all find the same thing, but you can never be sure that the next study isn't going to find something different.


And that's true. It just seems to me like setting an impossibly high threshold for doing anything at a much higher bar than we would apply to anything else. That was my take. After our talk. But, you know, I can certainly agree with him about the dangers of trusting our too blindly.


And and I think it's a good thing that people are critiquing effective altruism. That is an important an important check on on any kind of philosophy or ideology or movement. Although the specific examples that I brought up multiple times of Yae interventions like cash transfers or antimalarial bed nets or vaccines, which isn't something give well does, but that's just because it's been pretty well covered by other organizations by now. He didn't really seem to think those were worrisome or harmful. And the examples he did give of aid with harmful side effects were not things that is advocate.


And yet I don't think that I succeeded in changing his picture of what it is or how good it is. So I guess I'm I still have a fair amount of uncertainty about what he thinks about what it actually is. I'm not sure then to go back to the first half of our conversation about deaths of despair. This is a really important trend, and I am glad that Angus and Encase noticed it and are calling attention to it and studying it.


I just as you may have inferred from my questions, I'm less convinced about their causal explanation for deaths of despair, which is roughly that it's the result of a loss of meaning in people's lives caused by a decline in good jobs for people without college educations and a breakdown of support systems, social support systems like union memberships and marriages and so on.


And my problem was basically that, you know, there are these two big facts about the rise and death of despair that it started in the late 90s and that it's been mostly limited to white people until the last few years. And it didn't really seem to me like the story about loss of meaning accounts for those two facts. So but maybe he's right about a decline in racism being a protective factor for minorities against death of despair.


I just don't know. It's an additional piece we're adding onto the theory at this point and it's hard to test. And so I don't know. Anyway, so if this conversation whet your interest, you can read more about depths of despair in Angus and and Casey's new book, Depths of Despair and the Future of Capitalism. And you can also read Angus's criticisms of effective altruism in the piece that he wrote for the Boston Review, which I was talking to him about.


It's called The Logic of Effective Altruism and a link to both of those things. And a few more on the podcast website that is all for this episode. I hope you'll join me again next time for more explorations on the borderlands between reason and nonsense.