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Efficient Charity: Cheap Utilons via bone marrow registration

17 Post author: atorm 29 January 2012 03:52AM

This topic is not really related to the things normally discussed here, but I think it's really important, and it might interest Less Wrongers, especially since many of us are interested in ethics and utility calculations that are essentially cost-benefit analyses. Bone marrow donation in the United States is managed by the National Marrow Donor Program. Because typing donors for matching purposes can be costly, they often require people signing up to donate to pay a registration fee, which probably prevents a lot of people from signing up. These costs are being covered until the end of the month by a corporate sponsor, which means that right now, all you need to do if you live in the US is go to http://marrow.org/Join/Join_Now/Join_Now.aspx and fill out a simple questionnaire. You will be sent a kit to collect a cheek swab, and then you will be entered into the donor database. Doing this does not require you to donate if a match comes up.

The reason I think this might interest Less Wrongers is that this is a really cheap way to improve the world. According to their website, about 1 in 500 potential donors are actually asked to donate, so registering doesn't actually make it all that likely that you will be asked to do anything more. If you ARE a match for someone who needs a donation, the cost to you is at most the temporary pain of marrow extraction (many donors are asked only for blood cells), whereas the other person’s chance to live is much improved. This looks like a huge net positive.

Unfortunately I only found out about this a few days ago, and it only occurred to me today that this might be a forum of people who would respond to the argument "you can make the world better at little cost to yourself." However, I ask that you go to the website and spend a few minutes signing up. This is like buying a 1 in 500 lottery ticket that SAVES SOMEONE’S LIFE. If the Singularity hits and an FAI can generate perfectly matched marrow for anyone who needs it from totipotency-induced cells, that will be wonderful, but this is a chance to make sure one more person gets there.

Comments (46)

Comment author: grouchymusicologist 29 January 2012 04:33:56AM *  7 points [-]

I've done this, and it is as easy as atorm says it is. I've also been the beneficiary of stem cell donation: my mother is currently alive and has a normal life expectancy after receiving a transplant that cured her of leukemia. She would otherwise have died within months of her diagnosis. Some years after her transplant, she was able to correspond with her stem cell donor, who told her that the donation was as simple as going to his local hospital and having his blood drawn. (These days, an agonizing, old-fashioned bone marrow transplant is rarely if ever necessary.) A cheap and easy source of utilons, indeed.

EDIT: this is especially worth doing if (as is apparently the case for another few days) a corporate sponsor has agreed to pay for the testing (but not to donate the same sum to the charity of your choice). If donors have to pay for their own testing, as is normally the case, I'm not claiming that this is necessarily a better use of the money than donating to some other charity. When I signed up, it was being paid for by my university.

Comment author: CarlShulman 29 January 2012 04:27:55AM *  25 points [-]

DISCLAIMER: This is awesome, a great source of fuzzies, and those who register are deserving of praise (I personally registered in the course of gathering data for the comments in this thread). The analysis below is done in the spirit of accurately understanding tradeoffs, and practice in thinking about do-gooding effectiveness. If the argument below convinces you not to register when you otherwise would have, please donate a few bucks to a more efficient charity, or a piggy bank until you think of something better, rather than simply cutting back on do-gooding.

Here's GiveWell's report on its top-rated charity in international health, Against Malaria Foundation:

We estimate that just under $2,000 spent on LLIN distributions saves a life. This does not include other benefits of ITNs. Full details at our report on mass distribution of LLINs.

You say that there is a 1 in 500 chance that one will be called on to donate bone marrow. ETA: the FAQ says it is 1 in 540. If one donates, it surely is not guaranteed to save the life of a young person with 40+ years of life (who would otherwise not get marrow, and would soon die with no other treatments working). A 10% (note: edited figure from 25% based on further Googling, and propagated changes) chance of saving such a life (or that expected value) seems reasonable, for a 1 in 5400 probability. Comparing in terms of direct life-saving, if it costs even 37 cents (in time and demands of registry, expected pain, expected donation hassle and recovery, additional testing, distraction, etc) one might do better by giving to AMF or some better charity.

According to the FAQ, benefits would be higher for US racial minorities (fewer donors to match against) and less for Americans of European ancestry.

Of course, saving the life of a rich person has other spin-off benefits (they may have more positive impact on the world thereafter than a potential malaria victim), and solidarity with other members of one's (rich) community is a perfectly understandable motivation.

Still, I am skeptical that this is near the efficiency frontier, even with the donors covering costs.

Comment author: grouchymusicologist 29 January 2012 04:53:16AM *  13 points [-]

I am very, very wary of wading into anything approaching a debate with you, given my respect for you. But I feel that this comment assumes an unrealistic picture of how time/money tradeoffs work in most people's lives. Most of us do not have direct ways we can translate a couple of spare minutes into the corresponding amount of money, and even if we did, we aren't perfect utilitarians who always make as much money as we possibly can and then donate every remaining penny to the most efficient possible charity. If anyone is that kind of person, they should indeed act as you suggest.

However, most people have some inflexibility in terms of how much of their spare time they can trade money for, and how much of that money they feel prepared to give away. If you can spare 3 minutes to swab your cheek that you would not otherwise spend to earn 3 minutes' worth of money and send it to the Against Malaria Foundation, then you should probably consider that "free" time. Then the calculus shifts over to the odds that your donation, should you be asked to give it, would save someone's life. You estimated a generous 25% ($500) -- I don't know, but I'll go with that. In that case, the time would probably be worthwhile.

Let me emphasize that I understand I am not assuming perfect rationality or perfect utilitarianism, but rather how these kinds of tradeoffs are likely to play out in ordinary people's lives.

Comment author: CarlShulman 29 January 2012 05:00:12AM *  10 points [-]

Thus the disclaimers.

then you should probably consider that "free" time

However, do note that the generalization of that argument would allow a vast number of posts asking for the use of "free time" on various less effective causes. Other matching grants (this one is expiring now, but there will normally be something in the same ballpark), petitions, tasks on Mechanical Turk, and so forth could be summoned.

If there were 100 such posts each month responding to them would clearly on average be a drain on your other activities, requiring willpower/glucose to deal with, etc. Likewise 50. As we get to smaller and smaller numbers the costs are harder to see, but they still exist (this is the flip side of computing benefits to marrow donation by subdividing the aggregate effect;). Likewise, there are costs in terms of page space, taxing some users (non-Americans who can't donate, people who don't want to see such things), and the like.

You estimated a generous 25% -- I don't know, but I'll go with that. In that case, the time would probably be worthwhile.

"Generous" means "probably lower." A bit of Googling suggests that the gain of some transplants (which are nonetheless performed, and thus good candidates for "marginal transplants") is only a few life-years (i.e. sub-10%) and regression (based on general medical ineffectiveness, and overestimation of effects in the medical literature) would drive a best guess lower.

If you can spare 3 minutes to swab your cheek that you would not otherwise spend to earn 3 minutes' worth of money and send it to the Against Malaria Foundation, then you should probably consider that "free" time.

I understand the thought, but it also illustrates the point about accuracy: the actual costs in time from mailing, reading instructions, etc, are more than 3 minutes.

With 20 minutes of work (it took me over 12 minutes to fill out the form, 10 minutes reading the commitment and FAQ, plus the time in mailing, swabbing, more forms, etc) plus rather than 3 required to register, a 1 in 540 chance of donating (less if European ancestry, more otherwise), and a benefit of 10% of a malaria victim saved (after costs of further testing, possible surgery, drug effects, etc) we get the equivalent of a 1 in 1800 chance of saving a life per hour of work. Using AMF to convert between money and time (and AMF itself is not at the frontier; if it is that effective then GiveWell itself has been doing more on the dollar by leveraged direction of funds to AMF, not to mention other causes), that's a wage of $1.11 per hour, less than one can earn on Mechanical Turk. Taking into account more "drag factors" would probably further worsen the picture.

Comment author: atorm 29 January 2012 06:55:42AM 1 point [-]

This all makes sense to me. Was I mistaken in posting this? I might say that if things like this happened once a month, the morale bonus from fuzzies would be worth the cost to me, but I don't think that would scale up. But if no-one did things like this, the registry would be empty of donors, and a world where everyone pumped their free time into money for malaria and neglected all other worthy causes seems distasteful to me.

Comment author: CarlShulman 29 January 2012 07:06:36AM *  24 points [-]

But if no-one did things like this, the registry would be empty of donors, and a world where everyone pumped their free time into money for malaria and neglected all other worthy causes seems distasteful to me.

That's unfortunately like the argument that one shouldn't become anything but a farmer, since without farmers we would have no food. One needs to think at the margin. First-world healthcare spending is many, many, times effective international public health expenditures. The major malaria, HIV, etc interventions would be overflowing before this got to be a big dent. If "everyone thought one way" and implemented the rule "first do the things that do the most good by your lights, until diminishing returns drive the good per dollar below the next alternative" you would get a more efficient charitable market, where one could do similar amounts of good in diverse fields, just as stock and bond markets are somewhat efficient.

ETA: Note that AMF is a placeholder here, I don't actually think that's the best way to help the current generation, let alone future generations.

Comment author: atorm 29 January 2012 03:49:38PM *  2 points [-]

I think that that might make more sense then the way charitable giving tends to happen now, but it seems like it would be an unstable system. As money flooded in to the most efficient charity, it would eventually find itself with more money than it could effectively use (Doctors Without Borders apparently had this problem with Haiti with regards to 'earmarked' money for disaster relief of a specific area), and its efficiency would go down. All of the donors would then direct their money to the next charity on the list until the same thing happens, and then move down again. I see two problems with this. First, how do you know when to move down the list, and second, how do you know when to move back up the list, i.e. when the first charity needs donations again.

Comment author: CarlShulman 29 January 2012 05:14:59PM 9 points [-]

Note that GiveWell carefully tracks room for more funding in its charities. They channeled funding to VillageReach until it had a few years worth of funding at the margin, and then moved on in their recommendation. But they keep track, and when VillageReach again shows that it can use money effectively it will be recommended easily. The problem with Haiti was that there were a lot of donors giving because of the TV images and charity fundraising even though it was clear that there was a surfeit of funding.

If those donors had been more sensible they could have used the recommendations of a service like GiveWell to identify the top organizations. Likewise for scientific research one can back a lab or fund that can allocate resources among many different experiments (or unrestricted grants to Doctors Without Borders which it can allocate to locations of greatest need). This doesn't seem to be too much of a problem in practice, as well as theory.

Comment author: atorm 30 January 2012 04:57:59PM 0 points [-]

Wow, GiveWell seems to be really good at what it does. The Haiti thing was a problem, but it DID spawn a lot of giving that otherwise wouldn't happen. Perhaps the organizations who advertise during emergencies shouldn't accept earmarked donations and instead take advantage of the surge of sympathy for disaster victims to acquire funding for the entire program. Or are there laws preventing that?

Comment author: jkaufman 09 February 2012 01:55:27PM 0 points [-]

Some people want to give you donations earmarked for Haiti. You tell them you only accept unrestricted funding. Many fewer donate.

Comment author: jacobt 29 January 2012 08:43:27AM 2 points [-]

Great point.

ETA: Note that AMF is a placeholder here, I don't actually think that's the best way to help the current generation, let alone future generations.

I can see how things like SIAI or FHI might be better for future generations, but what do you think is better than AMF for current generations?

Comment author: CarlShulman 29 January 2012 10:28:28AM *  12 points [-]

A few things I would see as better in expectation than AMF in terms of current people (with varying degrees of confidence and EV, note that I am not ranking the following in relation to each other in this comment):

  • GiveWell itself (it directs multiple dollars to its top charities on the dollar invested, as far as I can see, and powers the growth of an effective philanthropy movement with broader implications).
  • Some research in the model of Poverty Action Lab.
  • A portfolio of somewhat outre endeavours like Paul Romer's Charter Cities.
  • Political lobbying for AMF-style interventions (Gates cites his lobbying expenditures as among their very best), carefully optimized as expected-value charity rather than tribalism using GiveWell-style empiricism, with the collective action problems of politics offsetting the reduced efficiency and corruption of the government route
  • In my view, the risk of catastrophe from intelligent machines is large enough and neglected enough to beat AMF (Averting a 0.1% risk of killing everyone would be worth $14 billion at the $2,000/life AMF exchange rate; plus, conditional on intelligent machines being feasible this century the expected standard of living for current people goes up, meriting extra attention depending on how much better life can get than the current standard); this is much less of a slam dunk than if we consider future generations, but still better than AMF when I use my best estimates
  • Nukes and biotech also pose catastrophic risks, but also have much larger spending on countermeasures today (tens of billions annually), although smarter countermeasures could help, so probably not anything I can point to now, although I expect such options exist
  • Putting money in a Donor-Advised Fund to await the discovery of more effective charities, or special time-sensitive circumstances demanding funds especially strongly
Comment author: multifoliaterose 13 February 2012 12:45:52AM *  0 points [-]

GiveWell itself (it directs multiple dollars to its top charities on the dollar invested, as far as I can see, and powers the growth of an effective philanthropy movement with broader implications).

There's an issue of room for more funding.

Some research in the model of Poverty Action Lab.

What information do we have from Poverty Action Lab that we wouldn't have otherwise? (This is not intended as a rhetorical question; I don't know much about what Poverty Action Lab has done).

A portfolio of somewhat outre endeavours like Paul Romer's Charter Cities.

Even in the face of the possibility of such endeavors systematically doing more harm than good due to culture clash?

Political lobbying for AMF-style interventions (Gates cites his lobbying expenditures as among their very best), carefully optimized as expected-value charity rather than tribalism using GiveWell-style empiricism, with the collective action problems of politics offsetting the reduced efficiency and corruption of the government route

Here too maybe there's an issue of room for more funding: if there's room for more funding then why does the Gates Foundation spend money on many other things?

Putting money in a Donor-Advised Fund to await the discovery of more effective charities, or special time-sensitive circumstances demanding funds especially strongly

What would the criterion for using the money be? (If one doesn't have such a criterion then one forever holds off on a better opportunity and this has zero expected value.)

Comment author: [deleted] 29 January 2012 01:14:28PM -3 points [-]

Most of us do not have direct ways we can translate a couple of spare minutes into the corresponding amount of money

This. Several LWers and Randall Munroe take “time is money” way too literally.

Comment author: [deleted] 29 January 2012 02:16:34PM *  -1 points [-]

In their defense, in three minutes most people cannot make any money (short of looking for coins on the ground perhaps), but that is enough time to add to your skills somewhat if you have a certain kind of job - I am not certain exactly how you would correlate a small increase in present knowledge to future income but if you free up time every day and actually use it to study something that increases your value in whatever career you chose your long term prospects should improve. Some people actually do walk around with the latest OpenGL specification or whatever else they wish to study just in case a few minutes open up.

Comment author: [deleted] 29 January 2012 10:42:34PM -3 points [-]

Why was this downvoted to -3?

(Hey, there are quite a few people who couldn't translate lots of spare hours into the corresponding amount of money.)

Comment author: gwern 30 January 2012 01:17:35AM *  9 points [-]

They probably could, they just value their leisure time more. As I pointed out, many posting on this site have a minimum opportunity cost of $2-4 an hour - by working on Amazon Turk. Why not? Because Amazon Turk is miserable, $2 is peanuts, and they obviously get more utility out of watching a movie instead or something.

I'm not going to judge them too harshly for choosing leisure over work that pays that little, even if it were for charity - I donate very little and I am very selfish and make similar choices all the time, so it'd be hypocritical.

But don't try to tell me that there is no opportunity cost there.

Comment author: atorm 29 January 2012 05:30:26AM *  6 points [-]

Upvoted for calculation. Shakes fist for arguing against my pet cause. Although I didn't do the math, I suspected that it might turn out this way. I didn't mention that because of a chain of thought similar to grouchymusicologist's. I figure that people will not disrupt their money-earning time to sign up for this and for that reason donate less to charity. I think it's far more likely that they will be fooling around on the internet, reading LessWrong, and might feel motivated to use some time that would otherwise be spent unproductively on signing up. I hoped that the easy fuzzies might motivate some people into an act of "charity" that they otherwise might not make.

Comment author: CarlShulman 29 January 2012 06:20:31AM *  16 points [-]

Even if you get 100 Less Wrongers to register, it seems that the expected number of transplant patient lives saved will be less than the expected number of malaria victims saved by giving $40 yourself to AMF. It seems that wasting people's time (which works in small increments through willpower depletion, interrupting serendipity and other probabilistic or finely graduated effects), or conversely producing an interesting post and discussion about efficient charity (I enjoyed the post), will altruistically dominate the marrow effects.

ETA: Also, if you're going to pitch thousands of people, it's much, much, better for you to do that kind of basic background work rather than make the readers either go on faith or wastefully spend more cycles in parallel. General rule: if you can save the average reader 1 minute of processing with 20 minutes of work, that's a good deal.

Comment author: MartinB 29 January 2012 09:27:36AM 3 points [-]

The calculation doesn't mention the warm fuzzy feeling of getting personally involved. Registering might be a more involved way of support than donating, and make someone feel good about it. So best do both :-)

Comment author: atorm 30 January 2012 05:47:35PM 0 points [-]

I reposted this article in Discussion with a small addendum. Since your arguments are all really relevant, please repost them there if you have the time/inclination, so that people can still see and think about them. I didn't modify the article myself because 1) I'm lazy and need to get to class and 2) I'm hoping people will sign up before they read any arguments against it, because I do think that this is a way for people to put time towards charity that they otherwise wouldn't. But I respect and am grateful for your deconstruction of the mathematics of charity going on here.

Comment author: CronoDAS 30 January 2012 01:44:04AM *  4 points [-]

Actually donating is slightly more risky than you make out here; general anesthesia is used in 75% of donations that involve actual bone marrow (and not peripheral blood stem cells), and in general, there are plenty of reasons to avoid getting surgery that involves anesthesia.

Comment author: Yvain 30 January 2012 11:47:17AM 1 point [-]

POCD lasting more than a few weeks is vanishingly uncommon in the young, and the overall mortality rate for anaesthesia is impressively low. The doctor who claimed you were more likely to die in a car crash driving to the hospital than from anaesthesia was exaggerating a little* - but if it's a very long drive to the hospital, say five hours each way, his argument might still stand a chance.

*estimate based only on deaths from anaesthesia. Usually if you're under anaesthesia, lots of other dangerous things are going on at the same time, but deaths from surgical trauma or the condition that necessitated surgery in the first place aren't counted in those numbers.

Comment author: atorm 30 January 2012 05:00:55PM 0 points [-]

The National Marrow Donor Program website claims that local anesthesia can be used for marrow extractions. Your point has some validity, but I assume that the risk to a donor is much lower than the potential benefits to the person receiving the marrow, or the procedure wouldn't happen at all.

Comment author: CarlShulman 30 January 2012 04:58:58PM *  3 points [-]

On closer investigation, the marrow service allows some communication (anonymized for at least the first year, and sometimes with names later) if the recipient allows it. One could ask the recipient to "pay it forward" with some proportion of their benefits (since the benefits to them would be in the tens of thousands of dollars) going to donate to more efficient charities. It's quite unclear whether this would work. But if did with sufficient reliability to on average elicit many thousands of dollars in donations per recipient (a bit of a stretch) this could make for a win-win-win deal.

Comment author: atorm 30 January 2012 09:24:53PM 0 points [-]

Taken to the extreme, this sounds a little bit like selling your marrow or blackmailing the recipient. That might not actually be a bad thing, if the money were sent towards valuable charities. But people don't like the sound of that, so your way is probably better. If I am asked to donate, I'll be sure to drop hints to the recipient that I signed up because I wanted to make the world a better place, and that they should consider doing the same.

Comment author: wedrifid 31 January 2012 02:12:22PM 2 points [-]

Taken to the extreme, this sounds a little bit like selling your marrow or blackmailing the recipient. That might not actually be a bad thing, if the money were sent towards valuable charities.

It might not be a bad thing if it goes to your self interested hooker buying fund. Economic gains through trade! Everyone wins.

Comment author: atorm 01 February 2012 03:33:37PM 0 points [-]

Really, I could just trade marrow for services.

Comment author: CarlShulman 31 January 2012 12:11:34AM 0 points [-]

Really, donors ought to be compensated (like the doctors, nurses, etc) as a baseline so it doesn't seem so bad. Also recipients only have contact with donors if they choose to, and remain anonymous so that they can cease communication at will without trouble.

Comment author: sixes_and_sevens 30 January 2012 01:14:47AM 2 points [-]

If you're in the UK, you can instead sign up for the Anthony Nolan Trust Bone Marrow Register, which operates in a similar fashion. They're especially in need of young male donors, ages 18-30. Here's writer and journalist Charlie Brooker explaining it in a mildly entertaining manner.

Comment author: simplicio 30 January 2012 12:00:50AM 1 point [-]

I will sign up. I live in Canada and am a blood donor; I was already considering it. Just needed an extra push, I guess. Thanks.

Comment author: Solvent 29 January 2012 04:44:10AM 1 point [-]

Thanks for telling us this. If I lived in America I'd certainly consider this.

However, this should probably have been posted in Discussion. You might get downvoted for putting it here.

Comment author: atorm 29 January 2012 05:35:47AM 5 points [-]

I worried about that, but I decided that risking my karma was worth the potential gains of more people seeing it. If people downvote me into oblivion, I suppose I will have learned a lesson, but some of the early comments make me hope that this will get people to do something good that they otherwise wouldn't.

Comment author: Solvent 29 January 2012 05:41:40AM 0 points [-]

Possible point for consideration: Some people look at discussion and not main. I don't know if anyone reads main and not discussion.

But yeah, sure. I'm not annoyed at you.

Comment author: atorm 29 January 2012 06:40:08AM 1 point [-]

I actually didn't realize until now that articles don't pop up in the Main RSS unless they are upvoted to a certain value. Do you think I'd get more eyes on this if it were in Discussion rather than Main?

Comment author: Solvent 29 January 2012 06:58:18AM *  1 point [-]

I don't know. Maybe. What's that certain value?

Comment author: Swimmer963 29 January 2012 04:58:36PM 1 point [-]

From the Less Wrong FAQ:

Posts are "promoted" to the front page by the editors on the basis of substantive new content, clear argument, good writing, popularity, and importance. The posts with karma totals in green disks instead of gray circles have been promoted.

Comment author: atorm 29 January 2012 03:58:33PM 1 point [-]

I don't actually know. For all I know, articles become Promoted when Eliezer likes them enough to do background things in the blog. Maybe I should repost this in Discussion as well. I might worry that that would irritate people who see it twice, though.

Comment author: Swimmer963 29 January 2012 04:59:35PM 0 points [-]

I might worry that that would irritate people who see it twice, though.

You could post a disclaimer at the beginning: "This article is also posted in Main; however I want as many people as possible to see it. Please ignore if you have already read it."

Comment author: wedrifid 29 January 2012 05:06:36PM 0 points [-]

I actually didn't realize until now that articles don't pop up in the Main RSS unless they are upvoted to a certain value.

Does this apply to the RSS feed for plain old main or just the RSS feed for promoted main? I seem to find my RSS feed (the first link) is reasonably complete so if there is a karma requirement there it isn't a high one.

Comment author: Normal_Anomaly 29 January 2012 04:16:22PM 0 points [-]

I read discussion almost exclusively.

Comment author: wedrifid 29 January 2012 05:01:46PM 0 points [-]

I read recent comments (and posts that constitute the parents of interesting recent comments) almost exclusively. This seems to amount to much the same thing. For some bizarre reason the most interesting discussion occurs in 'discussion'.

Comment author: Dustin 29 January 2012 07:59:49AM 0 points [-]

I rarely read discussion.

Comment author: hamnox 29 January 2012 05:28:56AM *  0 points [-]

Possibly. Are the utilons he gets from having it more immediately available to be read and followed worth the possible negative karma? In any case, it looks like it's currently being upvoted.

Comment author: JoshuaFox 30 January 2012 09:14:59AM *  0 points [-]

Bone marrow drives are a textbook case of raging Scope Insensitivity.

Such campaigns invest tremendous money and effort in testing potential donors for one recipient.

Some Examples,

Luckily, the test results go into a database allowing donors to give to any recipient.

I wouldn't invest the effort to be tested for one person, unless I knew them personally; but I would do so, and did, for any of the thousands who might need it. According to the usual way of thinking, admitting to the first part of that sentence shows that I am callous to the suffering of others.

Comment author: paper-machine 30 January 2012 11:46:48AM *  2 points [-]

I think most bone marrow drives are self-aware enough to realize this. I'm sure I've heard the line "even if you can't help X, you may be able to help someone else," and the like enough from this sort of charity.

The recent campaign to find a donor for Amit Gupta also promoted South Asians giving bone marrow in general, due to the difficulty of finding South Asian matches. In some respects it worked against cultural narratives in that community that are afraid or ignorant about the bone marrow transplant process.