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Session 7 ‘Bridging Sepsis Knowledge Gaps in HICs and LMICs' from the 5th World Sepsis Congress. Featuring Andrew Argent, Sheila Myatra, Louise Thwaites, Elanor Gomersall, Victor Akelo, Wiltrud Abels, and Abdulelah Alhawsawi as your moderator.
A large proportion of economic activity takes place in the informal sector in every country, particularly in LMICs. Informality, and the lack of rights and protection that goes with it, affects the families who live in slums, the people who take off-the-books jobs, and the firms that choose to skirt regulations. It also affects the governments who want to increase the size of the formal sector – and the revenue they can collect from it. Gabriel Ulyssea of UCL and Mariaflavia Harari of the University of Pennsylvania are two of the editors of new VoxDevLit that examines what we know about the size of the informal sector and how it operates. They talk to Tim Phillips about the grey areas between formal and informal, and the limitations of policies that try to increase the size of the formal economy. Read the VoxDevLit here: https://voxdev.org/voxdevlit/informality
In the latest episode of the collaboration between Yale's Economic Growth Center and VoxDev, host Catherine Cheney is asking one of the most complex questions in global development: how can the clean energy transition move forward quickly and equitably, particularly for low- and middle-income countries still grappling with poverty? There is a balance between emissions reductions and economic growth. While wealthy nations historically contributed the most to climate change, LMICs are now under pressure to take costly action to avoid it. Catherine is joined by Max Bearak of the New York Times, Jessica Seddon of Yale Jackson School and the Dietz Family Initiative on Environment and Global Affairs, and Anant Sudarshan of the University of Warwick and the Energy Policy Institute at the University of Chicago. Read the full show notes here: https://voxdev.org/topic/energy-environment/climate-capital-and-conscience-who-will-pay-global-energy-transition
This week's episode we will discuss the resurgence of TB/ Tuberculosis. TB is a treatable and curable disease. Active, drug-susceptible TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information and support to the patient by a health worker or trained volunteer. Without such support, treatment adherence is more difficult. Since 2000, an estimated 66 million lives were saved through TB diagnosis and treatment. (credits: WHO) A total of 1.5 million people died from TB in 2020 (including 214 000 people with HIV). Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS). In 2020, an estimated 10 million people fell ill with tuberculosis (TB) worldwide. 5.6 million men, 3.3 million women and 1.1 million children. TB is present in all countries and age groups. But TB is curable and preventable. In 2020, 1.1 million children fell ill with TB globally. Child and adolescent TB is often overlooked by health providers and can be difficult to diagnose and treat. In 2020, the 30 high TB burden countries accounted for 86% of new TB cases. Eight countries account for two thirds of the total, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa. Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Only about one in three people with drug resistant TB accessed treatment in 2020. Globally, TB incidence is falling at about 2% per year and between 2015 and 2020 the cumulative reduction was 11%. This was over half way to the End TB Strategy milestone of 20% reduction between 2015 and 2020. An estimated 66 million lives were saved through TB diagnosis and treatment between 2000 and 2020. Globally, close to one in two TB-affected households face costs higher than 20% of their household income, according to latest national TB patient cost survey data. The world did not reach the milestone of 0% TB patients and their households facing catastrophic costs as a result of TB disease by 2020. By 2022, US$ 13 billion is needed annually for TB prevention, diagnosis, treatment and care to achieve the global target agreed at the UN high level-meeting on TB in 2018. Funding in low- and middle-income countries (LMICs) that account for 98% of reported TB cases falls far short of what is needed. Spending in 2020 amounted to US$ 5.3 billion less than half (41%) of the global target. There was an 8.7% decline in spending between 2019 and 2020 (from US$ 5.8 billion to US$ 5.3 billion), with TB funding in 2020 back to the level of 2016. Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs). Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable. TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected. About one-quarter of the world's population has a TB infection, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit it. People infected with TB bacteria have a 5–10% lifetime risk of falling ill with TB. Those with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill. When a person develops active TB disease, the symptoms (such as cough, fever, night sweats, or weight loss) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People with active TB can infect 5–15 other people through close contact over the course of a year. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die. Who is most at risk? Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. Over 95% of cases and deaths are in developing countries. People who are infected with HIV are 18 times more likely to develop active TB (see TB and HIV section below). The risk of active TB is also greater in persons suffering from other conditions that impair the immune system. People with undernutrition are 3 times more at risk. Globally in 2020, there were 1.9 million new TB cases that were attributable to undernutrition. Alcohol use disorder and tobacco smoking increase the risk of TB disease by a factor of 3.3 and 1.6, respectively. In 2020, 0.74 million new TB cases worldwide were attributable to alcohol use disorder and 0.73 million were attributable to smoking. Global impact of TB TB occurs in every part of the world. In 2020, the largest number of new TB cases occurred in the WHO South-East Asian Region, with 43% of new cases, followed by the WHO African Region, with 25% of new cases and the WHO Western Pacific with 18%. In 2020, 86% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted for two thirds of the new TB cases: India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa. Symptoms and diagnosis Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. WHO recommends the use of rapid molecular diagnostic tests as the initial diagnostic test in all persons with signs and symptoms of TB as they have high diagnostic accuracy and will lead to major improvements in the early detection of TB and drug-resistant TB. Rapid tests recommended by WHO are the Xpert MTB/RIF Ultra and Truenat assays. Diagnosing multidrug-resistant and other resistant forms of TB (see Multidrug-resistant TB section below) as well as HIV-associated TB can be complex and expensive. Tuberculosis is particularly difficult to diagnose in children.
It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: Mannkind releases info about it's Afrezza pediatric studies, Dexcom launches AI tech with Stelo, Health Canada approves Tandem/Dexcom G7, diabetes drug may help sleep apnea, an app in development to help drivers with T1D and more! Find out more about Moms' Night Out Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX Mannkid expects to talk to the FDA about Afrezza inhaled insulin for pediatric approval early in 2025. The company just announced six-month results from its Phase 3 INHALE-1 study of kids aged 4-17 with type 1 or type 2 diabetes comparing either inhaled pre-meal insulin or multiple daily injections (MDI) of rapid-acting insulin analog, both in combination with basal insulin. A 26-week extension phase in which all remaining MDI patients were switched to inhaled insulin is ongoing. HbA1c change over 26 weeks exceeded the prespecified non-inferiority margin of 0.4% (0.435%), largely driven by the variability of a single patient who did not adhere to the study protocol. A modified ITT (mITT) analysis, which excluded this subject, did not exceed the predetermined threshold of 0.4% (0.370%), thereby establishing the non-inferiority of Afrezza to MDI, which was the primary endpoint of the study. Over 26 weeks of treatment, there were no differences in lung function parameters between the treatment groups, There were no differences between groups or concerns in other safety measures, including hypoglycemia. https://www.medscape.com/viewarticle/inhaled-insulin-benefits-kids-diabetes-too-2024a1000nex XX Dexcom announces the use of AI for its Stelo platform. The company says the new Dexcom GenAI platform will analyze individual health data patterns to reveal a direct association between lifestyle choices and glucose levels while providing actionable insights to help improve metabolic health. Stelo users will start seeing the features this week. The AI is modeled after Google Cloud's Vertex AI and Gemini models. We'll hear more about this in January – Dexcom will be part of a panel at the Consumer Electronics Show about AI and healthcare. BTW this press release is the first time I've seen what seems to be a new slogan for Dexcom – Discover What You're Made Of. https://www.businesswire.com/news/home/20241217011997/en/Dexcom-Launches-the-First-Generative-AI-Platform-in-Glucose-Biosensing XX Staying with Dexcom, users report that the geofencing issue we reported on seems to be resolved. Previously, if you had an issue with Dexcom G7 outside of your home country, you couldn't reinstall or use the app without customer support. With the latest iOS and Android G7 apps, this seems to be resolved. This is according to the folks in the DIY community who first brought it to my attention. XX Interesting insulin development to watch. Egypt approves EVA Pharma's insulin drug products, which is a collbaration between Eli llly and EVA, an Egyptian company. The Egyptian Drug Authority approved the insulin glargine injection manufactured by EVA Pharma through a collaboration with Eli Lilly and Company (NYSE: LLY). Launched in 2022, the collaboration aims to deliver a sustainable supply of high-quality, affordable human and analog insulin to at least one million people annually living with type 1 and type 2 diabetes in low- to middle-income countries (LMICs), most of which are in Africa. Lilly has been supplying its active pharmaceutical ingredient (API) for insulin to EVA Pharma at a significantly reduced price and providing pro-bono technology transfer to enable EVA Pharma to formulate, fill and finish insulin vials and cartridges. This collaboration is part of the Lilly 30x30 initiative, which aims to improve access to quality health care for 30 million people living in resource-limited settings annually by 2030. https://www.prnewswire.com/news-releases/lilly-and-eva-pharma-announce-regulatory-approval-and-release-of-locally-manufactured-insulin-in-egypt-302333269.html XX Can we add treating sleep apnea to the list of applications for terzepatide? That's the generic for Zepbound and Mounjaro. Phase 3 study shows that 10- and 15-milligram injections of Zepbound "significantly reduced the apnea-hypopnea index" among those who have obesity and moderate-to-severe obstructive sleep apnea. Eli Lilly said there was nearly a 20% reduction in weight among those in the trials. The company said it plans to submit its findings to the Food and Drug Administration and other global regulatory agencies beginning mid-year. https://www.aol.com/popular-weight-loss-drug-could-131507702.html XX Health Canada okays Tandem's tslim X2 with Dexcom G7 and G6 making it the first and only insulin pump in Canada that is integrated with both Dexcom sensors. Now, t:slim X2 users in Canada can experience even more choice when it comes to CGM compatibility, along with the option to spend more time in closed loop with Dexcom G7's 30-minute sensor warm-up time, faster than any other CGM on the market.3 In addition, t:slim X2 users who pair Dexcom G7 with an Apple smartwatch4 can see their glucose numbers directly from their watch without having to access their pump or smartphone4. Tandem will email all in-warranty t:slim X2 users in Canada with instructions on how to add the new compatibility feature free of charge via remote software update. t:slim X2 pumps pre-loaded with the updated software will begin shipping to new customers in early January 2025. To check coverage and start the process of getting a Tandem insulin pump, please visit tandemdiabetes.ca. https://www.businesswire.com/news/home/20241210731189/en/Tandem-tslim-X2-Insulin-Pump-Now-Compatible-with-Dexcom-G7-CGM-in-Canada XX A federal jury on Tuesday awarded Insulet $452 million in its patent skirmish with EOFlow over insulin patch pumps. The jury awarded Insulet $170 million in compensatory damages from EOFlow and an additional $282 million in exemplary damages for willful and malicious misappropriation. A judge has not yet entered a judgment on the decision. Insulet filed a lawsuit in the U.S. District Court for the District of Massachusetts in 2023, claiming EOFlow copied patented components of its Omnipod insulin pumps. In October 2023, the Massachusetts district court issued a preliminary injunction against EOFlow. Following that decision, Medtronic called off plans to buy EOFlow for about $738 million. A federal appeals court later overturned the preliminary injunction, and EOFlow resumed selling its devices in Europe. The company recently defended against a separate injunction filed by Insulet in Europe's Unified Patent Court, according to Korea Biomedical Review, an online English newspaper based in Seoul, South Korea. The Massachusetts jury found this week that EOFlow and CEO Jesse Kim, as well as two of three former Insulet employees who were named as defendants in the lawsuit, misappropriated Insulet's trade secrets. Insulet CEO Jim Hollingshead said the company is “extremely pleased with the jury's verdict.” EOFlow did not immediately respond to a request for comment. https://www.medtechdive.com/news/insulet-eoflow-jury-verdict-patent-lawsuit/734745/ XX A tele-education program for health care providers who treat people with diabetes resulted in significant improvements in patient outcomes, including better blood sugar levels and increased use of medical devices to manage the disease, a University of Florida study finds. Led by researchers in the UF College of Public Health and Health Professions and the UF College of Medicine, the program used the Extension for Community Health Care Outcomes model, which has been adopted worldwide to train clinicians who treat patients with a variety of conditions. Known as Project ECHO, this is one of the first to demonstrate patient benefits for the program in a large, randomized trial. The findings appear in the journal Diabetes Care. https://ufhealth.org/news/2024/clinician-training-program-leads-to-better-outcomes-for-patients-with-diabetes XX New app under development to make driving safer for people with diabetes. Diabetes Driving Pal says it will use CGM data and guide you while you are driving without any annoying alerts. Guidance/suggestions will be on your car dashboard so that you don't have to look at phone and it will be very individualized and actionable. In a study last year, ~70% of people have reported (5% reported accident) to have at least one low blood sugar while driving and most reported that CGM alerts were not enough to protect them. We are hoping to start beta testing in a few months. We are trying to raise the fund to develop this product. We need your support. For more information, please visit: https://lnkd.in/gTDhnDc4 XX I'm also going to link to the top ten most read diabetes and endocrinology stories of 2024 from Medscape. This is almost all GLP-1 related.. and mostly for people with type 2. https://www.medscape.com/viewarticle/icymi-top-10-diabetes-endocrinology-stories-2024-2024a1000n6u?&icd=login_success_email_match_fpf XX That's it for the last In the News of 2024! Don't miss out episode next week with a look ahead to what we're watching in 2025. I'm SS I'll see you back here soon…
In the second episode of the collaboration between Yale's Economic Growth Center and VoxDev, Catherine Cheney speaks to Amit Khandelwal of the Yale Jackson School of Public Affairs, Isabela Manelici of the London School of Economics, and Arvind Subramanian of the Peterson Institute, As globalisation faces new headwinds, they discuss the outlook for those countries that didn't reap the trade benefits from the spread of globalisation, and the new challenges for LMICs.
New Things Under the Sun is once again putting together a list of dissertation papers related to innovation. If you want your paper to be included, email the title, an abstract, and a link to the paper, to matt@newthingsunderthesun.com by the end of November.In this post, coauthored with Caroline Fry, we look at the evidence on the effects of training programs for scientists in lower and middle income countries (LMICs). This podcast is an audio read through of the (initial version of the) article Training scientists in low and middle income countries, originally published on New Things Under the Sun.Articles mentioned:Schreiber, Kelsey L., Christopher B. Barrett, Elizabeth R. Bageant, Abebe Shimeles, Joanna B. Upton, and Maria DiGiovanni. 2022. Building research capacity in an under-represented group: The STAARS program experience. Applied Economic Perspectives and Policy 44(4):1925-1941. https://doi.org/10.1002/aepp.13310Fry, Caroline V., and Michael Blomfield. 2023. If you build it, they will come: The impact of clinical trial experience on African science. SSRN Working Paper. http://dx.doi.org/10.2139/ssrn.4629654Fry, Caroline, and Ina Ganguli. 2023. Return on returns: Building scientific capacity in AIDS endemic countries. NBER Working Paper 31374. https://doi.org/10.3386/w31374Fry, Caroline Viola. 2023. Bridging the gap: Evidence from the return migration of African scientists. Organization Science 34(1). https://doi.org/10.1287/orsc.2022.1580Kahn, Shulamit, and Megan J. MacGarvie. 2016. How Important is U.S. Location for Research in Science? The Review of Economics and Statistics 98(2): 397-414. https://doi.org/10.1162/REST_a_00490Kahn, Shulamit, and Megan MacGarvie. 2016. Do return requirements increase international knowledge diffusion? Evidence from the Fulbright program. Research Policy 45(6):1304-1322. https://doi.org/10.1016/j.respol.2016.02.002
This podcast features a panel discussion on desgining and developing drug delivery and devices for LMICs with representatives from Gilead Sciences, the Bill & Melinda Gates Foundation, ApiJect and AbbVie From the 2024 PODD: Partnership Opportunities in Drug Delivery. The panelists discuss unique and compelling challenges of the last mile for LMICs, the role of pharma and medtech in the evolution of LMIC drug development, trends in the space, case studies of successful products and how to better consider cultural differences between LMICs and more developed markets. To learn more about the PODD conference, please visit PODDConference.com.
In this episode, hosts Arian Sultan and Laila Akhlaghi discuss financial tools that enable healthcare markets to function more efficiently and how forecasting plays an important role in their execution with Hema Srinivasan of MedAccess. Hema Srinivasan is a senior advisor to MedAccess, supporting work to identify and execute opportunities for financial tools to help lower prices and increase the availability of medical products. She supports the Health Markets team in sourcing and developing pipeline opportunities for the deployment of MedAccess' tools, managing the monitoring and implementation of transactions post-execution, and analyzing development impact throughout the partnership development and implementation process. This episode explores her career and how she has used forecasting to develop market-shaping mechanisms and the methodologies that have led to increases in access to life-saving medical products. This includes analyzing market failures, identifying leverage points for intervention, and implementing policies or programs to rectify imbalances. The episode discusses how these interventions can lead to sustainable and scalable impacts, particularly in sectors where market inefficiencies hinder progress. It highlights interventions that lower prices and increase access to pharmaceuticals, diagnostics, and other medical products in low and middle-income countries (LMICs).
Small businesses in LMICs provide most of the employment. But they could provide many more jobs if the best of them could unlock their potential to grow. In the latest of our series of VoxDev Talks based on J-PAL special reports, Tim Phillips talks to David Atkin about how we can do a better job of connecting firms and entrepreneurs to markets. Read the full show notes here: https://voxdev.org/topic/firms/how-connecting-firms-markets-can-promote-economic-development
More children than ever in LMICs go to school – but they still don't learn as much as we would want, and the difference between the educational haves and the have-nots is widening. Noam Angrist joins Tim Phillips to talk about the size of the gap between education policy and practice, why it exists, why economic development alone isn't closing it, and how we can improve policy implementation in future. Read the full show notes here: https://voxdev.org/topic/education/gap-between-education-policy-and-practice
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Fungal diseases: Health burden, neglectedness, and potential interventions, published by Rethink Priorities on September 4, 2024 on The Effective Altruism Forum. Editorial note This report is a "shallow" investigation, as described here, and was commissioned by Open Philanthropy and produced by Rethink Priorities from January to February 2023. We revised the report for publication. Open Philanthropy does not necessarily endorse our conclusions, nor do the organizations represented by those who were interviewed. Our report focuses on exploring fungal diseases as a potential new cause area for Open Philanthropy. We assessed the current and future health burden of fungal diseases, provided an overview of current interventions and the main gaps and barriers to address the burden, and discussed some plausible options for philanthropic spending. We reviewed the scientific and gray literature and spoke with five experts. While revising the report for publication, we learned of a new global burden study ( Denning et al., 2024) whose results show an annual incidence of 6.5 million invasive fungal infections, and 3.8 million total deaths from fungal diseases (2.5 million of which are "directly attributable" to fungal diseases). The study's results align with this report's estimate of annual 1.5 million to 4.6 million deaths (80% confidence) but were not considered in this report. We don't intend this report to be Rethink Priorities' final word on fungal diseases. We have tried to flag major sources of uncertainty in the report and are open to revising our views based on new information or further research. Executive summary While fungal diseases are very common and mostly mild, some forms are life-threatening and predominantly affect low- and middle-income countries (LMICs). The evidence base on the global fungal disease burden is poor, and estimates are mostly based on extrapolations from the few available studies. Yet, all experts we talked to agree that current burden estimates (usually stated as >1.7M deaths/year) likely underestimate the true burden. Overall, we think the annual death burden could be 1.5M - 4.6M (80% CI), which would exceed malaria and HIV/AIDS deaths combined.[1] Moreover, our best guess is that fungal diseases cause 8M - 49M DALYs (80% CI) per year, but this is based on our own back-of-the-envelope calculation of high-uncertainty inputs. Every expert we spoke with expects the burden to increase substantially in the future, though no formal estimates exist. We project that deaths and DALYs could grow to approximately 2-3 times the current burden until 2040, though this is highly uncertain. This will likely be partly due to a rise in antifungal resistance, which is especially problematic as few treatment classes exist and many fungal diseases are highly lethal without treatment. We estimate that only two diseases (chronic pulmonary aspergillosis [CPA] and candidemia/invasive candidiasis [IC/C]) account for ~39%-45% of the total death and DALY burden. Moreover, a single fungal pathogen (Aspergillus fumigatus) accounts for ~50% of the burden. Thus, much of the burden can be reduced by focusing on only a few of the fungal diseases or on a few pathogens. Available estimates suggest the top fungal diseases have highest burdens in Asia and LMICs, and that they most affect immunocompromised individuals. Fungal diseases seem very neglected in all areas we considered (research/R&D, advocacy/lobbying, philanthropic spending, and policy interventions) and receive little attention even in comparison to other diseases which predominantly affect LMICs. For example, we estimate the research funding/death ratio for malaria to be roughly 20 times higher than for fungal diseases. Moreover, fewer than 10 countries have national surveillance systems for fungal infections, an...
Send us a Text Message.In this episode of the Global Neonatal Podcast, the hosts interview Dr. Emily Njuguna and Kimberly Mansen MSPH RDN from PATH to discuss the importance of human milk in low and middle-income countries (LMICs) and the strategies used to support lactation. The guests highlight the challenges faced by mothers in LMICs and emphasize the importance of early lactation support for mothers of the most vulnerable newborns. Emily and Kimberly discuss the three-pronged approach of kangaroo mother care, lactation support, and human milk banks in providing human milk for babies in LMICs. They also shared examples of successful initiatives, such as the establishment of a human milk bank in Kenya, and discussed plans for scaling up these programs in other countries. Resources mentioned in episode:PATH Newborn Nutrition page: https://www.path.org/who-we-are/programs/maternal-newborn-child-health-and-nutrition/newborn-nutrition/Article on potential effectiveness of human milk banking and lactation support on neonatal outcomes at the Pumwani Maternity Hospital in Kenyahttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750015/ Contact: Kimberly Mansen https://www.linkedin.com/in/kimberly-mansen/kamundson@path.org Emily Njuguna MD https://www.linkedin.com/in/emily-m-njuguna-062b7724/?originalSubdomain=keenjuguna@path.org Episode Webpage Link: https://www.the-incubator.org/post/213-closing-the-gap-improving-access-to-human-milk-in-lmicsAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Dr. Nathan Pennell and Dr. Christopher Booth discuss Common Sense Oncology, a global initiative that aims to advance patient-centered, equitable care and improve access to treatments that provide meaningful outcomes. TRANSCRIPT Dr. Nate Pennell: Hello. I'm Dr. Nate Pennell, your guest host today for the ASCO Daily News Podcast. I'm the co-director of the Cleveland Clinic Lung Cancer Program and vice chair of clinical research at the Taussig Cancer Center, and I also serve as the editor-in-chief of the ASCO Educational Book. My guest today is Dr. Christopher Booth, a professor of oncology and health sciences at Queen's University in Kingston, Ontario, where he also serves as the director of the Division of Cancer Care and Epidemiology. He joins me today to discuss his recently published article in the 2024 ASCO Educational Book titled, “Common Sense Oncology: Equity, Value, and Outcomes that Matter.” Dr. Booth also addressed this topic during a joint ASCO/European Cancer Organization session at the 2024 ASCO Annual Meeting. Dr. Booth, welcome. Thanks for joining me. Dr. Christopher Booth: Thanks for inviting me here, and I look forward to our conversation. Dr. Nate Pennell: In your article in the Educational Book, and again, thank you so much to you and your co-authors for writing that for us, and during your presentation at the ASCO Annual Meeting, I think your topic really resonated with a lot of people. You explained that the essence of oncology is delivering compassionate care, and I really was struck by the statement, “the treatments need to provide meaningful care, meaningful improvements in outcomes that matter regardless of where the patients live.” Can you just tell us what exactly is Common Sense Oncology? What's your vision for what it can do to help address some of our growing challenges today? Dr. Christopher Booth: Thanks, Nate. So, the Common Sense Oncology initiative was launched just over a year ago, and it really was a grassroots gathering of clinicians, policymakers, academics, as well as patients and patient advocates who recognize that there's many things we do well in the current cancer care system, but there's also areas that we can improve. And so it was created as a space for us to advocate for greater access for the things that we know really help people, but also to create a space where we can be willing to have some tough conversations and some humility and look within our field at some of the things that maybe aren't working as well as they should, and try to be constructive and not just be critics of the system, but actually be solution-focused and to try to move things forward. The Common Sense Oncology initiative, which has really taken off over the last year, really brings together people from all health systems who care deeply about people and their families who are with cancer. And our mission is that cancer care systems deliver treatments that have outcomes that matter to patients. And the vision is that, as you stated in your introduction, regardless of where someone lives, they have access to those cancer treatments which really do make a difference in their lives. Dr. Nate Pennell: That certainly sounds like something everyone should be behind. Before we talk about some of what Common Sense Oncology may be doing to help address some of the inequities in cancer care, one of the challenges that is addressed in your paper is the focus on modern clinical trials and perhaps some of the mistakes that we're making in how they are designed. In many ways, we sort of live in a golden age of clinical trials with biomarker driven treatments, which can be incredibly effective in small populations of people, sometimes at great expense. So, focusing on our modern clinical trials, some of the criticisms that have arisen are that perhaps the endpoints that are being designed really aren't ones that are meaningful for patients, or that the gains that they're trying to look for in these trials may not be particularly meaningful. So, talk a little bit about that, if you might. Dr. Christopher Booth One day, I might write a book called Paradoxes in Cancer Care. But there's a number of these things I think about. I'll start, Nate, in response to your question by talking about something I think of called the ‘three buckets paradox.' The three buckets paradox, I think, reflects a communication failure on the part of our field whereby if a patient or member of the public only reads the newspapers about cancer, they might wonder why we even have cancer hospitals and why Dr. Pennell and Dr. Booth even have a job, because everything we're doing is curing cancer. But we know the reality is different. And so, I conceptualize cancer treatments as going into three different buckets. We have the red bucket, which are those treatments, which really are transformational, and I've been working in oncology for 20 years now and we've seen a number of these treatments. They markedly increase cure rates or help people live for many, many months or extra years of life. And we have those treatments; they're almost out of a science fiction movie. The green bucket is a series of treatments. They're not perhaps transformational, but they're very, very good. They offer substantial benefits to our patients, and we have quite a few of those. The concern that I think many of us recognize, and just to state emphatically that the problems that CSO is thinking about are not new problems; I think every oncologist has struggled with these things throughout each of our own careers. The concern is the third bucket, which includes many of our newer treatments, some of which, of course, are transformational. But many of the new treatments fall into this bucket, which have important side effects. They have major financial toxicity for patients' families and the system. They have time toxicity, especially in the last year of life. And the reality is most of these new treatments, either there's no proven benefit they help people live longer or better lives, or if they do, it's measured in a number of weeks. I think we need to reconcile the fact that we need to maybe speak honestly about some of the challenges in our field to recognize there's probably too many treatments going into that last bucket, and we need to push harder in the research ecosystem and the policy space to ensure we have more treatments in the first two buckets and that they remain widely available to everyone. So, to get to the specific issues you raised in your question, Nate, some of the effect sizes and the endpoints we're choosing are problematic, I think. We have many, many examples of incredible clinical trials and new treatments that really make a difference for the lives of our patients. I want to state emphatically that the RCT remains the best tool we have to identify new treatments for patients of tomorrow, and any challenges with clinical trials, actually, it's not the fault of the RCT; these are self-inflicted by us who design, interpret, and act on clinical trials. And so the use of surrogate endpoints is a major issue in our field. And I just want to also state emphatically that there are circumstances where surrogate endpoints make a lot of sense and we should be using them. The problem is, I think with our excitement to get treatment answers more quickly, we've really embraced surrogate endpoints in a very, very rapid way. And in fact, I shouldn't even refer to them as surrogate endpoints. Maybe we should use the term alternative endpoints because in many cases they have been found to not be valid surrogates for those things which we know matter to patients: overall survival and quality of life. So certainly, there's a place for surrogate endpoints. I think we live in an era now where the majority of clinical trials are being designed to detect improvements in progression-free survival rather than overall survival. So historically, most clinical trials were being launched to see if we could help people live longer or feel better. Now, the default endpoint is progression-free survival, which largely is based on tumor measurements on a CAT scan. And certainly, there are circumstances where those tumor measurements do relate to how someone feels or how long they live, but in most circumstances, that's not the case. I think we need to take a step back and just see the big picture here about where it is that we're going, and how can we raise the bar and ensure that we're identifying treatments that really offer meaningful gains to patients. Because we have to be honest about the fact that the patients and families are the ones who need to live through the side effects, the time toxicity and financial toxicity of these treatments. So, this is about maybe raising the bar and aiming a bit higher than we currently are. Dr. Nate Pennell: And it looks like CSO basically is putting together teams around evidence generation, evidence interpretation and evidence communication that I guess, is trying to advocate and influence this? Dr. Christopher Booth: Yeah. So, when we launched this initiative, which now is this large global coalition of people, we wanted it to be really solution focused. So, our workstream is oriented around trying to improve how we generate evidence, how we interpret evidence, and how we communicate evidence. So, the evidence generation workstream is being led by a series of leading clinical trialists from all over the world, together with patients and patient advocates who are looking at how we can come up with a framework and principles to design, perhaps a more thoughtful approach to the design, reporting, and conduct of clinical trials. So that's kind of a clinical trials workstream. And I should mention all of these project teams are populated by clinicians, academics, members of the public, as well as patient and patient advocates who, in some cases, are co-leaders of the workstreams. The evidence interpretation workstream is an educational bucket being led by clinicians and educators, together with patients, to see how we can improve the skill set of the next generation of oncologists to be better equipped in skills and epidemiology, critical appraisal, and critical thinking, so we can better dissect trials which have been well designed from those which might have some limitations, identify those treatments which have very substantial gains from those which are perhaps more marginal. And then the third workstream relates to how we communicate evidence. And this is communication broadly, how we talk about these very complex and nuanced issues at the bedside between oncologist and patient. But how we talk more broadly in society, through the media, with public and policy makers, about some of the challenges in cancer care, recognizing, of course, that no one individual, group or person is going to have the answer for what treatments matter for any specific patient. This is going to vary by every patient with their unique values, preferences and goals in life. But we think we can do a better job of talking about these issues and empowering patients to have the information they need so they can make the treatments that match their own goals and wishes. Dr. Nate Pennell: Oh, thank you. Another thing that I was interested in in your paper, and when we talk about value and whether these endpoints that are being released for drugs that become approved are meaningful to patients, the other aspect of value is, of course, the cost. And we know that basically every new drug that gets approved, just an astronomical cost these days, which doesn't often factor into whether to approve them. It doesn't often factor into a doctor's decision about whether to use them. Can you talk a little bit about this? And is cost of drugs something that CSO is interested in addressing, or is that more of just a part of the equation in determining value of these? Dr. Christopher Booth: No, I think it's a really important point. So the value construct, I'm not an economist, so I think about this as a simple Canadian chemotherapy doctor would, which is the interface of what you get - so the magnitude of benefits, that's the endpoint, and the effect size - relative to the downsides, the cost, the clinical toxicity, time toxicity, and financial toxicity. So historically, I mean, I think, Nate, you and I will remember maybe 10 or 15 years ago when this really came on the scene, all the conversations focused on the denominator, the cost of cancer medicines, which became astronomical over the last 10 or 20 years. And we've learned a few things about that over time, and I'll get to that in a moment in reference to your question. But I think as individual clinicians or investigators, or even people writing guidelines, we don't have a lot of ability to influence the price of cancer medicines, although I think we still need to speak out about these prices, which are largely unjustified. I'll come back to that. But where I think there's growing interest, and we've seen this in the last five years, is the numerator in that value construct, which is the magnitude of benefit, the endpoint, the effect size. And I think that's where we actually have much more ability to influence. We are the doctors who make treatment recommendations, the experts who write guidelines, the investigators who design trials and so I think we need to take a bit more ownership when it comes to this magnitude of benefit construct. And that's where a lot of the work that Common Sense Oncology is doing rests. But to answer your question about cost, this is a major problem. We've known that it's been shown by several groups that the price of a cancer medicine is not justified by the R and D cost, that's been shown over time. We also have a problem where the magnitude of benefit offered by that drug also has no bearing to the price. And so this speaks to the need to really, I think, undertake more rigorous health technology assessment and think very carefully about- you know every other economic model that you and I live in, Nate, if, you know, if we have a growing family, we need a larger apartment or house, we spend more money, we get a bigger house. If we want to keep up with our kids on their fast bicycles, we spend more money, we get a better bicycle. And when it comes to cancer medicines, we found that not only is there no relationship between how well the drug works and its price, our group and others have found, if anything, there's an inverse relationship, whereby the drugs with the smallest benefit have the largest price tag. And I don't think you need a PhD in economics to know that is an incredibly broken system. So, I think there's a lot that we need to talk about when it comes to cost. Common Sense Oncology cares deeply about this because it's a huge issue about health justice and global equity and access to cancer medicines. And I think we need to work on that. But we also can't forget about the numerator, which is, to what extent do these treatments help people? Dr. Nate Pennell: I know that every time I see one of these fabulous new presentations at ASCO Plenary or something like that, I just imagine many of the doctors and patients who live outside the U.S., maybe in low- and middle-income countries, who don't have the same access to basic oncology care and specialty oncology care that we do in Western countries, and what goes through their minds when they think about this. And so, I know that this is another big part of what CSO is doing, is thinking about global equity and access to cancer care. And so, can you tell me a little bit about how you're hoping to address that? Dr. Christopher Booth: Yeah. And so, you're right. I guess I'll tell you another Booth cancer paradox. I call this the cancer medicine paradox, which is, on the one hand, in many health systems, I think we'll recognize that there's often overutilization of cancer medicines that are toxic, expensive, and small benefits, especially in the last year of life. So, we have that kind of overutilization paradigm in some parts of the world, but we also have this paradox where we have massive underutilization of those treatments that we know actually have large benefits. And the tragic part of this is many of those treatments are old, generic drugs that actually should be very affordable. Some of this work comes out of myself and a number of my founding colleagues of Common Sense Oncology have a policy role with the World Health Organization Essential Medicine list. My interest in this started, I guess, many years ago when I had a sabbatical in India and lived and worked at a large government cancer hospital for a period of time. And so, from this WHO working group, we launched a project. It's been called the Desert Island study. It was called the Desert Island Project for reasons I'll tell you in a moment. But essentially it was a survey of 1,000 oncologists on the frontlines of care in 82 countries worldwide. And what we are interested in doing is in our role as an advisory group to the WHO Essential Medicine List, we come up with a list of those medicines which are really most important and should be provided in all health systems. And we were interested in going to the frontlines of care, leaving the boardroom of Geneva, and going to the frontlines of care and asking real doctors in the real world, “What medicines do you think are the most important for the patients that you look after?” So, it was a survey. We asked a lot of demographic questions about their clinical practice and their health system, but we called it the Desert Island Project, because the core question of the survey was based on the thought experiment that you and I have done many times with friends at dinner parties. For example, if you're moving to a desert island and you could only take three books, what would those books be? If you're going to have dinner with any famous podcast host in the world other than Dr. Pennell, who would that person be? And so the thought experiment was, imagine your government has put you in charge of cancer care for your country. You can choose any cancer medicines you want that will be freely available for all cancers and all people in your country. Cost is not an issue, but you can only choose 10. You can only choose 10 of those medicines to take to the desert island to look after all the people in your country, what would those medicines be? And it's amazing; of those thousand oncologists, we found, first of all, remarkable convergence between doctors, regardless of where they work, whether it was a high-income country, middle-income country, lower-income country, the doctors were very pragmatic. When we looked at the drugs that went in that suitcase over and over again, the most common drugs were the good old fashioned cytotoxic chemotherapy drugs and hormone drugs we've been using for 20 or 30 years that we know have very, very large benefits, and in the modern era now should be very affordable because they've been off patent for many years. In that list of medicines that went to the desert island, there also were some of our newer drugs that are new and they're very expensive. But they are those drugs that have very large benefits. And, of course, all of us would want access to those for our patients. So we found that the doctors are pretty pragmatic about which medicines if they're pushed to offer the largest benefit. But the next part of the question was, okay, you've told us which medicines you want to put in your suitcase to take to the desert island, please now tell us the reality in your health system to what extent can you deliver these medicines? And it was shocking. The vast majority of oncologists, a huge number of them, said they could not even provide doxorubicin or cisplatin without causing major financial toxicity for that patient and family. Even for trastuzumab, now available as a biosimilar, only 15% of oncologists globally said they could provide it universally to all women with breast cancer. Two thirds of oncologists said, “Look, I can give it, but I will catastrophically ruin that patient's family's finances for generations to come.” So, we have a big problem in the sense that we need to focus on those treatments which make a big difference and ensure that they're available to all patients who could benefit, while at the same time raise the bar so that the modern treatments that we're offering also have large benefits. Dr. Nate Pennell: I think that's really eye opening, and I hope lots of people take away from this, that this is the reality for a huge number, potentially billions of people on the planet that don't have easy access to the same kinds of drugs. We're not even necessarily talking about the expensive drugs with the three-week DFS benefit, but ones that actually could be curing them of their breast cancer and their testicular cancer and their lymphomas, and they can't even get access to those, even though here we might say that they're inexpensive and relatively accessible. So how do we fix that? Maybe this is too big a question for a few minutes in a podcast, but I'm curious to see what CSO is doing to try to help. Dr. Christopher Booth: Well, the challenges are substantial, and so that's why we've kind of created this group, because it's going to require kind of collective input, I think, of everyone in our field and beyond. And I also think, one of the reasons we've been overwhelmed with interest by the next generation, the young, the trainees, the young oncologists who are very interested in this, and I think they're recognizing that this might be an alternative place for them to put their energy, talent, as they build their own academic careers, is tackling some of these really, really tricky problems where the solutions are not immediately obvious. One thing I think, Nate, that's important is for us to talk about these things and recognize that there's a range of cancer treatments, and that this might help set better expectations for the patients and families when they walk into our cancer centers, let alone in the U.S. and Canada, but also globally. We've seen challenges with all of us as human beings are technophiles, we're drawn towards the new shiny targeted therapy or a robot or treatment in cancer care, and we've seen that play out somewhat tragically. Some of my friends and colleagues in LMICs have told stories where the Minister of Health is about to make a major investment in cancer care, but they want the shiny new monoclonal antibody, because that's perceived as being newer and better, when the reality is that that might add two months of PFS compared to other agents that are much, much- have much larger benefits and, of course, are much more affordable. And there's modeling where even just one of these new medicines, for one cancer, would wipe out the entire cancer medicine budget for that country. Yet we don't have tamoxifen, doxorubicin, cisplatin or even morphine for palliative care available. So, some of this is about socializing these issues, talking about these things that, again, these are not new problems. I think every oncologist worldwide has wrestled with these things, but just at least creating a space where we can talk honestly about this and work towards solutions. Dr. Nate Pennell: Yeah, I think even just having the framework and the awareness and getting people involved is going to make a big difference. And of course, the people who ultimately are impacted the most by this are the patients with cancer. One of the big aspects in your paper is talking about how patients and patient advocates are central to the CSO movement. So, tell me a little bit about how they became involved and what role they play in CSO. Dr. Christopher Booth: Yeah, so this has been a very intentional and deliberate part of the building of the Common Sense Oncology initiative. So this started with a planning meeting of- a very small planning meeting of 30 people in Kingston, here at Queen's University just over a year ago, with 30 people from 15 different countries, a mix of academics, clinicians, editors, and in that room were five or six patients and patient advocates from day 1, because we wanted to make sure that this is really all about their needs and creating a system that revolves around the outcomes that matter to patients and families. So since then, we've continued to engage broadly. We have a patient priorities project team. There's co-leadership there. One is a colleague and oncologist from New Zealand, but the other co-leader is a patient advocate from- a breast cancer patient advocate from the United States. And all of our project teams have patients and patient advocates as part of their membership. The Patient Priorities Team is working to design a patient charter to guide the design and implementation of clinical trials from the patient's perspective. And as part of that exercise we've been undertaking, we call the CSO speaking and listening tour, where we've had a series of webinars with patient advocacy groups from all over the world, where part of the webinar is us talking about the CSO mission vision, workstream and some of the challenges and solutions we see so that we can provide some education, but also get honest feedback from the front lines to learn kind of where we might be off, what we might be missing, what we should focus on. But then also, the second part of the webinar is about sharing this kind of draft patient charter and getting more broad input from patients and families about what it is they're looking for in a cancer system. And I can tell you that some of the most gratifying correspondence I've had since launching CSO, which has been essentially become my third full time job, is letters from patients and family members of former patients who have since deceased or active patients on treatment, who are saying how much they appreciate this work and how much they feel that oncology can perhaps do a better job talking about some of these things. And they've been giving us some very good ideas and suggestions that, in fact, I'm already incorporating into my clinical practice, because ultimately all of us came into this field to help people with cancer, and I think they can and should and are remaining the center of everything. Dr. Nate Pennell: I think, thankfully, that is a movement throughout medicine, certainly cancer medicine, that patients are becoming more involved much earlier in the process of designing trials. And hopefully that alone will help change the endpoints that we're building into these studies to make them much more meaningful. So, people are going to read your paper, they're going to get excited, they're going to listen to this podcast, they're going to get even more excited about how they're going to change the world through a little more common sense. So how can they get involved? Is this something that you're open to people working with you? Are there other things people can do to try to help solve some of these frustrating problems? Dr. Christopher Booth: Yeah, absolutely, Nate. So, we have a website at commonsenseoncology.org. Some of our co-leaders are very active on social media, so they can follow us through social media channels. If you go to our website, there is a membership button where people can join. There's no fee and we won't bombard you with too many emails. But what that has allowed us to do is build this network of people who have diverse interests and skill sets that we can then tap into various projects and workstreams where we could use the help and support. And members have access to things like virtual webinars, journal clubs, critical appraisal sessions, and they get a newsletter from us every two or three months about activities and about ideas and allow exchange of dialogue going back and forth. So certainly, we look forward to growing this initiative, and the challenges are large, but we think that with the collective input of stakeholders from around the world, we could make a difference in moving towards some solutions. Dr. Nate Pennell: And for our listeners, that is commonsenseoncology.org. You can go check this out and join if you are interested in learning more. Chris, thanks so much for sharing your insights and for all of your work on addressing these complex challenges in cancer care. Dr. Christopher Booth: Thanks, Nate. Grateful for the interview and also for ASCO for giving us the opportunity in the Educational Book and at the Annual Meeting to talk about this work. Dr. Nate Pennell: Thank you. And I also want to thank our listeners for joining us today. You'll find links to the article discussed today, as well as Dr. Booth's presentation at the Annual Meeting, in the transcript of the episode. Finally, if you value the insights that you heard on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers: Dr. Nathan Pennell @n8pennell Dr. Christopher Booth Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Nathan Pennell: Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi Dr. Christopher Booth: No relationships to disclose
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: The Giving Green Fund is evolving, published by Giving Green on July 17, 2024 on The Effective Altruism Forum. Giving Green's mission is to direct climate mitigation funding towards the highest-impact projects possible. We wanted to give a short update from the Giving Green Fund, with links to more details. 1. The Giving Green Fund received an anonymous gift of 10M USD in April, to be used for granting to high-impact climate organizations. We intend to allocate all these funds by the end of 2024. 2. In reaction to this large gift, we updated our fund strategy to support high-impact initiatives beyond our list of top climate nonprofits. 3. In 2024, we are likely to recommend grants in some subset of our priority funding areas: 1. Industrial decarbonization 2. Decreasing livestock emissions 3. Carbon removal 4. Supporting the energy transition in low- and middle-income countries (LMICs) 5. Nuclear power 6. Solar geoengineering governance and coordination Please feel free to reach out with any questions: givinggreen@idinsight.org. Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Apply now: Get "unstuck" with the New IFS Self-Care Fellowship Program, published by Inga on July 16, 2024 on The Effective Altruism Forum. You finally want to resolve deeper-seated inner conflicts, and remove inner blocks in the way of becoming a more fulfilled, resilient, and well-performing version of yourself? This post allows you to learn how IFS as a coaching or therapy approach can help with mental wellbeing, if it might be the right approach for you, if so to get excited about it and inform you about the opportunity to take part in Rethink Wellbeing's online IFS group course starting this August. Executive Summary Rethink Wellbeing's (RW) launches a brand new online IFS course for ambitious altruists. Learn powerful, and practical tools to uncover the dynamics of your inner conflicts, become a more whole and resilient self, and transform your mental wellbeing and performance. You will meet with a peer group of 5-7 like-minded ambitious altruists led by a trained peer facilitator, for 6 weeks and 3 follow-ups. The course empowers you to learn IFS skills and apply those to your life until they become habitual. This includes 9 group sessions, home practice based on an IFS "playbook", individual progress tracking, and support from the Rethink Wellbeing Online Community. Participation takes ~5 hours per week for 6 weeks, and 2-3 hours the 8 weeks after. You can apply via the form now in less than 15 minutes. Due date: until 20th July 2024. All groups start in August 2024. We accept suitable participants until all spaces are full. The earlier you apply, the higher the chances to secure your spot. No or low costs - two options and all in between: No costs and a motivational deposit of $200 (less in LMICs) that you get back upon successful participation, or $550 to cover the costs of your attendance. Internal Family Systems (IFS): When talking about themselves, many people naturally use expressions like "a part of me." For example, someone who was considering a job offer might say, "one part of me is excited about this opportunity, but another part of me is afraid of the responsibility." Internal Family Systems (IFS) is a form of psychotherapy that takes this kind of language literally and assumes that people's minds are divided into parts with sometimes conflicting beliefs and goals. IFS aims to reconcile conflicts between those parts and get them to cooperate rather than fight each other, so that they can become a more healed and whole self. The goal is to improve self-leadership, ground, and grow yourself, your new self, in the 8 C's of IFS: curiosity, compassion, calmness, clarity, confidence, creativity, courage, and connectedness. How IFS works Do you know what would be beneficial for you to do, but just can't make the change? Do you keep coming up against the same challenging or unresolvable inner blocks? Do you recognize these behaviors in yourself: Avoiding, putting off, and neglecting things: Are you procrastinating important tasks and goals, finding yourself endlessly planning but never executing? Do you find yourself turning to distractions or comfort activities when faced with stress? Feeling guilty for not doing what you planned to do? Or not good enough for not having done enough or good enough? Judging yourself, and high expectations: Are you constantly doubting your abilities despite your achievements? Feeling like an imposter in your field? Do you set excessively high standards for yourself that are almost impossible to meet? Or do you believe you need to keep doing more to be good enough? Monitoring yourself when with others: Do you try to make sure others think well of you by controlling what you do or don't say? Do you keep trying to please others or take care of them so that they like you more or do what you want? Do you neglect your own needs a...
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: MHFC Spring '24 Grants, published by wtroy on July 4, 2024 on The Effective Altruism Forum. Summary: AIM's Mental Health Funding Circle ran its latest round of grants this spring, distributing $367,000 across six grantees. About the MHFC: Global mental health continues to be highly neglected despite contributing more to cumulative suffering than many more highly-prioritized physical health conditions. A handful of effectiveness-minded funders come together twice a year for an open grants round, looking to find and fund the most impactful mental health projects. If you or someone you know may be interested in joining us, we would warmly welcome new members! If you give (or are interested in giving) at least $50,000 annually to effective global mental health projects, please reach out or apply here to join. The Grants: As all circle members make their own funding decisions, the justification given for each grant may not represent the thinking behind each funder's actions. That being said, I'm writing some justifications because it's fun to do so, and otherwise this is just a dry and boring list. It's worth noting that due to limited resources, we were unfortunately unable to fund some highly promising applicants. Nonetheless, we are thrilled to support the following grantees: $83,000 to Restore Hope Liberia (RHL): RHL provides interpersonal group therapy (IPT-G) to depressed individuals in (you guessed it) Liberia. IPT-G, made famous by the likes of Strong Minds and Friendship Bench, is the gold standard therapy for cost-effective mental health treatment (as documented extensively by the Happier Lives Institute). RHL is one of the few mental health organizations operating in Liberia, a country and greater region with well-documented rates of depression and trauma. In addition, RHL is developing a tailored LLM that will help train their facilitators, eliminating one of their biggest bottlenecks to scaling. $125,000 to Overcome*: This organization provides free digital and phone-based therapy to sufferers of a variety of mental disorders in LMICs. By exploiting a unique demand for client-facing practice hours by highly-trained graduate students in high-income countries, Overcome can provide extremely cheap mental health treatment for sufferers with truly no other options. In addition to being potentially highly cost-effective, Overcome has shown great potential in its first year as an organization. $80,000 to the Swiss Tropical and Public Health Institute*: This grant supports the work of Irene Falgas-Bague on suicidality in Zambia. Given the scarcity of suicide data in Sub-Saharan Africa, and the proven success of initiatives like the Centre for Pesticide Suicide Prevention, this research could inform highly cost-effective interventions to reduce suicide rates. Preliminary data suggests that a significant percentage of suicides in Zambia may involve pesticides or other poisonous materials. $50,000 to VIMBO: This digital startup provides mental health support for individuals with depression in South Africa. Digital mental health interventions offer enormous scaling potential, and VIMBO's promising financial model could potentially become self-sustaining at scale. $50,000 to FineMind*: This grant supports FineMind's work on stepped care in northern Uganda. Their increasingly cost-effective intervention shows significant scaling potential. The stepped care model allows for the assessment of a large population and the provision of appropriate care based on symptom severity. $69,000 to Phlourish*: This funding supports Phlourish's work on guided self-help for adolescents in the Philippines. Guided self-help is one of the most promising interventions, and Filipino adolescents have disturbingly high rates of depression and self-harm. Phlourish is a promising young organization...
In developing countries, we know comparatively little about how well the elderly cope with problems like depression and loneliness. There are few policies to support sufferers, partly because of this lack of data. Maddie McKelway and Garima Sharma tell Tim Phillips about some of the surprising revelations of a new cross-country study and suggest ways in which policy can improve the mental health of seniors.
Join Resiliency Within as Kate Sachs Leventhal, Chief Program Officer, and Steve Leventhal, CEO, share their experiences with WorldBeing and how WorldBeing's vision and inspired programs are changing the lives of youth -- and the systems that support them. WorldBeing (formerly CorStone) is an internationally recognized nonprofit organization that conducts innovative in-school wellbeing programs to empower vulnerable and marginalized youth in low- and middle-income countries (LMICs). These programs help youth to re-frame their identities, unleash their potential, and transform their life trajectories. WorldBeing helps us understand that mental health concerns among LMIC youth are fueled by systems of entrenched inequities, discrimination, and resource scarcity, exacerbated by a lack of access to services. WorldBeing's programming particularly focuses on gender equality and building the skills of marginalized youth, especially girls, to advocate for their rights, stay in school, and resist early marriage. To improve mental health, WorldBeing believes it is crucial to target improving these systemic injustices and social determinants of poor mental health. WorldBeing's Youth First and Girls First programs represent one of the first human-centered approaches to youth mental health promotion and prevention, taking injustices and social determinants seriously. Working from ‘the inside out,' WorldBeing's evidence-based wellbeing programs support youth to access their inner wellbeing and resilience, and cultivate their power as change agents within their families, schools, and communities. Since 2009, WorldBeing has developed, researched, and conducted well-being programs for nearly 500,000 youth and 250,000 teachers in 3,500 schools across India, Kenya, and Rwanda. Effectiveness trials of WorldBeing's programs have provided some of the first evidence demonstrating that fostering wellbeing and resilience amongst vulnerable and marginalized youth significantly improves adolescent mental, emotional, and physical wellbeing; gender equality; and education-related outcomes. Additional impacts include improved school engagement, classroom behaviors, relationships with teachers, and delayed marriage.
Join Resiliency Within as Kate Sachs Leventhal, Chief Program Officer, and Steve Leventhal, CEO, share their experiences with WorldBeing and how WorldBeing's vision and inspired programs are changing the lives of youth -- and the systems that support them. WorldBeing (formerly CorStone) is an internationally recognized nonprofit organization that conducts innovative in-school wellbeing programs to empower vulnerable and marginalized youth in low- and middle-income countries (LMICs). These programs help youth to re-frame their identities, unleash their potential, and transform their life trajectories. WorldBeing helps us understand that mental health concerns among LMIC youth are fueled by systems of entrenched inequities, discrimination, and resource scarcity, exacerbated by a lack of access to services. WorldBeing's programming particularly focuses on gender equality and building the skills of marginalized youth, especially girls, to advocate for their rights, stay in school, and resist early marriage. To improve mental health, WorldBeing believes it is crucial to target improving these systemic injustices and social determinants of poor mental health. WorldBeing's Youth First and Girls First programs represent one of the first human-centered approaches to youth mental health promotion and prevention, taking injustices and social determinants seriously. Working from ‘the inside out,' WorldBeing's evidence-based wellbeing programs support youth to access their inner wellbeing and resilience, and cultivate their power as change agents within their families, schools, and communities. Since 2009, WorldBeing has developed, researched, and conducted well-being programs for nearly 500,000 youth and 250,000 teachers in 3,500 schools across India, Kenya, and Rwanda. Effectiveness trials of WorldBeing's programs have provided some of the first evidence demonstrating that fostering wellbeing and resilience amongst vulnerable and marginalized youth significantly improves adolescent mental, emotional, and physical wellbeing; gender equality; and education-related outcomes. Additional impacts include improved school engagement, classroom behaviors, relationships with teachers, and delayed marriage.
How do we address the dire shortage of neurosurgical care in low- and middle-income countries (LMICs)? What challenges do medical professionals face when pursuing a career in critical yet underserved areas? In regions where nearly five billion people lack access to basic surgical care, the journey to becoming a neurosurgeon is fraught with obstacles, from limited resources to inadequate training facilities. Enter Dr. Atta Ul Aleem Bhatti, a neurosurgeon whose career has navigated these very challenges. Having grown up in the remote areas of Tharparkar Sind, Pakistan, and trained across various global locales from Switzerland to East Africa, Dr. Bhatti has witnessed firsthand the stark disparities in healthcare. His experiences have forged a deep resolve to transform neurosurgical care in LMICs. Dr. Bhatti's journey is a powerful testimony to perseverance and dedication. After completing his advanced training and contributing to neurosurgery in diverse settings, he has returned his focus to where it's needed most. His mission, "Neuro Health Care 4 LMIC," co-founded with neuroradiologist Dr. Bernd Daeubler, aims to introduce innovative, cost-effective neurohealth solutions that can be widely implemented in underprivileged regions. Currently, Dr. Bhatti is involved in direct patient care and plays a crucial role in forming strategic partnerships and seeking support from international agencies, NGOs, and health ministries. These collaborations are essential for sustainable improvements and ensuring that effective neurosurgical practices are adopted and maintained. Join us in this inspiring episode as we explore Dr. Bhatti's efforts to overcome barriers and advance neurosurgical care in LMICs. Whether you're a healthcare professional, a student interested in global health, or passionate about medical equity, Dr. Bhatti's story will offer valuable insights into the complexities of healthcare in the world's most challenging environments. Tune in to learn more about the transformative impact one dedicated individual can have on the global stage of neurosurgery. About the Podcast Guest: Dr. Atta Ul Aleem Bhatti's PlinkedIn Profile: https://www.linkedin.com/in/brainsurgeonattaulaleembhatti/ Email: nsattapk@hotmail.com Dr. Bhatti established Neuro Health Care 4 LMIC, a Geneva-based humanitarian organization aiming to enhance neuro health in developing regions. The mission of NHC4LMIC is to improve and expand neuro-related services in Low- and Middle-Income Countries, aiming to uplift millions of patients facing neuro-related disorders worldwide. This initiative focuses on upgrading hospital infrastructures and training medical staff at regional hospitals. NHC4LMIC upholds a commitment to serve humanity without discrimination based on color, gender, race, religion, or belief. Its efforts include providing care and support to individuals with neuro-related challenges, offering educational and clinical support to global health professionals, and fostering collaborations with governments, health ministries, and international partners. By engaging with various stakeholders, NHC4LMIC strives to create sustainable improvements and significant impacts on neuro health care in LMICs, ensuring access to quality care for all in need. About the Podcast Host: The Neurocareers podcast is brought to you by The Institute of Neuroapproaches (https://www.neuroapproaches.org/) and its founder, Milena Korostenskaja, Ph.D. (Dr. K), a neuroscience educator, research consultant, and career coach for people in neuroscience and neurotechnologies. As a professional coach with a background in the field, Dr. K understands the unique challenges and opportunities job applicants face in this field and can provide personalized coaching and support to help you succeed. Here's what you'll get with one-on-one coaching sessions from Dr. K: Identification and pursuit of career goals Guidance on job search strategies, resume, and cover letter development Neurotech / neuroscience job interview preparation and practice Networking strategies to connect with professionals in the field of neuroscience and neurotechnologies Ongoing support and guidance to help you stay on track and achieve your goals You can always schedule a free neurocareer consultation/coaching session with Dr. K at https://neuroapproaches.as.me/free-neurocareer-consultation Subscribe to our Nerocareers Newsletter to stay on top of all our cool neurocareers news at updates https://www.neuroapproaches.org/neurocareers-news
Advancing Acute MI Care In Densely Populated LMICs: Innovative Standalone Chest Pain Units For Expedited Triage And Timely Management - A Role Model For Global Healthcare Systems
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Introducing Ansh: A Charity Entrepreneurship Incubated Charity, published by Supriya on May 29, 2024 on The Effective Altruism Forum. Executive Summary Ansh, a 1-year-old Charity Entrepreneurship incubated charity, has been delivering an evidence-based, scientifically proven intervention called Kangaroo Care to low birth weight and premature babies in 2 government hospitals in India since January 2024. Ansh estimates that their programs are saving, on average, 4 lives a month per facility and a total of 98 lives per year. The cost of one life saved is approximately $2077 (current costs, not a potential estimate). Ansh is now replicating the programs in two additional hospitals, doubling their impact before the end of this year. According to the World Health Organization (WHO), neonatal conditions[1] are among the top 10 causes of death worldwide[2]. This makes neonatal mortality one of the largest-scale causes of suffering and death today. In 2022, 2.3 million babies died in the first 28 days of life (i.e. the newborn/neonatal period) (World Health Organisation, 2024). Let's compare that number to one of EA's other top cause areas. In 2022, 608,000 people died of malaria, which is about 26.4% lower than neonatal conditions. However, we have a cost-effective, scalable model for preventing malaria-caused death (e.g., with AMF and Malaria Consortium). Unfortunately, there has been no equivalently cost-effective and scalable model for preventing neonatal mortality. In this post, we will introduce Ansh, a 1-year-old Charity Entrepreneurship incubated charity that is working towards building tractable, scalable solutions to neonatal mortality in low- and middle-income countries (LMICs). 81% of neonatal deaths happen in low and Low-Middle SDI countries. The disparities in mortality rates between low and high-resource contexts suggest that most neonatal deaths are preventable. In the sections below, we will first introduce Ansh and its mission statement, share our results thus far, and then introduce some of our plans for how to increase our reach and impact over the next few years. We are very excited to share the work we've done so far with the EA community, and to hear your constructive feedback on how we can make our non-profit even more impactful! I. The Problem and Solution More than half of all neonatal deaths occur within the first three days after birth (Dol J, 2021) and over 75% in the first week of life (WHO, 2024), making it imperative to reach babies as soon after birth as possible. Moreover, low birth weight (LBW)[3] is considered the number one mortality risk factor for children under 5. In fact, according to the Global Burden of Disease, around 89% of all newborn deaths in India (the country where about 22% of all newborn deaths in the world occur) happen to LBW and preterm newborns. Further, 81% of all newborn deaths occur in Low or Low-Middle SDI countries (Global Burden of Disease Collaborative Network, 2019). Hence, the most effective path toward reducing neonatal mortality rates globally lies in developing interventions aimed at helping LBW babies during their first week of life in LMIC contexts. Thankfully, such an intervention exists: Kangaroo Care. Kangaroo Care (KC) needs neither fancy equipment nor expensive technology - the methods of KC are both simple and highly effective, especially for LBW newborns. KC requires early, continuous, and prolonged skin-to-skin contact between the mother (or another caregiver) and the baby for about 8 hours of contact per day-paired with exclusive breastfeeding and close monitoring of the baby. This is often assisted with a cloth binder, between the LBW newborn and caregiver (preferably the mother), to allow for mobility. Estimates from the 2016 Cochrane review suggest that KC can reduce LBW neonates' chance of (i) ...
In both high- and low-income countries, taxes are the main source of government revenue. They fund roads, schools, and social programmes. But the average tax-to- GDP ratio in a developing country is less than half of the ratio in the global north. Oyebola Okunogbe tells Tim Phillips about the innovative ways that many LMICs are using to collect the taxes that will finance their growth.
Inequality is high in many LMICs, and progressive taxation is a policy tool that would reduce it. But would a personal income tax or a consumption tax redistribute in the same way as in a high-income country? Lucie Gadenne of Queen Mary University of London and the IFS tells Tim Phillips that one of these taxes may be less progressive, and one may be more progressive, than we expect.
Access 2 Perspectives – Conversations. All about Open Science Communication
Rosemarie Bernabe is a Professor of research ethics and research integrity at the University of Oslo; and an adjunct professor of medical research ethics at the University of South-Eastern Norway. With her expertise and leadership, she is dedicated to advancing research ethics and integrity in various contexts and serves as the project coordinator of several initiatives, including: Responsible Open Science in Europe project (ROSiE) Beyond Bad Apples: Towards a Behavioural and Evidence-Based Approach to Promote Research Ethics and Research Integrity in Europe (BEYOND) The Equitable, Inclusive, and Human-Centered XR Project (XR4Human) Improving Post-Trial Access in Africa (AccessAfrica) Strengthening Clinical Trial Regulatory and Ethical Review Oversight in East Africa (AccessAfrica2; https://cordis.europa.eu/project/id/101103296) Developing national and global agendas for the ethics of post-trial arrangements in LMICs during pandemics/epidemics (Pandemic Ethics) Ethics in Research and Clinical Practice (ETHIMED) Rosemarie is our guest on this podcast episode and she joins Jo to discuss her involvement in the ROSiE project, her background in research ethics and integrity, the complexities of open science, and the importance of citizen science. They emphasized the broad applicability of citizen science while recognizing the need for careful consideration and equitable inclusion of diverse stakeholders in research projects. Find more podcast episodes here: https://access2perspectives.pubpub.org/podcast Host: Dr Jo Havemann, ORCID iD 0000-0002-6157-1494 Editing: Ebuka Ezeike Music: Alex Lustig, produced by Kitty Kat License: Attribution 4.0 International (CC BY 4.0) At Access 2 Perspectives, we guide you in your complete research workflow toward state-of-the-art research practices and in full compliance with funding and publishing requirements. Leverage your research projects to higher efficiency and increased collaboration opportunities while fostering your explorative spirit and joy. Website: https://access2perspectives.pubpub.org --- Send in a voice message: https://podcasters.spotify.com/pod/show/access2perspectives/message
As Women's History Month comes to its final week, today's podcast sees web editor Nicole Raleigh in conversation with Debra Weiss, COO of the Bill & Melinda Gates Medical Research Institute (Gates MRI), discussing her role as a female leader in the leader and the non-profit organisation's work in developing novel biomedical interventions and lessening the burden of disease in LMICs.
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Posts from 2023 you thought were valuable (and underrated), published by Lizka on March 22, 2024 on The Effective Altruism Forum. I'm sharing: a list of posts that were marked as "most valuable" by the most people (who marked posts as "most valuable" in Forum Wrapped 2023), and a list of posts that were most underrated by karma relative to the number of "most valuable" votes. These lists are not objective or "true" collections of the most valuable and underrated posts from 2023. Relatively few people marked posts as "most valuable," and I imagine that those who did, didn't do it very carefully or comprehensively. And there are various factors that would bias the results (like the fact that we ordered posts by upvotes and karma on the "Wrapped" page, people probably remember more recent posts more, etc.). Consider commenting if there are other posts you would like to highlight! This post is almost identical to last year's post: Posts from 2022 you thought were valuable (or underrated). Which posts did the most Forum users think were "most valuable"? Note that we ordered posts in "Wrapped" by your own votes, followed by karma score, meaning higher-karma posts probably got more "most valuable" votes. "Most valuable" count Author(s)[1] Title 28 @Peter Wildeford EA is three radical ideas I want to protect 28 @Ariel Simnegar Open Phil Should Allocate Most Neartermist Funding to Animal Welfare 24 @AGB 10 years of Earning to Give 14 @Bob Fischer Rethink Priorities' Welfare Range Estimates 13 @Rockwell On Living Without Idols 12 @Nick Whitaker The EA community does not own its donors' money 11 @Jakub Stencel EA's success no one cares about 11 @tmychow, @basil.halperin , @J. Zachary Mazlish AGI and the EMH: markets are not expecting aligned or unaligned AI in the next 30 years 10 @Luke Freeman We can all help solve funding constraints. What stops us? 10 @zdgroff How Long Do Policy Changes Matter? New Paper 9 @kyle_fish Net global welfare may be negative and declining 9 @ConcernedEAs Doing EA Better 7 @Lucretia Why I Spoke to TIME Magazine, and My Experience as a Female AI Researcher in Silicon Valley 7 @Michelle_Hutchinson Why I love effective altruism 7 @JamesSnowden Why I don't agree with HLI's estimate of household spillovers from therapy 7 @Ren Ryba Reminding myself just how awful pain can get (plus, an experiment on myself) 7 @Amy Labenz EA is good, actually 7 @Ben_West Third Wave Effective Altruism 6 @Ben Pace Sharing Information About Nonlinear 6 @Zachary Robinson EV updates: FTX settlement and the future of EV 6 @NunoSempere My highly personal skepticism braindump on existential risk from artificial intelligence. 6 @leopold Nobody's on the ball on AGI alignment 6 @saulius Why I No Longer Prioritize Wild Animal Welfare 6 @Elika Advice on communicating in and around the biosecurity policy community 6 @Derek Shiller, @Bernardo Baron, @Chase Carter, @Agustín Covarrubias, @Marcus_A_Davis, @MichaelDickens, @Laura Duffy, @Peter Wildeford Rethink Priorities' Cross-Cause Cost-Effectiveness Model: Introduction and Overview 6 @Karthik Tadepalli What do we really know about growth in LMICs? (Part 1: sectoral transformation) 6 @Nora Belrose AI Pause Will Likely Backfire Which were most underrated by karma? I looked at the number of people who had marked something as "most valuable," and then divided by [karma score]^1.5. (This is what I did last year, too.[2]) We got more ratings this year, so my cutoff was at least three votes this year (vs. two last year). "Most valuable" count Author(s) Title 3 @RobBensinger er The basic reasons I expect AGI ruin 3 @Zach Stein-Perlman AI policy ideas: Reading list 3 @JoelMcGuire, @Samuel Dupret, @Ryan Dwyer, @MichaelPlant, @mklapow, @Happier Lives Institute Talking through depression: The cost-effectiveness of psychotherapy in LMICs, revised and...
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: EA Philippines Needs Your Help!, published by zianbee on March 21, 2024 on The Effective Altruism Forum. Summary In light of the current funding constraints in the EA community, EA Philippines has had a difficult time securing the means to continue its usual operations for this year. This can mean less support for growing a highly engaged community of Filipino EAs. We are seeking USD 43,000 as our preferred funding for 1 year of operations and a 2-month buffer. The minimum amount of funding we are seeking would be USD 28,000 for 1 year of operations. This will help us with our staffing as well as being able to produce valuable projects (e.g. introductory fellowship for professionals, career planning program, EA groups resilience building, leadership retreat, etc.) and guidance to encourage, support, and excite people in their pursuit of doing good. You can help our community with a donation through our Manifund post. :) Outline of this post Why donate to EA Philippines? What are EA Philippines' goals and how do we aim to achieve them? Who is on your team? What other funding is EA Philippines applying to? What are the most likely causes and outcomes if this project fails? (premortem) Concluding thoughts Why Donate To EA Philippines Track record EA Philippines was founded in November 2018 by Kate Lupango, Nastassja "Tanya" Quijano, and Brian Tan. They made great progress in growing our community in 2019 and 2020, and the three of them received a community building grant (CBG) from CEA to work on growing the community from late 2020 until the end of 2021. Since then, EA PH has become one of the largest and most active groups among those in LMICs and Southeast Asia. The group has received grants from the EA Infrastructure Fund to fund us from 2022 2023, with Elmerei Cuevas serving as our Executive Director during this period. Since being founded, EA PH has: helped start three student chapters in the top three local universities organized a successful EAGxPhilippines conference being the 3rd most likely to be recommended among EAGs and EAGxs had over 300 different people complete an introductory EA fellowship of ours or our student chapters) had over 80 active members join EAG/EAGx conferences around the world including EAGxPhilippines (which also garnered 40 first-timer Filipinos) had 2 retreats for student organizer leadership and career planning members who have started promising EA projects (with a total of at least 14 EA-aligned organizations in the Philippines), such as the ones in the next section. However, EAIF's last grant to EA PH was only for 6 months (from April to September 2023), and they decided to just give the then team a 2-month exit grant rather than a renewal grant at the end of it. Due to the lack of secured funding, as well as wanting to rethink and redefine EA Philippines's strategic priorities, EA PH's board decided that it would be in the organization's best interest to explore new leadership to pursue its refined direction. The new leadership would then have to fundraise for their salaries and EA PH's operational expenses. The board led a public hiring round, and this led to them hiring us (Sam and Zian)[1] in late December to serve as interim co-directors of EA PH and to fundraise for EA PH. EA-Aligned Organizations in the Philippines: Case Studies Over the last few years, several EA PH members have started cause-specific organizations, projects, and initiatives. Below we highlight some Animal Empathy Philippines Animal Empathy Philippines was founded by Kate Lupango (co-founder of EA Philippines), Ging Geronimo (former volunteer at EA Philippines), and Janaisa Baril (former Communications and Events Associate of EA Philippines). The organization started with community building and now focuses on bringing farmed animal issues in the Philippines ...
There are three kinds of memory that all work together to shape your reality. Neuroscientist André Fenton explains. Neuroscientist André Fenton discusses the intricate relationship between memory, perception, and reality, shedding light on the complexity of human cognition. Fenton believes memories are not fixed but are continually modified by our experiences and mindsets. This, in his mind, underscores the importance of humility and empathy in acknowledging the fallibility of our memories and the need to consider different perspectives in our quest for truth. We created this video in partnership with Unlikely Collaborators. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Go Deeper with Big Think: ►Become a Big Think Member Get exclusive access to full interviews, early access to new releases, Big Think merch and more ►Get Big Think+ for Business Guide, inspire and accelerate leaders at all levels of your company with the biggest minds in business -------------------------------------------------------------------------------------------------------------------------------------------------------------------- About André Fenton: André Fenton, professor of neural science at New York University, investigates the molecular, neural, behavioral, and computational aspects of memory. He studies how brains store experiences as memories, how they learn to learn, and how knowing activates relevant information without activating what is irrelevant. His investigations and understanding integrates across levels of biological organization, his research uses genetic, molecular, electrophysiological, imaging, behavioral, engineering, and theoretical methods. This computational psychiatry research is helping to elucidate and understand mental dysfunction in diverse conditions like schizophrenia, autism, and depression. André founded Bio-Signal Group Corp., which commercialized an FDA-approved portable, wireless, and easy-to-use platform for recording EEGs in novel medical applications. André implemented a CPAP-Oxygen helmet treatment for COVID-19 in Nigeria and other LMICs and founded Med2.0 to use information technology for the patient-centric coordination of behavioral health services that is desperately needed to equitably deliver care for mental health. André hosts “The Data Set” a new web series on how data and analytics are being used to solve some of humanity's biggest problems. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Get Smarter Faster, With Daily Episodes From The Worlds Biggest Thinkers. Follow Big Think Leave A 5 Star Review Learn more about your ad choices. Visit megaphone.fm/adchoices
Interviewee: Dr. Rhonda Moore Interviewer: Dr. Lisa Meeks Description: In this episode of the Docs with Disabilities podcast, Dr. Rhonda Moore, a medical anthropologist and program officer at the NIH shares her journey grappling with chronic pain, autism, and attention deficit disorder, all amidst the backdrop of the COVID-19 pandemic. She very candidly shares insight into her journey as a kid, from growing up with a brother with autism, to taking theater classes as a means to derive and learn confidence. Through her personal narrative, Dr. Moore shed light on the challenges faced by black women in navigating the healthcare system, highlighting the importance of representation and support for individuals with disabilities. The conversation was marked by a deep sense of empathy and understanding, creating a safe and empowering space for Dr. Moore to share her experiences. Together, Drs. Meeks and Moore delve into the complexities of disability, chronic pain, and the pursuit of equity and inclusion in the medical field. Dr. Moore emphasizes the significance of diverse narratives and the power of self-acceptance and support. Bio: Rhonda Moore (she/her) is an Autistic Medical Anthropologist and Program Officer for the Genetic Counseling Resource at the National Institutes of Health (NIH) All of Us Research Program. Her work combines anthropological methods, ethics, data science and clinical medicine to better understand patient experiences and health disparities across culturally and medically diverse care settings (cancer, pain, palliative care), community engaged research, and the differential and ethical impacts of new and emerging technologies on health outcomes in diverse and vulnerable populations. She is writer/editor of the following books: Climate Change and Heath Equity (forthcoming, Springer 2023), the Handbook of Pain and Palliative Care (Springer, 2012, 2nd edition, Springer, 2019), Biobehavioral Approaches to Pain (Springer 2009) and Cancer Culture and Communication (Springer 2004). Prior to serving at the All of Us Research Program, she was a Program Officer in Global Mental Health at the US NIMH. Her program in Global Mental Health focused on social determinants of health, ethics of new and emerging technologies, citizen science, climate change and mental health, and reciprocal innovation. She was also the program lead for the digital global mental health technology program in low- and middle-income countries (LMICs). She received her PhD in Cultural Anthropology from Stanford University, followed by post-doctoral fellowships and training in Behavioral Science (Stanford Medical School), Epidemiology (University of Texas MD Anderson Cancer Center) and Hospice/Palliative Care (St. Austell, Cornwall UK). Transcript Keywords: medical anthropology, actually autistic, community engaged research, disability in medicine, mental health, health equity, ADHD, AuDHD, neurodiversity paradigm, neurodivergence, chronic pain, EDS, Ehlers Danlos, Fibromyalgia. Produced by: Pranati Movva, Jasmine Lopez, R.E. Natowicz, Jacob Feeman and Dr. Lisa Meeks. Audio editor: Jacob Feeman Digital Media: Katie Sullivan Resources: National Institute of Mental Health. (2023). Autism Spectrum Disorder. National Institutes of Health. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd#:~:text=Autism%20Spectrum%20Disorder-,Overview,first%202%20years%20of%20life. Autism Society (2023). https://autismsociety.org/
The process that economists call labour market dynamics lets workers improve their lives by switching jobs. But do our assumptions about it apply in LMICs? Because if the dynamics are different, then maybe the policies should be different as well. Kevin Donovan and Todd Schoellman tell Tim Phillips about the surprising evidence they discovered about labour market flows, and why it might lead us to rethink job creation policy in LMICs.
Our latest episode is with Joanne Muchai Murunga, the Chief Operating Officer at Kentaste, a leading producer of coconut products in Kenya. Kentaste supports economic development by connecting rural farmers to an international supply chain. Moreover, Kentaste has a focus on women's empowerment, with women representing over 50% of their senior management. Kentaste is a recent awardee through the USAID Feed the Future Food Loss and Waste Partnership Facility. The FLWPartnership Facility provides catalytic co-investment to MSMEs in LMICs to scale innovations that reduce FLW with a focus on nutritious value chains. In this episode, Joanne and I discuss how the coconut value chain has been impacted by climate change, how Kentaste is working to reduce FLW, and how Kentaste is empowering women and improving the capacity of smallholder farmers.Over one-third of the world's food is lost or wasted, undermining efforts to end hunger and malnutrition while contributing 8 to 10 percent of global greenhouse gas emissions. In low- and middle-income countries, over 40 percent of food loss occurs before a crop even makes it to market, whether due to inadequate storage, pests or microbes, spoilage, spillage in transport or otherwise. Eliminating food loss and waste (FLW) would provide enough food to feed two billion people, as well as reduce greenhouse gas emissions. Addressing FLW is critical to global food security, nutrition and climate change mitigation, with the private sector engagement and women's empowerment playing an important role in these efforts. In order to raise awareness, exchange information and share success stories, USAID's Food Loss and Waste Community of Practice created the USAID Kitchen Sink Food Loss and Waste Podcast. Our goal is to share monthly, bite-sized episodes that highlight the approaches USAID and the U.S. government are taking to address FLW. We hope these episodes provide a valuable resource for those interested in why we should care about FLW and how we can reduce it. You can subscribe to receive the latest episodes of USAID's Kitchen Sink and listen to our episodes on the platform of your choice: Apple, Spotify, and more! Video recordings of the episodes are available on YouTube. Check in every month for new episodes as global experts discuss a range of issues about FLW and methane emissions - from the critical role of youth to the staggering economic costs - and learn about specific ways that USAID is tackling FLW around the world. If you have an idea for an episode topic you'd like to see featured or if you would like to participate in an episode of USAID's Kitchen Sink, please reach out to Nika Larian (nlarian@usaid.gov).There's no time to waste!
The percent surface area burn for which half of patients survive, known as lethal area 50, or LA50 depends on where in the world the injury occurs. Calling all surgeons and trainees with an interest in providing more equitable delivery of global injury care - Join our Burn Surgery team as we welcome Dr. Manish Yadav, Plastic and Burn Surgeon at Kirtipur Hospital in Kathmandu, Nepal to discuss several recent challenging cases. We'll discuss the global burden of burn injuries, how emergency burn care systems reduce preventable morbidity and mortality, innovations in resuscitation of burn shock, use of checklists for critical care and safe early excision, and application of palliative care in different cultural contexts. (Co-hosts: Dr. Barclay Stewart, Burn and Trauma Surgeon at Harborview Medical Center and Paul Herman, UWMC/HMC Surgery Resident) Hosts: (affiliation and SM handles) 1. Manish Yadav, Kirtipur Hospital, Nepal 2. Barclay Stewart, Harborview Medical Center 3. Paul Herman, UW/Harborview General Surgery Resident, @paul_herm 4. Tam Pham, Harborview Medical Center (Editor) Learning Objectives 1. Describe the global epidemiology of burn injury, disparities in burn injury and care, and highlight efforts to improve burn care in low and middle-income countries 2. Discuss two cases at a burn center in Kirtipur, Nepal, highlighting challenges in burn care in LMICs and innovations to address these challenges and provide high level care a. Highlight enteral resuscitation as an innovative strategy with advantages for treating burn shock in low resource settings b. Discuss the key burn concept of early excision and steps to ensure safe application in low resource settings 1. References a. Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank. b. Stewart BT, Nsaful K, Allorto N, Man Rai S. Burn Care in Low-Resource and Austere Settings. Surg Clin North Am. 2023 Jun;103(3):551-563. doi: 10.1016/j.suc.2023.01.014. Epub 2023 Apr 4. PMID: 37149390. https://pubmed.ncbi.nlm.nih.gov/37149390/ c. Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744. https://pubmed.ncbi.nlm.nih.gov/29475744/ d. Hebron C, Mehta K, Stewart B, Price P, Potokar T. Implementation of the World Health Organization Global Burn Registry: Lessons Learned. Annals of Global Health. 2022; 88(1): 34, 1–10. DOI: https://doi. Org/10.5334/aogh.3669 https://pubmed.ncbi.nlm.nih.gov/35646613/ e. Jordan KC, Di Gennaro JL, von Saint André-von Arnim A and Stewart BT (2022) Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front. Pediatr. 10:954995. doi: 10.3389/fped.2022.954995 https://pubmed.ncbi.nlm.nih.gov/35928690/ f. Mehta K, Thrikutam N, Hoyte-Williams PE, Falk H, Nakarmi K, Stewart B. Epidemiology and Outcomes of Cooking- and Cookstove-Related Burn Injuries: A World Health Organization Global Burn Registry Report. J Burn Care Res. 2023 May 2;44(3):508-516. doi: 10.1093/jbcr/irab166. PMID: 34850021; PMCID: PMC10413420. https://pubmed.ncbi.nlm.nih.gov/34850021/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here https://behindtheknife.org/listen/
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Why EA should (probably) fund ceramic water filters, published by Bernardo Baron on January 3, 2024 on The Effective Altruism Forum. Epistemic status: after researching for more than 80 hours each, we are moderately certain that ceramic filters (CFs) can be more cost-effective than chlorination to prevent waterborne diseases at least in some - and possibly in many - LMICs. We are less certain of the real size of the effects from CFs, and how some factors like household sizes affect the final cost-effectiveness. At least 1.7 billion people globally used drinking water sources contaminated with feces in 2022, leading to significant health risks from waterborne enteric infections. According to the Global Burden of Disease (GBD) 2019 study, more than 2.5% of total DALYs lost that year were linked to unsafe water consumption - and there is some evidence that this burden can be even bigger. This makes the improvement of access to clean water a particularly pressing problem in the Global Health and Development area. As a contribution to target this problem, we have put together a report on ceramic water filters as a potential intervention to improve access to safe water in low and medium income countries. This was written during our time as research fellows at Charity Entrepreneurship's Research Training Program (Fall 2023). In this post, we summarize the main findings of the report. Nonetheless, we invite people interested in the subject to check out the full report, which provides much more detail into each topic we outline here. Key takeaways: There are several (controlled, peer-reviewed) studies that link the distribution of ceramic filters to less frequent episodes of diarrhea in LMICs. Those studies have been systematically reviewed and graded low to medium quality. Existing evidence supports the hypothesis that ceramic filters are even more effective than chlorination to reduce diarrhea episodes. However, percentage reductions here should be taken with a grain of salt due to lack of masking and self-report and publication biases. Despite limitations in current evidence, we are cautiously optimistic that ceramic filters can be more cost-effective than chlorination, especially in countries where diarrheal diseases are primarily caused by bacteria and protozoa (and not by viruses). Average household sizes can also play a role, but we are less certain on the extent to which this is true. We provide a Geographic Weighted Factor Model and a country-specific back-of-the envelope analysis of the cost-effectiveness for a hypothetical charity that wants to distribute free ceramic filters in LMICs. Our central scenario for the cost-effectiveness of the intervention in the top prioritized country (Nigeria) is $8.47 U.S. dollars per DALY-averted. We ultimately recommend that EA donors and meta-organizations should invest at least some resources in the distribution of ceramic filters, either by bringing up new charities in this area, or by supporting existing, non-EA organizations that already have lots of expertise in how to manufacture, distribute and monitor the usage of the filters. Why ceramic filters? There are plenty of methods to provide access to safe(r) water in very low-resource settings. Each one of those has some pros and cons, but ceramic filters stand out for being cheap to make, easy to install and operate, effective at improving health, and durable (they are said to last for a minimum of 2 years). In short, a ceramic filter is a combination of a porous ceramic element and a recipient for the filtered water (usually made of plastic). Water is manually put into the ceramic part and flows through its pores due to gravity. Since pores are very small, they let water pass, but physically block bigger particles - including bacteria, protozoa and sediments - from passing....
What is the fairest and most efficient way to improve not just access to education, but outcomes too? Should policymakers focus on a broader markets and systems approach to education reform? Emiliana Vegas and Asim Khwaja tell Tim Phillips about what a markets and systems approach to delivering education reform is, and what it has already achieved in Pakistan and Chile.
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: CE-incubated tobacco & NCD policy Charity: updates, funding gap, and future plans for Concentric Policies, published by Yelnats T.J. on December 29, 2023 on The Effective Altruism Forum. Executive Summary Tobacco is a massive global issue: 8 million annual deaths and 230 million annual DALYS (15% and 9% of global totals respectively). There are evidence-based policies - outlined by the WHO's MPOWER framework - that countries can adopt to reduce tobacco use. Policy advocacy for implementing MPOWER measures in neglected countries can avert DALYs with cost-effectiveness matching GiveWell's top charities. Since starting in mid-September, Concentric Policies has engaged with seven ministries of health, met with four, and received a partnership request from one to develop a multisectoral plan for noncommunicable diseases. Closing our Year 1 funding gap ($21,000) is critical for building the necessary capacity to support our government advocacy plans in 2024. About Us Concentric Policies is a nonprofit focused on preventing and controlling noncommunicable diseases. We support the adoption of evidence-based health policies in countries underserved by large NGOs and the international community. Through collaboration with governments, civil society, and citizens, we aim to reduce the unhealthy consumption of tobacco, alcohol, sodium, and sugar. Concentric Policies provides free assistance by engaging stakeholders, strengthening the evidence base through research, and offering technical assistance throughout the policy process. Concentric Policies was launched through Charity Entrepreneurship, a London-based incubator that turns well-researched ideas into high-impact organizations. Charity Entrepreneurship has helped launch over 30 charities that are now reaching over 20 million people annually with their interventions. Problem Annual deaths from tobacco were 6 million in 2013 and rose to 8 million before the pandemic. Today, more people are killed annually by tobacco usage than malaria, HIV, and neonatal deaths combined… twice over.[1] In addition, tobacco usage increases healthcare expenditures, decreases productivity, exacerbates inequality, degrades the environment, and contributes to child labor. This EA Forum post from World No Tobacco Day covers these harms in more detail. Solution The WHO's MPOWER framework provides cost-effective demand-reduction measures to help countries reduce tobacco consumption. Since MPOWER was introduced globally 15 years ago, an estimated 300 million less people are smoking than might have been if smoking prevalence had stayed the same.[2] Tobacco taxation is the most effective (and cost-effective) intervention for reducing tobacco consumption, yet it is the most neglected intervention.[3] Tobacco has an average price elasticity in LMICs of around -0.5, meaning that for a 10% increase in the retail price of tobacco, consumption decreases by 5%.[4] Opportunity The number of countries that have adopted at least one MPOWER measure at the highest level of achievement has grown from 44 in 2008 to 151 in 2022. However, only a handful of nations have full compliance with MPOWER guidelines and 44 countries remain unprotected by any of the MPOWER measures.[5] Despite nearly every country signing the WHO's treaty on tobacco, only 13 nations outside of Europe meet the WHO's recommended minimum of taxing tobacco at 75% of retail value. Since starting work in September, we have learned and reaffirmed the following: Some governments are not aware of the potential ROI from comprehensive implementation of the MPOWER framework Consolidated funding in the tobacco control space has led to only a dozen or so of the highest-burden countries receiving the majority of resources Many smaller countries do not receive any attention from major tobacco control organizat...
It's heartbreaking when a drought or flood causes crops in a region to fail, and children to go hungry. Kids can starve to death or endure social, economic, and health problems well into adulthood due to malnutrition. But what if there was a way to predict when these weather disasters are likely to happen, so governments, aid organizations, and residents could prepare? A team at the University of Chicago says people could already do this, using one of the best-known weather patterns: the El Niño Southern Oscillation or ENSO. “ENSO has destabilizing effects on agriculture, economic production, and social stability throughout areas of the global tropics that are teleconnected to it. It has been linked to human health outcomes directly through its effects on vector- and water-borne infectious diseases, as well as indirectly by decreasing agricultural yields and increasing food insecurity and the likelihood of conflict,” they write in a Nature Communications article. It's possible to predict this Pacific Ocean-based pattern, says Dr. Amir Jina, an Assistant Professor at the University of Chicago's Harris School of Public Policy and a Senior Fellow at the Energy Policy Institute of Chicago. In this episode of One World, One Health, listen as Dr. Jina explains how people could use predictions about El Niño years to get ahead of some of the forces that make children go hungry.
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: You can have an hour of my time, to work on your biggest problem, for free., published by John Salter on December 11, 2023 on The Effective Altruism Forum. Who the fuck are you? I run EA's biggest volunteer organisation. We train psychology graduate volunteers to treat mental illnesses, especially in LMICs. To lead by example, I don't take a salary despite working >50Hs per week. To pay the bills, I coach rich people's children to be happier and more productive. While it funds my living expenses, it's not very impactful. I'm hoping to start serving EAs to fix that. EA stuff I've done Authored or co-authored ~$350 000 of successful grant applications for EA charities Grew my org from 1 person to ~60 FTEs in the first 3 months post-launch Now treating one case of depression / anxiety / phobia for ~$50 on the margin (although, just ~ 1000 clients a year right now; planning to treat 13 000 for ~$20 on the margin by 2025) Trained coaches who've helped ~100 EAs overcome social anxiety, depression, procrastination and other barriers to being happily productive. I played on hard difficulty No relevant connections Cause area for which EAs give few shits Bottom 10% of familial income between age 13 and 21 Shoestring budget to start charity Not extraordinarily smart or hardworking Lost three of the prior five years, before starting the charity, to depression I raise this because it's likely that disproportionate amount of my success is due to my decision-making, as opposed to my circumstances or character, and is thus replicable. People I think could be a good fit Early career EAs, especially entrepreneurs and people with leadership ambitions University students struggling to get the most out of their time People who know they are being held back by psychological issues (e.g. fear / risk aversion / procrastination / anxiety / depression / lack of discipline / bad habits) Anyone interested in entering mental health as a cause area How the hour would work Tell me what you'd like to make progress on and we work on it directly via Zoom. Based on the value provided, decide if you want to continue as a paying client. If so, pay by the session (no contracts etc). If not, no hard feels. ~80% of people who chat with me for an hour decide to hire me on a session by session basis thereafter, sticking around for ~9 months on average. How much would you charge afterwards? Full-time EA coaches charge ~$300 per hour I'm going to start out at $80 per hour. I'd only raise it for new clients thereafter. Relevant Links Website for my charity: https://www.overcome.org.uk/ LinkedIn: https://www.linkedin.com/in/john-salter-b685181ba/ To book the free hour https://calendar.app.google/N1iBRnPHEBis8NXy5 If no time works, but you're really keen to give it a go, dm me and I'll see what I can do. Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: PEPFAR, one of the most life-saving global health programs, is at risk, published by salonium on December 10, 2023 on The Effective Altruism Forum. Summary: International funding and coordination to tackle HIV/AIDS and support health systems in lower- and middle-income countries, is at risk of not being renewed by US Congress, due to demands that it should be linked to new abortion-related restrictions in recipient countries. This program is estimated to have saved over 20 million lives since it was launched by the Bush Administration in 2003, and even now averts over a million HIV/AIDS deaths annually. Since it has also helped support health systems in LMICs, and tackle malaria and tuberculosis, its impact is likely greater than this. In my view this is the most important risk to global health we face today, and I think it isn't getting enough attention. If anyone is interested in research, writing or advocacy on this issue, please do so. If you are interested in jointly working on this, or if you already know of ongoing efforts, please comment below or get in touch. My email: saloni@ourworldindata.org Relevant background reading: The U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment in history by any single country to address a disease, is estimated to have averted 25 million deaths from AIDS and enabled 5.5 million babies to be born free from HIV infection over the past 20 years.1 It has provided more than $100 billion in funding for HIV prevention, care, and treatment internationally, supporting 55 low- and middle-income countries that are collectively home to 78% of all people living with HIV. Together with the Global Fund to Fight AIDS, Tuberculosis, and Malaria, PEPFAR has transformed AIDS in low-income countries, especially those in Africa, from a death sentence to a readily treatable chronic disease by deploying programs that provide antiretroviral treatment even in the most remote villages. Right from the start, PEPFAR was more than just an AIDS program; it partnered with countries in Africa to support the development of health systems for essential community services, trained thousands of health care workers, fostered security and stability in affected countries, and engendered hope amid a devastating global AIDS crisis. Karim et al. (2023) Why is it at risk? Republican colleagues [...] accuse the Biden administration of using PEPFAR to fund abortion providers overseas and House Democrats who refuse to reinstate Trump administration rules that prohibited foreign aid going to groups that provide or counsel on abortions. Discussions about a compromise that would extend the program for more than one year but less than five, with language stressing the existing ban on federal money directly paying for abortions, have collapsed. Now, the best hope for re-upping the $7 billion annual program is a government spending process beset by delays and divisions and slated to drag into January and February with no guarantee of success. PEPFAR can hobble along without reauthorization unless there's a prolonged government shutdown. But its backers say that without a long-term U.S. commitment, groups fighting HIV and AIDS around the world will struggle to hire staff and launch long-term projects. Complicating any hope for compromise is the 2024 election. Congress passed two short-term funding patches that expire in January and February. That eliminated the possibility of the typical end-of-year omnibus bill that many on both sides of the PEPFAR fight saw as the best vehicle for its reauthorization and kicked the fight into an election year when compromise - particularly on a contentious issue like abortion - will be more challenging. Politico [7 Dec. 2023] The lawmakers stalling the reauthorization are seeking to impose on PEPFAR a prohibition...
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: What do we really know about growth in LMICs? (Part 1: sectoral transformation), published by Karthik Tadepalli on December 3, 2023 on The Effective Altruism Forum. To EAs, "development economics" evokes the image of RCTs on psychotherapy or deworming. That is, after all, the closest interaction between EA and development economists. However, this characterization has prompted some pushback, in the form of the argument that all global health interventions pale in comparison to the Holy Grail: increasing economic growth in poor countries. After all, growth increases basically every measure of wellbeing on a far larger scale than any charity intervention, so it's obviously more important than any micro-intervention. Even a tiny chance of boosting growth in a large developing country will have massive expected value, more than all the GiveWell charities you can fund. The argument is compelling[1] and well-received - so why haven't "growth interventions" gone anywhere? I think the EA understanding of growth is just too abstract to yield really useful interventions that EA organizations could lobby for or implement directly. We need specific interventions to evaluate, and "lobby for general economic liberalization" won't cut it. The good news is that a large and active group of "macro-development" economists have been enhancing our understanding of growth in developing countries. They (mostly) don't run RCTs, but they still have credible research designs that can tell us important things about the causes and constraints of growth. In this series of posts, I want to lay out some stylized facts about growth in developing countries. These are claims which are backed up by the best research on this topic, and which tell us something useful about the causes and constraints of growth in developing countries. My hope is not to pitch any specific interventions, but rather to give you the lay of the land, on which you can build the case for specific interventions. The way I hope for you to read this series is with an entrepreneurial eye. "This summary suggests that X is a key bottleneck to growth; I suspect Y could help solve X at scale. I should look more into Y as a potential intervention." or "This summary says that X process helps with growth; let me brainstorm ways we could accelerate X." As part of that, an important caveat is that I will not cover topics where I believe there's no prospect for an effective intervention. For example, a large body of work emphasizes the importance of good institutions for development; I don't believe that topic will yield any promising interventions, so I won't cover it. Sectoral Transformation In this post, I will start with the fundamental path of growth: sectoral transformation. Every country that has ever gotten rich has had the following transformation: first, most of the population works in agriculture. Then, people start to move from agriculture to manufacturing, coinciding with a large increase in the country's growth rate. Finally, people move out of manufacturing and into services, coinciding with the country's growth slowing down as it matures into a rich economy. This is the process of sectoral transformation, and it is basically a universal truth of development. So it's no surprise that a big focus of macro-development is how to catalyze sectoral transformation in developing countries. 1. Agricultural productivity growth can drive sectoral transformation... or hurt it. Every economy starts out as agrarian, because everyone needs food to survive. Agricultural productivity growth allows economies to produce enough food with fewer people, so that most people can move out of agriculture. This is why the US can produce more food per person than India, even though 2% of the US workforce in agriculture compared to 45% of India's workfor...
In this week's Everything Epigenetics episode, I speak with Dr. Toinét Cronjé about what epigenetics can do for the field of epidemiology. Epidemiology is the study of the distribution and determinants of health-related states or events in populations and the application of this study to control health problems. By studying epigenetics and epidemiology in tandem, Dr. Cronjé seeks to understand patterns of diseases in populations, identify risk factors, and develop strategies to prevent or control health issues.More specifically, Dr. Conjé researches epigenetics in understudied populations including the association between DNA methylation and noncommunicable diseases and how DNA methylation clocks perform in these groups.By making the most of the data we have available at the moment (from high-income countries) and of opportunities provided to researchers like herself to work at leading universities like the University of Copenhagen, she hopes that we will get closer to finding the tools to ease the burden on the research communities in low and middle income countries (LMICs). If we can truly start to investigate data from LMICs can you imagine the richness of the information we will unearth?Many of the questions that we are struggling with will be easier to address if we have more diversity in research data sets (e.g. genetics, cultural, dietary, and environmental), as rich (diverse) data sets allow researchers to see more angles to approach their questions from that they might not have been able to see before.Dr. Cronjé's hope is to develop blood-based screening tools for a disease. Only then, when disease screening is accessible to all (e.g. through a blood test instead of intensive and invasive procedures) will we actually know what proportion of populations around the world actually suffer from diseases like these.Using that as a starting block we can finally proceed to addressing stigma and improving care.In this episode of Everything Epigenetics, you'll learn about: Toinét's unique backgroundOMIC epidemiologyWhat epigenetics does for epidemiology The importance of biobanks What we can tell you about yourself when investigating the epigenome using an archived sample from a biobankWhy it's important to research understudied populations What we can learn from low and middle income countriesWhat the research community is missing out on by not studying these groupsNoncommunicable diseases (NCDs)The association between DNA methylation and NCDsThe urban-rural divide which provides a unique opportunity to investigate the effect of the combined presence of multiple forms of environmental exposure on DNAm and the related increase in disease riskToinét's study on “Comparison of DNA methylation clocks in black South African men”Epigenetic age acceleration in the cardiometabolic disease among migrant and non-migrant African populationsAn editorial Toinét wrote in late November 2021 titled “Could unlocking methylation-based blood cell counts revolutionize epidemiology?”The current challenges in epigenetics that should be addressed in future workToinét's next epigenetic-based project Support the showThank you for joining us at the Everything Epigenetics Podcast and remember you have control over your Epigenetics, so tune in next time to learn more about how.
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Road safety: Landscape of the problem and routes to effective policy advocacy, published by Rethink Priorities on November 29, 2023 on The Effective Altruism Forum. Editorial note This report was produced by Rethink Priorities between May and July 2023. The project was commissioned and supported by Open Philanthropy, which does not necessarily endorse our conclusions. This report builds on a short investigation conducted by Open Philanthropy in 2022, which found that previous philanthropic work on road safety looked potentially cost-effective. This report extends that analysis through in-depth case studies, expert interviews, cost-effectiveness modeling, and research into risk factors, the funding landscape, and promising interventions. We have tried to flag major sources of uncertainty in the report, and are open to revising our views based on new information or further research. Key takeaways Executive Summary According to the 2019 Global Burden of Disease (GBD) study, there were about 1.2 million deaths due to road injuries in 2019. About 90% of these take place in LMICs, and the majority of those killed are between 15 - 50 years old. Additionally, WHO analysis and expert interviews indicate that road safety laws in many LMICs do not meet best-practice.[1] While there is limited information about what risk factors contribute most to the road safety burden, or what laws are most important to pass, the available evidence points to speed on the roads as most risky, followed by drunk driving. We conducted case studies of key time periods in China and Vietnam to better understand the relative impact of (philanthropically-funded) policy changes versus other factors. Our assessment of China is that we think Bloomberg's implementing partners contributed minimally to the key drunk driving policy change in 2011, and we think it's likely that this law was only one of many drivers to reduce burden. In contrast, we think laws were a more important driving force in Vietnam, and advocacy by Bloomberg, the Asia Injury Prevention Foundation and others significantly sped up their introduction. We did not find any sources that gave insight into drivers on a global scale. Regarding future burden, it's likely that this will follow trends in motorization. Self-driving cars may mitigate burden as they become more common; one source estimates they could constitute 20% of the global market by 2040, though we expect this to be lower in LMICs. This report builds on a short unpublished investigation conducted by Open Philanthropy in 2022. A quick BOTEC from that report, based on an existing impact evaluation (Hendrie et al., 2021), suggested that Bloomberg's road safety initiative might be quite cost-effective enough (ROI: ~1,100x). This report extends that analysis by reviewing Hendrie et al.'s estimates of lives saved, and comparing the authors' estimates for China and Vietnam to data on road outcomes from multiple sources. For China, we found that while the data shows reduced fatalities after 2011, we could not link them specifically to fewer incidents of drunk driving. For Vietnam, quantitative evidence for the impact of the helmet laws was stronger than for the drunk driving laws. As can be seen in our BOTEC, this analysis led us to reduce the estimated effectiveness of policy changes by 40% - 80%. In addition, we used our case studies to estimate specific speed up parameters for advocacy of 0.4 years in China and 3.8 years in Vietnam, versus the 10 years used previously. These changes significantly reduce our estimate of lives saved to 17% of Open Philanthropy's previous estimate. If we use the same methodology as the previous estimate (i.e., divide this estimate by 259 million USD, the entirety of Bloomberg's spending between 2007 - 2020), then the ROI drops to 148x. However, we propo...
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Talking through depression: The cost-effectiveness of psychotherapy in LMICs, revised and expanded, published by JoelMcGuire on November 28, 2023 on The Effective Altruism Forum. This is the summary of the report with additional images (and some new text to explain them) The full 90+ page report (and a link to its 80+ page appendix) is on our website. Summary This report forms part of our work to conduct cost-effectiveness analyses of interventions and charities based on their effect on subjective wellbeing, measured in terms of wellbeing-adjusted life years ( WELLBYs). This is a working report that will be updated over time, so our results may change. This report aims to achieve six goals, listed below: 1. Update our original meta-analysis of psychotherapy in low- and middle-income countries. In our updated meta-analysis we performed a systematic search, screening and sorting through 9390 potential studies. At the end of this process, we included 74 randomised control trials (the previous analysis had 39). We find that psychotherapy improves the recipient's wellbeing by 0.7 standard deviations (SDs), which decays over 3.4 years, and leads to a benefit of 2.69 (95% CI: 1.54, 6.45) WELLBYs. This is lower than our previous estimate of 3.45 WELLBYs ( McGuire & Plant, 2021b) primarily because we added a novel adjustment factor of 0.64 (a discount of 36%) to account for publication bias. Figure 1: Distribution of the effects for the studies in the meta-analysis, measured in standard deviations change (Hedges' g) and plotted over time of measurement. The size of the dots represents the sample size of the study. The lines connecting dots indicate follow-up measurements of specific outcomes over time within a study. The average effect is measured 0.37 years after the intervention ends. We discuss the challenges related to integrating unusually long follow-ups in Sections 4.2 and 12 in the report. 2. Update our original estimate of the household spillover effects of psychotherapy. We collected 5 (previously 2) RCTs to inform our estimate of household spillover effects. We now estimate that the average household member of a psychotherapy recipient benefits 16% as much as the direct recipient (previously 38%). See McGuire et al. ( 2022b) for our previous report-length treatment of household spillovers. 3. Update our original cost-effectiveness analysis of StrongMinds, an NGO that provides group interpersonal psychotherapy in Uganda and Zambia. We estimate that a $1,000 donation results in 30 (95% CI: 15, 75) WELLBYs, a 52% reduction from our previous estimate of 62 (see our changelog website page). The cost per person treated for StrongMinds has declined to $63 (previously $170). However, the estimated effect of StrongMinds has also decreased because of smaller household spillovers, StrongMinds-specific characteristics and evidence which suggest smaller-than-average effects, and our inclusion of a discount for publication bias. The only completed RCT of StrongMinds is the long anticipated study by Baird and co-authors, which has been reported to have found a "small" effect (another RCT is underway). However, this study is not published, so we are unable to include its results and unsure of its exact details and findings. Instead, we use a placeholder value to account for this anticipated small effect as our StrongMinds-specific evidence.[1] 4. Evaluate the cost-effectiveness of Friendship Bench, an NGO that provides individual problem solving therapy in Zimbabwe. We find a promising but more tentative initial cost-effectiveness estimate for Friendship Bench of 58 (95% CI: 27, 151) WELLBYs per $1,000. Our analysis of Friendship Bench is more tentative because our evaluation of their programme and implementation has been more shallow. It has 3 published RCTs which we use to info...
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Kaya Guides- Marginal Funding for Tech-Enabled Mental Health in LMICs, published by RachelAbbott on November 26, 2023 on The Effective Altruism Forum. This post was written by Rachel Abbott, Kaya Guides' founder. TLDR Who we are: Kaya Guides is a global mental health charity incubated by Charity Entrepreneurship. We operate a self-help program on WhatsApp to reduce depression at scale in LMICs, focusing on youth with moderate to severe depression Status: We launched in India this year and are running an ongoing proof of concept with 111 people How it works: A WhatsApp chatbot delivers videos in Hindi that teach participants evidence-based techniques to reduce depression. Participants practice the techniques day-to-day and have a 15-minute weekly call with a trained supporter for 5-8 weeks Evidence base: Self-help combined with low-touch human support can have the same effects as face-to-face psychotherapy in reducing depression, even if total staff time is less than two hours per participant What we've done: This year, we adapted the World Health Organization's digital self-help program to India's context, built a WhatsApp chatbot, produced 40 videos in Hindi, and launched our ongoing proof of concept Impact: Delivering on WhatsApp means we can reach those who need it most, at a large scale. The WHO program, studied in two RCTs, had moderate to large effects on depression Initial findings: Mental health organizations usually struggle with recruitment, but we got 875 people to message the chatbot in 1 month (similar organizations report getting 1K users in a year), achieved a 12.69% conversion rate from initial message to appearing in a guidance call, and only spent $0.95 per acquisition Cost-effectiveness: Kaya has the potential to increase subjective well-being 30x as cost-effectively as direct cash transfers by Year 3 Scaling potential: As a tech initiative, we can scale rapidly and believe we can treat 100K people in Year 5 2024 plans: Next year, we'll: 1) 10x our impact from this year by treating 1K youth with depression and 2) Establish the product, team and systems we need to scale rapidly from 2025 onward What we need: We're raising $80K to meet our 2024 budget of $160K, having so far raised $80K from the EA Mental Health Funding Circle What is Kaya Guides and what do we do? Kaya Guides is a global mental health charity incubated by Charity Entrepreneurship. Our focus is on reducing depression at scale in low and middle-income countries, beginning with India. Youth with moderate to severe depression are our target group. We deliver a self-help course via WhatsApp that teaches youth evidence-based techniques to reduce depression. During the 5-8 week course, participants have 15-minute weekly calls with trained supporters and practice the techniques day-to-day. This treatment approach (self-help, plus low-touch human support) is called guided self-help. It was recommended by Charity Entrepreneurship due to its high projected cost-effectiveness. Research indicates that guided self-help has the same effects as face-to-face psychotherapy- even if human support is only 15 minutes per week, the supporter has no clinical background, and the program lasts just five weeks. Why should we care about mental health? Mental health disorders account for 5% of global disease burden and 15% of all years lived with disability. This figure is an underestimate: the Global Burden of Disease counts suicide as an injury, even though an estimated 60-98% of suicides are attributable to mental health conditions and 700,000 people die by suicide each year. Depression and anxiety alone account for 12 billion workdays lost annually. Despite the need for expanded mental healthcare, on average just 2% of government health budgets go to mental health. Scale of the problem in India We selected...
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Vida Plena: Transforming Mental Health in Ecuador - First Year Updates and Marginal Funding Opportunity, published by Joy Bittner on November 19, 2023 on The Effective Altruism Forum. TLDR Vida Plena is a nonprofit organization that is tackling Ecuador's mental health crisis through cost-effective, proven group therapy led by local leaders from within vulnerable communities. We do this through the direct implementation of Group Interpersonal Therapy, which is the WHO's recommended intervention for depression. We are the first to implement it in Latin America. We launched in early 2022 (see our introductory EA forum post) and took part in the Charity Entrepreneurship Incubator program that same year. In the fall of 2022, we carried out a proof concept alongside Columbia University, which found positive results (see our internal report, and the report from the Columbia University Global Mental Health Lab). So far this year, we've made a positive impact on the lives of 500 individuals, consistently showing significant improvements in both depression and anxiety. Our strategic partnerships with local institutions are flourishing, laying the groundwork for our ambitious goal of scaling our reach to treat 2,000 people in 2024. For this marginal funding proposal, we seek $200,000 to expand our work and conduct research to apply behavioral science insights to further depression treatment in Latin America. This enhanced therapy model will be evaluated through rapid impact assessments, deepening the evidence base for our work, and culminating in a white paper and a RCT in 2025. We also share additional ways to support our work. This post was written by Joy Bittner and Anita Kaslin, Vida Plena's co-founders. In it, we share: An overview of Vida Plena and our work The scope and scale of the problem we are addressing Our solution and the evidence base Our initial results to date Present our proposal for marginal funding opportunities Additional funding opportunities and how you can support our work 1) An Overview of Vida Plena and Our Work Problem: Mental health disorders are a burgeoning global public health challenge and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Mental illness and substance abuse disorders are significant contributors to the disease burden, constituting 8.8% and 16.6% of the total burden of disease in low-income and lower-middle-income countries. According to The Wellcome Global Monitor on Mental Health, the largest survey of depression and anxiety rates worldwide, Latin America exhibits the highest rates globally. This situation is worsened by low public investment. Despite a 2021 Gallup poll ranking Ecuador among the top 10 worst countries in the world for emotional health, only 0.04% of the national healthcare budget is dedicated to mental health - 9x less than other Latin American countries. Therefore, most mental health conditions, especially depression, go untreated. Depression is defined by intense feelings of hopelessness and despair. The result is suffering in all areas of life: physical, social, and professional. Untreated depression's repercussions extend to daily economic and life decisions, impairing attention, memory, and cognitive flexibility. This hampers personal agency and worsens the cycle of poverty and mental disorders. Poor mental health is associated with a host of other issues: chronic medical conditions, drug abuse, lower educational achievement, lower life expectancy, and exclusion from social and professional arenas. As a result, it's not surprising that health problems are related to economic factors such as loss of productivity, absenteeism (both for the patients and caregivers), and financial strain due to the cost of care. Conversely, research unders...
Air – it's our most basic need. It's far more vital than water, food, or medicine. People can survive just minutes without its most important component: oxygen. But in much of the world, people struggling to breathe lack access to medical oxygen, a treatment that makes the difference between life and death. The COVID-19 pandemic highlighted the problem and made it exponentially worse. “I will never forget the images,” Leith Greenslade, coordinator of the Every Breath Counts coalition, tells us on the One World, One Health podcast. “Patients suffocating to death as hospitals ran out of oxygen.” A team at the University of Washington estimates that 25 million people die every year of both acute and chronic conditions that need treatment with medical oxygen. “It's unclear exactly how many of the estimated seven million COVID-19 deaths could have been prevented with adequate supplies of medical oxygen, but a study of COVID-19 deaths in African intensive care units found that half of patients died without ever receiving it,” Greenslade and the One Health Trust's Ramanan Laxminarayan wrote in a recent article. “Shamefully, world leaders have turned a blind eye to the lack of access to medical oxygen.” Listen as Leith explains the scope of the problem and the possible solutions in this episode of One World, One Health.
Drug-defying superbugs can be found in manure, soil, the ocean, and especially in sewers. These places are sources of infection, but they also provide a way to keep an eye on which drug-resistant germs are where – and how much they are changing. The World Health Organization encourages mapping all of the places drug-resistant organisms are popping up, and what kind of organisms there are. “If no action is taken, AMR (antimicrobial resistance) could cost the world's economy US$ 100 trillion by 2050,” WHO says. Windi Muziasari, PhD, became passionate about tracking these deadly germs while doing postdoctoral research at the University of Helsinki in Finland. The Indonesian-born scientist founded her own company to do this mapping for governments, communities, and companies. As Founder and CEO of ResistoMap, Muziasari has looked for drug-resistant microbes in agricultural runoff, in hospitals, under city streets, among wildlife, and elsewhere in dozens of countries. The hope is to act as an early warning system so that companies, governments, and others can do something about the problem. “Almost everywhere is polluted,” she tells us on the One World, One Health podcast. Listen as Windi Muziasari tells host Maggie Fox about how and why she got started and what she's learned since launching ResistoMap.
In 2023, KEI has set out on its "Rethinking Korea initiative," which explores the evolution of U.S.-Korea relations, Korea's place in the world, and rapid changes in Korean society itself. The initiative involves both retrospective inquiry as well as prospective analysis about future trends. As part of this initiative, KEI looks to build upon its previous programs and publications and deepen understanding of the key issues they explore. Today's two guests help us do so. Dr. Jerome Kim, is the Director General of the International Vaccine Institute (IVI), based in South Korea, and an international expert on the development and evaluation of vaccines. Interviewing Dr. Kim is Salome Da Silva Duarte Lepez, a researcher and analyst in health policy with a background in neuroscience and rare neuromuscular diseases. Previously, Salome coauthored a paper published in KEI's On Korea 2023, titled, “South Korea as a Global Vaccine Hub.” During their conversation, Dr. Kim and Ms. Lepez explore a range of issues, including the history and evolution of IVI; the IVI's role in working with the World Health Organization's (WHO) biomanufacturing training hub established in South Korea in 2022; the nature of the training and coursework IVI and the biomanufacturing hub provide and how it aims to improve public health in lower- and middle-income countries (LMICs); how these efforts fit into a broader array of public and private institutions, an uncertain geopolitical environment, and South Korea's own science diplomacy; and how such efforts may evolve in the future, particularly as the world moves beyond the COVID-19 pandemic.
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