Skeptical Thinking About Charity

How the standards of skeptical thinking can be used to reject ineffective charities in favour of effective charities.

New Zealanders spend millions of dollars every year on alternative healthcare therapies that either have no evidence that they are effective, or have evidence that they are not effective. The practitioners of these alternative therapies usually want the best for their clients. As skeptics know, good intentions on behalf of the practitioner is an insufficient reason to get a health care treatment.

We expect treatments to have good evidence that they are effective, ideally based on rigorous, randomised controlled trials. It is not sufficient for the treatment to seem like it should work based on some theory (e.g. alleged “subluxations” in the spine causing disease, or the parts of the feet matching parts of the body.) Nor is it enough that the treatment is provided by a person that has the patient's best interests in mind. The treatment should actually work. And given that there is only so much money spent on healthcare, we'd prefer the most cost-effective treatments are used so that more people can be helped.

The same skeptical thinking that we use to reject ineffective alternative treatments in favour of effective conventional medicine can also be used to reject ineffective charities in favour of effective charities.

There are many ways in which medicine is different to charity, but the requirements that I described above for healthcare are very similar to the requirements I have for charity.

Just like in healthcare, I want charities to have good evidence that they are effective, ideally based on rigorous randomised controlled trials. It is not sufficient for the charity to seem like it should help based on some theory. Nor is it enough that the charity is run by people that have the best interests of their recipients in mind. The charity should actually work. And given that there is only so much money I can donate, I'd prefer to give to the most cost-effective charities so that more people can be helped.

Randomised controlled trials are the main method for how modern medicine is tested. In their simplest form, randomised controlled trials involve a group of people with a particular health need. Some are randomly selected to receive a treatment, and the rest don't. The treatment is deemed to be effective if the people who are treated have significantly better outcomes than the people who are not.

Randomised controlled trials have been used to see if social programs and charitable activities work too. The use of these trials is fairly new compared to the long history of trials in healthcare. Also the conclusions are not as certain as those in healthcare. Nevertheless, there have been some very interesting results. In some cases the evidence showed that programs intended to help people, actually harmed them. One unfortunate case was the program Scared Straight, which took at-risk youth to prisons for a day to deter them from committing crimes in the future. Despite the best intentions, and a plausible theory, the program didn't work. Nine randomised controlled trials showed that this program actually increased offending in youth.

Conversely, some randomised controlled trials have identified programs that are very effective at helping people. The first large trial on international education was conducted in the 1990s and tested what interventions would improve student's performance in schools in Kenya. The trial tested class sizes and availability of school resources (for example textbooks), and found no discernible difference in student performance. Then they tried treating the kids for intestinal worms, and found that this made a significant impact on the education of the kids. In fact, they found that every $100 spent on deworming seems to result in 10 more years of education across the whole village, because the whole village has less of a disease burden. A follow up study 10 years later showed that the kids who were dewormed were employed for more hours as adults and earned more. Another 14 controlled trials back up these findings.

GiveWell is an organisation that assesses global health and poverty charities on their evidence base and cost-effectiveness. They currently recommend only charities that operate in developing countries, because the poorest people globally are worse off than the poorest in developed countries, and one dollar goes a lot further in the developing world compared to a developed country like New Zealand. Even within charities operating in developing countries, the effectiveness can vary by orders of magnitude, so GiveWell looks for charities with the best evidence base, the best cost-effectiveness, and room for more funding, so that donors can be confident their money will be used in the best possible way.

GiveWell's top ranked charity for 2016 is Against Malaria Foundation which distributes insecticide treated bednets for approximately $7 each, depending on the area. The nets go over sleeping areas to prevent malaria-infected mosquitos from biting people. Each net protects two or three people, and lasts for about three years. The randomised controlled trials of bednets suggest a fatal case of malaria is prevented for every $5000 spent, plus many non-fatal cases of malaria are averted. GiveWell believes this is the most cost-effective way of saving lives that they have investigated. Against Malaria Foundation has the added benefit that it is tax-deductible in New Zealand. GiveWell also recommends Schistosomiasis Control Initiative and Deworm the World, which treat children for intestinal worms for less than 50c per person per year, and GiveDirectly which gives unconditional cash grants to very poor households in Uganda and Kenya.

GiveWell is one organisation that is a part of a growing social movement and philosophy called effective altruism, which encourages people to do the most good that they can. There is of course a lot of debate within the effective altruism community about how exactly each person can do the most good. Some people are concerned about global poverty, some think that you can do more good by investing resources into reducing animal suffering, others think your time and money might be better spent ensuring a good life for future humans by avoiding catastrophic risks to humanity such as extreme climate change or nuclear war, and still others are researching to find out if there are any other cause areas that might be very effective to work on.

When I first encountered these ideas I was compelled by just how easily a person like me, living in a first world country, can make such a huge difference in the lives of others, without significantly affecting the quality of my own life. Despite me slaving away all year trying to give teenagers some understanding of science, the good my donations do probably far outweigh all the good I do in my job. I live very comfortably on 90% of my income, and with the remainder I get to provide enough bed nets so that statistically speaking, I am likely to save a life and a half every year! Imagine if I went around saving a life of a child or two every year around my neighbourhood. I'd be the stuff of legends, a hero! And yet, due to accident of birth, and the perversity of extreme inequality, I can use skeptical thinking and evidence to save lives pretty easily with no great skill, superpower, or sacrifice.

Learn more about applying skeptical thinking to doing good at charityskeptics.com, or look into effective altruism in New Zealand at effectivealtruism.nz