"But looking more closely at the increased deaths, they were mostly from autoimmune diseases that couldn’t plausibly be related to their donations."
Kidneys make calcitriol. One kidney means you'll make less, and if you don't supplement, you'll become deficient. Deficiency would (possibly) lead to autoimmune diseases.
Also EPO (erythropoietin). One kidney means less, and less (possibly) means fewer new red blood cells, then (possibly) anemia. Anemia wreaks havoc.
And bicarbonate.
To be clear, if you want to donate a kidney, then do it if it's the right choice. It's very kind. Just know what to pay attention to to keep yourself in good health.
One small advantage of kidney donation is that it comes with lifetime screening without some of the gatekeeping normally attached to that. I dunno exactly how it works in the US, but here in Canada you can't just really demand blood tests purely for screening reasons, there needs to be a reason for it. But if you're a donor, your transplant clinic will insist on periodic screening both to monitor for GFR dropping as well as other issues like the ones you mention.
Transplant centres vary for sure (to a surprisingly huge degree), but at least where I am if you do donate the clinic will be watching out for this stuff on your behalf.
About erythropoietin (EPO), I understand it's a hormone whose amount is regulated by the need for oxygen in the blood (i.e. a feedback loop which regulates the amount of red blood cells to be just what is needed to satisfy the oxygen needs of the body).
So EPO is not limited by the ability of the kidneys to produce it (I expect, by a large margin). So one kidney would just as well be able to produce all the EPO you may need, the kidney is not the limiting factor.
>they were mostly from autoimmune diseases that couldn’t plausibly be related to their donations
Sounds extremely brittle logic. Why couldn't they be "related to their donations"?
For starters, the donations could make their immune system weaker (and thus make any autommune diseases they already have more impactful) or make it go haywire to combat the post-operation stress...
> Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors.
Having worked for a few years in the diabetes space, I‘ve been hearing that cheaper CGMs are coming from the big players, apparently for <= $1 a day. This will allow people with diabetes to keep their time in the ideal BG range longer, reducing risk for kidney disease _significantly_.
It's a good read. I enjoyed the data analysis and his snarky wit about a few things. I enjoyed him finding out he could apply to another hospital and doing it "out of spite."
I know he wants to encourage you to donate a kidney. I still wish we tried harder to heal the "original equipment from the manufacturer" we are all born with. I have been on the record a long time with this opinion. I get a lot of hatred for it, though I have a condition that frequently results in being a transplant recipient and my only wish here is for better baseline care for people like me instead of razzle-dazzle headlines about flashy "tech" solutions.
Good solutions tend to be boring. I want a boring life where I just get to have good health and not an "exciting" one where I get to tell you how I was dying until some kind stranger died in a motorcycle accident at a shockingly young age and let me have their leftover body parts. (Because people like me need body parts that are a little hard to spare as an act of charity.)
The author states: "the risk of dying from the screening exam was 1/660"
And demonstrates with: "This involves a radiation dose of about 30 milli-Sieverts. The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660."
Sorry but there is a flaw here: calculation seems good but conclusion is completely wrong.
Calculation: increased risk ratio of cancer-related death for 30mS = 1.05^0.03S = 1.001465... So +0.15% = +0.0015 = around +1/660 (with less rounding +1/682)... fine!
Conclusion: this is not your risk of dying, but the increase of your risk of dying. If it was X%, the exam brings your risk at X% x 1.0015
X depends on the medicine quality in your country, your access to it, your health, your exposure to cancer-triggers (pollution, tobacco, food...), your DNA, your gender...
Let's state a depressing 1%, then the screening exam brings you to 1.0015%, or +0.0015% additional risk due to the screening exam = 0.000015 = rounded 1/67000. So your chance of dying from an exam-related cancer is absolutely not 1/660.
One Sv increases your absolute risk of fatal cancer by an added 5% or so. It doesn't multiply it by 1.05.
Quoting Wikipedia: "According to the International Commission on Radiological Protection (ICRP), one sievert results in a 5.5% probability of eventually developing fatal cancer based on the disputed linear no-threshold model of ionizing radiation exposure."
Also, where on earth did you get 1% as a "depressing" upper bound from? For lifetime risk of dying of cancer? It's over 15% in the US.
I tried googling the risk and it's all a bit inconclusive but:
>The linear no-threshold model is disputed by several health organizations, including the American Association of Physicists
in Medicine and the Health Physics Society,
both of which concluded that cancer risk estimation should be limited to doses greater than 50 mSv. Both organizations
state that risks from doses below this threshold are too small to be detectable and may be nonexistent.
"the risk of dying from the screening exam was 1/660"
For someone as smart as Scott Alexander, this is an astonishing mistake.
If CTs were such death machines, we would have seen a worldwide epidemics of CT-related cancers. There is no way you can cover up such a strong signal, given that people are screened all the time.
Edit: thanks for unleashing such an interesting debate. I guess the problem is in my perception. "Risk of dying from the exam" means lifetime risk, while my perception was "1 of 660 people who get the exam drops dead pretty soon afterwards".
> Conclusion: this is not your risk of dying, but the increase of your risk of dying.
No, it does not increase your risk of dying. Your risk of dying was 100% before the procedure and is 100% after it. We all die at the end with certainty. Risk of dying is only meaningful when you qualify it with a timeframe (let say next 5 years) or cause (let say getting terminal cancer).
You're not wrong, but he's probably farther off that that. Danger from radiation doesn't scale linearly, although (to be extra safe) standards are set as if it is. In fact, there is some evidence that small doses of radiation can even be beneficial (hormesis).
An anecdote to go along with his rejection. Once I got rejected from doing a medical donation in US because in the giant table of family sicknesses they gave me I marked X next to one of the mental conditions for my father who was an alcoholic because apparently alcoholism technically is that kind of mental condition (yes, the X had to be explained in the form, which I did). As you can imagine alcoholism is not that heritable, and had more to do with the environment (I grew up in Russia where it was extremely prevalent), but for the clerks an X is an X.
I've always enjoyed this author's work, but there's something almost pathological about the way he assumes that the risks of this act are well-quantified enough to make a rational mathematical decision about it, or that those risks are even well-quantifiable at all; there are ten thousand paths to medical complication here that aren't captured in "this is the percentage of healthy kidney donors who died during the operation or died of kidney disease later".
Honestly, I would have respected "I wanted to do it, I became obsessed with doing it, I knew it was likely dangerous and I can't quantify how dangerous, but it did it anyway because I thought it was important" more than this many-page attempt to mathematize the un-mathematizable.
Which I guess raises a larger point about how the rationalist and EA and other similar communities have a tendency to try to reduce fiendishly complex multivariable human issues to equations and statistics without realizing that some problems are not math problems and will defy any attempt to be quantified, statistitized, or calculated.
Yes, from the outside his fervent desire to donate a kidney looks like a compensation for his rationalism. Personally, I find EA to be uncompelling because it implicitly assumes both that there are objective universal values and that price and value are in direct proportion. Even if we could agree on our values (historically we can't), I don't believe that there is a pricing model that could possibly get this right. But even if such a model existed, it still would be unsatisfying for me to do proxy work to satisfy the model (i.e. earn to give) rather than the direct embodied work in the world that needs to be done.
It is unsurprising to me that people attracted to rationalism/EA get stuck in this tension and find a need to demonstrate their values in an embodied way. Interestingly, anonymous kidney donation is both embodied and abstract unless you have a relationship with the recipient. I admire that the author had the conviction to act on their principles, but I also have a suspicion that this will not truly resolve the internal conflict that led to their act.
This comment reminds me of the central thesis of Red Plenty [0] - that all the mathematical or algorithmic sorcery in the world frequently fails on contact with actual human beliefs and desires. We seldom have simple enough utility functions to meaningfully optimize in real life - all of our philosophies, theologies, and other cultural debris have evolved to manage those complexities (often imperfectly).
It makes me wonder what the world would be like if Bishop Joseph Butler was more popular among rationalists, and generally more well known as an Enlightenment thinker. It's been a while so excuse my spotty memory, but in summary his work challenged prevailing Enlightenment ideas about self-interest and centered human sentiment in understanding ethics. It goes to show you can be a rationalist and still talk about human morality with words like compassion and resentment.
I understand that the rationalist project has been to bypass the emotional and get to some kind of cold hard truth of right and wrong, but I've long suspected that this is impossible.
> Honestly, I would have respected "I wanted to do it, I became obsessed with doing it, I knew it was likely dangerous and I can't quantify how dangerous, but it did it anyway because I thought it was important" more than this many-page attempt to mathematize the un-mathematizable.
Eh, I felt that already came across strongly in the article itself. He attempted to quantify the risk, but every avenue resulted in "it's fine, maybe?", and he chose to go ahead with it despite not having any dependable numbers.
> Which I guess raises a larger point about how the rationalist and EA and other similar communities have a tendency to try to reduce fiendishly complex multivariable human issues to equations and statistics without realizing that some problems are not math problems and will defy any attempt to be quantified, statistitized, or calculated.
Some of my old coworkers were really into EA, LessWrong, and the rationalist community.
At first it was fun to read some of the articles they shared, but over time I observed the same pattern you described: Much of the rationalist writing felt like it started with a conclusion and then worked backwards to find some numbers or logic that supported the conclusion. They had already made up their minds, after which the rationalist blogging was all about publicly rationalizing it.
The other trend I noticed was how much they liked to discard other people's research when it didn't agree with something they wanted to write. They were very good at finding some obscure source that had a different number or conclusion that supported their claims, which was then held up as an unquestioned source with no further scrutiny.
Someone once described it to me as "second option bias": Rationalist writings have a theme of taking a commonly held belief and then proposing a slightly contrarian take that the closest alternative explanation is actually the correct one.
Once you start seeing it, the pattern shows up everywhere in rationalist writings. In this article for example:
1. Argument that kidney donation is actually much safer than people think because the author picks 1 or 2 specific failure modes and cites those as if they captured all possible downsides.
2. Argument that CT scans are actually much more deadly than people think because there are many possible downsides that we can't account for. Author admits to surveying a contentious field and selecting the most conservative risk estimate he found.
3. Argument that the Center for EA buying their own expensive castle to host their own meetings is good, actually. Anyone who questions the Center for EA spending millions on a remote castle so they could meet there must be wrong and misinformed and outsiders, with little more than "just trust them that the math is right" as the argument.
This author is a very good writer so he's masterful at breezing past the details, but it's hard to miss the pattern once you start seeing it. The pattern is more obvious in a lot of the less popular rationalist writings where it's clear the authors discarded any sources that were inconvenient to their conclusion but elevated any sources that told them what they wanted to hear.
Another common pattern in rationalist writing is to make strong claims based on weak evidence, then to hedge in the footnotes as a way to preemptively defuse counterarguments. Sure enough, this article has some footnotes that acknowledge that the radiation risk numbers he used in the main article are actually highly disputed and he chose the most conservative ones. This point is conveniently separated from the main article to avoid detracting from the point he wanted to make. The main article confidently makes one claim, then anything that might weaken that claim is hidden in a footnote.
Predictably, many of the comments on HN questioning the radiation numbers are met with "he addressed that in the footnote" comments that try to shut down the debate, so the strategy clearly works. Something about hedging in footnotes inoculates certain readers against questioning the main article. It's another pattern that becomes obvious once you start seeing it.
If your philosophy presupposes that all problems are nails, then you will probably try to hit them with a hammer regardless of what other tools you have.
I respect the British organizers’ willingness to sacrifice their reputation on the altar of doing what was actually good instead of just good-looking.
Surely their reputation is a factor in their ability to do good? Optics sometimes necessitate sacrificing the "mathematically superior choice" for one that's worse in the name of not pissing off a ton of people the support of whom you rely upon.
The solution of giving people money to donate their kidneys is terrifying to me however. I do not like the thought of desperate people selling their internal organs to survive one bit.
Of course, if inequality was dealt with and nobody was desperately poor, it would be a different question. If everyone had enough money to comfortably get by, and the extra $100,000 from a kidney donation would just go to luxury goods, I wouldn't have a problem with it. But that's not the world we live in.
What is it that makes "giving people money to donate their time" so much less repugnant? Is it that time is finely divisible, whereas kidneys come in twos?
What about lazy people? I'm not desperate at all, just regular depressed, desensitized, uncaring, unmotivated, due to all the shit going on constantly in this nice fancy interconnected world, blablabla.
selling kidneys doesn't preclude us having the same thorough screening process we have now, although it means there may be people who try harder to game the screening process.
i just don't see kidney donation as being a significant enough harm to outweigh the harm of the recipient not getting the kidney. if we're worried about people being financially desperate, we should allow organs to be sold and build a stronger social safety net (with the money we save on dialysis?)
The post mentioned a tax credit though. In theory the poorest people would benefit the least from this. But there could still be issues as you increase your income, I agree.
While I've appreciated some of the author's articles in the past, I think the numbers in this one miss the mark quite a bit.
> the risk of dying from the screening exam was 1/660
> The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660.
Well not quite. First of all, this assumes that exposure events are additive over a lifetime (rather than individual events being more damaging at higher doses). This does seem to be the case, though I'm curious if we really know.
More to the point, it's a 5% increase of chance of death from cancer. Combining 5% with 30mSv/1Sv, you get an extra 0.15% chance of dying of cancer indeed.
But the chance of dying of cancer in the U.S. is something like 17.5%, although that does increase (and then decrease) with advanced age. According to https://usafacts.org/articles/americans-causes-of-death-by-a... , something like 29% deaths in the 65-74 age group are cancer, while in the 75-84 year age group it drops again to 25%.
Regardless, this means if you figure out your lifetime chance of dying by cancer based on your current age, it's 30% at the most (in aggregate, obviously personal risk factors vary a lot from person to person).
A 0.15% increase in that is 0.045% additional chance of dying by cancer, or 1 in 2,222. Using the average mortality incidence of 17.5% its more like 1 in 3800. And for someone who's this concerned about dying of cancer and I assume limiting risk factors much more than the average citizen, perhaps it's a 1 in 5000 chance.
All in all you're much more likely to reduce your chance of death by cancer by much more than a CT will increase it, via a number of lifestyle changes: healthier eating, quitting alcohol, staying out of the sun.
> The vast majority of donors, 98 to 99 percent, don’t have kidney failure later on. And those who do get bumped up to the top of the waiting list due to their donation.
Can’t help but picture a roller coaster queue wrapping around the back of a hospital, and some guy is cutting the “Singles” line, defending himself from scowls with, “I’m not cutting! I’m just getting my kidney back!”
I dunno, I feel like this whole article just makes it clear how fundamentally flawed the idea of calculating your way to good (in both the moral and the practical sense) decisions is. It's clear from the article that even the first-order effects of a kidney donation decision are incalculable: no one really knows the exact risk accrued from the CT scan, or the surgery, or the upside to the recipient. It doesn't seem OP included the direct costs of the transplant itself at all (all those tests and scans and screening interviews, the travel and lost time from work, and then the cost of the two surgeries). Then one could go on and on with calculating higher-order effects forever. ("I'm married to someone who gives $500K a year of their income to EA causes, but if I die in surgery there's a 5% chance they will commit suicide out of grief, denying XYZ dollars in future income to the cause...")
Indeed, OP tries to present a bunch of arithmetic to justify their decision, but admits that it ultimately rested on an emotional gut feeling: "It starts with wanting, just once, do a good thing that will make people like you more instead of less."
Or the risks of hospital-acquired infection (maybe his girlfriend considered that). What about effects like if it aches for years afterwards but won't kill him; at what level of ache would that turn from "reminder that I did a good thing" to "damnit"?
Hand transplants are a thing - would he give up his non-dominant hand to someone who lost both of theirs in an accident?
Eye transplants aren't a thing, but if they were, would he give up one to a blind person?
If it was really easy to see the damage (hand) and lose an obvious piece of functionality (eye) it would be much harder to argue with numbers "studies show that most people who lose a hand survive more than 7 years". Would he lose an eye, a hand, a kidney, a lung, a lower leg, a foot of intestine, a chunk of liver, a section of skin, a few litres of blood, if it did more good to someone else than to him?
> "Indeed, OP tries to present a bunch of arithmetic to justify their decision, but admits that it ultimately rested on an emotional gut feeling: "It starts with wanting, just once, do a good thing that will make people like you more instead of less.""
The Last Psychiatrist wrote that you shouldn't need validation from other people, shouldn't want it, and if you do want it - fix that. Doing it hoping you gain some indelible "society values me" token to carry around with you forever so you can use it as a trump card and people will like you more, feeling like you've never done anything good and that you need to to be likeable, doesn't sound much like "altruism: Unselfish concern for the welfare of others; selflessness.", does it?
I’m keeping both my kidneys for if someone I love needs one.
When I am dead however, they can take my kidneys, heart, lungs, liver and whatever else that is salvageable and give them to whoever needs them (assuming I die in the right circumstances that this is possible).
Can anyone (with a better understanding of radiation risks) confirm the math for the added mortality risk from a single CT? I know a CT is a lot of radiation, but the mortality risk seems very high.
> People got so mad at some British EAs who used donor money to “buy a castle”. I read the Brits’ arguments: they’d been running lots of conferences with policy-makers, researchers, etc; those conferences have gone really well and produced some of the systemic change everyone keeps wanting. But conference venues kept ripping them off, having a nice venue of their own would be cheaper in the long run, and after looking at many options, the “castle” was the cheapest. Their math checked out, and I believe them when they say this was the most effective use for that money. For their work, they got a million sneering thinkpieces on how “EA just takes people’s money to buy castles, then sit in them wearing crowns and waving scepters and laughing at poor people”. I respect the British organizers’ willingness to sacrifice their reputation on the altar of doing what was actually good instead of just good-looking.
When other organizations do so, they are wasting money that could have been well-spent. When effective altruists do so, they are “sacrificing their reputation for a good cause”.
There are so many unknowns and unknown unknowns in medical sciense, especially regarding the human body.
Did evolution really keep two kidneys if you actually just need one? I doubt it. When considering a donation you should also not only think about if you might die. There are more factors like quality of life. In the end, a whole organ will be removed from your body. This will have some effect.
> Yet only about 200 people (0.0001%) donate kidneys to strangers per year. Why the gap between 25-50% and 0.0001%?
Scott is right to point out the gap, but I don't expect him to donate another kidney next year. Even for those who follow through on their good intentions, kidney donation is a one-time event not an annual event, so it shouldn't be compared to an annual rate. Assuming that would-be kidney donors have a window about 50 years to follow through on their good intentions, the gap should be between 25-50% and 50 x 0.0001% = 0.005%.
> Obviously this kind of thing is why everyone hates effective altruists. People got so mad at some British EAs who used donor money to “buy a castle”.
This feels like a spin on how this all went down. A lot of the anger about that group utilizing funds to, literally, buy a castle came from EA groups too.
Trying to downplay the situation and pretend that the anger was only coming from uninformed outsiders feels like a dishonest attempt to rewrite history.
There was a lot of debate about it in EA circles. A lot of it turned into mental gymnastics as they tried to find ways to explain how spending a
amount of money on a literal castle so they could meet in it somehow had an expected value that was positive for humanity or something.
Weird to see this incident pop up in an article about kidney donation, but even weirder to see the critics of the decision downplayed and sneered as uninformed outsiders when so much of the anger came from inside the EA community. Really feels like a subtle signal that if you don’t toe the line on every EA organization decision, you must be an outsider.
>Really feels like a subtle signal that if you don’t toe the line on every EA organization decision, you must be an outsider.
Bingo. I like Scott's writing in general, I've interacted with him a few times, and EA criticism is one of three or so topics where disagreement gets you the outsider treatment.
He's slightly more amenable if you can provide an example that would've been "more effective," but "this was a bad decision"-type critiques will default to "the bigwigs are smarter than you."
The Vox article refers to the donation chain effect from the US kidney exchange, where one donor can trigger a cascade of donations. Economist Alvin Roth won the Nobel memorial prize in economics for this in 2012.
Hopefully the Ozempic breakthroughs will alleviate some of the need for kidney donation as it lowers the occurrences of End-Stage Renal Disease (ESRD).
There was recent news on an Ozempic study that shows reduced risk kidney conditions for diabetic patients.
> Based on the trial’s design, Ozempic needed to reduce the absolute risk of one of those kidney-related conditions by at least 3.5% when compared to placebo, or a relative risk reduction of around 16.5%, Akash Tewari, a Jefferies analyst who covers Lilly, wrote in a note to clients.
[+] [-] matisseverduyn|2 years ago|reply
Kidneys make calcitriol. One kidney means you'll make less, and if you don't supplement, you'll become deficient. Deficiency would (possibly) lead to autoimmune diseases.
Also EPO (erythropoietin). One kidney means less, and less (possibly) means fewer new red blood cells, then (possibly) anemia. Anemia wreaks havoc.
And bicarbonate.
To be clear, if you want to donate a kidney, then do it if it's the right choice. It's very kind. Just know what to pay attention to to keep yourself in good health.
[+] [-] ryanbrunner|2 years ago|reply
Transplant centres vary for sure (to a surprisingly huge degree), but at least where I am if you do donate the clinic will be watching out for this stuff on your behalf.
[+] [-] mpreda|2 years ago|reply
So EPO is not limited by the ability of the kidneys to produce it (I expect, by a large margin). So one kidney would just as well be able to produce all the EPO you may need, the kidney is not the limiting factor.
[+] [-] coldtea|2 years ago|reply
Sounds extremely brittle logic. Why couldn't they be "related to their donations"?
For starters, the donations could make their immune system weaker (and thus make any autommune diseases they already have more impactful) or make it go haywire to combat the post-operation stress...
[+] [-] threefour|2 years ago|reply
As an aside, I’m also Buddhist so if the kidney goes I’m going with it. This obsession with prolonging life is just a distraction from living it.
[+] [-] manmal|2 years ago|reply
Another solution would be to tackle type 2 diabetes, since a big amount of kidney failures is caused by that. Apparently, 1/3 of Americans are at risk: https://www.health.com/cardiovascular-kidney-metabolic-syndr...
Having worked for a few years in the diabetes space, I‘ve been hearing that cheaper CGMs are coming from the big players, apparently for <= $1 a day. This will allow people with diabetes to keep their time in the ideal BG range longer, reducing risk for kidney disease _significantly_.
[+] [-] DoreenMichele|2 years ago|reply
I know he wants to encourage you to donate a kidney. I still wish we tried harder to heal the "original equipment from the manufacturer" we are all born with. I have been on the record a long time with this opinion. I get a lot of hatred for it, though I have a condition that frequently results in being a transplant recipient and my only wish here is for better baseline care for people like me instead of razzle-dazzle headlines about flashy "tech" solutions.
Good solutions tend to be boring. I want a boring life where I just get to have good health and not an "exciting" one where I get to tell you how I was dying until some kind stranger died in a motorcycle accident at a shockingly young age and let me have their leftover body parts. (Because people like me need body parts that are a little hard to spare as an act of charity.)
[+] [-] illys|2 years ago|reply
And demonstrates with: "This involves a radiation dose of about 30 milli-Sieverts. The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660."
Sorry but there is a flaw here: calculation seems good but conclusion is completely wrong.
Calculation: increased risk ratio of cancer-related death for 30mS = 1.05^0.03S = 1.001465... So +0.15% = +0.0015 = around +1/660 (with less rounding +1/682)... fine!
Conclusion: this is not your risk of dying, but the increase of your risk of dying. If it was X%, the exam brings your risk at X% x 1.0015
X depends on the medicine quality in your country, your access to it, your health, your exposure to cancer-triggers (pollution, tobacco, food...), your DNA, your gender...
Let's state a depressing 1%, then the screening exam brings you to 1.0015%, or +0.0015% additional risk due to the screening exam = 0.000015 = rounded 1/67000. So your chance of dying from an exam-related cancer is absolutely not 1/660.
Please correct me if I did it wrong...
[+] [-] snarkconjecture|2 years ago|reply
One Sv increases your absolute risk of fatal cancer by an added 5% or so. It doesn't multiply it by 1.05.
Quoting Wikipedia: "According to the International Commission on Radiological Protection (ICRP), one sievert results in a 5.5% probability of eventually developing fatal cancer based on the disputed linear no-threshold model of ionizing radiation exposure."
Also, where on earth did you get 1% as a "depressing" upper bound from? For lifetime risk of dying of cancer? It's over 15% in the US.
[+] [-] tim333|2 years ago|reply
>The linear no-threshold model is disputed by several health organizations, including the American Association of Physicists in Medicine and the Health Physics Society, both of which concluded that cancer risk estimation should be limited to doses greater than 50 mSv. Both organizations state that risks from doses below this threshold are too small to be detectable and may be nonexistent.
[+] [-] inglor_cz|2 years ago|reply
For someone as smart as Scott Alexander, this is an astonishing mistake.
If CTs were such death machines, we would have seen a worldwide epidemics of CT-related cancers. There is no way you can cover up such a strong signal, given that people are screened all the time.
Edit: thanks for unleashing such an interesting debate. I guess the problem is in my perception. "Risk of dying from the exam" means lifetime risk, while my perception was "1 of 660 people who get the exam drops dead pretty soon afterwards".
[+] [-] lr1970|2 years ago|reply
No, it does not increase your risk of dying. Your risk of dying was 100% before the procedure and is 100% after it. We all die at the end with certainty. Risk of dying is only meaningful when you qualify it with a timeframe (let say next 5 years) or cause (let say getting terminal cancer).
[+] [-] bradley13|2 years ago|reply
[+] [-] streakfix|2 years ago|reply
[+] [-] simonebrunozzi|2 years ago|reply
[+] [-] lostmsu|2 years ago|reply
[+] [-] gwern|2 years ago|reply
Alcoholism is that heritable: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345133/ At ~50% heritability, it is in no way unusually low, and entirely comparable with many other traits.
[+] [-] CommieBobDole|2 years ago|reply
Honestly, I would have respected "I wanted to do it, I became obsessed with doing it, I knew it was likely dangerous and I can't quantify how dangerous, but it did it anyway because I thought it was important" more than this many-page attempt to mathematize the un-mathematizable.
Which I guess raises a larger point about how the rationalist and EA and other similar communities have a tendency to try to reduce fiendishly complex multivariable human issues to equations and statistics without realizing that some problems are not math problems and will defy any attempt to be quantified, statistitized, or calculated.
[+] [-] thefaux|2 years ago|reply
It is unsurprising to me that people attracted to rationalism/EA get stuck in this tension and find a need to demonstrate their values in an embodied way. Interestingly, anonymous kidney donation is both embodied and abstract unless you have a relationship with the recipient. I admire that the author had the conviction to act on their principles, but I also have a suspicion that this will not truly resolve the internal conflict that led to their act.
[+] [-] no_moms_no_hugs|2 years ago|reply
[0] https://www.theguardian.com/books/2010/aug/08/red-plenty-fra...
[+] [-] throw4847285|2 years ago|reply
I understand that the rationalist project has been to bypass the emotional and get to some kind of cold hard truth of right and wrong, but I've long suspected that this is impossible.
[+] [-] mcphage|2 years ago|reply
Eh, I felt that already came across strongly in the article itself. He attempted to quantify the risk, but every avenue resulted in "it's fine, maybe?", and he chose to go ahead with it despite not having any dependable numbers.
[+] [-] Aurornis|2 years ago|reply
Some of my old coworkers were really into EA, LessWrong, and the rationalist community.
At first it was fun to read some of the articles they shared, but over time I observed the same pattern you described: Much of the rationalist writing felt like it started with a conclusion and then worked backwards to find some numbers or logic that supported the conclusion. They had already made up their minds, after which the rationalist blogging was all about publicly rationalizing it.
The other trend I noticed was how much they liked to discard other people's research when it didn't agree with something they wanted to write. They were very good at finding some obscure source that had a different number or conclusion that supported their claims, which was then held up as an unquestioned source with no further scrutiny.
Someone once described it to me as "second option bias": Rationalist writings have a theme of taking a commonly held belief and then proposing a slightly contrarian take that the closest alternative explanation is actually the correct one.
Once you start seeing it, the pattern shows up everywhere in rationalist writings. In this article for example:
1. Argument that kidney donation is actually much safer than people think because the author picks 1 or 2 specific failure modes and cites those as if they captured all possible downsides.
2. Argument that CT scans are actually much more deadly than people think because there are many possible downsides that we can't account for. Author admits to surveying a contentious field and selecting the most conservative risk estimate he found.
3. Argument that the Center for EA buying their own expensive castle to host their own meetings is good, actually. Anyone who questions the Center for EA spending millions on a remote castle so they could meet there must be wrong and misinformed and outsiders, with little more than "just trust them that the math is right" as the argument.
This author is a very good writer so he's masterful at breezing past the details, but it's hard to miss the pattern once you start seeing it. The pattern is more obvious in a lot of the less popular rationalist writings where it's clear the authors discarded any sources that were inconvenient to their conclusion but elevated any sources that told them what they wanted to hear.
Another common pattern in rationalist writing is to make strong claims based on weak evidence, then to hedge in the footnotes as a way to preemptively defuse counterarguments. Sure enough, this article has some footnotes that acknowledge that the radiation risk numbers he used in the main article are actually highly disputed and he chose the most conservative ones. This point is conveniently separated from the main article to avoid detracting from the point he wanted to make. The main article confidently makes one claim, then anything that might weaken that claim is hidden in a footnote.
Predictably, many of the comments on HN questioning the radiation numbers are met with "he addressed that in the footnote" comments that try to shut down the debate, so the strategy clearly works. Something about hedging in footnotes inoculates certain readers against questioning the main article. It's another pattern that becomes obvious once you start seeing it.
[+] [-] enragedcacti|2 years ago|reply
[+] [-] BobaFloutist|2 years ago|reply
Surely their reputation is a factor in their ability to do good? Optics sometimes necessitate sacrificing the "mathematically superior choice" for one that's worse in the name of not pissing off a ton of people the support of whom you rely upon.
[+] [-] mort96|2 years ago|reply
The solution of giving people money to donate their kidneys is terrifying to me however. I do not like the thought of desperate people selling their internal organs to survive one bit.
Of course, if inequality was dealt with and nobody was desperately poor, it would be a different question. If everyone had enough money to comfortably get by, and the extra $100,000 from a kidney donation would just go to luxury goods, I wouldn't have a problem with it. But that's not the world we live in.
[+] [-] eru|2 years ago|reply
> I do not like the thought of desperate people selling their internal organs to survive one bit.
See https://en.wikipedia.org/wiki/Repugnant_market
Do you prefer desperate people have fewer options? Especially, do you prefer taking options from people that they prefer to take?
[+] [-] fritzo|2 years ago|reply
[+] [-] pas|2 years ago|reply
[+] [-] sadtoot|2 years ago|reply
i just don't see kidney donation as being a significant enough harm to outweigh the harm of the recipient not getting the kidney. if we're worried about people being financially desperate, we should allow organs to be sold and build a stronger social safety net (with the money we save on dialysis?)
[+] [-] makeworld|2 years ago|reply
[+] [-] pcthrowaway|2 years ago|reply
> the risk of dying from the screening exam was 1/660
> The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660.
Well not quite. First of all, this assumes that exposure events are additive over a lifetime (rather than individual events being more damaging at higher doses). This does seem to be the case, though I'm curious if we really know.
More to the point, it's a 5% increase of chance of death from cancer. Combining 5% with 30mSv/1Sv, you get an extra 0.15% chance of dying of cancer indeed.
But the chance of dying of cancer in the U.S. is something like 17.5%, although that does increase (and then decrease) with advanced age. According to https://usafacts.org/articles/americans-causes-of-death-by-a... , something like 29% deaths in the 65-74 age group are cancer, while in the 75-84 year age group it drops again to 25%.
Regardless, this means if you figure out your lifetime chance of dying by cancer based on your current age, it's 30% at the most (in aggregate, obviously personal risk factors vary a lot from person to person).
A 0.15% increase in that is 0.045% additional chance of dying by cancer, or 1 in 2,222. Using the average mortality incidence of 17.5% its more like 1 in 3800. And for someone who's this concerned about dying of cancer and I assume limiting risk factors much more than the average citizen, perhaps it's a 1 in 5000 chance.
All in all you're much more likely to reduce your chance of death by cancer by much more than a CT will increase it, via a number of lifestyle changes: healthier eating, quitting alcohol, staying out of the sun.
[+] [-] Waterluvian|2 years ago|reply
Can’t help but picture a roller coaster queue wrapping around the back of a hospital, and some guy is cutting the “Singles” line, defending himself from scowls with, “I’m not cutting! I’m just getting my kidney back!”
[+] [-] caust1c|2 years ago|reply
(Not even sure this is an option, orientation and all, just imaging)
[+] [-] ryanbrunner|2 years ago|reply
[+] [-] allturtles|2 years ago|reply
Indeed, OP tries to present a bunch of arithmetic to justify their decision, but admits that it ultimately rested on an emotional gut feeling: "It starts with wanting, just once, do a good thing that will make people like you more instead of less."
[+] [-] jodrellblank|2 years ago|reply
Hand transplants are a thing - would he give up his non-dominant hand to someone who lost both of theirs in an accident?
Eye transplants aren't a thing, but if they were, would he give up one to a blind person?
If it was really easy to see the damage (hand) and lose an obvious piece of functionality (eye) it would be much harder to argue with numbers "studies show that most people who lose a hand survive more than 7 years". Would he lose an eye, a hand, a kidney, a lung, a lower leg, a foot of intestine, a chunk of liver, a section of skin, a few litres of blood, if it did more good to someone else than to him?
> "Indeed, OP tries to present a bunch of arithmetic to justify their decision, but admits that it ultimately rested on an emotional gut feeling: "It starts with wanting, just once, do a good thing that will make people like you more instead of less.""
The Last Psychiatrist wrote that you shouldn't need validation from other people, shouldn't want it, and if you do want it - fix that. Doing it hoping you gain some indelible "society values me" token to carry around with you forever so you can use it as a trump card and people will like you more, feeling like you've never done anything good and that you need to to be likeable, doesn't sound much like "altruism: Unselfish concern for the welfare of others; selflessness.", does it?
[+] [-] Vecr|2 years ago|reply
[+] [-] Quinzel|2 years ago|reply
When I am dead however, they can take my kidneys, heart, lungs, liver and whatever else that is salvageable and give them to whoever needs them (assuming I die in the right circumstances that this is possible).
[+] [-] datadrivenangel|2 years ago|reply
I'm surprised by how relatively risky the scan creening seems to be though.
[+] [-] elromulous|2 years ago|reply
[+] [-] laserlight|2 years ago|reply
When other organizations do so, they are wasting money that could have been well-spent. When effective altruists do so, they are “sacrificing their reputation for a good cause”.
[+] [-] ckdot2|2 years ago|reply
[+] [-] mitthrowaway2|2 years ago|reply
Scott is right to point out the gap, but I don't expect him to donate another kidney next year. Even for those who follow through on their good intentions, kidney donation is a one-time event not an annual event, so it shouldn't be compared to an annual rate. Assuming that would-be kidney donors have a window about 50 years to follow through on their good intentions, the gap should be between 25-50% and 50 x 0.0001% = 0.005%.
[+] [-] Aurornis|2 years ago|reply
This feels like a spin on how this all went down. A lot of the anger about that group utilizing funds to, literally, buy a castle came from EA groups too.
Trying to downplay the situation and pretend that the anger was only coming from uninformed outsiders feels like a dishonest attempt to rewrite history.
If you’re not familiar with this story, here’s a source: https://www.newyorker.com/magazine/2022/08/15/the-reluctant-...
There was a lot of debate about it in EA circles. A lot of it turned into mental gymnastics as they tried to find ways to explain how spending a amount of money on a literal castle so they could meet in it somehow had an expected value that was positive for humanity or something.
Weird to see this incident pop up in an article about kidney donation, but even weirder to see the critics of the decision downplayed and sneered as uninformed outsiders when so much of the anger came from inside the EA community. Really feels like a subtle signal that if you don’t toe the line on every EA organization decision, you must be an outsider.
[+] [-] germyj|2 years ago|reply
Bingo. I like Scott's writing in general, I've interacted with him a few times, and EA criticism is one of three or so topics where disagreement gets you the outsider treatment.
He's slightly more amenable if you can provide an example that would've been "more effective," but "this was a bad decision"-type critiques will default to "the bigwigs are smarter than you."
[+] [-] cromulent|2 years ago|reply
https://www.bbc.com/news/business-50632630
[+] [-] rednerrus|2 years ago|reply
[+] [-] pkaye|2 years ago|reply
> Based on the trial’s design, Ozempic needed to reduce the absolute risk of one of those kidney-related conditions by at least 3.5% when compared to placebo, or a relative risk reduction of around 16.5%, Akash Tewari, a Jefferies analyst who covers Lilly, wrote in a note to clients.
https://www.biopharmadive.com/news/novo-nordisk-ozempic-kidn...