Noble work: Anand Giridharadas on the EKS

There was a recent discussion on the IDinsight #philosophy Slack channel about a recent Ezra Klein Show (EKS on this blog from now on, since I talk about it all the time) podcast with Anand Giridharadas. My contribution built off someone else’s notes that Giridharadas is spot on about how companies (also IDinsight in some ways) sell working for them as an extension of the camaraderie and culture of a college campus, how he doesn’t offer concrete solutions and that’s very annoying, and some reflections on transitioning from private sector consulting to IDinsight’s social sector, non-profit consulting model. I related more to the moral arguments in the podcast, and this is what I shared:

I connected most with his argument about how the overall negative impact of many big for-profit companies on worldwide well-being vastly outweighs any individual good you can do with the money you earn. One of EA’s recommended pathways to change is making a ton of money and giving it to effective charities, but if you do that by working for an exploitative company, then you’re really contributing to the maintenance of inequality and of the status quo racist, sexist, oppressive system.

My dad was always talking about having a “noble” profession when I was growing up (he’s a teacher and my mom’s a geriatric physical therapist) and even though “noble” is a strange way to put it, I think it is really important to (as much as possible) only be party to organizations and companies that are doing good or at least not doing active harm.

That being said, there are more reasons for going into the private sector and aiming to make money than are really dealt with in the podcast. For example, a few people we’ve talked to in South Africa have mentioned that many highly skilled South Africans are responsible for the education costs for all siblings/cousins and that is a strong motivator to take a higher paying salary.

It becomes very related to the debate about how much development or social sector workers should get paid, relative to competitive private sector jobs. I think IDinsight does a pretty good job of being in the middle for US associates anyways – paying enough that you can even save some, which is more than a lot of non-profits provide, but not necessarily trying to compete with private sector jobs because our model relies a lot on hiring people who are in it to serve, not for the money. Something for us to continue thinking about is how this might exclude candidates who have other financial responsibilities and how we should respond to this issue in how we hire and set salaries.

It’s so frustrating when people identify a problem without offering solutions. The closest he comes to offering solutions is to have organizations stop lobbying for massive tax breaks or in other ways deprioritize the bottom line of profitability. Sounded to me like his vision involves a lot more socialist ideas: the full solutions to these issues would involve massive-scale reorganizing of the existing economic system… although maybe we are heading in that direction with more co-op style companies and triple bottom line for-profit social enterprises? (Don’t know a ton about this co-op stuff – mostly from another Ezra Klein show episode probably, but it sounds cool!) …Maybe his next book will try to map out solutions, though?

Complicating (and improving) our narratives of sex

CW: sexual assault

Partners with different sex drives

This week, one of my favorite podcasts – AdultSh1t from Kate Peterman and Kelsey Darragh of Buzzfeed – answered a question from a listener whose sex drive is much higher than that of her long-time girlfriend. The listener said she felt bad and uncomfortable asking for more sex because she doesn’t want to feel “rape-y” or like she’s pressuring her girlfriend into doing sexual things she doesn’t want to do. But she’s not getting the sexual fulfillment she needs right now.

Kate and Kelsey advise even more communication, but also to make sure you’re getting what you need in the relationship. I would add a few things to what they shared:

  1. Start the conversation from a point of, “I love you and I want to figure this out together. We seem to need different things and I want to understand why you need what you need and explain why I need what I need.” It is super scary to start a conversation with a long-time partner that you know could lead to some really painful and possibly break-up-inducing discussions. Phrasing it like you’re tackling an issue together makes it seem less intimidating to get into it at a deeper level.
  2. Be careful to not attack her perspective/experience. I think this is especially challenging because there’s an assumption that everyone wants to have sex inherent in U.S. culture. Being sensitive to the fact that she might be ready to get defensive about that assumption (just like you could be sensitive about the assumption that having a higher sex drive is “sinful”) can help. Avoid approaching it like there’s a problem with her. It’s a problem between the two of you.
  3. Share that you don’t want to feel like you’re pressuring her, that you’re struggling to approach the issue, and that that’s a point of pain for you. Specifically share that it can make you feel unwanted, unsexy, and confused. Maybe this can lead to her sharing ways that you can introduce sexy times without it being pressuring, or what specific language y’all can use to discuss whether to get it on in the future. Also, ask her to tell you how these situations make her feel – is she uncomfortable? Annoyed? Sad? Frustrated? It might also be hard for her to know she’s not fulfilling all your sexual needs. My good friend Annaji introduced me to the powers of the “I” statement. If you keep it about how you feel, that acknowledges there’s room for misinterpretation and offers the other person space to clarify where they’re coming from, too.
  4. Once you’ve both been able to share how y’all are feeling about your sex life, then you can talk about next steps more freely and as a team. Maybe you can brainstorm some solutions or compromises. Maybe, even though it’s scary, you both will find you really do need a partner whose sex drive matches your own more closely. Even though it’s a tough decision to make after so many years together.

I was once in a relationship where I found out almost 2 years in that my partner was unhappy with how much sex we’d been having. He felt like we had sex too often. He told me that our intimacy cut into his time to do personal projects that were important for him to be fulfilled. This was partially because we would sleep over in each others’ dorm rooms a lot and go to bed early, cutting into hours he would have previously used to create.

It was really painful to hear that he felt pressure to have sex, even if he said that pressure wasn’t coming from me so much as from society. I still worry that he did feel pressure from me. Maybe, as I discuss below, he just couldn’t tell me he was uncomfortable.

We did break up shortly after this revelation, which came at a complicated time in our relationship for other reasons. I’m not sure how we would have dealt with our mismatched sex drives given more time. Thankfully, we still have a good relationship as friends. And I think that’s in large part due to the fact that we did have honest conversations about our sex life before the break-up.

Men’s experiences: the same, but different

This episode also deepened my thinking on the Beautiful / Anonymous episode I shared earlier this week, where a man called in to talk about how he was sexually assaulted three times in his life, twice by women. I had a moment at work today to discuss it with my colleague who recommended the episode. One of our big takeaways was that it was amazing how familiar the caller’s description of his doubt, shame, and struggle sounded.

Most women have heard female friends’ stories of sexual assault or experienced it themselves. Through most stories, there are common threads: feeling unable to react fast enough or strongly enough, doubting whether we truly couldn’t have done anything, wondering if the other person genuinely thought it was okay and just missed our signals, whether the signals we sent were strong enough. All of that self-doubt I have heard expressed by numerous women – it was a revelation to hear a man share the same doubts.

Anyone can have their bodily autonomy and safety violated. Even if you know that in your brain, hearing this man’s story makes it stick in your soul in a new way. I think all of us still carry with us ingrained messaging about men’s relationship to intimacy, sex, and violence. Those narratives lead us to make assumptions that can really hurt other people; this podcast invites us (women) to examine our part in perpetuating these assumptions about gender and sex.

It’s hard to think about, because it really complicates narratives that are easier to keep clean cut. Women are victims, men are violent, sex-driven animals. We (feminists) know it’s a gross simplification, but it’s still so tempting when the statistics are that most victims of sexual violence are women, and most perpetrators are men. That narrative can even be comforting/validating on some level for women who are violated in that way – you’re not alone, this happened to us too, we’re here for you, it’s not your fault.

While the male caller shared these same doubts and feelings of shame and guilt as so many women, the way he expressed the doubts was also telling. My colleague and I both marked that he was bewildered by those feelings and without a narrative to put them into that accounted for both his masculinity and his vulnerability.

My female friends and I, on the other hand, can see how our own experiences fit into the larger societal phenomenon of violence against women. Each of our experiences is intensely personal and can feel isolating. Yet when we’ve been able to talk to each other about those experiences, we can wryly see it as part of “womanhood” in our culture. A terrible yet shared burden. We all contribute a piece to the larger narrative. And, we can also share in the new narratives that are rising about self-care, how to survive & thrive after sexual violence, how to find sisterhood in this massive, horrifying phenomenon.

It is both to men’s privilege and to the caller’s disadvantage that he is not part of this narrative. This podcast called me to think about ways in which I perpetuate bad myths about gender, sex and violence, and ways in which I can bring non-female survivors of sexual assault into the sisterhood component of the narrative I hold.

 

Are we murderers for not donating our organs? [repost]

Zell Kravinsky risked his life to donate his healthy kidney to a complete stranger. Would you do the same?

Kravinsky is a radical altruist. He believes in giving away as much as possible to others, including his nearly $45 million fortune and his own body parts. Most people would consider donating a kidney as going above and beyond, but Kravinsky told the New Yorker in 2004 that he considers anyone who doesn’t donate their extra kidney a murderer.

We probably don’t, as individuals, have a moral responsibility to donate our organs, but maybe we do have a societal responsibility to find a system by which we can match kidney donors and recipients so that no one has to die just because there isn’t a transplant available. In 2012, there were 95,000 Americans on the wait list for a life-saving kidney, according to economists Gary Becker and Julio Elias. The average wait time for a kidney in 2012 was over four years.

Becker and Elias are proponents of creating a formal, legal market for organs to eliminate long wait times and better match recipients with donors. Right now, it is illegal to sell your organs in most of the world, including in the U.S.

The main risks of monetary compensation for organ donations are the coercion of unwilling donors, the potentially unequal distribution of donors — poor people would be more likely to become donors, and the moral question of whether or not it is okay to sell body parts, even if they are our own.

Purely moral arguments aside for a moment, there are ways to alleviate the risks of a market for organs. Waiting periods between registration and donation, psychiatric evaluation ahead of registration as an organ donor, and strict identification requirements or even background checks can all combat coercion in the market for organs, while saving the lives of the many Americans who die on an organ waitlist. Becker and Elias also point to the fact that people in lower income brackets are disproportionately affected by long waitlists: the wealthy can fly abroad to obtain a healthy organ or manipulate the current waitlist system in their favor, while poorer Americans face longer wait times. While donors may be disproportionately poor, which raises concerns of implicit economic coercion, the lower income brackets also benefit disproportionately from the policy.

Even more powerful than a legal market alone would be a combination of a legal market for organs and an implied consent law, which would mean people would have to opt out of being an organ donor, rather than the U.S. standard of opting into being a donor. A 2006 study by economists Alberto Abadie and Sebastien Gay found that implied consent laws have a positive impact on organ donations. Under a combination of these two initiatives, essentially all organ donor needs might be met, and a person’s will might come to include provisions for their organs to be harvested and family members to be compensated.

While Kravinsky donated his kidney for free, he once offered a journalist $10,000 to donate a kidney to a stranger, according to Philadelphia Magazine. But the journalist backed out of the deal he struck with Kravinsky after his wife and friends convinced him not to go through with it. They convinced him that the risk of surgery, though relatively minor, was not worth saving a life. But if a safe, legal market for organ sales is established, perhaps the establishment of a market price for organ donation and a normalization of the procedure will allow Americans to save lives and make money, without requiring Kravinsky’s extreme, and perhaps aggressive, sort of altruism.

Originally written for my Economics of Sin senior seminar, spring 2017; previously published at the Unofficial Economist on Medium.

Is my job moral? [repost]

If I continue on my current career path, I may end up arbitrating who lives and who dies. (And maybe I’ll tell their story in an economics journal and make a living doing so.)

I am planning on pursuing a career in development work, specifically in the evaluation of development programs. The “gold standard” for evaluating programs is a Randomized Control Trial (RCT).

Consider a non-profit distributing books to children with the goal of improving literacy. The non-profit wants to know whether their books really have any impact on children’s literacy. Ideally, they could look at what happens when they give a group of children the books and also what happens when they don’t give the same children books.

However, due to thus far unchangeable time-space continuum properties, this isn’t possible. So, in order to confidently say that their books had an impact, the non-profit needs to compare the literacy scores of children who received the books with other very similar children who didn’t get books. Let’s say they hire me to run an RCT for this very purpose.

To determine which children will get the books (the treatment group) and which children will serve as the comparison group (the control group), I take a list of 100 schools and randomly assign half of them to receive the extra books program. After the books are distributed and some time has passed, I go back to the schools and I have all the children take literacy tests. I compare the test scores of children in each group, and find that, on average, children who received books did much better on the literacy tests.

The non-profit is very happy and uses the results to convince more people to donate to their program. Now they can give books to many more children, and presumably those children’s literacy scores will also increase.

This is all good and well. Even if some children in the study were chosen not to receive books, there are several commonly accepted justifications for why we studied them without providing a service:

  • The non-profit did not have enough money to give books to all the schools anyway. Randomly determining which schools received the books makes it as fair as possible.
  • While the books program was unlikely to have negative effects on children, we didn’t know if it would have no effect or a positive effect at the start. So we didn’t know if we were really depriving children of a chance to improve their literacy.
  • Being able to conduct the evaluation could inform policy and global knowledge on effective ways to improve literacy, and could improve decision-making at the non-profit.
  • In this case, maybe the control group children were the first to receive books when the non-profit’s funding increased.

These are common justifications for development evaluations. They seem quite reasonable — randomly giving out benefits might be the fairest option, we don’t know what the effect really is, and the study will contribute to our shared knowledge and lead to better decisions and even better outcomes in the future.

What if, instead of working on literacy, the non-profit wanted to reduce deaths from childbirth by improving access to and use of health facilities by pregnant women?

Suddenly, so much more is at stake.

If I randomly assign half a county to have access to a special taxi service that drives pregnant women to hospitals for safer deliveries, and one of the women who was assigned NOT to receive the taxi service dies because she gave birth at home, is the evaluation immoral? Am I morally culpable for her death?

Because I work with numbers and data, it is easy to separate myself from the potential negative consequences of the work. I didn’t choose her to die — the random number generator made me do it. 

Photo by Markus Spiske on Unsplash

So what if we’re in a situation where a randomized control trial seems immoral? How can we still learn about what works and what doesn’t?

There are other evaluation methods that can give us an idea of what programs work and which don’t. For example, quasi-experimental methods look at situations where comparable control and treatment groups are incidentally defined by the implementation of a policy. Then we can compare two groups without having to be responsible for directly assigning some people to receive a program while others go without.

Qualitative or other non-experimental methods involve gathering data by talking to people, doing research, and meeting with different groups to get various opinions on what’s happening. These methods can also help paint a picture of whether a program is having a positive effect.

But the RCT is the gold standard for a reason. A well-designed RCT can tell us what the effect of a program is with much higher confidence and precision than other methods.

UNICEF Social Policy Specialist Tia Palermo recently wrote a post titled “Are Randomized Control Trials Bad for Children?” for UNICEF’s Evidence for Action blog. She makes a powerful point to consider: What are the alternatives to running RCTs? Are they better or worse?

Palermo sees the alternative as worse: “Is it ethical to pour donor money into projects when we don’t know if they work? Is it ethical not to learn from the experience of beneficiaries about the impacts of a program?” she asks.

Her most convincing argument is that there are ethical implications every research method we might choose:

“A non-credible or non-rigorous evaluation is a problem because underestimating program impacts might mean that we conclude a program or policy doesn’t work when it really does (with ethical implications). Funding might be withdrawn and an effective program is cut off. Or we might overestimate program impacts and conclude that a program is more successful than it really is (also with ethical implications). Resources might be allocated to this program over another program that actually works, or works better.”

And there are ethical implications to not evaluating programs at all. If non-profits aren’t held to any standard and don’t measure the effect of their program at all, there’s no way to tell which interventions and which non-profits are helping, having no effect on, or even harming the program recipients.

In the case of the woman who died because she didn’t get to a health facility, if the study had never taken place, would she have gotten to a health facility or not? It is impossible to know what would have happened, but it’s not impossible to minimize the risk of harm and maximize the benefits to all study participants. 

Photo by Anes Sabitovic on Unsplash

Ultimately, RCTs generate important evidence when they are well executed. The findings from such studies can be used to make better decisions at non-profits, at big donor foundations like the Gates Foundation or GiveWell, and at government agencies. All of which can lead to more lives saved, which is the ultimate goal.

So what to do about the ethical implications of randomly determining who gets access to a potentially life-saving program? Or any program that could have a positive impact on people’s lives?

There are a variety of measures in place to ensure ethical conduct in research and many more ~official~ economists are thinking about these ideas.

The 1979 Belmont Report in helped establish criteria for ethics in human research, focusing on respect for people’s right to make decisions freely, maximizing benefits and doing no harm, and fairness in who bears any risks or benefits. Institutional Review Boards (IRBs) are governing bodies that ensure these principles are being upheld for all research.

Economists Rachel Glennerster Shawn Powers wrote a highly recommended piece on these ethical considerations, “Balancing Risk and Benefit: Ethical Tradeoffs in Running Randomized Evaluations,” which I’m currently reading.

Yet persistent concerns about how to run ethical evaluations suggest that there is more work to do.

Taking the time to consider the ethical implications of each project is key. And I think there is more room for evaluators to read deeply on the subject and really dig into how to make evaluations more just and more beneficial to even those in the control group who don’t receive the program.

A driving principle, especially for researchers running RCTs in the development field, could be that an evaluation must have a direct positive impact on all study participants, either during the study or immediately following its completion. There are a variety of ways, some more commonly used than others, that researchers can apply this principle:

  • If we truly don’t know whether the effect of the program is positive or negative, we can make plans to provide the program to control households if it is found to have a positive effect.
  • If we suspect the program has a positive effect, the control group can be offered the program immediately after the study period has ended.
  • We can offer everyone in the study a base service, while the study tests the effectiveness of an additional service provided only to the treatment group. This way, everyone who is contributing time and information to the study receives some benefit in return.
  • Extensive piloting (testing different ideas and aspects of the evaluation before the start of the study) can also reveal potential moral dilemmas to evaluating any particular program.
  • Community interest meetings can be held before the study is implemented to gain community-level consent to participate in the study. These meetings could also be held quite early on to inform research designs and improve the quality of the study results. For example, in some cultures, it is not appropriate for a man to be alone with a woman he is not related to. If this is the case in a study area, then hiring male staff to conduct surveys would lead to a less successful study.
  • Local staff can be hired to conduct any surveys or data collection to ensure that the surveys are culturally appropriate.
  • We always obtain full and knowledgable consent from participants, which may require translating surveys into participants’ native language.
  • If study participation requires much time or effort from control group individuals, they can be appropriately compensated.
  • All reports on evaluations (RCTs and other designs) can be fully transparent about research decisions and how ethical concerns were addressed. This will contribute to the international research community’s combined knowledge of how to ensure the rights of participants are provided for in RCTs and other research.
  • The learnings from the study can also be shared with the participating community and should add to their knowledge about their own lives; contributing to the abstract “international research community” is not enough.

Enacting these measures requires more of researchers: some have the potential to affect the legitimacy of the evaluation results if they are not properly accounted for in analysis. But a strong sense of ethics and a dedication to the population being served (often low-income individuals from the Global South, contrasted with well-off researchers from the West) demand that we take the extra time in our research to consider all ethical implications.

Originally published on my Unofficial Economist Medium publication, November 4, 2017.