[Draft] Fighting Aging as an Effective Altruism Cause

Reading through this I have some pretty significant concerns.

First the model behind the "$0.24 for each life saved" figure seems very suspect:

• The assumption of radical life extension technology being developed by 2100 is totally unsupported, with the one citation being to a survey of machine learning researchers which gave a 50% chance of AI reaching human level in all activities by 2062. It is unclear how this relates to the development of radical life extension technology however, something significantly out of reach of (current) human level ability
• It assumes that Metformin would definitely extend human life expectancy by 1 year. However since much of the current evidence is from animal or cohort studies, it cannot be assumed that it definitely has an effect.
• Even given all of the above it is not clear to me that the model actually provides a good estimate of the number of people likely to be saved. It is based on an extreme simplification (assuming 5 billion people are all born in 2020 and take Metformin for their entire lives) and as far as I can tell there is no attempt to justify its accuracy.

I am also unconvinced by the quality of argument elsewhere in the paper. For instance in the section "False arguments against badness of death" they list common arguments against the badness of death and then claim to refute them. However the responses are often extremely shallow and do not engage at all with the core of the argument. Here are some examples:

1) Stopping death will result in overpopulation. Only the number of births counts for overpopulation (Gavrilov & Gavrilova, 2010), and short-lived organisms like lemmings are the type of species that suffers from overpopulation.

2) Stopping death could result in stagnation, infinite totalitarianism, or other bad social outcomes. Our world changes so quickly that there is no time for such “stability” to take root.

3) Stopping death takes opportunity from non-born people, who would be born if resources were freed up by death of aging humans. The idea of an infinite universe where everything is possible kills the objection.

The paper contains many other arguments of a similar level of quality, and so although I largely agree with many of its conclusions, I find it generally very uncompelling.

Finally, as the most minor point there are quite a high number of grammatical issues.

The argument that aging is the world's greatest cause of suffering relies heavily on prax. Do older people report lower levels of day-to-day happiness or overall life satisfaction? I recall reading that they do not. If we are to believe that they are wrong, then a direct explanation for it is in order.

The death of investor paradox doesn't work under basic utilitarian math, since it neglects the opportunity costs of fewer new people being born and having utility of their own.

For 3.4:

1. Death is the end of everything, but again this neglects the opportunity cost of allowing new people to be raised with the same resources.

2. Baillie 2013 doesn't seem to indicate that there is a loss of well-being from knowledge of death. It's an analytic philosophy paper divorced from human experience.

3. Not certain or substantiated, but highly plausible. Ok.

4. Again, opportunity costs. Though this response is substantially mitigated by the time required to train a new person to be productive (20-25 years).

5. I don't believe there is any direct moral reason to value the information in a human mind. Sure there is some pragmatic value, but again there is the problem of opportunity cost, since new minds will have unique memories and information of their own.

6. That's a good point. But you really should be integrating these straightforward considerations into a single quantitative model that aggregates the costs and benefits.

7. Yes.

8. Only if we care little for the utility of yet-to-be-born people.

9. Yes, though this is a counterargument to arguments which I wouldn't make. Actually there is a good Pascallian Wager argument to be made here about minimizing the number of potential bad afterlives.

Regarding opportunity costs, you write "The idea of an infinite universe where everything is possible kills the objection." What? I just have no idea what this argument is. Like, it makes no sense. Do all possible universes exist, so that it doesn't matter what we do entirely? Then why talk about fighting aging? I don't get it.

For the $0.24 figure, your calculation for 250 million people being saved doesn't make sense to me. As someone without prior background on the Gomopertz-Makeham law, it just isn't clear. Also, it's not clear what part of gwern's post supports the claim that life expectancy would be extended by one year. And there are explicit quantitative problems.

First, 90% of drugs that reach Phase I trials are not approved (https://www.bio.org/sites/default/files/Clinical%20Development%20Success%20Rates%202006-2015%20-%20BIO,%20Biomedtracker,%20Amplion%202016.pdf), so you should increase the expected cost by a factor of ten.

Second, the drug may not be approved for Phase I trials even if we fund the study.

(The possibility that it is nonetheless approved outside of the US is counterbalanced by the possibility that it is approved within the US but not elsewhere.)

Third, just because a drug is approved does not mean everyone will be able to afford it. This is especially true in poorer countries outside the West, where most of the world population is located. 84% of the world lives on under $20 a day, and gwern says that this drug costs $8 a day in the US. So it looks like most people in the world won't be able to afford it anytime soon.

Fourth, just because someone can afford it does not mean they are open to the concept. Western medicine is not embraced by everyone in the West, and it is often rejected in many other parts of the world. This study found that 27% of Chinese did not consult a Western doctor for their most recent illness.

Fifth, even if someone is okay with Western medicine, they may not want to take an anti-aging pill. 40% of Americans drink practically nothing despite the purported anti-aging benefits of red wine, the remaining 60% don't all drink red wine, and the ones who do presumably don't all do so for anti-aging reasons. Very few people, a tiny minority, take resveratrol. Only a small minority takes Vitamin D, despite its anti-aging benefits. Only a small minority are vegetarian, despite evidence of vegetarian longevity. Anti-aging blood transfer and cryonics are both commonly regarded as creepy jokes in popular culture. And no one seems to be attempting to illegally take metformin. Given all these examples, only a minority can be expected to take metformin prior to the longevity horizon.

Sixth, just because someone is willing and able to take it doesn't mean it's the most effective way to increase their lifespan with their limited excess money. If you are very poor, spending the same money on meat, vitamin fortification, or conventional healthcare may have a greater impact on your longevity. Gwern's calculations on metformin seem to support this.

Seventh, even if metformin is optimal for a poor person, it will still have a nontrivial opportunity cost in the form of foregone health and nutritional expenses.

Eighth, this is still a rough and simple argument which must be adjusted for the Optimizer's Curse when compared against something like anti-malarial bed nets.

Estimating these numbers in my head, it seems like you are overestimating the cost-effectiveness by an order of perhaps several thousand. That is a massive error. Imagine if Givewell had started out by saying that bed nets save lives for $1 each and then revised it up to the current $2,000.

There's significant doubt about the effectiveness of Metformin or caloric restriction among humans. NAD+ is being claimed by George Church and others to be more effective, though they might have vested interests since they produce and sell them.

Also, let's not privilege the hypothesis. If you had $60m to invest in gerontological research, would you spend it on Metformin trials?