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This is the fourth of four posts on DPR. In this part I provide some simplistic but illustrative cost-effectiveness estimates comparing an imaginary campaign for DPR against current interventions for poverty, physical health and mental health; I also consider what EAs should do next.

Links to the articles in this series:

Part 1 (1,800 words): Introduction and Summary.

Part 2 (8,000 words): Six Ways DPR Could Do Good And Anticipating The Objections

Part 3 (3,000 words): Policy Suggestions, Tractability and Neglectedess.

Part 4 (3,500 words): Estimating Cost-Effectiveness vs Other Causes; What EA Should Do Next.

6. Speculative cost-effectiveness calculations

For the sake of argument, assume there is an effective campaigning organisation we could fund, or set up, if we wanted to bring about drug policy reform. How cost-effective would it need to be to be more cost-effective than other things effective altruists currently fund, such as Give Directly (unconditional cash transfers to those in poverty) or the Against Malaria Foundation (‘AMF’; bednets to stop children dying from malaria)?

In addition to Give Directly and AMF, I’m also going to add Basic Needs, a mental health charity that operates in the developing world, to the list, even though it isn't a GiveWell top charity. This is because I(’m an outrageous heretic and) think that, if you want to make people happier, it's probably easier to target misery directly by treating mental illnesses such as depression. By contrast, targeting disease and poverty seem a nuch less direct way to achieving the same goal. I’ve made this point elsewhere and won’t restate the case.

Technical paragraph non-philosophers may want to skip:

I’m also assuming we’re interested in happiness, where happiness is understood in a roughly Benthamite way as positive conscious states – those that feel good to you, that you enjoy – and unhappiness the opposite, as negative conscious states.[1] All plausible moral theories think this matters, even if they don’t think it’s the only thing that matters, so let’s start with a concept of valuable mental states everyone at least shares (even if you think well-being consists in having your desires realised, one desire everyone presumably shares is feeling good). I’ll assume we can do interpersonal cardinal comparisons of happiness, i.e. we can compare units of happiness, where one unit to you feels as good as it does to me. This is just the QALY-approach, but using happiness instead of health. Let’s also say 1 is maximum sustainable happiness, 0 is neutral and -1 is minimum sustainable happiness.[2]

If we’re going to do the comparison, what we need to know is:

  1. The cost of the intervention
  2. The number of people it could affect
  3. How long it affects each of them for
  4. The amount it increases their happiness by (on the -1 to 1 scale)

I’ll explain my thinking in words, but I’ve also put the figures in this google sheet I invite people to copy and use to create their own estimates.

Let’s consider AMF’s cost-effectiveness. Give Well estimate it costs $7,500 to save each child under 5 from dying from malaria.[3] Assume that child lives another 45 years (developing world life expectancy), each year at full happiness (very improbable), then that’s one happiness-adjusted life year (‘HALY’) for each $166.6 spent. Or, that’s 60 HALYs/$10,000. (You need to have some quite implausible beliefs about population ethics and the badness of death to get these numbers, which I’ve discussed here, but let’s leave those aside for now.)

I’m less sure how to do the numbers for Give Directly. Suppose recipients are given $1/day extra and this increase their happiness by 1 (i.e. very improbably taking them from neutral to full happiness) for a year. This is $365 per HALY or 27.4 HALYs/$10,000. (I think this is extremely generous to Give Directly and I’m sceptical it increases happiness at all, which I’ve discussed here, but let’s leave this aside too.)

Basic Needs estimate it costs $14/participate/month to run their programme, which is $168/participant/year.[4] Assume the effect lasts one year and increases happiness by 0.3 over that year. It costs Basic Needs $560 to generate one HALY. Or, that’s 17.8 HALYS/$10,000.

Currently, AMF is well in the lead with $166.6 per HALY, so that’s the one to beat. Now, let’s assume we could fund a rescheduling campaign in just the UK to change the schedule on just the psychedelic drugs, LSD and psilocybin (magic mushrooms). This would make it easier to use them to research and treat depression and anxiety, which together affect around 1/6th of the UK’s 66m population each week.[5] Let’s round down the 11m figure down to 10m, to be conservative. Assume the research caused by the rescheduling reveals ways to increase the happiness of each of these 10m people by 0.1 for a single year (I think this is a conservative figure). [Update 14/08/2017: following Tom Sittler's comment below, I should have said that this rescheduling would increase the happiness of those 10m by 0.1 on average; it's unreasonable to assume all will get this treatment. However, we might assume that if some people get the new treatment, which I presume is cheaper, that frees up resources for more people, who wouldn't have received the old treatment, to get that in the first instance]

We don’t know how much it would cost to run a successful campaign, but we could ask the question the other way: how much could we spend on a successful rescheduling campaign – I.e. one that worked, got the law changed and allowed research to happen – and for that campaign to still be as cost-effective as our currently most cost-effective pick, AMF?

On the assumptions made above, the rescheduling campaign would generate 1m HALYs (0.1 HALY for each of 10m people). As AMF generates 1 HALY for $166, a successful rescheduling campaign costing less than £166m would be more cost-effective than AMF. If we spend $83m on the campaign it would be twice as cost-effective, if we spend $333m on the campaign before it succeeded that would be half as cost-effective as AMF, and so on.

To be clear, and before the figure is anchored in the mind, I am not suggesting this is how much a successful rescheduling campaign would, in fact, cost. The point is that if you had £166m to spend and thought you could pull off the rescheduling campaign for less than that, you should do that instead of giving you money to AMF as the rescheduling campaign is, in expectation, going to do more good.

What I suggested is a simple, relatively conservative cost-effectiveness estimate. I’ll now add a few more considerations.

You might worry the chance of success really varies with the size of campaign: you can’t believe a campaign for less than $10m would have any impact; thus, adding your $100 once there's a $10m pot is much more effective, in expectation, than adding your $100 to a £1m pot. This could be true, but if it is, this is a reason for a big funder to kick-start the campaign before smaller donors add their money, not a reason to give up on the project. 

You might also worry that an extra $100 here or there can’t make a difference between a policy change happening and not happening. This is a ‘sorites’-type problem (e.g. "how many grains do you need to add before it become a heap of sand?")[6] If you think $100 wouldn’t change people’s minds but $1bn would, you have to accept these extra $100s will matter somewhere because if you keep adding $100s, as eventually you’ll get to $1bn. Also, this objection applies just as easily to other interventions, such as AMF: how do you know any of your additional nets made the difference between life and death for someone? Presumably you accept the idea that $7,500 saves a life in expectation.

Having noted those two worries, I’ll now suggest my earlier estimate how much we should be prepared to pay for the rescheduling campaign was conservative.

I assumed the happiness impact was 0.1. We might expect someone who is depressed or anxious to be below 0 (as 0 is the neutral point, this means there are mostly unhappy) on a -1 to +1 scale. Potentially, someone could go up 1 point if they’re going from -0.5 to 0.5, so my 0.1 should be upgraded ten times to 1.

However, counted against this is consideration the size of the impact is really counterfactual, not absolute. We should be asking: how much better will the treatment they received due to the rescheduling campaign be than what they would have received without it? This can get a bit complicated: maybe the psychedelic-based treatments would be cheaper and more effective, so the government could treat more people; maybe the drugs offer only a tiny improvement; maybe many of those people would never sought or received treatment in either case; maybe the fact some people get cheaper, more-effective psychedelic-assisted therapy frees up resources to treat those who wouldn't have been treated with current therapy; etc. Having considered the counterfactuals, let's now divide the cost-effective estimate by three. As we increase the estimate by 10 in the last paragraph and reduce it be 3 in this one, the net increase is 3.3 (i.e. 10/3).

Next, we should recognise that the rescheduling policy, if it occurred, wouldn’t last for just one year, but would last in perpetuity and continue to provide better treatment than the status quo. This also needs to be counterfactual: if some group of EAs didn’t campaign for rescheduling, how many years would it be before it happened anyway? 5? 10? 50? Let’s say the campaign counterfactually makes the policy happen 10 years earlier, so it has an effective duration of 10 years. An additional confusing thought is that, if we 'solved' DPR, then current drug policy campaigners would probably move on to do something else good instead. Let's ignore this additional fact as it's unclear how this 'replacement' feature is going to play out.

If Britain changed its drug policies, this might have a knock-on effect around the world as other countries took note and copied. Alternatively, this might be isolated just to Britain. Total isolation seems unlikely, so let’s assume a spillover effect and double the number of people affected.

In considering the rescheduling of drugs for mental health, I haven’t factored in any of the other 5 arguments I mentioned in section 2. It seems, if you’re going to campaign for drug policy reform, once you’re campaigning for rescheduling, the additional cost of campaign for decriminalisation and/or legalisation is presumably quite small and, if the rescheduling did happen, it might do so alongside other drug policy reforms. I haven’t assessed the impact of the other 5 arguments but think the impact of mental health is likely to be by far the biggest anyway. Let’s cautiously add 5% on top of the effect.

For this more optimistic estimate we multiply our original £166m figure by 3 (counterfactual impact) x 10 (counterfactual duration) x 2 (spillover) x 1.05 (other benefits of drug policy reform) which is a multiplier of 63, giving is £10.5bn, a rather high number. While the number is large, I don’t find it implausible. It’s the result of bringing about a systemic change could potentially improve the lives of very many people by a sizeable amount.

What the estimated figure of £10.5bn means is that, if you believed an imaginary rescheduling campaign would succeed with less than £10.5bn of funding, then you should think that campaign would be more cost-effective than giving your money to AMF and, therefore, you should support it over AMF. I accept this is currently hypothetical – I haven’t identified a place readers could send their money to (yet) – but I would ask the reader to make their own guess about how much money it would require to run a successful rescheduling campaign. This will give them a sense of how cost-effective they think drug policy reform is compared to the other charities I mentioned (AMF, Give Directly, Basic Needs). If you believe a cool £100m is all that’s required to get the laws changed, the rescheduling campaign would be 105 times more cost-effective than AMF.

If we want an even bigger number to chew on, consider that around 500m people have either depression or anxiety worldwide. If we could improve their happiness level by 0.3 and do so 10 years earlier, we could spend up to $250bn on that campaign and it would be as cost-effective as I’ve assumed AMF is.

I’ll now anticipate two objections to my cost-effectiveness estimates and the conclusion I reach.

First, one could accept everything I’ve said is true, but argue another cause is still more cost-effective. I’ve claimed DPR looks particularly good at increasing happiness for presently existing people. However, you might, for instance, be a total utilitarian whose wants to maximise the happiness of the history of the universe. If you were such a person, you’d care not just about the happiness of those alive today, but about the happiness of all future, possible people too, and might think existential threats to humanity, such as AI safety, as more pressing.

For those who think something else is more important, I would be very grateful if you could produce some (very rough) estimates of how many times more cost effective money to their preferred cause is than DPR. As far as I’m aware, there is only one cost-effectiveness estimates comparing near-term causes like Give Directly and AMF to far-future ones, (Michael Dicken's, which I'm not smart enough to use) so I don’t know how much better X-risk charities are supposed to be.[7] As all plausible moral theories hold improving the happiness of existing people is good, even total utilitarian X-risk advocates should be prepared to support near-term altruism if it can be done cheaply enough (e.g. if you think MIRI, an AI safety research charity, is 5x more effective than AMF, but then conclude DPR is 10x more effective than AMF, you should switch to DPR). Certainly, even if you’re largely uninterested in the happiness of present people, the long-run effects benefits of DPR are considerable: stopping the War on Drugs with its associated crime, corruption and instability, as well as helping potentially half a billion mentally ill or drug addicted people get back to work would be quite an economic and societal boon.

Second, one might object DPR only looks attractive because I’ve used a suspicious mechanism to generate the expected value calculations: systemic change campaigns look (delusionally) effective because they have a small chance of affecting so many people. Roughly, the complaint is that I’ve found a new Pascal’s Mugging. I’m not sure how suspicious this kind of mugging is: I’m at least talking about real, concretely existing people, rather than conjuring up a near infinity of possible people. There doesn’t seem to be anything strange about systemic changes per se; everyone should accept the abolition of slavery, which affected millions, was a substantial systemic change that had a large positive impact. For those who think my estimates are too generous I would welcome them pointing out exactly which part they disagree with; that would be helpful and allow me to improve them.

An alternate way of pressing the second objection would be to accept the type of expected value calculations I’ve used but claim they don’t favour DPR more than any another cause. The idea here is to claim “fine, but all systemic change campaigns look ludicrously effective”. The critic could then generate some additional numbers to show, for instance, it has a higher expected value for private individuals to support a campaign that lobbies governments to increase international development spending than it does for those donors to send their straight cash to Give Directly (or AMF or Basic Needs). On this sort of analysis, one could object what my argument has really done is push EA towards systemic change interventions and away from ‘sticking plaster’ interventions (those which help one person at a time), such as Give Directly, in general, rather than push EAs towards drug policy reform in particular.

I think it is possible that systemic change campaigns could have higher expected value than their ‘sticking plaster’ alternatives. This would be a very interesting result and I would like to see people producing worked out systemic changes estimates for say, poverty and physical health. However, my sense is that DPR is uniquely well placed to be a good systemic change intervention. This is because not only would it not cost governments any more money, it could generate lots of revenue. Drug policy reform is the in the enlightened self-interested of taxpayers and governments. In contrast, raising taxes to fund greater aid spending runs counter to the self-interest of taxpayers, and taking money from one part of government spending to increase international aid will similarly meet resistance from whoever loses by this redistribution. There may be some, but I can’t think of any other policy changes that would simultaneously reduce costs and increase happiness and so do without even an initial investment from the government.

7. What should EAs do now?

I admit I don’t have a top charity EAs should give to, nor an ironed-out plan for DPR campaigning; I haven’t got that far. I thought the prudent thing to do, in the first instance, would be to write this up and see if others agree it is an important, unrecognised cause. If there are some crucial considerations that render this area unpromising, it makes sense to establish that now before spending time trying to plan the next steps are in detail.

Somewhat glibly, my answer to the question “what should EAs do now?” is “Answer that question.” Supposing people do agree this is important, I think what’s needed is more research to figure out what to do. I don’t think I fully understand what the best way to tackle this problem is. More concretely, some obvious next steps would be to talk to the charities in the area, get their thoughts and try to assess where money, time and research could be best used.

There are also a whole host of questions I’ve littered through this document I think need answers. I’ve collected them here in case anyone wants to help. These are in the order I raised them, not necessarily of importance:

  • How effective and how expensive are treatments of anxiety? Do people relapse? I only have information for depression currently.
  • What is the worldwide scheduling system on drugs? How does it differ from place to place?
  • How much happiness might be gained from arguments 2-6 that I didn’t really included in my cost-effectiveness speculations? Questions that need to be answered to find this out include:
  • How valuable is the illicit drug trade? Does the drug trade fuel other crimes including terrorism? How much crime, corruption, etc. would be removed by legalisation? How much happiness would this create?
  • How much do governments spend on locking up drug users? How much does getting a criminal record impact one’s life prospects and happiness?
  • How much could governments raise from legalising and taxes drugs? How much good could this extra money do?
  • What would the recreational benefits, if any, be from legalising (some) drugs? How big is this compared to the other benefits?
  • What are good ways of thinking about tractability? How effective are public opinions or lobbying campaigns? What are good comparisons to make?
  • What are the best campaigning organisations working on this? How do we assess how effective such organisations are? Should we just fund them or try and start something of our own? If so, what?
  • What should effective altruists do next?

[1] J Bentham, An Introduction to the Principles of Morals and Legislation, 1789.

[2] ‘Maximum ‘sustainable’ happiness refers to the highest average happiness level one can keep up over a lifetime, which contrasts with maximum ‘peak’ happiness, the most intensity happiness could can feel at a given point, which is presumably higher than maximum sustainable happiness.

[3] GiveWell, “Against Malaria Foundation | GiveWell,” 2016, http://www.givewell.org/charities/against-malaria-foundation.

[4] Basic Needs, “Basic Need Annual Report.”

[5] NHS, “Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England,” 2014, http://content.digital.nhs.uk/catalogue/PUB21748.nnhs

[6] The paradox of the heap: if you take away a grain of sand from a heap of sand, when does the heap stop being heap? No single grain seems to make a difference but if you keep taking grains away eventually they’ll be nothing left, at which point there must be no heap.

[7] Michael Dickens’ cause prioritisation model can be found here (http://mdickens.me/causepri-app/). Sadly I am not mathematically competent enough to tweak so it matches my assumptions. I also understand CEA are working on a model comparing near-term to far-future causes.

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Are the drugs you're talking about actually cheaper than existing treatments for depression? That surprised me a lot.

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This is a very impressive series. My fiancé and I are focused on animal and far-future causes at the moment, but he had been pushing for us to choose a mental health charity to the extent we'd focused on present-day humans. I'm going to send this his way, as I think he'll appreciate it.

good to hear!

Hello Thomas,

no cost-effectiveness estimates comparing near-term causes

On reflection, I should state 'there's only one model' rather than 'there are none' but mention one in the footnote. I guess I meant, which is still true, "there are no models I known how to use"...

ix Ways DPR Could Do Good, yet your quantitative model only seems to take into account the first of these, improved treatment for mental health.

I think the mental health effect is the biggest, it's also the easiest to think about because I know what the numbers are - it would take me a long time to assess the happiness impact of DPR caused by reducing crime (how much happiness does a crime remove? how many are there around the world? how many of those are attributable to drugs? etc...). I don't plan to do any further modelling as I need to get back to my thesis and the detail of DPR now looks like it will be outside it. FWIW, I think the mental health impact of DPR is about 80% of it's value, but when I asked Lee the same question (before telling him my view) I think he said it was about 30% (we were potentially using different moral philosophies).

Does this assume that every single person suffering from depression or anxiety in the UK will adopt the new treatment?

Yeah, I'm not clear on this. It's probably unreasonable to assume everyone would get/use the new treatment, although that's what I initially thought. I take the 0.1 as the (mean) average change across all those could be treated.

You assume a 0.1 change

I just guessed the number based on (a) the happiness impact of removing depression via other methods and (b) my qualitative sense from reading the studies of how much more effective psychedelics seems to be than alternatives. If there's a cardinal scale I can use that shows how much better psychedelics are that would be great, but I didn't dig through because doing something like what Lovisa and Konstantin did didn't occur to me.

with regard to the £166m figure. It would be useful to get an order of magnitude estimate of the cost of past campaigns

I agree it would be good to do this. I looked into this a bit but couldn't find anything useful on the cost-effectiveness of lobbying (I skimmed your paper too; it doesn't really bear on the question at hand). It's also a long way from my area of expertise and thought I was better to share what I had rather that wait until I'd found time to dig into this (which may not happen for months). If anyone read this and wanted to have a go, I'd be very grateful.

FWIW, two more things, 1) I think £166m figure is conservative and the real figure is closer to £10.5bn.

2) This is compared to AMF. As I note above and have argued elsewhere, you would have you to hold a particular, implausible philosophical view to believe AMF is as cost-effective as I stated; I was being generous to my imagined critics. A more realistic comparison is probably Basic Needs, which I say above is about 3x less cost-effective than AMF on AMF's unbelievable numbers, So really we should multiply the ammount we would spend on a DPR campaign by three to get something like £560m (conservative) or £35bn (optimistic).

I'm a huge supporter of drug policy reform and try to advocate it as much as I can in my personal life. Originally, I was going to post here suggesting we need a better breakdown of particular issues which are particularly ripe for policy reform (say reforming how drug weights are calculated) and the relative effectiveness of various interventions (lobbying, ads, lectures etc..).

However, on reflection I think there might be good reasons not to get involved in this project.

Probably the biggest problem for both EA and drug policy reform is the perception that the people involved are just a bunch of weirdos (we're emotionally stunted nerds and they are a bunch of stoners). This perception reduces donations to EA causes (you don't get the same status boost if its weird) and stops people from listening to the arguments of people in dpr.

If EA is seen as being a big supporter of DPR efforts this risks making the situation worse for both groups. I can just imagine an average lesswrong contributor being interviewed on TV as to why he supports dpr and when the reporter asks him how this affects him personally he starts enthusiastically explaining his use of nootropics and the public dismisses the whole thing as just weird druggies trying to make it legal to get high. This doesn't mean those of us who believe in EA can't quietly donate to dpr organizations but it probably does prevent us from doing what EA does best, determining the particular interventions that work best at a fine grained level and doing that.

This makes me skeptical this is a particularly good place to intervene. If we are going to work in policy change at all we should pick an area where we can push for very particular effective issues without the risk of backlash (to both us and dpr organiations).

I don't think the average nootropics user would appear to have a goal of getting a legal high in a television broadcast.

It's more interesting for a journalist to tell a story about a computer programmer who takes LSD to help him with a difficult programming problem on which he worked for months without a satisfying answer than to tell a story about the computer programmer wanting to get high with LSD.

The story about how nerds in Silicon Valley do everything to enchance their performance is more interesting than the story about a random person taking drugs.

More generally EA is also full of weird causes as Scott Alexander describes very well in his blog post about EA Global.

You could have written the same thing 2 years ago replacing "drug policy reform" with "artificial intelligence" and made exactly the same argument: "AI is weird, it will damage EA, imagine interviewing an AI nerd like Elon Musk on tv, etc". Except lots of people now take AI seriously, it's received lots of public money and attention and lots is getting done.This is presumably because the arguments for AI were strong.

You seem to be presenting me with a Morton's Fork (a false dilemma caused by contradictory observations reaching the same conclusons): "if X is seen as weird, don't work on it. If X is not seen as weird, then it can't be neglected so there's no point working on it either." This can't be right, because it would rule out every cause.

I think the role EA fills in the world is exactly finding the important problems in the world others are ignoring, perhaps because those problems seem to weird, and then argue they are worth taking seriously. Notice there's something odd about saying "I've become convinced the arguments for X are very strong, but no one else will be convinced so let's abandon cause X". If you found argument for X persuasive, others probably will too and X is well worth working on. Clearly, we should avoid arguing for weird causes that would do no good. I didn't think DPR was important, now I think it's very substantial.

More generally, I think concerns about reputation and backlash our overstated (#spotlight effect), but I'd be open to someone showing me evidence to the contrary.


Thanks - very interesting. Could an EA pay for drug medical studies in Portugal? It seems like there are millions of people working on marijuana legalization, and many critics of the war on drugs. I know you are looking more holistically, but overall it doesn't seem that neglected.

For those who think something else is more important, I would be very grateful if you could produce some (very rough) estimates of how many times more cost effective money to their preferred cause is than DPR.

Some people would say ~10^40 times (computer consciousnesses and spreading intergalactically). Of course there are many reasons why this vision may not pan out, but it does seem like we should have a non-negligible probability that we are alone in the galaxy (or even the visible universe) and that we can and have the will to colonize the stars if we don't destroy ourselves. These qualifiers might only take a few orders of magnitude off. Then even if you do not believe in the tractability of AI, there are many other concrete interventions that could reduce existential risk, like asteroid defense and alternate foods. So basically I do not believe the prior of cost effectiveness of global poverty interventions should be strong, so I don't think we should adjust these expected value calculations downward nearly as much as some proposed models have done.

Also, if one does not value the far future, there are other claims of cost effectiveness better than global poverty.

Hey Denkenberger, thanks for your comment. I too tend to weight the future heavily and I think there are some reasons to believe that DPR could have nontrivial benefits with this set of preferences. This was in fact why, as Michael mentions above:

"FWIW, I think the mental health impact of DPR is about 80% of it's value, but when I asked Lee the same question (before telling him my view) I think he said it was about 30% (we were potentially using different moral philosophies)." because I think DPR's effects on the far future could be the source of most of its expected value.

DPR sits at the juncture between international development & economic growth, global & mental health, national & international crime, terrorism, conflict & security, and human rights. I think we should expect solving the world drug problem to improve some or all of these issues, as Michael argued in the series.

I think it could be easy to overlook the expected benefits of significant reductions in funding and motivation for crime, corruption, terrorism, and conflict for fostering a stable, trusting global system. My weak conjecture is that such reductions would bring an array of global benefits composed of reduced out-group fear (on community and international levels), stronger institutions, and richer societies.

DPR might thus offer a step in the right direction towards solving issues of global coordination, which in turn may increase our expectations for solving the coordination problem for AI and, thence, the long-term future. I admit this is a fairly hand-wavy notion and that the causal chains are undesirably long and uncertain, relying on unpredictable assumptions (such as the timing of an intelligence takeoff compared with the length of time it would take to observe the international social benefits, for a start). My confidence intervals are therefore commensurately wide, but still I struggle to think of ways in which it could be net negative for global coordination. So almost all of my probability weight is positive. Multiplied by humanity's cosmic endowment, I weigh this relatively heavily. Of course, there may be other, more certain activities that we can do to improve the EV of humanity's future, and I think there are, but I don't think DPR is obviously a waste of time if that's what we care about.

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