S

Sanjay

4234 karmaJoined Jun 2015

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378

At the time, the comment was "it's not obvious, more rationale needed" -- i.e. I expressed sympathies for the proposal of transparency, but erred towards not doing it. 

I think the main thing which has changed is that it's a slightly more academic question now -- we no longer have the resource to run something like this. 

If, hypothetically, we did have the resource to run this again, would we default to asking funders to be transparent (rather than our previous default choice of not making this request)? I'm not sure -- as I say, it's a rather more academic question now.

Thanks very much for this, much appreciated. Your best guess of vaccines being less cost-effective than bednets and SMC, but not by an order of magnitude, sounds sensible.

Thanks very much for the comment, this is really interesting. The idea of explicitly adding in suicide risk is an interesting direction for the analysis, it sounds like good work. When you publish your paper, I'll be interested to consider whether the underlying estimates of the badness of depression (perhaps implicitly) already reflect the suicide angle.

At some point it might be useful to do a more careful compare and contrast between your method (using Pyne et al's paper) and our method (using the Sanderson paper). Given that the methods are quite different, if anything, I think it's actually quite striking that the methods ended up with numbers that are actually fairly similar (0.145 DALYs per SD-year vs 0.18 DALYs per SD-year).

I certainly would like to equip my toddler with more maths (and preferably computer science) skills than we see in schools. I was planning to remedy this by taking more time on teaching her the content myself (assuming she's willing!) I appreciate this won't work for everyone -- it's time-consuming and not every parent has great maths.

I'm hoping that I will be able to get into a routine of regular maths fun with Daddy. At first this will be the basics (my daughter can't talk yet, so she still has a lot to learn!), and then over time moving on to more advanced things. At the moment she loves it and eagerly asks for maths, so I'm hoping that will last.

  • We play maths games on the computer. She's enthusiastic about them, but I'm far from confident that it's improving her numerical capabilities. Some evidence in favour of it is that she can now say the number "two" -- this doesn't impressive, but she has very few words at the moment. At least it's more likely to help than harm (I suspect) and at worst it's daddy-daughter bonding time. 
  • Similarly dice seem to be entertaining for her, so I got hold of educational ten-sided dice, and I'm still experimenting how best to use them. 

I have ideas for fun things to do together when she's older, which I'm currently keeping track of in this document.

I said this in another comment, but in case it gets missed, I just want to highlight that 1Day Sooner has shown an excellent attitude. When we reached out to them, they were consistently welcoming of the criticism and had constructive useful comments. I've found these virtues to be more common in the EA community than elsewhere, but I still like to call them out when I see it.

Thank you Josh. I've found 1Day Sooner's collaborative spirit to be exemplary here -- both being welcoming of the challenge and adding useful thoughts.

It seems intuitive to me that the following package of considerations may lead to vaccines and nets/SMC having roughly the same cost-effectiveness:

  • vaccines are 10x (ish) more expensive (bad for vaccines)
  • vaccines are more targeted at the most vulnerable ages (good for vaccines)
  • misc other considerations, like insecticide resistance (this is a bit hand-wavey at the moment, but I guess probably nets out to being good for vaccines)

A hint at the possibility that this might end up with similar cost-effectiveness is the Imperial/Oxford study that Josh mentioned.

Other considerations include:

  • Replicability: when we create these sorts of models, we don't normally give 100% credit to the efficacy figures for vaccines. Rather we recognise there isn't yet a large evidence base, and typically the efficacy is more likely to go down than up with more evidence; estimating how much it would go down by as we got more and more evidence is sometimes called an internal validity adjustment, or replicability adjustment.
    • For bednets this is negligible (adjust by 5%), and with good reason -- nets are a very well-established intervention with plenty of evidence
    • I expect that such an adjustment for vaccines might be significantly less favourable, but I'd need to look at the evidence properly to say anything more precise than that

My best guess, having not researched it properly, is that the cost-effectiveness of the R21 vaccine probably will still be clearly behind that of existing interventions (bednets/SMC), but it may well be above the cost-effectiveness thresholds of the bodies you're advocating to (e.g. because they are large aid agencies with large budgets), meaning that the advocacy still makes sense. I wouldn't be surprised if either of these guesses were incorrect

Sorry for asking about a minor detail, but Figure 3 in section 3.2.1 shows an internal validity adjustment of 90% for ITNs (top row of figure). I thought this was 95%? Am I misunderstanding how you're thinking about the adjustment in this document?

I've often thought that more quantification of the uncertainty could be useful in communicating to donors as well. E.g. "our 50% confidence interval for AMF is blah, and that confidence interval for deworming blah, so you can see we have much less confidence in it". So I think this is a step in the right direction, thanks for sharing, setting it out in your usual thoughtful manner.

Good question. 

It's also helpful because the wording of my post was meant to convey that "expert opinions tend to believe that the therapeutic alliance matters" (and not necessarily that I'm confident that that's the case). 

One of the papers that I referenced did flag that most of the studies are observational rather than experimental, which does validate your concern. (I think it was Arnow & Steidman 2014 which said this; I don't know if a more recent paper sheds more light on this).

I'm not planning to look into this topic in any depth, but perhaps someone more knowledgeable can give a more definitive answer.

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