Currently, the World Health Organization recommends providing regular deworming treatment to school-aged children in areas with high risk for parasitic infections. This week, however, a study published by the Cochrane Infectious Diseases Group raised doubts about the effectiveness of routine deworming treatments. This is the third study published in recent months that questions the health benefits of routine school-based deworming programs.
Two of The Life You Can Save’s recommended charities focus on deworming treatment: Schistosomiasis Control Initiative (SCI) and Evidence Action’s Deworm the World program. Here's our take on the study's findings:
SCI and Evidence Action
According to GiveWell, the studies do not undermine the strongest arguments for donors to support deworming programs. At this point, based on GiveWell's analysis, we see no reason to change our recommendation of SCI or Evidence Action's Deworm the World program. In addition, Evidence Action has responded to the study findings here, in which they argue that preventative treatment is still the cheapest and most-cost effective way of treating parasitic worms in children.
Should the deworming controversy change how our donors give?
These studies questioning the efficacy of deworming initiatives likely raise concerns for many people about the risk that their charitable donations are not being used most effectively.
I offer a way to think about this concern that I hope will help lead skeptics to continue donating generously to highly effective charities that have been vetted thoroughly by The Life You Can Save and charity recommenders like GiveWell.
We believe that not donating to well-vetted charities poses a much bigger risk than donating when we don’t yet know all of the variables.
Managing risk is part of our everyday life—and it is not always easy to do. When we choose to have an invasive medical test, make a left turn, or allow our children to walk to school, we take what we believe are sensible risks. In those situations, what we intuitively realize is that the benefit outweighs the risk.
When I face a risk that seems hard to analyze from a cost/benefit analysis, I use the following methodology: I assume that there is a Type I error and a Type II error that I could make. In this case, Type I is I don’t do whatever is being considered and it turns out that it would have been good to do. Type II is that I do the thing I was considering and it turns out to be a bad decision.
In the case of whether to make a charitable donation—assuming the charity has been judged effective by experts—the question is would I prefer to make a Type I or a Type II error? It is clear that not making a donation that would have saved lives and/or reduced suffering (Type I error) is far more damaging than making a wasteful donation (Type II error). In the former case we have failed to do great good, while in the latter we have lost discretionary spending money.
We should continue giving money to charities with strong track records of effectiveness—even if we can never eliminate all uncertainties. That decision is certainly less risky than choosing to give no money at all, or choosing to give less.
So, while it is upsetting to see new evidence that calls into question the efficacy of our donation, it would be very sad if that evidence is used as a rationalization to avoid being generous with one’s resources—both our time and money.
We continue to believe that relying on experts in the field of charity evaluation and the scientific method is the most reliable way to mitigate the risk that one’s charitable donations will be wasted. In the mean time, we believe that while being cautious might mitigate risk, it can never eliminate it. But failing to donate guarantees that people living in extreme poverty will not get the help they desperately need.