Comparative effectiveness: what the big money should be funding

  • Do aid programs work? If so, which ones are the most effective?
  • Does education increase value? By how much? Which methods work best? For whom?
  • Does this or that medical treatment actually benefit the patient? Is there an easier, cheaper method that's just as effective? What routine practices would reduce death or morbidity rates?
  • Does increasing density benefit the economic life of cities? What mix of density and sprawl gives maximum freedom and happiness to the population?
  • Which practices most effectively preserve biodiversity, or decrease atmospheric carbon, or preserve scarce resources?

These are all difficult questions. They are hard to answer because there are so many vested interests and existing practices, and the benefits aren't clear cut. There is a huge amount of noise in each of these systems. And testing comparative effectiveness is extremely expensive and time-consuming.

This is where the big charitable foundations, like the Gates Foundation, should be putting their money. And I mean, all of it. There is huge potential value in improving all of these systems. Only large amounts of disinterested money, with no stake in the outcomes, can effectively fund studies that will provide credible, reliable results.

But, oddly, many of these foundations continue to fund actual programs. Educational programs. Aid programs. Urban development programs. Even though no one really knows which of them works, and what the most effective procedures are.

Even these guys want to seem to be doing something. Just learning what works seems so removed from human affairs, so academic. But it isn't. Without such studies, we are wasting our time and money.

Part of it, of course, is that everyone is afraid of the answers. Which treasured programs, practices, and beliefs actually don't do anything, or are actually harmful? A lot of vested interests stand to be disrupted.

And no big foundation is in the disruption business. They are in the cultural assumption validation business. No one goes to a fancy charity ball to celebrate proving that the past five decades of aid to some country's poor has been entirely wasted.

Still, I want to see someone do it. In fact, that's a charity I would donate to.