Bjorn Lomborg is the president of the Copenhagen Consensus Center and author of the recent book, Best Things First.Copenhagen Consensus: https://copenhagenconsensus.com/Best Things First: https://www.amazon.com/Best-Things-First-BjornLomborg/dp/1940003482/ref=tmm_pap_swatch_0?_encoding=UTF8&sr=8-1 *****VanMan: Tallow and honey balm, and many other animal based personal care products. Go to vanmanscompany.com/darkhorse and use code darkhorse for 10% off your first order.*****Find Bret...
I have the honor today of sitting with Bjorn Lomborg, who is the president of the Copenhagen Consensus and the author of the excellent book, Best Things First.
Bjorn, welcome to Dark Horse.
Thank you very much, Pat.
So maybe I should just set the discussion in motion this way.
I don't know if you know, Bjorn, but my training is in evolutionary biology and I focused heavily on complex adaptive systems.
My two favorite principles are probably diminishing returns and opportunity cost, and your book is predicated on the intersection between these two things, and in fact you can see it in the title.
The idea is we can't do everything, as you explore in the introduction to your book, Which means that every dollar we spend somewhere we're not spending anywhere else, so we should probably be hard-headed about deciding how to allocate our efforts so that they give us the highest return on investment.
Is that a fair summary?
It totally is.
I should have had you write the foreword.
Well, in any case, it is exactly the way we ought to approach things.
Of course, I also know from the study of complex adaptive systems that nothing goes the way you expect it to do when you intervene in such a system because of the complexity at its heart.
And so I do have to ask you,
When trying to identify, and in your book you put forward 12 policies that you argue should be at the top of the list because they give us the highest bang for the buck as interventions go, how concerned are you that what one attempts to accomplish with these interventions might produce unintended consequences that are outside the range of what we've thought to measure in planning them?
So it's definitely a good question, and nothing you do will ever go according to plan.
But in many ways, we're not arguing that this is amazing new stuff that we've never done before, and we don't quite know how it works.
These are incredibly well-studied, proven things, most of them.
that we've tried a lot of times.
And we know that they fail in all kinds of ways.
But what we're saying is they're so good that even if they fail at sort of the normal rate, if people are being incompetent at the normal rate, if systems bungle part of the implementation at normal rates, it will still be a fantastic idea. if systems bungle part of the implementation at normal rates, So I'm not promising in the book, and none of our research are promising everything is going to be perfect or fine.
But they see saying it's very likely that we're going to do incredible good, even assuming that people are going to bungle at the normal rate and that people are going to be corrupt and all kinds of other things.
So the idea is really just to say, look, there are some things we know will do an enormous amount of good.
There are lots of things that will do pretty much.
Pretty amount of good.
And then there's probably a lot of things that'll actually do very little good.
Let's just focus on the really good ones first.
Let's do those first.
And, you know, it's not very complicated.
It's not really rocket science.
This is just, you know, as you say, it's recognition of you have limited resources and that there's diminishing returns.
Let's do the smart stuff first.
Yeah, do the smart stuff first is always the right way to approach these things.
Anytime you have a value based on some complex set of interactions, and you know, I'm fond of the idea that there's an inflection point at which diminishing returns kicks in, which is nature's way of telling you to move on to the next intervention, right?
You've milked the intervention for the big bargain at the beginning, and there's no reason to chase it all the way down You know, to 95% when the sweet spot might be 80% and then you go to the next thing and keep doing that.
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That said, and I will say among the many strong points of your book, It is presented in a perfectly straightforward, utterly comprehensible way.
You just simply say, here's the policy.
Here's how we know it works.
Here's what we expect the effect to be.
And, you know, here's what we expect it to cost.
And therefore we can calculate what the benefit is.
But I do worry that in many of these cases, You couldn't possibly measure all of the important consequences.
So, the fact that there are several things you can measure and that the return on investment may be very high doesn't even mean that the intervention is net positive.
It can go the other way.
Okay, I'll probably take exception with that.
Can I just sort of set the stage a little more?
Because a lot of our listeners and viewers won't really know why the hell are we having this conversation?
And then I'll get back to answering your question.
Yeah, the world has sort of set the stage and saying, we want to do everything.
Not surprisingly, when you put together lots of politicians to say, what do you want to happen?
And they will end up saying, we want to promise everything.
And we want to go all the way not, not your 80% of the 95%, but we want to go 100% of the way for all of these different things.
So, you know, fundamentally, it's called the sustainable development goals.
It's a setup of of goals that all the UN countries have done back in 2015, promising for 2030.
And they basically promised everything.
So they promised we're going to fix, you know, poverty and hunger, and we're going to get everybody in school, and we're going to, you know, get rid of war and climate change and corruption and everything else.
So it literally is a very, very long list of all the things that you could possibly imagine, and then quite a few you couldn't, like we want to have more organic apples, and we want to have community gardens for handicapped people.
And, you know, we want to have more knowledge about sustainability and beautiful forests and all kinds of other things.
Now, there's nothing in there that you can really disagree with, in a sense.
enough money for everything we should do all of those things but of course we don't and we many of them we just don't know how to do in any you know sensible way obviously you know no war is clearly a challenge right now and and so what we tried to say is what does the knowledge that we already have tell us about where can we spend
an extra dollar or preferably say a billion dollars or a million dollars, you know, a substantial amount of money, but not, you know, a huge amount of money and do an incredible amount of good.
And that's where we came up with these 12 ideas.
Then what you're saying is, well, isn't it so that we might know, you know, there's a lot of positives, there's some negatives and there's some costs and there's some benefits and you've worked on all of those, but isn't it so that it could actually be that we'd be really surprised and it could actually, although you say it's great, it could actually turn out although you say it's great, it could actually turn out to be net negative.
I would be surprised.
We're humans, so I can't give you an absolute guarantee.
But many of these people, of the researchers who have been working, have spent most of their lives, and there's been a lot of people involved in this, trying to find out what is the cost, what is the benefit.
Let me take you one example of fixed education.
So education is a huge problem in the world.
I think everyone agrees that, you know, having more education is a good idea.
And we're simply taking the very, very first steps, learning how to write, learning how to do, you know, basic math, probably a good idea to teach kids.
And remember, in most of the poor half of the world, and this is almost entirely about the poor half of the world, they are almost all in the school.
Very few of them are learning very much.
So, you know, there's this wonderful study that tries to, you know, sample about 60, 600,000 people.
and give kids a test.
And one of the tests they give them is a reading test.
And you have to actually read this.
And it says, you know, VJ has a red hat, a yellow shirt, and blue pants.
What color is the hat?
Now, if you ask people this, they obviously can say, well, it's red.
But if you read it, once you get down to the what color is the hat, you sort of lost the plot if you're not very good at reading.
And so it turns out that 80% of 10-year-olds in the poor half of the world, so about 400 million kids, can't read this sentence and a lot of other similar sentences.
They fundamentally don't know how to read, although they've spent a lot of time in school, but it's a very poor school.
And one of the things the researchers say is if you teach them at their own level, You have much greater success.
So right now we have, you know, one teacher, 50 kids, they're all over the place, and there's no way the teacher can sort of teach that particular kid at his or her own level.
So a lot of kids are bored, a lot of kids have no idea what's going on, and it's really, really hard.
If you put them in front of, say, a tablet with educational software, it turns out that software can adjust the level very quickly to your exact level and teach you much better.
If you do this one hour a day, so the rest of the day is still, you know, same old boring school, you actually learn much, much more.
We have good evidence that show you will learn what you normally would have spent three years of learning.
So you have all the rest of the school that cost lots of money and you learn almost nothing.
But then that one hour a day at about $31 per kid per year, you've learned twice as much.
This is what the study shows, right?
And it assumes that, you know, people are being incompetent.
Some of them will steal the tablets.
There won't be electricity.
There will be lots of things that don't work.
Not all of the software translations are going to be good.
All these things.
But, and that was your question, is it really plausible to imagine that these kids, so we estimate that for every dollar you spend, you'll do $65 of social good.
You'll deliver them to be much smarter so that when they become adults, they'll go on and have higher incomes.
Is it plausible that that real number could be instead of $65 back in the dollar, actually just $0.90 back in the dollar?
I can't guarantee you, I can't imagine a world where that would be true, but it seems very, very implausible.
It's much more likely that it could be $40 or it could be $100, but it's not going to be $1.
So we're pretty darn sure that this is a very good investment.
That's really what I'm trying to say in the book.
Well, I do agree that of the interventions that you label in the book, this is the least likely to have a net negative outgrowth, but I would point out just Reducto ad absurdum.
We spend a lot of money on education in the West, and it appears to be making people stupider by the year.
So it is not that the simple application of A good idea like, hey, let's gather people together in a place with people who have learned something who can lead them through the thought process.
That seems like a slam dunk and it isn't inherently one.
So there's that and I will also just say as an educator, I know that the key involves the person at the front of the room understanding you as an individual and tailoring a lesson so that every student can see it, and I definitely recognize the challenge that you outline in the book, which is that you've got a room full of people at vastly different levels, and the person at the front of the room
A, you point out quite correctly, the person at the front of the room may not be all that far ahead of the lessons that they're teaching, and B, they may not have the skills to address all those different skill levels at once.
So in principle, yes, the idea that, you know, software which can detect a level is the right mechanism for dealing with this sounds great.
On the other hand, You know, and this goes to some of the other stuff you point out in your book.
I'm concerned that once we decide that the remedy for people who don't have access to good education is a tablet with software on it, that somebody is going to spot that as an opportunity to capture young minds around the world and persuade them of things.
And I'm concerned about what we're going to find on those tablets down the road.
Yeah.
And that's a great point.
And look, again, I think there's two things that are worth taking away just from this conversation.
It is that we're just solving a very simple part of the problem.
Namely, how do you get from going to school but not actually learning anything to learning how to basically read and basically be able to do some math?
That you can do with a tablet one hour a day.
By the way, the reason why it's one hour and not more hours is because that turns out to be much, much harder to get teachers along with.
Because, you know, not surprisingly, teachers are a little wary that you're going to try to replace them with tablets.
And I get that.
I think it's possibly not totally unreasonable to be concerned about that.
And that's why it's one hour.
That's what we've tested.
That works.
Now, I'm not saying that we should take our university studies and do the same thing.
I don't think we have any data to support that, and it would probably fail spectacularly.
Also, You're absolutely right if you then take this and then say, oh, but now we're going to have state authorized, you know, education programs on these computers that will try to teach you what's the right way to think about this, that, and the other.
All kinds of other problems would occur.
Again, we're not solving everything in the world.
Actually, we're solving a fairly slim part of the world.
But it's just incredibly effective policies.
And so, in some sense, I'm happy to say we haven't solved everything.
Absolutely not.
But we've solved or identified some very, very important things because they're very cheap, they're very effective, and they will do a tremendous amount of good.
And that's certainly worth something.
Yes.
And, you know, again, I don't want people to get the wrong impression.
I sort of think my job in any context is to push somebody around so that you can see the strength of their idea, because it does stand up to scrutiny.
And you don't pretend to solve these problems.
One of the great strengths of your presentation is that you say, here is a place that we have disproportionate return on investment, which is not the same thing as saying, let's make war on poverty, right?
It's a matter of saying here, if you want to, if you hold the value of taking people out of poverty, At a high level as most people do, then here would be the way you would approach it to get the biggest bang for your buck.
So please don't take this as hostile to your premise.
I'm favorable to your premise for sure.
But let's look at something else just to make my point a little bit clearer about what can exist outside of the frame that an academic might measure in order to see what the return on investment was.
There is a famous, now largely forgotten, chapter from an ecologist named Garrett Hardin, who is the He's the originator of the scientific principle of the tragedy of the commons.
He wrote a science paper, I believe, in the 70s.
In any case, he famously departed from the world consensus about the proper remedy for hunger around the world.
said effectively you can't solve hunger with food which of course strikes everyone who hears it as madness because of course what other remedy would you apply but his point was that the net impact of feeding hungry people around the world is more mouths and in the end it may in fact cause more hunger rather than less hunger so counterintuitive as that may sound
There's a reason to try to figure out what the impact of a policy is in ways that are extremely challenging to measure.
And the same can be said, you know, I think we all want to cure malaria.
It's a terrible disease, and it is one that Seems quite tractable because it is mosquito born because mosquitoes can't get through window screens through bed netting and all of this And because there are places in the world where it has been controlled and malaria used to be a problem in the United States and it has been Eradicated it was eradicated from the canal zone in Panama.
It has been eradicated almost entirely from Costa Rica so it is a tractable problem if one invests resources, but Then the question becomes, well, what were the other consequences of the eradication program?
So anyway, I've put a lot on the table.
I do want you to talk about, you discuss in the book questions of nutrition and hunger, and you also discuss malaria.
Maybe you want to put your case on the table?
Sure.
So on the malaria bit, this is one of the great investments again, and it's simply to get more insecticide-treated bed nets out.
So remember, a lot of people have this idea that malaria is a tropical disease, but as you point out, that's just because we've eradicated it in most other places.
In some sense, it's only almost entirely based in Africa.
Because we fixed it everywhere else.
It used to be huge in India.
There used to be large parts of India where you couldn't live, you know, say, two, three hundred years ago because there was just too much malaria burden.
And one of the things that happened in the rich world is when you get rich, you can afford to put screens on your houses.
You will typically drain your swamps to build up more agricultural land.
And then you'll also have more cattle, more livestock.
And the beautiful thing about that is that Mosquitoes mostly don't care.
They'll bite you, but they'll also bite the cattle.
The more cattle you have, the less they'll bite humans, and then the transmission rate declines dramatically.
All of these things, along with the fact that once you get sufficiently rich, you will cure yourself and your kids because you can afford the medication, simply means that we've gotten rid of this.
We've both gotten rid of it.
through drastic methods where we've drained the swamps, where we've sprayed insecticides all over large areas, and of course, through all of these things we just talked about.
The problem with Africa is partly that they have low infrastructure ability, They have typically low income.
But also that they're stuck with the most dangerous parasite.
There's different versions of malaria parasite.
And they have the most deadly one.
And then they have the mosquito.
There's several different species of mosquitoes.
And the mosquito that transmits malaria in Africa is one that don't actually care for livestock.
So it only bites humans.
So they simply have a much much harder problem.
That's one of the reasons why they haven't done it.
But the main thing again is if you get more bed nets and bed nets with insecticide, long-lasting insecticides, so that when the mosquitoes come not only can't they get to you but they actually sit there and then they get the insecticide and they die and that means that they don't transmit it.
That is the way to basically get rid of a lot of the malaria burden.
Again, as you point out, about 600,000 people die each year.
I'm not saying let's go down to zero, like a lot of people would say.
But we're saying, well, we can get quite a bit away.
So what we're finding is that for about $1.1 billion a year, and this isn't distributing more of these mosquito nets, not all of them are going to be used, not all of them are going to be used correctly, and so on.
But if you do that, you will actually reduce transmission so much that you will save about 200,000 lives.
This is a great investment, again, because one of the things that happens when you don't get malaria is that you also grow up to be stronger.
You don't have as many problems.
So even if you don't die, you are also going to be much stronger if you didn't get repeated malaria.
One of the big problems with malaria is actually not that you die, but that you're consistently sick for, say, a third of the year because you get bitten over and over again.
and you don't get resistance.
And so you end up being much less productive.
So not only does it kill your kids, but also makes you much less productive.
We're very happy we're living in most of the rich world that we don't have.
mosquitoes that carry malaria and make us this unproductive.
We could do the same in the poor half of the world.
And that would cost very little.
So we're estimating that here you could get about $48 back in the dollar.
Again, a great investment.
And it is very unlikely that this will totally not happen.
Now, you mentioned Garrett Hardin and the whole sort of Malthusian thinking, you know, sort of originates from back in around 1800 with this idea that if you feed people better, if you make them better off, they're just going to get more kids.
And it's sort of going to take out all of the benefits of all the good that you do.
That had some plausibility back in 1800.
Because it was pretty much all we'd seen.
Whenever people got a little better off, they would very quickly get more kids and these more kids would survive because they were better off and so they would sort of get everybody down on the same level.
That's not what we see anymore.
We don't see it most places in the world because now we've gotten it so good that what really limits the number of kids you want is typically the woman saying, I'd actually like to have an education.
I'd like to have an opportunity to do business.
I'd like to be able to do other things with my life than just being a mother.
And we know that one of the strong predictors for that is education and opportunity to do business for women.
And if you have that, it is very unlikely that if you make it so that their kids survive more, that they have more opportunity, that they become richer, that they're just going to have more kids.
We don't see that almost anywhere in the world.
So again, Do the models adequately reflect this?
I fear that they don't because when you talk to people who do malaria modeling they're typically not the people who do this well what happens with education and then onwards to to talk about what happens with with perhaps getting more kids.
But we seem to know that this would more sort of be an error term.
It would mean that instead of being 48 back in the dollar, maybe it would only be 20 back in the dollar kind of thing in a very worst case scenario, but not that it would be a bad idea by any means.
All right, I want to take up several of the points that you make.
First of all, I don't think that what we've learned in the intervening years since Garrett Hardin made his argument actually falsifies his claim.
What it says is that actually when one applies food to hunger in the context of greater education, opportunity, and birth control, that you don't have this necessary connection.
So I think we've learned something about the complexity of that system.
But it's not wrong that if what you've got is a hunger problem and that all you apply is food, you're very likely to trigger exactly the phenomenon that Hardin pointed to.
But let's go back to the question of the mosquito nets, because I believe that this is a case where actually, if I had to guess, I would say it is likely that there are costs that you simply will not capture if you measure narrowly the consequences for malaria.
The nets, you're talking about nets that have been impregnated with a relatively new pesticide.
It's chlorphenipure, is that right?
There's two different ones and I won't be able to pronounce them because I've only ever read them.
But yes, it's an old one and then there's parts where the mosquitoes become resistant and you need to buy a more expensive pesticide.
And so I read a little bit on this pesticide.
It is...
Considered a good thing because it addresses, as you just pointed out, mosquitoes that have become resistant to traditional pesticides, because it works on it with a different mode of action.
It actually interferes with energetic metabolism.
But as a biologist, I fear that a net that has a compound That triggers a disruption of metabolism is a problem for people potentially because we have exactly the same type of mitochondria that allow us to metabolize.
Now there is a question, there's a
stage in the pathway of the effectiveness of the pesticide in which it has to be turned into a metabolite by the mosquito's physiology and it is the metabolite that kills the mosquito so it is possible that this could have no effect on people but my guess would be you're dealing with disrupting the functioning of a creature with which we share a long evolutionary history believe it or not and so if from
My bet would be that there are consequences.
I mean, the pesticide itself is regarded as a toxin to humans.
It's not understood to be safe for humans.
So there's a question, even if your approach was to deal with the mosquitoes with these nets, whether or not the benefit that comes from the pesticide that kills the mosquito outweighs the cost of people sleeping under these pesticide Coded nets, especially in light of the fact that the pesticide kills the mosquito through the mosquito simply contacting it.
The mosquito does not have to consume this pesticide, it just has to touch it.
So that suggests a rather dangerous compound.
I also know from history long ago in graduate school that very frequently what happens when you distribute nets to people to control mosquito-borne illnesses like malaria and yellow fever is that enterprising people use them for other things like seining fish out of rivers.
And that's, on the one hand, potentially environmentally bad, but it's potentially much worse if they're impregnated with insecticide that then gets into the water supply, potentially gets into the fish people are eating, gets into the water people are drinking downstream.
stream.
So I guess, you know, I don't know what the net consequence would be, but I guess I'm curious as to whether or not the added benefit that comes from the insecticide is actually worth the various hazards that come along with it.
So, again, I have to confess, we work with a lot of the experts in all of these different areas, and as you might imagine, I can't be more than sort of a jack-of-all-trades, a little bit of a sock puppet for all the smart people who've been working on this.
With respect to that, though, I would tend to say that I know that there's been Significant environmental assessments of all of these, certainly because these pesticides are also used in rich countries, and I struggle to believe that this would be a problem.
I know that a lot of pesticides work by disrupting the metabolism and they, you know, EPA has been A large sum of money, mostly other people's money, and the people who actually want to get them past the regulatory process to find that this is not dangerous for humans.
With respect to putting them in the lakes, I can totally see that, and also the idea of saying that's going to go into fish that possibly humans will be eating.
That sounds like a plausible point.
I don't know anything about it, so I can't say anything but saying, yeah, that seems like something we should be looking at.
I would be surprised if people haven't looked at it, but I will actually ask our lead researcher on that and try to get you an answer.
But I also think it's important to keep in mind we're talking about something where you could save 200,000 people every year, and something that creates many millions of deceased experiences each and every year.
So even if this had some negative impacts, I'll be very, very surprised if they're even sort of in the order of magnitude that we're concerned.
But I would be very surprised if there is a big pesticide issue with the insecticide-treated nets.
Again, remember, we use enormous amounts of pesticides in most agriculture.
And yes, I don't know whether we're going to... Let's not go too far down that line.
It's also very clear that the agriculture in many ways sustained a population of 8 billion people in a way that we couldn't possibly imagine otherwise.
So, you know, there are trade-offs all of these places.
Yeah, it's trade-offs all the way down.
I certainly agree with you on that.
I do have nothing but concern over the environmental impact that comes from the application of pesticides throughout that massive agricultural infrastructure.
But, you know, I understand A do-gooder might look at that and say, well, you know, what is the cost to all of these chemicals?
Not just the pesticides, but the rendering of nitrogen as biologically available using the Haber-Bosch process.
But a do-gooder would be likely to kill billions of people if you try to turn one of these processes off.
So, you know, if there is something to be done, It's a matter of recognizing the full impact on the complex system, weaning yourself from these processes in favor of something that has a better cost-benefit profile, but none of it's simple.
That's the basic fact.
Just because that's sort of from my other life, which is very much sort of in the environmental conversation.
One of the things that we often forget is when you have very intensive agriculture, it's also one of the reasons why we haven't had to cut down all the world's forests.
In order to feed the world, that we can actually do it on a fairly small amount.
I'm not saying this is small, but you know, and not all the world's land where we can produce food so that there's actually space for nature.
And so we have to remember both of them.
One of the obvious things that you can have a conversation about is that We're clearly in today's agriculture, not just producing food for 8 billion people, but we're also producing for more than 8 billion cows, sows, lambs, chickens, all that kind of stuff.
And I'm vegetarian, so I can easily just go ahead and say, Well, maybe you should eat less meat.
Most people don't seem to be very open to that conversation, but at least we could have the discussion of saying, is there a more effective way to grow meat?
That's obviously the whole lab meat kind of conversation.
Which I see, and again some people are going to be totally turned off by that idea, but clearly that's one of the ways that we can envision in the longer term that we could have our meat but not necessarily spend quite as much of the land to utilize it.
But I think that's slightly a different sort of conversation.
I mean, not really.
I think it's actually, it's a perfectly, it is maybe the ideal example of what I suspect is going to be a contrast between your perspective and my perspective.
My feeling is I can, I can look at lab meat.
And I can see the argument for it.
And if you zoom in on the knowns, it's a slam dunk, right?
It's just simply environmentally better.
I care deeply about the environment.
This is a superior technology.
There's no question about it from the point of view of protecting the environment.
And, you know, I could go all day listing the benefits.
You just don't want to eat it.
It's not even that I don't want to eat it.
I guarantee you it's going to be terrible for you.
And I can guarantee that on the basis that we don't understand very much at all about what it is that we do when we metabolize meat.
But the idea that you're going to trick cells from a food animal into a state that is healthy under laboratory conditions with the small amount that we understand about the intervening biology strikes me as approaching zero.
I mean, the fact is, we even know that there are health differences between cows that are raised on grass and those that are raised on grain.
That has health implications for people.
So that's a tiny difference compared to extracting cells from a cow and growing them on a wall.
So anyway, my feeling is, oh, I know where this train's going.
It's going into the station at 60 miles an hour and no plan for how to bring it to a halt.
But my argument is obviously based on you don't know enough to make that stuff healthy.
And that argument, as much as I'm all but sure it's correct, is no match for the experts who know a tremendous amount about And that's a fair argument.
can quote you chapter and verse about why it will be healthy and all of the work that they've done to tinker the epigenetics of the cells in question so that they really do reflect the natural state, blah, blah, blah.
But I'll believe it when I see it.
And I'll believe it when it's been going for 25 years and there hasn't been a holy moly, we're making people sick with this stuff scandal.
And that's a fair argument.
And again, I think this is one of the places.
And again, it's not one of the 12 solutions that we're advocating.
But this is one of the very many things that potentially could come out and deliver a great good for humanity.
But absolutely, we don't know yet.
And we certainly want to see the evidence rather than just, oh, this could be fun if it worked.
Right.
I think the difference, and you know, it's funny, this is a strange shoe-on-the-other-foot kind of conversation, because as my viewers know, I'm a dyed-in-the-wool liberal.
And as a young man, I would have looked at the world and said, look at all of the things that we can do better, and how hard could this possibly be?
And it is only as I've gotten older and I've watched Well-intentioned proposal after well-intentioned proposal turn into a disaster because of all of the unintended consequences that, you know, problem-solving liberals just don't spot.
That I've become, you know, I still believe we have to solve problems, but I now have a tremendous amount of trepidation about solutions because, you know, I've seen them and they almost always carry along major costs that you don't spot on the front end.
If I could just very quickly add there for the malaria thing that we were talking about, we're already distributing more than a billion insecticide treated nets every year, much of it funded by government.
So it's not like we haven't tried it.
What we're talking about is sort of adding on to that.
Likewise, when we talk about the tablet, although that's not nearly as broadly done, this has absolutely been tested at least in the order of 5 to 10 million kids for a year.
So it's stuff that we've actually tried to do and we know that we can just do more of that.
But, you know, lab-grown meat and lots and lots of other ideas.
You know, this is something Bill Gates have tasted, right?
And a few other people.
And very, very expensively, right?
So the idea here is this is a totally different category.
What I'm arguing for are these things that we have tested, that we know work.
There's a reasonable sense that we also know if there would be really bad things happening, that we would have seen them already.
But yes.
Alright, well, I will say, I mean, as much as I have trepidation about new technologies intended to solve problems, I'm all for Bill Gates eating that stuff.
I think that's a great idea.
I said some irony there, but okay.
Yeah, there was a little bit.
Actually, though, one more thing on the nets before we move on to some of your other proposals.
My real question with the nets is, in terms of the benefit of preventing malaria, how much is lost if the pesticide is not on the nets?
And there will be some, because a mosquito that lands on a net and then dies doesn't go on to bite somebody who's walking around.
So, you know, you're using the fact that the mosquitoes will be attracted to the sleeping person to get them in contact with the pesticide.
So, it's not that I would expect that cost to be nothing, but from the point of view of keeping people from getting bitten in their sleep, the net is perfectly sufficient on its own.
So, what I'd love to know, and I don't expect you to have the answer at your fingertips, but what I'd love to know is, is the sweet spot a net that isn't impregnated with pesticide?
Yes.
And again, I don't know the answer.
You were absolutely right.
But I understand the sort of setup.
So the problem is, the mosquito has to bite someone who has malaria.
And then it has to go over, it has to sort of ruminate this for a couple of weeks.
And then the parasite is ready to be transmitted on to another person as to go bite another person.
So this is why if they bite a lot of animals, you know, it gets a lot harder.
They just don't get to get rid of it.
If they die within that two-week period, it doesn't ever transmit.
But if you bite a lot of people, you will very likely end up transmitting it.
And so the problem is that for these very nasty mosquitoes in Africa that only bite people and that have a very virulent parasite, it is very hard to stop them.
You really have to stop them a lot.
It's not enough to just put in some screens.
You're absolutely right that that means the person underneath the net doesn't get bitten, but there will still be quite a few people, you know, Just simply because you're out and about, you know, you have other business to do and some people won't be lying on it.
There's enough that that will actually keep the infection going.
So you literally have to get sort of Almost 100% under bed nets, that's never going to happen.
But what the insecticide treated bed net does is it sort of acts as many many more bed nets because it kills off the mosquitoes.
So I think it is very important in order to get from Only avoiding a little bit of the transmission to getting quite a bit in there.
But you still need to get a lot of people underneath it.
But you know, yes, I can't answer your question because I haven't run the models.
Yeah, that's not what I did.
Yeah, I mean, you know, you have my liberal problem solver mind racing, you know, given your outlining of the problem.
I have all kinds of questions.
If I can just also, one other thing, if you look at what most rich countries did, they did a lot of spraying.
And actually, back in the 60s, we thought that that was what was going to be the solution to mosquitoes.
Turns out, that requires a really well functioning state.
And one of the things that are missing in many parts of the poor half of the world is that there's not a very well-functioning state.
So you'll be spraying some places, and then they survive other places, and then you won't.
And then somebody will say, we did it to take the money, but actually not do it.
You know, there's a lot of reasons why this doesn't work.
And that's one of the reasons why we're saying we shouldn't do that, because we've actually tried, and you know, the liberal, you know, We can fix this argument.
We've tried some of these things and we know they don't work.
Whereas the insecticide treated bed net works because it provides you with a very clear benefit.
You and if you put your kids underneath they don't die or they don't get as much sick.
It's still somewhat uncomfortable because also it reduces the wind flow so you get more sweaty which is in many of these countries somewhat uncomfortable.
So it's not without a cost.
And that's one of the reasons why people don't want to use it, but there is benefits to you.
And so it's much more aligned with the incentive structure to actually make people use it.
That's one of the reasons actually work.
Yeah, that makes sense.
I mean, the place where I mentioned it before, but the place where I've seen spraying work and mind you, I.
I don't know what all the consequences are, because you're obviously aerosolizing this toxic stuff in a place where people are breathing.
But I saw this work in the Canal Zone, where this was an American military-run zone of Panama, and they had a spraying program, and it worked perfectly.
For those who know about the canal, the French were driven out of their effort to dig the canal because they didn't understand the pathogen life cycle.
They didn't know that they were encouraging it by using little cups of water to keep ants from crawling up on their tables and beds during their effort to dig the canal.
And so anyway, it was a canal, it was a malaria-ridden area that was malaria-free when I was there, and it's still malaria-free even though it's been handed over to the Panamanians, they've maintained that.
That state because it was so well run so your point about the necessity of high quality governance To such a program is is well taken and obviously the nets Yeah, I can see people deciding not to use them because it's too hot definitely but I can also see people deciding to use them because nobody likes to be bit by mosquitoes and People understand that malaria is a serious problem.
I mean it's as you pointed out earlier It's not just the illness itself, but it's the lack of productivity that comes from being sick with something that robs you of your energy.
And, you know, there's a longer story there.
You mentioned that there are multiple different kinds of these parasites and, you know, the worst malarial parasites, they don't rob you of your energy, they rob you of your life.
It's the better version that actually is recurrent and hides in your liver.
But anyway, maybe we should move on to some of your other proposals.
You have a favorite you want to move to?
Oh, so you mentioned food.
So I just want to, again, to briefly talk about, it's very easy and a lot of people will say, oh, we should have more food.
We should maybe buy more food.
We should send more food to people who are hard up, you know, who are starving.
And that all makes good sense.
And, you know, so obviously very, very Human focused and very very nice and Thought about but but the problem of course is if you actually hand out free food you undermine the whole market for farmers In those areas and then you won't have the food next year and then you'll have to keep buying it and that actually becomes a very unsustainable Way for so there's a lot of
Talk about we want to have more people not starve.
The main problem really with food is not that we don't have enough.
We have plenty of food globally.
It is that people are poor.
And one way to avoid that is just simply handing out money.
Now that there's a lot of reason why that doesn't happen.
Partly because most rich countries are not willing to part with enough money that that would actually be a feasible Set up and it probably also would be a bad approach in the long run to do it.
But what we find is you should focus on getting people out of poverty and that's why we talk about free trade and some of these other things and obviously educating kids so they become smarter.
But you can also make food production more effective.
One of the ways that we've done that is by making yields higher.
So essentially take seeds and make them more productive.
That's what we did with the Green Revolution back in the 1960s.
And the guy who actually ran this got the Nobel Prize for it because, you know, Norman Borlaug, because as I said, he's possibly saved a billion people's lives, which is a pretty cool thing to be able to put on your CV.
But the reality here is we did this for rich country stuff.
So we did it for Corn for wheat for maize but we haven't done it for cassava and sorghum and all the other things the slightly odd things that they grow in in the poor half of the world partly of course because there's no or there's little commercial interest.
What we should do and this is what one of the things that we that we find is if you spent more money on having better and more research into yield increase enhancement.
Remember this is a long-term process that will take place over the next you know 30 years and it'll only be small increments but if you look at those increments over 30 years we know that that will add up so instead of having say half a percent of increase in yields uh every year if you could raise that to one percent
That still doesn't feel like a whole lot, but what it means is you will actually be able to produce more food, which means the price will get lower, which is great for all the people in the cities who buy them, but it'll also be good for the farmers because they'll be able to produce more food.
So what we find is you will have more food, cheaper, and the farmers will gain.
This sounds a little bit almost like magic, but you know, It also requires that more people move from the land into cities, which is how you get rich in the first place.
But the reality is, we find that if you spend, and so what we're talking about in agricultural research and development, so about five and a half billion dollars a year, you can actually make people better off to the tune of about 184 billion dollars a year or a bang for the buck of about 33.
So again this is one of the many ways that you could try to address a hunger but this is actually the one that all the economists say this one would work amazingly well.
Okay so if I understand this proposal you're looking at the super crops that we have engineered in the first world and saying that there's a loss opportunity in the fact that the things that people typically grow in the developing world haven't been turbocharged in the same way, that we can get bigger yields for the same effort.
But I'm concerned about this because let's say that you took Manioc and you engineered it so you got greater yields.
Those yields have to come from somewhere, right?
There's no free lunch here.
And so what you can do is you can get the plant to invest more in the edible part.
So maybe you get a root that's 20% larger on average, but that comes at the expense of something else.
For example, it could come at the expense of secondary compounds that the plant produces to fend off herbivores.
So how can you do that?
Well, you could do it by efficiently using a pesticide to substitute.
In other words, if you can free the plant or you could even engineer something in but you could get a crop that nominally produces a greater yield and fail to measure the cost of, for example, yoking tropical farmers to an industrial
Plow basically forcing them into a cycle where the only thing that they can grow are crops that require high inputs of agrochemicals in order to get their super yields which of course this is the thing that we never when we talk about the the miracle of these super crops that we've engineered in the first world What we don't say is actually they're all universally feeble if you try to grow them against a natural competitor.
They can't grow in nature.
They require intense human tending.
Humans to crop them up everywhere.
Yeah.
They require us to take over the jobs that the plants have freed themselves from doing in order to produce higher yields.
And so, again, not a slam dunk to me that that actually ends up causing a net benefit, though, and I think this is increasingly my concern across all such proposals, is you could get a concentrated benefit at a diffuse cost, and until you can measure the entire diffuse cost, you really don't know how far ahead you're coming, or even if you're coming out behind.
So I hear your points.
And just to give one sort of sense of this, there are some things where you would just need a lot more input, like fertilizers or pesticides.
But a lot of it is also just simply the plants are obviously not designed for you to eat them primarily.
They're designed to grow so that they will propagate themselves.
And one of the things that the first green revolution did was they simply took these very long stalks and make them half as long.
That was that was the incredible breakthrough.
And since nobody wants stalks, I mean, we don't care about stalks.
It meant that the plant would have to invest less in stalks.
So more in the fruit, the stuff that you I'm not.
This is that's not the right word, but, you know, the grains or whatever.
And They could actually bear them better.
They wouldn't, you know, blow over as easily because they were shorter.
This was just simply sort of moving its production from one set of parameters to another set.
That seems very unlikely to, and certainly when we look at it, we haven't seen evidence of this meaning that suddenly they became much less nutritious or anything.
It just simply meant that we could move it towards another equilibrium where we said this will actually give more of what we would like and of course that means that the propagation means that they will actually be much more successful if they are short rather than long.
So there are ways that you can do this.
And again, one of the things that we're advocating is not to say, let's make these products so that you can only grow them if you use this particular registered pesticide, and you also need to put in lots of fertilizer, because that turns out to be really hard and difficult.
And that will probably come later on in many of these poor countries, because that's what we've done in the rich world.
And there is probably good reason for why that would be a good idea for them to do in the The poor half of the world.
But what we're talking about now is just simply make sure that you get these yams or maniocs or whatever that actually grow more of the stuff you want and a little less of the stuff that is not needed.
And that seems at least plausible that you could do this in some parts of the way.
Again, remember, the maniocs have become more productive over the last 20 and 40 years.
But had we pushed that, we could probably have gotten there faster, and that means that each plot of land would have produced more, likely without any of those certainly net disbenefits.
The last bit, sure, farmers are pushed in the rich world towards utilizing lots more fertilizer and pesticides, but it's not like You could just choose not to.
Of course, you would not be very productive and you wouldn't be able to sustain yourself in the economy.
You wouldn't be able to produce the same amount and provide it at that price.
But this is exactly why we're in a civilization where you and I and Pretty much everyone who will be listening to this podcast are not working in agriculture because you know we're talking about one or two percent.
It's an amazing world where one or two percent are producing pretty much everything everyone lives off of so that we're free to sit here and have a conversation on a podcast.
How amazing is that?
I mean there are some concerns here and yes I get the point of saying there's a abundance and super abundance of of nitrogen, those kinds of concerns.
Those are real concerns.
I think we address them in some way by also making sure we have regulation in place for that.
But fundamentally, in an incredible world where most of us are not backbreaking out on the farm, but actually free to do other incredible things as well.
Yeah, I agree with you.
The achievement of civilization in this regard is stunning and not to be underrated in terms of, I mean, not just the ability
The liberation of people from nearly mindless toil that frees them to do things that are meaningful with their lives is something that we truly should value, and we should treasure it, and we should attempt to spread it, because, you know, a human being isn't just an animal.
We're capable of remarkable things, and to the extent that technology and good proposals like these liberate people to do that, it's a marvelous thing.
But I did want to return to your point about the stocks as a wasteful part of the plant, because I think it actually it makes the point on both sides.
You're absolutely right.
If you can get a plant to stop investing in some part that isn't useful to people, that's potentially a big savings.
On the other hand, The reason that the plant has long stalks is because that's how it competes with its herbaceous competitors, with weeds.
And so if you trick it into shorter stalks, you are almost certain to need to be more aggressive at interfering in competition on its behalf.
And maybe there are clever ways to do that that don't require herbicides, for example, but wouldn't I would I would bet substantially in favor of the idea that super crops that have been made super because they have shorter stalks are needier in terms of protection from herbaceous competitors and that that protection often comes in a chemical form, even if the connection is not a direct one.
It's a good point.
And again, I'm not.
What is a guy who could answer that?
I'm not a herbalist.
That's not the right agronomist or something.
But my understanding is, and certainly in rich world farming, it is pesticides that would deal with much of that.
I think a large part of it what was just around the the first Green Revolution was also just we planted massive amounts of these and so they just simply they grow up faster and they dominate the whole field before the the weeds can get get in sideways if you will.
But yes, you probably need someone to either go with a hoe where you get them out or do pesticides.
Sure.
Well, you'll forgive me for this, but there's an interesting digression here.
Some of our best crops are biennials, like carrots and radishes.
And the reason so there they have a strategy built into them, which actually elegantly addresses the problem of herbaceous competitors.
by having a two-year life cycle and so what happens you may know this but the plant will accumulate resources in its first year in which it does not produce or at the end of that first year it produces a storage organ and then in nature what it would do is it would use that storage organ
The carrot or the radish to leap up in its second year so that it could outstrip the capacity to grow of all of its competitors growing from seed, because the ones that grow from seed have to put up a little cotyledon, a solar panel, and they have to start from scratch.
But if you've got last year's profit banked, then you can grow tall before the sun is very intense.
And so anyway, they overtop their competitors and they flower and reproduce in their second year.
So, in any case, it's interesting that nature has built a mechanism for doing that that doesn't involve pesticides at all.
It involves a temporal trick.
And, you know, that's why we've partnered with those particular vegetables.
Let's just remember all of these plants also have pesticides.
I mean, that's one of the reasons why we have lots of natural pesticides, because they actually, they know how to try to get rid of people or sort of little animals that eat them.
That's true.
They all have secondary compounds.
Almost all.
There are occasional plants that don't, that often have some other mechanism for dealing with the problem.
Like, if you look at an ant acacia, an ant acacia effectively hires ants to protect it from herbivores.
And if you taste its leaves, they're not bitter, which is so interesting because it doesn't... They're just filled with ants.
Well, yeah, the thorns are filled with ants and the ants are very aggressive.
Anyway, so nature has all sorts of interesting solutions to these problems, but yeah, you're right.
Almost every plant has bitter leaves because those leaves are full of toxins to dissuade herbivores from eating them.
All right, so in our remaining time, what solutions are you most eager to talk about?
Well, I'd love to talk about two other things that we don't normally think about.
So one of them is corruption.
This was, if you remember, one of the things that the UN actually and every country in the world has promised the world we're going to fix by 2030.
And of course, we're not.
We've gotten nowhere with that.
And that's because it's really, really hard.
You know, there's a sort of built-in sentiment that, you know, if you can sort of screw up the system and make a lot of money, you probably will.
And, you know, some part of corruption is probably, you know, there's lots of people who argue, for instance, the corruption that you have in China is probably beneficial.
If you have a little bit of corruption so you can get things going smoother, maybe that's a good thing.
These are all hard things, but it's very clear that most corruption is bad in the long run, also stymies the country in many different ways, but there are very few ways that you can fix this.
One of the ways is a very, very clear proven way that we hear almost nothing about, and that has very, very little cost, and that's just been proven.
It's simply to take the biggest single thing that most countries spend on, which is procurement.
You know, these countries all buy roads and post-it notes and everything in between, but obviously roads are by far the most important thing, and they are typically incredibly corrupt.
So we work with Bangladesh, and they have, you know, this system where you have to hand in a sealed envelope at a certain government office for a bid that you have highlighted in this very obscure paper that you have to buy basically just to come with your bids for it.
And of course, what really happens is everybody says, well, we're going to pick the lowest bid.
But in reality, the local ruling families have already decided you're going to have the bid.
And then they put up goons outside the office, physical goons, so you can't come in with your bid.
And then, you know, not surprisingly, you got the bid and it's way over expensive.
And, you know, everybody loses a little bit.
What we find is if you do e-procurement, so basically put up all of these things on eBay, essentially, it's a little bit more than that, but roughly that's what it is.
You simply put it online, you get many more bids, it becomes harder to put up those goons.
You can still do it and people will still do some corruption but what we can prove is it's very cheap to do and it lowers the amount of corruption that you can sort of siphon off from this and it actually increases the quality because more people will be bidding.
It also has other great benefits.
You have quicker turnaround and all kinds of other things and obviously it's very transparent.
Now, again, not all of these are going to go well when you start developing these new systems.
South Korea famously did an enormously expensive one, you know, when you want all the bells and whistles.
But it's incredibly expensive compared to other countries, but it's still just tens of millions of dollars.
And what we find is you can save Billions of dollars.
So when we presented this to the Bangladeshis, the Bangladeshi finance minister was like, you know, I can get 700 million dollars every year in extra purchasing ability because my costs are going to go down.
I'd love that.
The reason why it hasn't happened, of course, is that the people two or three levels down will hate him for it because they're actually making money off of this corruption.
But if you have the political will, You can very, very surely get an enormous benefit for very low cost.
So we estimate you can, you know, it'll cost $76 million, not billion dollars, $76 million a year.
And the benefit is going to be about $125 back on the dollar.
This is just a slam dunk.
Now, a lot of countries, all rich countries have done it.
About half of all the poor countries have done it.
But the other half should also do it.
And this is one of the things that we're pushing for.
And this would, by itself, make the world better off.
It would make public services better.
And it would make it much cheaper and there'd be less corruption.
Again, we have not solved corruption.
We've simply made it a little smaller because there's this really, really smart thing that nobody's heard of.
Well, I love this idea and I also find it a little implausible because I have been focused on the problem of corruption for decades.
And on the one hand, I can see exactly why this should work.
To the extent that it will work, I know the corruptors aren't going to like it very much and they have a tremendous amount of power for reasons that should be obvious.
But I could also see it happening, you know.
Let's look at, for example, we have a terrible corruption problem in science where funders with a stake end up corrupting journals, they corrupt scientists, they corrupt the whole system.
And the way to end this is to make sure that people declare their conflicts of interest in their papers, which they now are required to do, and I can't say that I've watched the world get less corrupt as a result of it.
It should work, but somehow the corruption is so endemic that either the declarations are incomplete and they end up punishing people who are honest about it and rewarding people who are dishonest, or nobody cares about them because they're so busy reading abstracts and titles.
So anyway, my question is, If I model this, I love the solution because, you know, once the thing is electronic, then it doesn't matter if there are goons posted at the door because it's not coming through the door.
That's great.
Do I actually see the world become less corrupt, or do I watch the corruption, you know, somehow slide through the cracks like water and take up a new form that one doesn't see coming?
And I realize that could sound cynical, like I think the problem is unsolvable, which I don't.
But I do think anything that is high leverage against the corruptors is, you know, like trying to dam a river with a stone.
Yeah, so yes, we have actually done that.
So in Bangladesh, one of our researchers actually put 4% of Bangladesh budget online in a pre-trial.
And so, you know, obviously he couldn't do it, sort of, it wasn't a randomized controlled trial because you can't do that with these kinds of things.
But he could actually take these, you know, these 4%.
That's a pretty large amount of money.
And we could simply see the average price fell.
You could simply see there were more people bidding and they were typically giving cheaper bids compared to the 96.
Actually, not all of it.
You can't put all things online.
Obviously, you can't do this for military things.
There's other things you just can't do.
But for all the rest of the normal stuff, You could just simply see this difference.
And we've done this in a lot of different countries.
Not all of them have done it.
So, you know, very spectacular, more of it is sort of where you just use models to emphasize it.
And I totally get your point saying, well, but the guy who is corrupt, he's going to be really, really annoyed.
But the beauty, of course, of this, and this is true in many different ways, when you put up an incentive structure that just makes it harder to be corrupt.
You will try to be corrupt where you can, but some of those places are just not going to pay off anymore.
And so you'll have to bring home smaller pearl necklaces for your wife.
That's just the nature of the world.
It just sucks, but there you are.
Kind of thing.
So I think it really just is one of those places where you suck out some of the opportunity to be corrupt.
And that's why this works.
And why a lot of other things don't.
You know, like sort of declarations we're going to be more strong against corruption.
Because you can totally see how that's not going to work.
Because the corruptors, of course, will write all the right words and then still be corrupt.
And it's not actually going to cost them very much.
Yeah.
The other one I just want to briefly mention, you asked me for two things, is chronic diseases.
So, you know, we've talked a lot about and we also talked about not just malaria, but also tuberculosis.
There's a lot of, there's been a lot of focus on these communicable diseases and obviously that's what's been killing a lot of people, especially in the poor world.
But increasingly, Almost everyone has stopped dying from infectious diseases and now is dying from chronic diseases.
Now, there are two main chronic diseases, cancer and heart disease.
Let me call it heart disease.
It's not really cardiovascular disease, but that's just such a long word.
And cancer kills about a quarter of everyone, heart disease about a third of everyone, and then everything else is, you know, diabetes and Alzheimer's and all these other things.
Cancer is really hard to do something about.
So we should still do a lot when you're in the rich world because we're doing a lot about everything.
But it's not where you should start first.
But it turns out that heart disease has this incredibly simple solution.
The single biggest risk factor in the world is high blood pressure.
So the World Health Organization estimate that kills 11 million people.
So 17% of all death in the world comes from high blood pressure.
And we have very, very cheap medications to deal with that.
I don't know if you're on it.
Most elderly people are on it.
I am on it.
But it turns out that this is just something where you can give people a very, very cheap pill, and you can get them to have lower blood pressure.
So we estimate if you do this, you need to have some oversight over this.
You need to actually make people aware of this.
Most people in the poor world don't know that they have high blood pressure.
And once they know, you also need to make sure you don't just pop all these pills, but you actually get it.
in a controlled setting but if you do this at very low cost that will cost a couple of dollars to to screen people and then you also need to keep them fed with the with the pills we estimate that for about 1.7 billion dollars a year you can save about a million people's lives now remember these are going to be old people's lives So they're only, sorry, only there is an inverted commas, they're only going to survive another six years.
We don't know how to, you know, make people immortal.
But that's six years that you will actually live in higher life quality and not be dead.
That's, you know, something most people would take with and be pretty pleased about.
And that is, again, one of those places where we estimate for every dollar spent, you'll do $60 worth of good, a very, very good investment.
And one of the things that we Yeah, you probably saw my blood pressure go up at the mention of these inexpensive drugs.
Yeah, my problem is I now know way more about pharma than I would like to know.
And so I have at great expense come to the following, in retrospect, obvious conclusion, which is it is extremely difficult to improve a human being's health which is it is extremely difficult to improve a human being's health with an intervention if the person is healthy to And pharma has convinced us that this is not the case.
It has all sorts of stuff that it has, you know, it has arranged for us to stand in exactly the right place to imagine that something is a marvelous intervention that will bring us more life.
And inevitably, in the end, we discover that actually there was just something we weren't paying attention to, where there was a hidden downside and that the people we thought we were saving Suffered some other consequence.
So I am NOT a believer that This is even if it is accurate That by lowering blood pressure we can actually tack on six years to two lives of people Even if that were accurate, which I doubt There's an obvious Rejoinder which is There is some reason that people have this malady to begin with.
Evolution has designed us very well for an environment we no longer live in.
And we do a very poor job of figuring out, well, if these people are dying early and they don't have to die, what is the thing that is causing them to be unhealthy?
And would the intervention be better at eliminating that influence rather than trying to introduce a pharmaceutical remedy?
So, for example, I would just point to the hazard That, you know, you mentioned cheaper food.
All else being equal, cheaper food is good.
I agree.
But all else is very unlikely to be equal.
And trade-offs being what they are, when you alter a plant in order to get a higher yield, you are sacrificing other values.
It may be that the number of nutrients in the plant goes down in order to increase the weight, the calorie count, the starches, whatever it might be.
I guess the lesson that life has taught me is when you have a well-functioning system, intervening as little as possible is the thing to do.
That sometimes a corrective measure for a distortion is valuable, but that one always has to pay attention to the unintended consequences of these interventions, and I find the world
Not interested enough in chasing down the root causes of ill health and way too interested in figuring out how to address these things pharmaceutically down the road and just as with the the issue of lab meat it feels to me like this is just a fundamental misunderstanding of complex systems and the big payoff would be to correct that misunderstanding so that we can actually
Use late-life remedies as a last resort rather than a primary intervention.
See, you didn't raise my blood pressure but that's because I'm on drugs, no.
But no, this is a very interesting place to also sort of consider this whole conversation because, you know, any doctor and I think anyone would say absolutely Yeah, you should be exercising more.
You shouldn't be drinking.
You shouldn't be smoking.
You know, smoking is by far the biggest problem for much of the high blood pressure.
You shouldn't be eating so much.
And one of the consequences of food being cheap is that people eat a lot more.
And, you know, you can clearly say, well, that's sort of a precedent preference that when food is cheap, I'd rather eat and enjoy myself now.
And yes, then I become overweight and I'll die sooner.
And well, there it is.
I made that trade off.
But clearly, we should go out and tell people, well, actually, you should be exercising more, all these things.
But I think we can also both agree that that solution is going to be a very low selling Now, we should definitely tell people this, but we know from experience that 80-90% of all people are going to say, yeah, yeah, and then go home and not do it.
And to those people, again, my question is then, if we know, and let's just assume for a second that we do have the empirical evidence, and it seems to me that that's true, that if you give people these pills, they will actually have lower blood pressure.
I know I do, but I'm not arguing for me.
But we know from the very, very large cohort studies that if you give people these pills, they have lower blood pressure and they die later from other things.
And you know, that seems to me like a good second order, no, not first best, but second best solution.
So I totally get your point, but I think also in this world where you recognize that a lot of things just won't work, I think you also sort of innately would recognize These are all very well-intentioned, but they're not actually going to work for most people.
And so for most people, we should probably just say, you know, a little bit like, well, we should actually just be allowed to do whatever we want on the roads and, you know, just be careful out there.
But we know that most people are not going to do that.
And that's why we have dividers and you have to drive on the right side of the road and you can't drive more than this.
You know, all kinds of rules, just simply because we know that that's the only way you can get good outcomes in large societies.
I agree with you.
If the outcomes are what we think they are, and COVID has been a painful lesson.
Even those of us who thought we understood the degree of pharma's corruption of science got schooled at how deep that corruption goes.
So I'm just concerned.
Anytime I'm told, hey, there's a pill and it has this great advantage and minimal downsides, I want to know what it is that I don't know.
And that's a very good sort of intuition I think but it also seems reasonable to say given that we have medication that has fixed tuberculosis that we have medication that's fixed malaria we have medication that's fixed a lot of you know certainly a lot of the vaccines that we give our young kids that fix
Measles and all these, you know, terrible diseases, that we have a lot of things that actually have fixed a lot of stuff and made us live a lot longer.
One of the things I'm a little worried about when you also mentioned that, well, our evolutionary tendency, well, our evolutionary tendency was that most of us wouldn't survive, you know, for very long.
Some of us would get pretty old, but I would imagine that not very many got to be, you know, 50 or certainly 70.
In prehistoric times.
And so, in that sense, we're stuck in this situation that if we want to be able to live that long, we probably have to fix some of the things that haven't gotten an evolutionary solution because we never really got to have any strong pressure that far down the road.
And again, what I'm presenting is simply, these are very simple things.
Blood pressure pills, not terribly complicated stuff, and very, very large efficacy studies.
Unlike, for instance, and I totally agree with you that there was a lot of policy failures around COVID.
I think much more that we were just unwilling to have a conversation about.
Just like everything else, there are costs and benefits.
And there were benefits to COVID vaccinations, but there were also costs.
There were benefits to COVID regulations, but there were also costs.
And we just didn't seem to have that conversation.
And there, understandably, we only had a couple of years of data, but here we have much longer data series.
And we kind of know that these are things that reasonably work.
And again, going back to what we started off this conversation on, these are just simply, you know, sort of the very simple, incredibly effective things that I'm trying to pitch for.
Well, it would have to be a conversation for another time.
I started out believing that the COVID interventions were not well designed.
I I ended up believing that they were the inverse of what we should have done in every case.
So how you get to the inverse is a story in and of itself.
But nonetheless, I do agree with you that the right thing to do is to look for leverage points.
And your point is absolutely correct.
We have largely, in the first world, we have largely dispensed with infectious disease as a killer.
Right?
We've been particularly effective with bacteriological diseases.
People don't get gangrene, these sorts of things that used to be extremely devastating.
So I'm not disagreeing that solutions are possible and that we should be looking for them.
I'm just, I guess I'm lamenting The likelihood of finding good solutions in a system as corrupt as ours has become because it likes to pretend that things are solutions, which actually aren't.
But nonetheless, it's quite clear that you are dedicated to having those difficult conversations and to figuring out what the net impacts are.
And in fact, that is really the thesis of your book.
Whatever the net impacts are, we should Not pretend otherwise and we should we should deploy our resources in the optimal way because if we spend it poorly we do less good than we might.
If I could just end up, because I actually do that on the back of my book.
So the whole, you know, these 12 policies, so that's tuberculosis, maternal and newborn health, it's malaria, nutrition, chronic disease, childhood immunization, education as we talked about, agricultural research and development, e-procurement, land tenure, security, another thing we didn't get to talk about, trade and skilled migration.
If we do all of these things, It'll cost us $35 billion a year, so not nothing, but you know, a very small amount of money compared to most other things that we're talking about.
It's pretty close to nothing, actually.
It really is.
Well, it's not nothing for me, and I'm pretty sure it's not nothing for you.
Yeah, if you had to pay it, you'd feel it, but globally speaking, that is not.
Yes.
Oh, absolutely.
And the benefit would be that that could save, we estimate, 4.2 million lives each and every year.
And it can make the poor half of the world $1.1 trillion richer each and every year.
And that's mostly through education and some of those things that we talked about.
So it's just a phenomenal amount of good for very little money.
What we find is every dollar spent there would deliver $52.
And that's why I just want to show, I don't know if you noticed that, but I actually have the conclusion in the cover.
So it has the cost down here, it has the benefit here.
Um, and I, I just love it because I'm a, I'm a geek.
Uh, but you know, I, I think that's exactly the point of just simply saying, here are things that cost little and do an amazing job.
Shouldn't we do those?
Yeah.
I actually did not notice that feature of the cover of your book, which I also have right here.
Um, but, uh, all right.
So.
This has been a fascinating conversation and I wish more people were taking your approach and thinking seriously about what our values are.
I will add one final thought and then you can close us out.
Money is a decent proxy for value, but it's not a perfect proxy.
And I wonder how it is that we take an analysis like the one that you've done, and we say, well, what is it that actually liberates the most people?
It's not that it returns the most dollars, but what actually brings us to a state in which human beings are capable of Doing meaningful things at the highest rate and certainly that will be correlated with money but it's not synonymous with it.
No, there's a lot of good evidence that showed that money is you know fairly strongly correlated to a lot of things we like but you're absolutely right that it's not the only thing and it's you know we shouldn't confuse that and that's also why what we're talking about is people who are very poor And who are very sick and who are very unproductive, who basically got the short end of the stick in many, many different ways.
Because that's where it's very obvious what is great.
You know, you spend a dollar and you make sure that this kid doesn't die from malaria.
How easy is that?
That's, you know, almost everyone can agree with that.
If we get to the level of the rich countries, I'm not sure I know nearly as well.
And I think it's going to be a lot more politicized.
And I think it's going to be a lot harder to do because we've done all the, you know, the low-hanging fruit, the cheap, effective stuff.
But we still haven't done that for the whole world.
So I'm simply making, I'm in a sense, picking the low-hanging fruit of figuring out A simple solution to an incredible part of the problem, but it's not a solution that's going to work everywhere.
So eventually I'll be out of a job and we'll have other things to talk about, but I'm looking forward to that day.
All right.
Excellent.
Bjorn Lomborg, it's been a pleasure.
Your book is Best Things First.
And anyway, good luck with your work and I look forward to future conversations.
