C (3:28)

I think in an alternative life, I'm not doing what I'm doing here at GiveWell and instead I'm a academic studying the Talmud. It was something that at the time I was incredibly interested in. And in college I spent a lot of time in Talmud courses studying other religious texts and Judaism and otherwise. And I just found it incredibly fulfilling and interesting to think about how people had tried to answer questions about their lives.

B (3:55)

What is the Talmud for people who don't know? And what did you learn from studying it?

C (4:00)

It's a huge compendium of Jewish ideas and thought from roughly the 500s of the common era. And I think the thing it taught me most is how challenging it is to know anything. I spent about a year just studying Talmud, and in that year after high school, it was the first time that I think I had a really challenging intellectual experience where I wasn't able to understand the text and the content that I was trying to, but nevertheless found myself drawn to understand it and to deal with the layers of challenge that the text presented. And so, you know, I spent a year doing that. And then when I was in college, I would say that this was my main extracurricular activity outside of school was spending several hours a day studying Talmud and thinking about whether that is something I would do as a career and ultimately realized it wasn't the right fit for me.

B (4:52)

And what you move on to is Bridgewater, a very unusual hedge fund. What is that movement for you?

C (4:59)

You know, sometime as I moved through college, I was thinking about what my career would be and had the opportunity to have internships in many different places. So my parents are both lawyers. I got to work at a law firm that convinced me not to go to law school because I didn't think that would be right for me. I was able to get a job in finance at a small company and there essentially selling research to the big banks and just trying to figure out how to succeed as an organization. And because of that, they were willing to give me, a 21 year old college kid, a lot of leeway to try to do things and help the company grow. That experience of being in A place where I was needed and able to do something interesting and challenging motivated me to look for jobs in finance coming out of school. And so I went to, you know, I was able to get a job at Bridgewater associates, which in 2004, when I graduated college was not well known at all. Everyone I talked to said, don't, don't go work there. You know, go work at a well known investment bank. That'll be better for your career. But when I interviewed there, they asked me about my senior thesis, which I was a religion major. So it was about martyrdom in medieval Islam, Judaism and Christianity. And we talked about that for an hour and I got a call back and it was one of the few places that called me back as a. You might not be surprised to hear that religion majors don't often do so well interviewing for finance jobs. And because of that, I thought that this place, Bridgewater, was just one of the more interesting places to go work. And I was grateful to be able to work there.

B (6:24)

So it later becomes fairly well known because it's Ray Dalio's hedge fund. And Dalio, of course, is a sort of public finance intellectual now, but had a very strange and famous management style. What was working at Bridgewater like for somebody who doesn't know much about it? What is unusual about working at Bridgewater in that time?

C (6:46)

So what Bridgewater is known for is its culture of radical transparency. Just saying what you think, sharing that with other colleagues, not worrying too much about how you say it, but just saying what you believe. And then over time, or about how.

B (7:01)

They'Ll feel about it or how they'll feel about it.

C (7:02)

And over time, Ray developed these principles that were passed out inside the organization. The way I described it to my friends at the time is it felt to me like working in almost an academic environment. People didn't wear fancy clothes, they argued a lot about ideas. You know, sure, there were ways in which I think the culture wasn't ideal for many. You know, it was a place where it was more about getting things right and then worry about people's feelings later. And if that wasn't the right fit for you, then people moved on. But for me, it was an extremely valuable experience. And the thing that I appreciated certainly as a young person in my early 20s, is I would go to my boss sometimes, and he was one of the heads of the company, and say, hey, I think you're wrong about this. And he would listen to me, and sometimes I was wrong, sometimes I was right. But just to be taken seriously early in your career was so valuable, something I'm really grateful for them for providing me.

B (7:57)

I think this is relevant to what you end up doing. Because when hedge funds, investment banks, you are trying to understand a company, a sector quirk in the market at a level where you can make a trade other people will not make and you'll lose a lot of money if you're wrong. So how does a religion major coming out of college, what is the pathway to having something of any value to say when you're whatever it is?

C (8:28)

I think the core idea that was true then and I think has carried through in givewell and in my life today was first, in order to make decisions about what to do in the world, we have to understand the world accurately. And for a hedge fund, understanding reality is really key. If you are right, you make money, or you can. If you're wrong, you tend to lose money. And so the stakes of getting to the quote, unquote truth are very high. Part of that is you have to be careful not to fool yourself. So one of the things that investors do is they have an idea about what might perform well in the market. And then you can say, well, how well did this idea perform historically? And you can back test the idea. And when you do that, you have to be really careful not to fool yourself and fit your idea to the past. Instead, you have to ask this question.

B (9:15)

Can you describe what that would mean?

C (9:17)

So you might say like a simple rule, like let's say when I'm going to make something up that's entirely fictitious, but you know, let's say if oil prices go up, then train stocks go down because an input into railroad costs is the price of gas. And so when you know the input cost cost goes up, the performance will be poor. And you could try to look at this historically and say, let's say we tested this going back. Would this have been a successful strategy in the market? The challenge is it's very easy to convince yourself that you should tweak your rule in one way or another to enable the idea that you have to perform on the back test. But you don't want to do that because you only want to bet money on this idea if it really will work.

B (10:00)

So you're working at Bridgewater, a hedge fund, I would say, one of the more acquisitive industries that exist. Where does the interest for you, where does the glimmers of giving as a pursuit and giving differently come from?

C (10:18)

I'd been there for a couple of years. My friend had a friend there Holden Karnofsky. And he and I just started realizing we, we're young, we don't have high expenses, we're saving some money. Let's try to use some of this money to help people. And so back in the summer of 2006, he and I and a few others got together and said, let's just work on figuring out where we'll give by the end of the year a few thousand dollars. And it was in that process with that group of people that we learned a few things. First, we learned it's really hard to get answers about what charitable organizations do and how well it works. Number two, I just found myself somewhat obsessed by this question of where should we give? You know, at the time, I knew very little about what the lives of people around the world were like. It's not something I'd studied, it's not something I knew much about. But learning about the challenges, accessing water or disease, it was just a very motivating topic to work on. I remember this night in Probably December of 2006, I was up at 2 or 3 in the morning reading academic papers about diarrhea in Africa. If you find yourself reading about diarrhea at 3 in the morning, you know, you found something that is, you're really drawn to. And so after working on this essentially part time, Holden, my co founder and I left Bridgewater and started GiveWell as a full time project back in the summer of 2007.

B (11:40)

Two things in there. One is the impulse to start looking for the effectiveness data on the charities you might support. Not to just say, we're going to give the money to Doctors Without Borders, we're going to give it to unicef.

D (11:53)

Right.

B (11:54)

There are big charities out there, we've all heard of them. There was Charity Navigator, which is something that I used when I was younger. And also what happened, what you saw when you began looking.

C (12:03)

We just started asking some really basic questions and the answers we got back were shocking. So we each researched a different cause. I decided to research the cause of water in Africa. I'd call up first. We looked at Charity Navigator. And at the time, Charity Navigator essentially just reported financial metrics. So it said this is the amount of money that's spent on overhead versus programs and fundraising. And while this measure can tell you that a charity is a scam or not, it's not going to tell you whether the program is actually working. Let's say the charity spends all its money digging wells, but those wells disappear a year later, they fall into disrepair. Well, that's not very effective use of funds, even if all of it was spent on programs. And so I called the organizations up and asked them, well, so, so what do you do? What do I get if I give you money? And they said, I remember this. $20 provides a child water for life. Great, that's amazing. I would love to give to that. What do you mean? Like, how does that work exactly? What does it pay for and how do you know? And at that point it's like the conversation fell flat. They, they just didn't have answers. What they actually said was, we don't get questions like these from our million dollar donors. And like this light bulb went off that, you know, almost no one was asking these questions.

B (13:19)

Were they annoyed by you?

C (13:21)

Some of them were annoyed by us. One organization accused Holden of being a spy for a rival organization. He had asked, how much money do you spend in each country? And that question would only. They could only imagine it would be asked if he had some nefarious purpose. And so I think they were annoyed. I mean, we were what, 25 at the time, so I'm sure we were annoying. But we really saw how neglected this area was and it really motivated us to start GiveWell.

B (13:52)

What's striking to me about the way you approached it is that you even had the intuition that maybe you would give to a charity and what you were doing was making a bet in the same way that when you're trading, when you're trading, the bet is supposed to make you money. When you're giving to a charity, it's.

C (14:11)

Supposed to improve lives in some ways. This basic question of what is true, how can we know that it's true? How can we assess the empirical data and evidence that we have to make the best decisions? I mean, that's exactly what GiveWell does in a very different way, in a very different context, but it's bringing that same commitment to rigor and truth, seeking to bear on, trying to answer questions about what we should do in the world.

B (14:36)

What are the things that in your view, most commonly stand in the way of organizations? Organizations that care deeply about their mission or have financial or otherwise skin in the game from finding truthful answers. Organizations or for that matter, individuals.

C (14:54)

I mean, I think there's two big things that happen and there's many more that are downstream. The first is as an individual running an organization, you have an incentive for your organization to succeed and it's very difficult to look for information that would mean your organization is not succeeding or shouldn't receive money. It's Just, it's not. I think it's not realistic to expect someone who say is. Is running an organization that delivers food in a way that is very cost inefficient to determine that they should shut that program down and move on to something else. That's just not how human beings operate. And I think that's completely understandable. And then I think the second challenge is that in order to make good decisions about where to put money, it's very helpful to have a. A broad perspective. If you're focused on, let's just say, an inefficient delivery of food aid, you're not going to be thinking about the role that a malaria vaccine could now have and whether you should be, in fact, delivering malaria vaccines instead of delivering food aid. And so I just think the place that most people sit in the, let's call it the nonprofit economy makes it implausible that they would take this kind of perspective.

B (16:11)

I think that when I was younger and giving to charity, I didn't really think at all about the idea that the money could fail. And I mean, these are good people. They're trying to do something hard. They're out there working on the ground. The idea that you might just give money to some of them and that money would be useless, I actually think, until later on, didn't really occur to me deeply. What was the intuition that led you to treat money given to charity as money that could fail?

C (16:44)

I don't know what, you know, led us to have that realization. What I remember is it was at a time when, you know, you would go to CNET on the Internet for ratings of printers if you wanted to know which printer to buy. And it. It almost seemed intuitive that you should be able to get the same kind of information about any way that you would spend money, including about charitable organizations. And in many ways, that was the initial vision for GiveWell, which, you know, we've evolved far from today. But the initial vision was a place that donors could go and just get information that is as good about where they'll give as they could get at the time, about which computer to purchase or which printer to buy. And it just seemed offensive in some ways that that didn't exist for charitable organizations. You know, I think a lot of the focus that people bring to charity is on the donor. It's saying to, you know, donor, you should be generous. And then when you're generous, that's success. And of course, what that misses is that the person who you should ultimately be focused on is helping someone in need, that that's the goal. You know, I think that what really is important to remember is both the fact that you can fail to help the person in need, and that happens all the time, but also that charitable giving isn't just a nice thing that a donor can do. It's a very practical way to make the world a better place, that you can give and save lives. And this has been, you know, it's clear and demonstrable that supporting public health programs has this kind of impact.

B (18:18)

That point about the focus being on the donor is interesting. So in the tradition you and I share, the Jewish tradition, there is this idea of sedaka. And I remember being in Hebrew school when I was young, going around with a little tzedakah box and collecting, you know, coins. And I think it went to, at that time, unicef and being taught that there were different levels of tzedakah. And the highest level was when nobody knew you gave and you did not know who you gave to because that level was selfless in both directions. You were not expecting gratitude, you were not expecting prestige. I do wonder if some of it comes from the history of charity and generosity as, among other things, a spiritual practice. You're trying to develop a certain facility inside yourself as a virtuous and spiritually alive person. The idea that you'd be coming behind that money and checking up on it, I think would be seen in some ways as intention with the attributes you were trying to cultivate.

C (19:19)

When the focus of charitable giving is on the generosity of the donor, then that framework makes sense. And then there's this alternative way of seeing the world, which I think is more intuitive to us in modern times than Perhaps it was 3,000 years ago, which says, we know that we can make the world a better place. The world is a much better place, in my opinion, today than it was 3,000 years ago. We do that via improved technology. We argue about the best political systems and what policies we should have. And now I want. The argument that I'd like to bring forward is that charitable giving is one more way that each of us can take action and make the world better. And when you see it from that perspective, it's critical to think about the effects that the programs have where you can get as much impact as possible and also how to avoid failure.

B (20:07)

So you and Holden split off from Bridgewater. You create givewell. You begin trying to gather this data, begin trying to figure out even how you would make recommendations. How do you start?

C (20:22)

The idea we had is that when we were individuals Giving a few thousand dollars, it was hard to get information. But with some of the funds that we put together to start GiveWell full time, heavily from our former coworkers at Bridgewater, we could incentivize organizations to share data. We started by offering small grants that organizations applied for. I think at the time we offered several $25,000 grants. Organizations would send us data. And what we learned in that first year, after we recommended our first round of organizations, is that while we needed some data from organizations, what was really critical in pushing us to make recommendations was this huge trove of academic information about what works to help people overseas. So these are often rigorous, randomized controlled trials of health programs like distributing mosquito nets or provision of needed vaccines.

B (21:15)

Who are these academics doing this work? Because on some level, it's weird work to do to say to yourself, well, I'm going to see if giving a family a cow really does help them in five years. Where is this early evidence coming from? And what kinds of weirdos are collecting it?

C (21:31)

Well, I mean, there's different fields that, you know, whose information we rely on. One is the public health field. So people asking questions like, how effective are mosquito nets? Or what impact will we get from vitamin A supplements delivered to young children? This is coming out of public health. And I remember actually speaking to one of these malaria researchers who told me at one point early in his career, he had sat on the beach in Tanzania and just let mosquitoes bite him because they had to count how many bites he would get in some amount of time sitting on the beach. So certainly people who were themselves willing to go to great lengths and risk personal harm to create the information we rely on. And then separately, there's a movement in development economics around randomized controlled trials where people are trying to not just assess the health effects of programs, which are often more easily measurable, but the economic effects of programs like microfinance or provision of livestock, or even just giving people cash to let them spend how they want. And this, this movement in the 90s and early 2000s, in many ways, I think of as being an intellectual forbearer to GiveWell. And, you know, I think we're in our debt to all the work they did because they really helped generate many of the ideas that we've taken forward.

B (22:50)

How do you think about freeing yourself from the very natural human tendency to think along with your group? I do find people in finance or venture capital tend to be trained to look for places where the consensus might be wrong. I mean, at the hedge fund level, what Everyone else thinks on some level, if you only think what they think, you're not going to make money. But I think there's also this dimension, and I feel like this is important to the work you all end up doing at GiveWell, where there are things that are comfortable to think, stories we like to tell ourselves or are moved by, and the way in which we can get wrapped up in those sort of more emotionally driven approaches or socially driven approaches. Right. You know, everybody like you supports this kind of charity. Everybody like you knows that, you know, the economy is going to be bad next year.

C (23:45)

I mean, the ask that I would make of most people is, is not to try to break away from the norm in an extreme way, but instead, you know, there's this idea that I have that many have this traditional idea of giving 10% of your income to charity. It doesn't ask you to give 90.

B (24:04)

Very old religious idea, old religious idea, tithing.

C (24:07)

And so it's not giving 90% or even 50%, it's 10%. And I think in the same way, if someone is supporting local causes, if they're supporting programs that are meaningful to them, one step to take is just move away by 10% and move towards, you know, if you want the causes that we focus on, helping some of the poorest people in the world with 10% of your focus and energy. And I think that 10% move is one that is available to many people.

B (24:38)

So you're pointing towards a very particular intuition people have, which is that we all get wrapped up in local causes. And I want to say, for my giving, I sort of given a couple of different buckets and one is very local. Right. I believe I have a particular responsibility to the community I am part of. But there is a tendency for the stories that you know and are near you and people who know you tell you to overwhelm the sort of diffuse questions of global malaria or vitamin deficiency. How did you travel that path? Because my understanding of when you began in this, you began locally as well.

C (25:16)

When, when we started, we were based in New York. Now we're based in the Bay Area. But we were looking both at causes focused on New York and causes focused overseas. I think the first donation I ever gave was to a New York based organization called the Harlem Children's Zone. You know, well known local organization helping disadvantaged children in the New York City area. And what we learned after that first year of work at GiveWell was just how far a dollar can go overseas. And then I think there's a little bit of a In some ways we know this, but it's a little bit of a figment of our imagination that the people who we see every day are really closer to us in some way. Last summer I traveled to Malawi and this was just to see the types of programs we support, to speak with people who are there. And they're far away, it's true, but with 36 hours of flying, I can sit as close to them as I'm sitting to you and ask them about their lives, what they're struggling with, what they're dealing with. And then in the same way that in at home I can see someone who's in need, in sitting across from someone in Malawi, I hear about their struggle to have food, the days they went without eating. The mother who tried to bring her child to the local clinic, but she had to carry her child for an hour on her back, and then the clinic didn't even have the drugs in stock. And I can also talk to the parents who in maybe a way that's very familiar to me, maybe to you, are struggling with a new second grade math book because they're teaching arithmetic in a different way now in Malawian schools than they did when she grew up. And so she doesn't know how to help her child with the math because different than what she did. And so being there on one hand, there's the analytical argument that a dollar goes further. And then I think there's just the reality that people in Africa aren't as far away as we sometimes think. They're really there. You can go and talk to them.

B (27:06)

I think it is profoundly difficult as a human being to live as if other people's lives are as real and as valuable as your own. There is a vividness to us and the people right around us. I don't mean necessarily in our community, I mean our family, our friends whose stories interweave with our own. And to really treat people further from that, somebody fleeing from gang violence in Honduras, or just somebody struggling at subsistence level labor in another country, to treat their life as if it is as real as yours, to really believe that, not just say it. In some ways, I don't think human beings are wired for that, but it does strike me as a genuine, like, emotional and spiritual challenge.

C (27:54)

And I'm not sure that that's what we should be really aiming for because I don't think it's possible. If we felt like other people's lives were as important as our own, we wouldn't be talking about giving 10%. We'd be giving far more in the same way. I don't think it's reasonable to ask expect to even want parents to treat their children equally to all other children in the world. We want a society where all parents thought of their own child exactly the same way as every other. I don't think that's a realistic expectation.

B (28:22)

No, that'd be inhuman.

C (28:24)

And so. Well, quite literally. And so I think this and so I think sometimes, you know, the ideas that come from people who say, you know, you can give more and there are needs overseas. It sounds like someone is saying you must or you're bad if you don't, or you should give everything away because look at the great need. And in some way we must accept that. That's true to some extent. But more practically, I don't think that's the right target to shoot for. And in my experience, people who try to aim at the target which is treating others exactly like yourself or giving everything away to bring yourself down to the global median income. I mean that maybe succeeds in the short term, but certainly is not a long term path to helping others as much as possible.

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B (31:09)

I'm always struck by how few charities actually make it into your top charities. And it's pretty, it has been fairly stable year to year now for some years. So walk me through what they are and what makes you confident in them.

C (31:22)

Yeah, let me, let me first, if it's okay, like frame up how the top charities fit into our overall work. And so in 2025, we've directed funds to 70 organizations. Four of them are our top charities. And then, you know, there's more than 60 others that have received a lot of money. You know, perhaps they're newer or our knowledge of the program is newer or the evidence is slightly more complicated and you know, there's higher risk that the program fails. But if it works, it'll be incredibly successful. And so we direct a lot of funds to those, those types of programs too. And so what, what these top charities represent, to maybe use the finance analogy, is something like the blue chip programs, the ones that have the strongest combination of evidence and track record and data behind them. So that we can say to anyone, you know, if you're, if you're trying to help people overseas, these are really great places to give to. So our, our top charities. One is the Against Malaria foundation which funds malaria net distributions globally. The second one also works on malaria prevention and that's Malaria Consortium in its seasonal malaria chemo prevention program. This program provides seasonal anti malarial medication to children during the malaria high season to prevent cases of malaria and resulting deaths. 1 Helen Keller International focuses on provision of vitamin A supplements twice a year to children between the ages of 6 months and 5 years. And then the fourth is called new Incentives and they deliver cash incentives to caregivers to encourage them to come to clinics to receive necessary childhood immunizations. And you know, those four are not the, I wouldn't call them the best. There's, you know, other programs we've recommended outside of that for water and malnutrition prevention and the malaria vaccine which, you know, it's relatively new, it's not gonna get on our top charities list yet, but there's just this wide array of programs that help people around the world.

B (33:20)

And this gets to, there are multiple ways to donate through GiveWell. Walk me through those and how they relate to the sort of division you're making here.

C (33:27)

Well, I mean first just, you know, anyone can Use our research for free. So anyone can come to our website, read it, and you can donate to any of the organizations that you see on our top charities list directly without ever telling GiveWell that you've done it. I mean, we hope you do because that helps us understand our impact. But, you know, the primary options we offer people are first to give to our top charities fund. Those are donations that we'll only give to those four organizations based on the needs they have at the time we receive the funds. We push those money, you know, out the door. We commit those funds to organizations relatively quickly. The next option for donors is to support the All Grants Fund. And, you know, that just gives us the flexibility to give to either top charities or any of the organizations or programs that we might support, including giving money to help organizations or programs get off the ground, or funding the type of research that we need to make our decisions. And then finally, there are donors who give unrestricted. And, you know, that is the, in some sense, the highest level of trust. And giveWell, because you're allowing us to decide how much we need to allocate to our own operating expenses versus allocating funds to the programs we support. We've. We've been fortunate enough in the last few years that we've raised more unrestricted funds than we need for our own operations. And we've then designated that money for granting and, you know, sent it out the door to get it to people who need it around the world.

B (34:46)

The most common critique I hear of GiveWell, one I even somewhat believe, is that there's a limit to what can be measured. And it's possible to measure the effects of vitamin A supplementation in a way that measuring the effects of funding for political change or fortifying public health infrastructure is very, very hard. It's very hard to measure the effect of giving on climate change. How do you think about that question of what you can and cannot measure, knowing that much that cannot be measured is going to be important in human flourishing?

C (35:21)

Yeah, it's a great question. I mean, I think, to start, I think it's really important to have humility in this work that we can be wrong, and we know we can be wrong. And there are times when we've supported programs that seemed like they would clearly be effective. And then at the same time, we also funded a rigorous randomized controlled trial to go along with that program. There's an organization called no Lean Season or a program that we helped start. And you can read all about it on our website if you're interested. That program provided small cash incentives to encourage people to migrate from the rural areas of Bangladesh during the lean season to the cities so that they could earn more money and some money back home. There was a series of randomized controlled trials that preceded our support of it that showed that it was having this effect. People were earning more money, they were even more likely to migrate in future years. And then we provided funding to start up this program with a RCT randomized controlled trial alongside it. And at scale, it didn't have the effects that we expected. There's an interest, I mean, I have some theories about why do you think that is. So I think in this case there's just this big challenge of going from a 2,000 person research study to a 100,000 person program that's existing in the world. And I think what may have happened in this case, and this is what I heard from the, the lead, the researcher of that program, Mushfiq Mubarak, a great academic, that when they decided to deliver these cash incentives, they did it via microfinance institutions, essentially banks that were there in Bangladesh and the loan officers who were delivering these incentives, which were small loans at the time, their personal incentive was to find the people who are already likely to migrate because that made their job of finding people to take these incentives much easier. You know, in what itself is. You know, I think an interesting question about that program is we decided to no longer continue supporting it. Evidence Action, the organization that implemented it, shut it down. That was a joint decision at the time. And I'm not even sure that decision was right because it's possible that with more time we would have been able to solve this implementation challenge. But I think this story just illustrates how critical measurement is. Measurement is certainly limiting, but I think when you're trying to help people living 10,000 miles away, it's just necessary to find some mechanism for getting feedback. So be part of a feedback loop that tells you if your bets are right. To use the analogy, I think there's.

B (37:51)

Some way in which I feel, just hearing that story, the danger of being a donor. Because if I had donated to that, which probably I did, because I've been donating through GiveWell for a long time, if I donated to that, and what I had heard is there's great evidence that giving people grants to migrate during key seasons will help them out. And look, now we're giving all these people grants, it would never occur to me to think maybe it's not working.

C (38:17)

And.

B (38:20)

It makes you wonder how much money is out there. Being wasted or, and I think this would be the other question, if there's something wrong with the studies subjecting every project to the rigor of expensive randomized controlled trials, but you can't do that many of them. Do you have concerns that you might be discarding things that actually work or that work in ways that you're not measuring or that you're not measuring for long enough, et cetera.

C (38:53)

What we try to do is just find ways to build in a feedback loop so we learn something and we can update our predictions about the future based on the reality of what occurs. Sometimes that's a randomized controlled trial. It's a great way to do it. Other times we supported a program that, and we still do, that helped countries around the world transition from a single HIV test and syphilis test to individual products that were given to women who came into antenatal appointments to a dual test. And the idea was if we can transition from having to apply two tests and two products to one, we can reach more people. I think this program has been very effective, very cost effective. We don't know that from randomized controlled trial data. Instead we know that from more programmatic follow up about monitoring the data that comes from people who are going to antenatal visits, from seeing the stock levels in countries of these tests. I think that ultimately sort of wish it were the case that you could have a randomized control trial for everything and we could push in the direction of greater certainty. And I think it's clear that there are so many programs that could be so valuable that just can't be subjected to that level of scrutiny. I think we can see today, you know, programs like, you know, people who scaled up HIV treatment in Africa in the early 2000s, whether that was advocacy to the US government or the philanthropic work that supported tenfold reduction in drug prices, maybe hundredfold reduction in drug prices from some original levels. I mean, those are incredibly impactful programs. With hindsight, we can look back and say those programs saved a lot of lives per dollar. And I think that is a challenge that I feel like I'm always trying to make to researchers internally at GiveWell that we see as a challenge to ourselves, which is when are we inappropriately prioritizing certainty and measurability over expected impact?

B (41:01)

What are the areas or the charities that you think have either the highest expected impact or maybe more relevant for this, the highest possible impact, but you just can't measure it. And I'm thinking here in the present, not doing long termism and Trying to save society 10 billion years from now. What are the things that feel to you like they're the riskiest in terms of may not pay off, but man, maybe they do pay off and it's worth it for that reason.

C (41:32)

Yeah, let me give a couple different kinds of examples because I think the spectrum of potential impact but also risk is very wide. So one example is a program we've recommended for a long time, which is treating children for parasitic infections. Often this goes by the name deworming. And the reason there's so much uncertainty is that we have a single randomized control trial from about 30 years ago in one area of Kenya where they treated kids who had very high worm infections. Followed them for many years. They're still following them today. It's really an incredible study. And see that the kids who were treated as part of that experiment have much higher earnings today than the control group. This is one very strong piece of evidence. There's also evidence of improved weight gain from pooling multiple randomized trials and some evidence from the American south when hookworm was eradicated here in the early 20th century. But at the same time, I don't think any of us would see that as clear knockdown evidence of significant effect. The public health community says, you know, these trials don't meet our standards for rigor. We're not convinced by these results. And the worm levels today in 2025 are very different than they were at times in the past when these studies were implemented. And so at the same time, it's so cheap to treat a child for parasitic infections. We know that these parasitic infections are bad. And so this is one example of a program that, you know, may have an absolutely massive impact.

B (43:06)

But I'm asking you to answer in terms of something Pickering, that because you went to something again, where there's an incredibly clear specific causal mechanism. And the reason I'm fairly comfortable with deworming is the medicine works. You know, what you're funding there. There are a lot of other kinds of interventions, democracy promotion. Right. That we don't really know if they work, but if they work, they're transformative. What do you think about where you think we can't measure it, but maybe there's a case for it. Not in the way that you're just trying to figure out the magnitude of the impact of deworming. So where you can't figure out the magnitude of the impact and you know, you can't.

C (43:48)

A couple years ago we made a grant to support our world in data. They're A website that provides amazing information on problems facing the world. As someone who about 20 years ago tried to find good data on problems in global health and development, I wish that a site like Our World and Data had existed then because I know how hard it is to download multiple spreadsheets and match them up. And so we made this week I talked to their, their head Max Roser, and he was telling me that they were facing a challenge in raising operational funding. We made a grant to them out of our All Grants Fund. We can't measure what effect that had, but you know, that's a site that I think in aggregate has so much impact. Another example is a grant that we made this past year in response to the U.S. aid cuts. So we supported essentially consulting units at two organizations, one called CHAI and one called PATH, that would work closely with governments to plan their response to the aid cuts, to understand where they had gaps that needed to be filled, even to articulate the funding needs that they had so they could potentially raise money from other donors. But that sort of support to government decision making is something that clearly could be incredibly impactful on helping people in those countries. But we won't be able. We don't have a quantitative estimate of what's accomplished because of that.

B (45:12)

You all don't just subject charities to the binary question of does it work or does it not work. You have a certain measure of cost effectiveness. It has to clear, so working is not enough. It has to be cost effective compared to other interventions. Tell me about your measure of cost effectiveness.

C (45:34)

Yeah, I think I'll just use the cost per death averted as a simplified way of putting this. I mean, we do try to look at the effects that come from improved health, increased income to some extent, increased well being, and put it all into one measure that we can use to compare across programs. Of course that is incredibly subjective, but nevertheless, as we're trying to look across programs, we have it. But what we aim to do, to go back to the simplified version, is say if you could use $60,000 and avert the deaths of 10 children, that's a much better decision than using that same amount of money to avert the death of only one child. It's better to use the resources you have to help people to a greater extent.

B (46:16)

How do you weigh things against each other that are not the same thing? And I mean this on two levels. So one, there's a question of lives saved versus income versus what's the value of, you know, not suffering from an illness? It doesn't Kill you? What's the value of an education? And then there's also the way in which different people just weight different moral questions differently. I know you all have put a ton of work into this. So how do you try to do that? How do you both try to standardize the first set of questions and then how do you try to create space for the different ways different donors might think about what is important?

C (46:56)

Yeah, so the starting point for us is that, you know, in many cases donors come to us and they essentially say, we want you, GiveWell, to decide where and how to allocate our funds. And so because of that, we're responsible for making these decisions about how to weigh up different kinds of good against each other. You know, to do that, we're trying, as we often do, to collect the information we can and then just make the best judgments that we're able to with that information. And so for us, we do a variety of looking at academic research. So for example, in trying to weigh things like income against health, there's academic studies that look at the value of a statistical life. And we're trying to use that data to the extent we can. We also try to survey our donor community and understand the preferences that they have collectively. And we've also tried and have funded some studies in Africa where we just ask people how they would make these same choices and trade offs. All of this is very challenging. I would not claim that it is in any way getting us closer to truth, but it's the mechanism that we use to try to make these decisions. And then I think importantly, we're certainly not, I'm certainly not trying to say that our answer is correct. Instead, GiveWell fills an important part of in the donation ecosystem where, you know, we're trying to be almost like the economist's approach to giving overseas. And we're just trying to do that as well as we can. And of course, there are many other ways and many other approaches that people could take.

B (48:26)

So GiveDirectly is a program where you give them money and they give the money to other people. And the idea is that people know best how to spend the money in their own lives. And very controversially, a few years ago you stopped recommending them. That's a group I still support. I'm a believer in their work. And that was very controversial because your argument was not that it's not doing what it says it's doing or even that it's not good for people to get money. So what is the line for you and how do you think about some of the things that fall beneath it? Because they are not primarily, it seems to me, often about saving lives, but about changing incomes or changing health or improving lives.

C (49:03)

Yeah. And I should say I'm also a huge fan of GiveDirectly. I'm still personally a donor to GiveDirectly. I think the work that they do is amazing and wonderful. The reason that GiveWell doesn't recommend funds to GiveDirectly now is that, roughly speaking, we think the organizations we're supporting are able to do three times as much good per dollar as GiveDirectly does as a dollar to give directly right now. And so because of that, we feel like we're faced with the question, you know, with limited resources, where should we give? And especially now, when resources are lower than they've been in many years because of cuts in US Foreign assistance, we just think it's all the more important just to try and allocate resources where they'll do the most. And that doesn't mean that the organizations we're not supporting aren't doing good work or in some ways they're failing. It just means with the limited resources we have, we'd like to see them go as far as they can.

B (49:54)

GiveWell has an unusual relationship to transparency, to being pretty open about mistakes. If you go to the GiveWell website, you can click on a tab that says mistakes and read a ton about things you've gotten wrong and what has happened and places where you've erred. And in almost everything you do, there's a section on doubts and uncertainties. Tell me a bit about that approach. And maybe the best way to do it is for me to ask you just what have been your biggest mistakes?

C (50:23)

I've made a lot of mistakes over the years, both in terms of specific organizations. We've recommended methodological approaches we've taken for a long time. Just one example, we were relying primarily on one data source to estimate mortality from diseases in countries. And when we more recently went and collected more data sources, we saw how different they could be and the effect that those different sources of data about the causes of mortality could have on our ultimate recommendations. And so that's just a, I don't know, pretty significant mistake that we corrected in the last few years. I think transparency is so important because charitable giving isn't like solving a math problem where you can just say, you know, I. I know the right answer. I've proven it. Therefore, you should listen to me instead. There are huge amounts of judgment and values that go into the decisions that we're making. And so first, we think it's important for the people using our work to be in a position to understand it and judge it for themselves, to know that others have evaluated our work and looked at it critically. I also think it plays an important role in holding us accountable internally because every single decision that we make about how to spend money can be subjected to public scrutiny.

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B (53:34)

So Trump took office not even a year ago. It's been a long year. Very soon after his administration decapitated usaid, cut foreign aid in a number of other domains and directions. Almost a year later, how much less foreign aid is the United States as a government giving and how is the composition of what we're giving changed?

C (53:59)

So there's still a lot that we don't know. You know, the US government previously was giving about $12 billion a year to global health programs, and we think there Might end up being about a 50% cut in total US government giving. So that would be a whole of $6 billion going to global health programs. This is a large portion of aid going to health around the world because U.S. government was accounting for about 20% of total global health aid. And so $6 billion, or 10% of what was going to support these programs may be disappearing. We've seen plenty of great programs that needed money that weren't getting them. So these are programs that provide basic health services, malnutrition treatment and malaria control, where, you know, we were in a position to step in and we directed about $40 million in response to the cuts this year. Just as another example, when I was in Malawi this past summer, talked to clinicians and hospital administrators about their experience responding to aid cuts. And for them, some of the biggest cuts that they felt immediately were in HIV because the US Government has such a large HIV program. One hospital administrator told me the story that, you know, the day of the cuts, it was 9am, they had all come to work. There were patients lining up outside to get their AIDS treatment that they had come for. They were called into a staff meeting, the facility staff, and just told to go home immediately. And so you had these patients lining up and no staff to give them their medicine. Many people travel from miles and miles away because they'd rather pick up their HIV treatment further from home because of the stigma of having hiv. They don't want to be seen close to home getting their drugs. So then the hospital had to bring in some of their limited staff from other departments and get them in place to try and deliver AIDS treatment. I mean, people, the way he told me the story is they, they were like looking at the pill boxes that a patient brought in and trying to match them to what was on the shelf just to keep delivering what they had. Similarly, I visited a small clinic in a more rural area. And an important part of HIV treatment is viral load testing. So this is testing people to ensure that the treatment that they're undertaking is preventing them from progressing to full blown disease. And viral load testing, you know, really stopped in early 2025. I was able to see this because we just pulled up the data on their computer screen and we could see how they went from testing hundreds of people in a month to almost none in, you know, following the cuts.

B (56:27)

Are there significant areas where the money's been restored?

C (56:29)

We've seen a lot of money come through in malaria. So one of the programs we supported earlier this year was planning for these seasonal anti Malarial medication campaigns. Basically, in certain parts of the world, malaria has a high season and if we can provide children with anti malarial medication during the high season, we reduce about 80% of the cases during that time of year. And those campaigns, I believe were happening starting in June and the planning had to happen in March, April and May. And so this was right after the cuts and organizations didn't know if they were going to have money to conduct planning. And so, you know, we went to them and said if the money doesn't come through, will cover it. And if it does, then, you know, we won't have to. But you can go ahead knowing that you'll have funding to cover what you need. And ultimately many of those programs, the funding came back and we didn't have to spend a dollar to enable them to move ahead.

B (57:18)

When you've looked at what has happened, and I'm not trying to get you to be political, have you seen a theory of foreign aid or simply a hostility to foreign aid?

C (57:27)

We haven't seen a lot of interest in trying to answer the question, what would great foreign aid look, look like? You know, if you go back to January 15th, there are plenty of people on both sides of the aisle saying USAID should be a lot better. There are a lot of ways that we can improve foreign aid. And I think there were some people that I remember talking to before the cuts occurred where they were excited about the possibility of a focus on efficiency and delivering outstanding cost effective foreign aid. And I just don't think that's what we've seen.

B (58:01)

If somebody did come to you and said, we're going to restore USAID funding, but we want it to be better, we want our money to go as far as it possibly can. What does that theory of reform look like to you?

C (58:13)

I think two big pillars would be first focusing on the public health programs that we know how to deliver at scale, that we can deliver cost effectively at scale that have significant impact. And so these are similar to the programs we've been discussing. HIV treatment and prevention, malaria treatment and prevention and more. And then I also think there's a big place for just delivering cash directly to people who need it. At GiveWell's margin, I think that we're spending funds more cost effectively, but at large scale, I think cash is one of the most cost effective ways to just let people make their own decisions about how to improve their lives.

B (58:52)

And how about data? One thing that I've heard a lot of people worry about and seems to me like a particular problem for GiveWell, given how data oriented you try to be, is that these cuts ravaged a lot of the surveys and data collection and studies that create the possibilities of this evidence in these feedback loops. And being able to know next year what would be better than what we did this year, what has happened in that space, what seems to be being done about it.

C (59:20)

One of the most important tools that we and others rely on is something called the Demographic and Health Surveys or DHS that USAID has funded for years. And these are large nationally representative surveys that inform people in positions like us allocating money to low income countries, but also country governments themselves. You know, when they're trying to answer the question, how many students are going to be in each district? So therefore how many schools and teachers do we need? They're often relying on this kind of data. And you know, this is one of the data sets that has gone away under the cuts that we observed. These surveys are so critical that in one way or another I believe that some form of them will be preserved. It's something that I know other funders have looked at, we ourselves are considering, but it's just so critical that this data continues to exist. But it's undoubtedly been a big part of the challenge in understanding what has happened. You know, a question that you asked that I get a lot is well, what have the effects of the cuts been and where has money gone and not gone and where is it flowing and not, and what has been the humanitarian impact? And I think the true answer is we don't know. And some of that not knowing is a function of the data that we rely on is less available than it was before. And that makes the situation even more challenging.

B (60:36)

You talked a bit about how you've sort of directed 40 some million dollars around trying to fill some of these holes. What has happened in the rest of the philanthropic space? I mean, you have huge foundations, much bigger than GiveWell, like the gates Foundation. You have other countries, European countries, what is the landscape of players who could have possibly filled holes? You know, how has the sector responded?

C (61:01)

We've seen, you know, similar action from philanthropies, you know, trying to give what are large amounts of money in level terms, but certainly small relative to what governments were giving. Allocate more in response. I think the big challenge that everyone recognizes is philanthropy is just very small compared to the level of giving that the US government was providing. And then at the same time, many countries around the world are also giving less. And so in aggregate, it seems like we are entering a period where global foreign assistance, especially for health, will be lower than it has been in the recent past. And so what I hope that means is that individual donors will step up and give more. I also hope, and we've seen some evidence of this, that it means there'll be a higher priority focused on using the limited resources we have as well as we possibly can. I think that for a long time, we felt like ideas of cost effectiveness were not taken perhaps as seriously as you might expect in the world of global health and development. But I think with more limited resources, there's much more of a focus on taking what we have and trying to cause it to go as far as we can. And so that might mean, you know, allocating more funds towards Nigeria and the Democratic Republic of Congo for malaria, because they account for 40% of the global malaria burden. And I think we've seen a lot more interest, you know, behind those kinds of ideas.

B (62:29)

So then has this pullback in public health funding, has it changed looking forward, what you think will be the most effective opportunities for giving?

C (62:39)

It certainly might, and here's why, you know, what we're trying to do, deliver funds where they'll be most cost effective at the present margin. And really what these cuts mean is that the margin has shifted. So one area that we never really looked at before was hiv. HIV was extremely well funded. Another area that we made a grant to support an organization called Alima. And this grant was primarily focused on just enabling them to deliver primary health care services and malnutrition treatment in a very challenging area of Cameroon. And that's another kind of work that had been previously more supported by government donors. And so as we look forward, we know that the changing level of funding just means that there are going to be all sorts of programs that we didn't consider before that we're going to have to look at because this underlying situation has changed.

B (63:28)

Is lobbying on foreign aid, particularly paying Trump associated lobbyists, maybe an effective use of charitable funding?

C (63:36)

No, no. We've. We've worked with an organization that's just trying to inform people on the Hill about the facts of what can be achieved. And I, you know much more than I do about what would be effective lobbying. But what I think we can bring to the table is just providing accurate information about what can be accomplished and hoping that decision makers will. Will take that on board when they decide what to do.

B (64:00)

So I see one of the challenges for GiveWell, for this kind of giving as being that giving often relies on an emotional hook for people. There's charismatic megafauna in the philanthropic space. And then there's this more conversation about cost effectiveness and deworming and what are the spillover benefits of deworming. I can watch you trying to be objective about what you're funding and watch the requirement that that imposes on you to be serious about trade offs in ways that are probably emotionally kind of hard. And on the other hand, giving is an emotional project that people give, they give emotionally. We could talk about randomized controlled trials all day and all night, but most people don't get out of bed because they read an rct. So how do you reconnect those impulses running an organization that is so much about trying to correct for the biases our emotional drives might create for us?

C (65:04)

Yeah, I mean, first off, I think sometimes this argument can go too far. You know, we all know that most people are giving based on a personal attachment. And when we were thinking about starting GiveWell, I just remember everyone told us, donors don't give this way. This is never going to work. What are you even trying? And now, more than, you know, 18 years later, we have 100,000 plus donors who've used our research. We've directed more than $2 billion. So there's certainly a lot of donors and a lot of people who are excited to give this way. And then when I think about, you know, how this all works, you know, I'd say that the motivation to do this work comes from the emotional place. And you know, for me, sometimes that's people that I meet when I've traveled to Africa. You know, an experience I always have is I go to the pharmacy and I pick up amoxicillin for my kid and it has an ear infection and it cost me 50 cents. It literally takes me five minutes. And I always think it's so wild that I can just go to the store and pick up this amoxicillin like it's nothing. And I remember that there was a time when GiveWell supported an organization to deliver amoxicillin to Tanzania because they were running low on amoxicillin stock and they weren't going to have amoxicillin in all the clinics around the world. And so it's sure, you know, we spend all our time talking about the data because it's the data that helps us make the right decisions. But for me, and I think for everyone that I work with, it's just this knowledge that we're in such a fortunate position and there are so many people who aren't in that position. And yeah, sometimes we have to key on individuals to focus our work, but ultimately what we want to do is just bring those benefits to as many people as we can.

B (66:49)

And then always our final question, what are three books you'd recommend to the audience?

C (66:52)

One is Factfulness by the late Hans Rosling. This is a book that just brings global health data to the world. It's say the core argument of the book is something like in order to prioritize correctly, we need to understand the world accurately. And then for me, Hans Rosling's site gapminder was one of the things that got me very excited about this work back in 2006. Second book, Poor Economics by Esther Duflo and Abhijit Banerjee. They're two of the founding members of this randomized control trial movement in development economics. And this book gives an overview of their work and the ideas behind this work and this work. That's no, not just them, but people like Michael Kramer, Rachel Glenister, Dean Carlin, Ted Miguel. It really was part of the animating values of what has led to givewell in our work. And then finally, a book called behind the Beautiful Forevers by Catherine Boo. She spent years in Annawadi. It's an informal urban settlement sometimes known as a slum near the Mumbai airport. And it just paints a very vivid picture of what life is like in poverty.

B (67:55)

I think behind the Beautiful Forevers might be. It's definitely in my top five pieces of nonfiction ever. If people have not read that, they really should. Ellie Hassenfeld, thank you very much.

C (68:04)

Thank you.

B (68:19)

This episode of the ezra clanche is produced by jack mccordick. Fact checking by michelle harris with kate sinclair. Our senior audio engineer is jeff geld, with additional mixing by isaac jones. Our executive producer is claire gordon. The show's production team also includes annie galvin, marie cassion, roland hu, marina king, kristin lin, emma kelbeck and jan cobel. Original music by aman sahota and pat mccusker. Audience strategy by christina semiluski and shannon busta. The director of new york times pinion audio is annie rose strasser.

A (68:57)

Foreign.

D (69:02)

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