# Revisiting Guide Dogs and Blindness Prevention

In early effective altruism it [was common](https://www.jefftk.com/p/charity-variance-vision) [for people](https://80000hours.org/2011/11/it-is-effectiveness-not-overhead-that-matters/) [to give](https://80000hours.org/2012/09/is-there-such-thing-as-a-bad-charity/) [the example](https://www.ted.com/talks/peter_singer_the_why_and_how_of_effective_altruism) of deciding between donating to fund the training of guide dogs in wealthy countries or to reduce blindness in very poor countries. For example, here's what Giving What We Can [used to say](https://web.archive.org/web/20120327022808/http://www.givingwhatwecan.org/about-us/faq.php):

> For example, suppose we want to help those who are blind. We can help blind people in a developed country like the United States by paying to train a guide dog. This is more expensive than most people realize and costs around $50,000 to train a dog and teach its recipient how to make best use of it. In contrast, there are millions of people in developing countries who remain blind for lack of a cheap and safe eye operation. For the same amount of money as training a single guide dog, we could completely cure enough people of Trachoma-induced blindness to prevent a total of 2,600 years of blindness.

That writing went up sometime in [2011 or earlier](https://web.archive.org/web/20110819150138/http://www.givingwhatwecan.org/resources/references.php), and I think it's where this comparison entered [proto-EA](https://www.jefftk.com/p/when-did-ea-start), but if you know of earlier usage I'd be curious!

Over time, however, EAs have mostly moved away from this comparison. Instead global poverty EAs are [more likely to give](https://forum.effectivealtruism.org/posts/SMRHnGXirRNpvB8LJ/fact-checking-comparison-between-trachoma-surgeries-and?commentId=piMvaApCD8ekNBTR5) comparisons like:

*   A typical US income vs how much the world's poorest people live on.
    
*   How much the US is willing to pay to save the life of one of its citizens vs how much it costs to save a life where that's cheapest.
    
*   What the UK National Health Service is willing to spend per Quality-Adjusted Life Year (QALY) vs what it costs to provide a similar benefit to someone in a very poor region.
    

What these have in common is that there are charities working in these areas with strong evidence to support their cost-effectiveness. With GiveDirectly you can send money to people who are living on [under $1/day](https://www.givewell.org/charities/give-directly/November-2020-version), or with the Against Malaria Foundation you can provide bednets that [cut malaria deaths in ~half](https://www.givewell.org/charities/amf), at around $5k per life saved (~$100/QALY).

On the other hand, while GiveWell and other EA groups [have looked into](https://blog.givewell.org/2017/05/11/update-on-our-views-on-cataract-surgery/) [vision surgery](https://www.givewell.org/charities/IDinsight/partnership-with-idinsight/cataract-surgery-project), there are no high quality evaluations. \[1\] What do you do if you say something like "while a guide dog costs $X you can restore someone's sight for $Y << $X" and someone asks where they can donate to make that happen? Much better to give actionable comparisons.

  
\[1\] You might think of Hellen Keller International, another [GiveWell recommendation](https://www.givewell.org/charities/helen-keller-international), but looking at their [cost-effectiveness model](https://www.givewell.org/how-we-work/our-criteria/cost-effectiveness/cost-effectiveness-models), GiveWell is primarily rating it highly for mortality reduction. Looking at their [vision benefits writeup](https://docs.google.com/document/d/1wuZC00Llw3SpvNFGCadCHNFBSqwo4wU3Elu80n6Cl6k/edit?usp=sharing) and [BOTEC](https://docs.google.com/spreadsheets/d/1tIK6aJEzQReTq8PveyKk3o-JLwwWXquFr67_WrARXDc/edit), linked from the cost-effectiveness model, most of the supplementation is going to people who wouldn't otherwise become blind: yes, it's two pills for ~$2.70, but if I'm interpreting GiveWell's rough estimate correctly only 1:1,100 people who get the pill would otherwise become blind, and the supplementation isn't 100% effective, so it ends up being about $3k to prevent a case of blindness this way. ([more](https://forum.effectivealtruism.org/posts/oXgbkSwTSeJajvpjo/how-ea-is-portrayed-in-going-infinite?commentId=Bfq5tWzrxcZjNpsMq))