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Treating children for worms yields long-term benefits, says new study (news.berkeley.edu)
232 points by elsewhen on Aug 3, 2020 | hide | past | favorite | 168 comments



Parasite load seems to affect negatively cognitive abilities.

Decreased Parasite Load and Improved Cognitive Outcomes Caused by Deworming and Consumption of Multi-Micronutrient Fortified Biscuits in Rural Vietnamese Schoolchildren https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144834/

Parasite load explains 67% of the worldwide variation in intelligence: "Parasite prevalence and the worldwide distribution of cognitive ability" https://royalsocietypublishing.org/doi/abs/10.1098/rspb.2010...


From the scond paper:

"Templer & Arikawa (2006) also found that average IQ correlated significantly with average skin darkness (r = −0.92). The authors offered little explanation of why this trend exists, except that they believed skin colour was related to exposure to certain climates over evolutionary time."

I doubt that scientists today would dare to make such statements, for the fear of being "cancelled".


Half of the "fear of a standardized test planet" is that a certain fraction of elite children are as dumb as posts.

SAT prep courses help a little but won't bring them into the normal range. Their parents are big donors and make the case that they're doing a favor to the smart kids by hooking them up with the economically connected.

Harvard puts up Dan Bell's "Whiz Kids" to the task and discovers that standardized tests discriminate against minorities as much or more than they discriminate against their donors, so Stephen Jay Gould got grants to write books for ten years about how bad IQ tests are.


It is very hard to create unbiased IQ tests. There will always be cultural differences and differences in opportunity.

IQ tests should be taken with a grain of salt.

It also depends on what you think is important. Smart people are not always wise people.


I certainly agree with that. Nonetheless, being myself one of the "darker" skinned ethnicities, I see no offence in the statement that as a whole, darker nations seem to have lower IQ, there might be thousands of reasons for that; for some nations, colonial opressions, for some it might inherent biological reasons.


The problem with saying it, is even if you mean IQ is academically the average result on a particular test design, people understand it in common English to mean something more like 'value as a member of society'.


I dunno. There are "Raven's Progressive Matrices" which have no language component, but they have been cracked for a long time.

If you look on the net you will hear that some celebrity (say Alyssa Milano) took an IQ test and got a crazy high score.

There are just 60 of them so it is not hard to practice and I am sure there is some racket of psychologists in Hollywood who coach people to take the test and then send them to the psych across the street to get them tested.


Science should not be concerned with the interpretation of its discoveries.


Interpretation is an inseparable part of science. Take the issue of race for example. People since the 30s have repeatedly pointed out that there's no consistent biological basis for race. The concept is just flat out not biologically rooted. Yet scientists kept using it because it was convenient and they came from a worldview where race was very much a reality. Thus studies were (and continue to be) done on the basis of biological racial categories.


Not sure about races, but one can certainly tell the difference between ethnicities; I can tell apart a Russian and an Armenian for example, with more than 75% success rate. Therefore there certainly is difference between people in different geographic areas. If people have differences in their outer appearances, there might be differences (not very large, obviously) in the way their neural systems work;denying that, IMO is a very ideological position.


It's the consensus of the vast majority of relevant professionals that "humans cannot be divided into biologically distinct categories", i.e. races. That quote comes from the ASHG [1], but another relevant field is anthropology where again, the largest professional organization (the AAAS) says the same thing [2]. The AAPA concurs [3]. If you think these associations might be a little biased, someone published a national survey of anthropologists a couple years ago confirming these views [4].

Some technical caveats: So yes, on some level you can approximately group sets of people into things roughly matching modern broad racial categories on the basis of genetics. This isn't because of anything real (i.e. there's nothing all members of a group share that doesn't exist "outside" them), but simply because you can broadly categorize any large set of things, regardless of whether those categories are actualized. Race as a social construct (e.g. identifying someone as "black" or "caucasian") is absolutely, undeniably a thing. It's simply not reflecting an underlying biological reality. There are also people in the community who argue that even if racial categories aren't biologically actualized, they're still useful (or that the definition I gave previously doesn't apply), but that's a much more complicated matter for which entire libraries' worth of debate exist.

[1] https://www.cell.com/ajhg/fulltext/S0002-9297(18)30363-X [2] https://www.americananthro.org/ConnectWithAAA/Content.aspx?I... [3] https://physanth.org/about/position-statements/aapa-statemen... [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299519/


Differences in opportunity, in the formative years, will actually make a person dumber, and that is likely permanent. The IQ test doesn't cause such an effect; it just reveals it.

Since tests are necessarily biased, maybe the way forward is to tune the bias to the test subjects. Then, out the window goes "standardized", at least for that interpretation of "standardized" which means everyone takes exactly the same test. (And which is never literally true, because year over year, you cannot use exactly the same test questions.)

I think tests tuned to cultural differences would never fly in America because the idea is contrary to political correctness. Everyone is equal by definition, why would they need a special test. Cultural differences, what? We are all Americans; gear the test to American culture!

And then, what if it turns out that members of a certain minority group do better on IQ tests designed for them, yet is is found that white, upper-middle class kids also do better if given those tests? Oh the horror: members of minority X are actually dumb, and the test they are given isn't actually tuned to them culturally, but nothing more than dumbed down. The conservatives would have field day.


Correlation is not causation. Beyond just the fear of "cancellation", which certainly exists, any good scientist would want to find an airtight causal mechanism before publishing a socially and morally disturbing statistic that would hark back to unscientific eugenics movements from before the discovery of DNA.

And, call me a canceller myself, but somehow I doubt any such causal mechanism would actually be intrinsic to the human populations themselves. Such a strongly disadvantageous mutation as decreased cognitive ability would get weeded out by natural selection: you don't spend 20% of the body's calorie budget on an organ that isn't doing its job.


It saddens me greatly to think that scientists could not share data that they can't fully explain if it has any possible social injustice angle to it.

How many scientific breakthroughs across history took more than one person to figure them out and where subsequent thinkers built atop foundations and tidbits of those who went before them? (Almost all of them, IMO.)

Imagine if in the early days of AIDS, we couldn't talk about the role HIV might play in AIDS for fear that it would cast a negative light on communities affected by AIDS.

Imagine if we couldn't talk about the effects of parental, community, and early educational involvement in children's outcomes in life until we had perfect proof. Imagine we couldn't talk about the effects of inter-generational poverty until we had perfect proof.

"Until we have airtight causal links, we need to keep this quiet" is certainly not the way to make the fastest nor most effective scientific progress.


On the other hand in the day and age we live in we could certainly approach such an issue. The concept of 4chan is that everyone is anonymous therefore nobody ever gets special treatment based on their identity only the contents on that which they share. If you create a publishing platform for scientists that allows them to publish anonymously it will be the contents of the papers that will be evaluated strictly and no reputation damage is involved, maybe even let them digitally sign it in case they ever wish to show that they themselves wrote the paper if it became significant enough.


Anonymity is a weak (but better than nothing) solution to this problem.

The stronger solution IMO is "publish what you observed, what you conclude from it, what you think good next steps are, and provide your signature and contact information" and let people openly collaborate and build on each other's work.

Imagine if Linus Torvalds published the first version of Linux anonymously. Would we be in the same spot now as a technology society if collaboration were limited to anonymous, arms-length interactions on public channels?


This makes me think of TrueCrypt, and all sorts of other pieces of software released only under online aliases.


"Such a strongly disadvantageous mutation as decreased cognitive ability would get weeded out by natural selection".

Yeah, right, then the only living large animals would be humans.


Brain and body go together. Other animals have adaptations to their ecological niches. We have our adaptations to ours. Powerful brains are one of our adaptations to our niche, and an organism that has to live in our niche without our adaptations isn't going to do very well.


As soon as the cognitive capacity is sufficient for survival in some particular environment, there won't be any pressure for improvement of that, because it might in fact lead to maladaptive consequences, such as rise in depression and psychiatric disorders. Instead, there will be pressure for some physical fitness, improved immunity etc.


That's a misconception. The role of the brain our biology is not to direct somatomotor behavior, but visceromotor behavior. That is, the brain regulates the inside of the body. Increased cognitive capacity is largely directed to improving metabolic efficiency, immunity, and other basic bodily functions -- manipulating the external world is a bonus.


The higher levels of human intelligence are more useful for navigating the social than the physical environment, and obviously the social environment can vary drastically depending on where you live.


I would hope they wouldn't dare to do so as the scientific community aren't particularly accepting of papers espousing the correlation of airplane usage to autism diagnoses either. If the public is now more aware of garbage science used to promote political ideology, it means we have a more educated and scientifically engaged population than before, and who are capable of helping stunt wasteful research.


"garbage science used to promote political ideology".

It goes both way. Anyone who suppresses politically incovenient, yet relevant information about minorities, actually doing disservice to them; it is a worst kind of racism and "white privilege", to set arbitrary boundaries what is true and what is not wrt to some group of people.


>Anyone who suppresses politically incovenient, yet relevant information about minorities, actually doing disservice to them; it is a worst kind of racism and "white privilege", to set arbitrary boundaries what is true and what is not wrt to some group of people.

People bringing up racial crime statistics as a valuable scientific avenue of investigation has contributed to hurting and discrediting me and my community throughout my life and historically. Even if the correlation exists, can we meaningfully act on it other than as a mechanism for discrediting programs that holistically address the issue in a system where guilt by association or ethnicity means nothing?

Denouncing statements about correlations between autism and airplanes haven't done people with autism a disservice in this sense either; it's driven research towards holistic and sensible studies and interpretations.

I hope one day you do not dismiss the issues that minorities like myself have encountered for generations as "white privilege" in the future.


IQ tests were invented to justify a belief that white people were superior - literally by eugenicists.

How is it "white privilege" to say we should reject a test design that was designed to support white supremacy?


I took it several times, and have not seen anything racist in them, being non-white myself.Just geometric and word puzzles. In any case, brushing off a test, just because you do not like the results and its origins, without actually researching why the scores are lower, is actually disrespectful to those who indeed scored lower.


Did you know it's illegal in the state of California to administer an IQ test to a black child? [1] This is a fantastic episode from radiolab about the history of IQ tests in the US and goes into how a test can be racist even without seeming so.

[1] https://www.wnycstudios.org/podcasts/radiolab/articles/g-mis...


No I did not. Nor I believe that properly constructed test, with all explicit cultural references removed can be racist. Asians, straight from Korea or China, with some basic knowledge of English are able to reach normal or above normal results on IQ tests.


IQ tests were invented to identify children with learning disabilities. People have been (mis)using them in various ways ever since.

Some would indeed try to use IQ tests to validate their prejudices and proclaim that "science says dark-skinned people are not as smart as asians". Um, no. Science says we should stay humble and ask questions.


Rockets were designed to kill people, now they take us to space. A test is just a tool. How you use the tool is what matters most.

In the context of medical research specifically, different groups experience different health issues at different rates. It's important to understand these differences so that we can help the groups in question, or to gain further understanding into what causes the issue as we search for a universal improvement.


In that first paper, it does not seem to indicate that there was a difference in the level of cognitive improvement in the albendazole + fortified biscuits group versus the placebo + fortified biscuits group.


I mean anything that is as closely associated with poor socioeconomic development as parasite load would explain 67% of worldwide variation in intelligence...


How about inside United States?

Parasite prevalence and the distribution of intelligence among the states of the USA https://www.sciencedirect.com/science/article/abs/pii/S01602...

> we found that the correlation between average state IQ and infectious disease stress was − 0.67 (p < 0.0001) across the 50 states. Furthermore, when controlling the effects of wealth and educational variation among states, infectious disease stress was the best predictor of average state IQ.


Yes, even in the US, even controlling for wealth and educational variation, I'd expect a high correlation to show up.


I have an adopted child who is not exactly the brightest. Like 91 iq I think from state testing. Was a sweet child.

We always assumed it was from bio mother drug use. We have since met various bio grandparents, etc.

Apparently reduced IQ just runs in the family.


The variation in intelligence may explain parasite load.


Ok, but how? Taking medicine doesn't require intelligence so the only deciding factor is whether you get treatment or not. Does your doctor give you an IQ test and deny treatment if your score is too low?


Being smart helps you get a good job and be rich.

With those come good health insurance, being able to afford co-pays, being able to take time off work to go to the doctor, being able to comply with complex instructions like changing your diet, being able to research your diagnosis even if it's in lots of long latin words, being able to tell good advice from bad when researching online, being able to take time off for treatment or recovery, knowing the magic incantations to get yourself taken seriously, knowing when it's a good idea to get a second opinion and how to go about that, less stress caused by financial worries or job insecurity, etc etc


Two hypothesis: higher IQ people learn hygiene sooner and manage to avoid getting infected. Higher IQ parents provide both better hygiene and high IQ genes and nurture.


I have one more - smart people taste bad.


"More intelligent environment" may prevent one from even contacting anything that can get one worms.

For example, most first world urban kids do not eat berries directly from the bushes. These berries they eat are controlled for worms among other things.


That seems unlikely. Parasites are pretty good at infecting their hosts, and for a long time, there wasn't really a good way of getting rid of them once they were inside you.


Your point proves what I said, actually.

If for long time there were no means to get rid of worms, how come the difference in intelligence that allowed to invent a cure for worms to be?

I see "worm free living" as a consequence of higher intelligence than vice versa.


At an earlier stage, this work attracted a fair bit of methodological controversy, e.g.

https://www.vox.com/2015/7/24/9031909/worm-wars-explained

https://statmodeling.stat.columbia.edu/2015/08/18/macartan-h...


Presumably the 2019 Nobel Prize committee had seen that criticism?

Frankly I'm appalled that intestinal worms still plague so many human beings. I happily spend about $50 a year to worm a herd of horses, a herd of cattle, and a dog. Surely as a species we can find the resources to buy these children some pills, at least until we cowboy up and eradicate these worms from our planet entirely.


I'm sure they did! Kremer is a really important figure in the history of economics, and the magnitude of the effects of his work on deworming are debatable. These things are perfectly compatible. I think the articles I posted might help readers form their own conclusions about the work, rather than deferring on account of Kremer's prestige and authority; per Feynman, "Science is the belief in the ignorance of experts." [0]

Regarding the fact that it's appalling that so many people still deal with this problem -- I agree. As Gelman says (second link I posted in GP), the reason that magnitude of effects is important is opportunity costs:

> The 800-pound gorilla in the room is opportunity cost, or cost-benefit analysis. As you say, who could be against de-worming kids? I’m reminded of Jeff Sachs’s argument that all of these sorts of interventions are worth doing, and that rather than trying so hard to rank the cost-effectiveness of different health and economic interventions, the rich countries should just kick in that 1% of GDP or whatever and do all of them. I’m not saying Sachs is necessarily right on this, I’m just saying that most of the discussion seems to be on traditional statistical grounds (Is there an effect? Is it statistically significant? Has it been proven beyond a reasonable doubt?) and the cost-benefit or opportunity cost calculations are implicit.

[0] https://news.ycombinator.com/item?id=23816584


> Surely as a species we can find the resources to buy these children some pills

We did: it's called universal healthcare - and many of our species' nation-states already use this system and have been seeing the overall positive results for about a century now - but some societies, for a variety of reasons, do not.


One supposes Kenya and other, poorer nations in Africa will appreciate this advice, and then they'll snap their fingers and all will be well...


I think the parent was talking about the USA.


It's actually relatively straightforward to get Medicaid coverage for children in the US. There is a specific program to cover them (and pregnant women).

https://www.medicaid.gov/chip/index.html

"The Children’s Health Insurance Program (CHIP) is a joint federal and state program that provides health coverage to uninsured children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage."


I appreciate that for many Americans this feels like it's enough, or at least almost enough, but it's nowhere close.

Dozens (every US state and territory is handled separately) of separate systems in which you can fill out a bunch of paperwork to apply to have insurance for children is nowhere close to the zero friction "free at the point of use" goal of universal healthcare.

Some countries with universal healthcare don't do a great job of achieving zero friction, but they're all way ahead of a disjointed paperwork process that only results in getting insurance that ought to have been free for everyone from the outset.

And, one of the most obvious problems is: CHIP only covers children you can provide an SSN for. So maybe Steve, aged 4 is covered because you had him in San Antonio but his older sister Esther was born in Mexico and travelled over the border with you. She can't get CHIP because she doesn't have an SSN and powerful people want to make sure it stays that way.


Esther’s situation is problematic, but extending socialized benefits to non-citizens is a nonstarter and isn’t the case in any of the other Western societies that supporters of single-payer universal healthcare would like to model the US system on.

I am not going to enumerate all the reasons why it’s a nonstarter, but at least one is that it massively increases the cost of any such social program to a point it becomes both practically and politically untenable.

I’ve visited and used healthcare services in many of those other Western countries as a foreigner, and every single time I was required to file paperwork and pay a deposit in cash (or rarely by card) before receiving services. I would not have expected any differently, as I’m not a tax-paying citizen in those countries. On a mostly unrelated note, I write this while currently residing in San Antonio (as used in your example scenario).


Single-payer universal healthcare is, as far as I know, never based on citizenship, but rather on residency. More pragmatically, it's based on where you pay your taxes. Example: I'm covered in Japan where I live and work, although I'm not a Japanese citizen. And the other way around: I'm a French citizen, but I'm not entitled to any coverage in France since I don't live/work/pay taxes there.

So you probably meant non-residents and illegal immigrants. I'm not aware of non-residents (tourists, mostly) being covered anywhere. As for illegal immigrants, it depends: France has at least some free coverage, so has Spain and I'm sure some other countries. In France it's called the AME (Aide Médicale d'État). Like any system it's being gamed and abused, hence why it's being reformed and should not be copied as-is. But at 1 billion EUR/year the benefits certainly outweigh the cost.


If you are a member of one of (some of) the national healthcare systems in Europe you are also covered in many other European countries (not just the EU) as if you were part of their system, even when you're just a tourist.

(The back of your card in Germany has the international information.)


Spain has free healthcare for people who immigrated illegally. It’s notable in being the only OECD country to extend non-emergency universal healthcare to such people.


Interesting, I was unaware of that. I spent 53 days in Spain in 2016 (which was awesome by the way) that started off with me going directly to the hospital on arrival because a prior case of bronchitis had escalated into severe pneumonia (more severe than I realized). I was hospitalized for just shy of a week and had to pay a 3000 EUR deposit up front to be admitted and receive treatment. I don’t remember the exact amount of my total bill, but I got the bulk of my deposit back in the end.

Maybe they’ve changed the rules since then, but at least my personal experience was the flow was to establish whether I was a Spanish or EU citizen, as I was not I was obligated to pay a sizeable deposit before even being seen for triage. There was certainly no indication any other foreigner would have been treated differently.


There's usually a distinction drawn between residents and mere visitors. That is, between people who ordinarily live in the country and those who are just here temporarily.

That distinction can be in addition to, but will more often wholly replace a distinction between citizens and non-citizens.

You can make a purely economic rationale for this if you want: Residents pay tax, and non-residents don't (in the US some non-residents still pay tax but that's not usual for any other country). If your universal healthcare is largely paid for as an "insurance" scheme, such residents are probably obliged to join the scheme, so it makes sense they'd also get the benefits.


I don't know how it works in Spain, but in France where illegal immigrants can also get some form of coverage, the process is definitely not done in hospitals: you have to apply for it, and then you are issued a specific insurance card. As far as I know you can't get it if you've been in France for less than three months: it's for immigrants, not tourists.


I was reading another website about Spain. From what I gather (not sure the accuracy), but if you're in Spain illegally, you can convert to legal status if you show continued residence, employment, no trouble with the law. Maybe it's that type that gets non-emergency healthcare?

I assume if you're in Spain, with no proof of residence you'll be asked to pay?


> I was hospitalized for just shy of a week and had to pay a 3000 EUR deposit up front to be admitted and receive treatment.

Do you recall which hospital was that? Sounds like you were sent to a private hospital.


Yes, this was a private hospital it seems (I just checked). I went where I was instructed by my travel safety program / travel insurance, which ended up reimbursing most of my costs involved anyway. It was selected because it was the only hospital in the area with a foreigner's department.

My experience may not have been representative then, as it could have gone differently in a public hospital, but I am unsure. It seemed based on what I was told at the time that I could only seek treatment at hospitals that accept foreigners except in the case of an emergency severe enough to require an ambulance (I called an Uber to take me). I think any hospital would have ensured I was stable but not admitted me for multiple days of care other than one with a foreigner's department. But, it may be that a public hospital would have treated me without any concerns about my citizenship or residency.


I'm glad to hear you've recovered most of the money. Yes, I also think you would've been treated and hospitalised anyway. I don't think (but I may be wrong) that hospitals in Spain have a "foreigner's deparment". That may go against some EU laws.


Nearly every country I visited in Europe had defined foreigner's departments in the hospitals (but not in all hospitals). The entire purpose of those departments was to work with people who did not reside there and likely did not speak the language. For instance, in the case of the foreigners department in Spain, they had translators on staff during the day for communicating with specialists or the doctors as well as English speaking nurses during the day, which was not guaranteed in other parts of the hospital.

In some countries I visited the foreigner's department was more involved in handling currency exchange and payment details, but less concerned with care or providing services (Czech Republic was this way at FN Motol for instance: https://www.fnmotol.cz/en/samoplatci/).

If you are a resident citizen of an EU country, you can often seek treatment in other EU countries under the same social medicine scheme they have and your citizenship/residency paperwork covers you. I'm not sure if Country A bills Country B or how that works exactly, but it was pretty clear that the foreigner's department concept was for non-EU citizens who were private pay and ineligible for social medicine.


I assume you mean “non legal residents” as typically universal healthcare covers legal residents. Do you have evidence that it makes financial sense to leave unauthorized residents (likely) untreated? One might imagine they’re disproportionately young and healthy and not suffering from terminal cancer if they came here to work in fields. Going to the ER uninsured is very expensive for society.


I was legally in every country I’ve been in, including several where I became temporarily resident. In every case as a non-citizen I was obligated to pay and was not covered under the social medicine scheme. I know the rules on non-citizen permanent residents are different in most countries however.

I would believe it’s more financially sensible in the larger scheme of things to cover the cost of healthcare for illegal residents, but I haven’t seen any evidence that demonstrates that, and even with such evidence its still politically untenable.

My point is that such a scheme is so politically untenable that even existing Western universal healthcare countries do not have such a scheme. It’s far more radical than what is typically advocated in the US.


>extending socialized benefits to non-citizens is a nonstarter and isn’t the case in any of the other Western societies that supporters of single-payer universal healthcare

As others have pointed out, I don't think any of these societies limit benefits to citizens. In the UK, emergency care is free for everyone, and there are few checks on other forms of care in practice. I seriously doubt that someone who was in the country illegally would have any problem registering their child with a GP. Doctors aren't trained to perform immigration checks, and are not usually interested in doing so.


Slighlty pedantic correction... Citizenship is irrelevant in any national health system I've encountered. The person must be enrolled in the country's national health insurance scheme. A prerequisite of that is of course being a legal resident.


Fair point that getting CHIP may not be frictionless and it does vary state by state.

But someone without an SSN? In Canada, you don't get healthcare coverage without proof of legal residency. And that's what most (not all) western countries do. Why would we hold the US up to a higher standard?


From the start of this year, Esther has free healthcare.

https://en.wikipedia.org/wiki/List_of_countries_with_univers...

Most likely, Esther can also "provide an SSN". Identity theft is normal.


> families with incomes too high to qualify for Medicaid, but too low to afford private coverage.

I guess that it is widespread knowledge that you can be in such a situation, but to read it spelled out on medicaid.gov is really something...

At least they're nice enough to let you go without medical assistance, but save your children.


Not specifically; the US is not the only country in the world without UH - and UH is not the same thing as single-payer nor free-at-the-point-of-need. Emphasis on “variety of reasons” - which includes the US, though in their case the tragedy is that those “variety of reasons” are the most asinine reasons compared to, say, countries that simply haven’t reached the necessary level of civil stability and infrastructure development to support UH.


How does this demonstrate the universal healthcare doesn't work?


Please see [0]. Many people do find the money to buy those children pills. Pretty sure the study is tracking the consequences of that intervention. You could give a little as well to help make it even more broadly effective. So could the readers of this comment. In fact, please consider doing so.

[0] https://www.givewell.org/charities/sci-foundation


Perhaps of interest: GiveWell touched on the ‘Worm Wars’ here: https://blog.givewell.org/2016/12/06/why-i-mostly-believe-in...


Does this new paper change the conclusions or decisions made by give well?


How do you spend so little? My dog's monthly heartworm medicine alone costs $5/dose.


Dog heartworm pills are a MASSIVE rip-off. The active ingredient - ivermectin - can be purchased without prescription at any farm supply shop in sufficient quantity to last several dogs' lifetimes with plenty to spare. The maintenance dosage is miniscule.

Pet prescription meds are only slightly less of a scam than human prescription meds.


I’m a retired DVM. What you say is true, but I just want to caution anyone reading this that ivermectin is deadly for collies and many herding breeds. Rule of thumb is “white feet, do not treat.”


Thanks for the tip, I wasn't aware. Is this something I should flag to my vet? I have a herding breed dog but afaik the vet never did an ACB1 test. My dog has been taking the medicine for a long time though.


Good cautionary note, thanks. Yes, please, anyone looking to go this route should do their research first - I'm not kidding about the tiny doses required, they sell very dilute solutions for use in very large animals; a little dog potentially needs less than a drop!


Please don’t be offended, but I find this absolutely fascinating. Abstractly I know veterinary science is at least as complex as anything involving humans. But somehow I tend to dismiss just how much variability a veterinarian is expected to be able to account for.


please don't be offended but if you find yourself saying "please, don't be offended", LPT, you can generally reword what you are about to say so it's simply a compliment instead of containing the negative messsage.

You are impressed by how much variation a veterinarian must account for in a single species, and they handle multiple species.


The “offended” would be “sometimes, I dismiss” – there's no way to re-word that to be less offensive (even though it isn't particularly offensive, I wouldn't think) without omitting it entirely.


Maybe he was about to write something else! Or word the same thing differently...


I would imagine veterinary medicine is more complex than humans. Vets operate not just on different species, but on different different branches of the animal kingdom tree (reptiles, mammals, birds). But I guess maybe vets also specialize?


if you cannot find a reasonable local supplier then check out pet supplies [0] which ship to the US. Their prices on heartgard are much cheaper than any vet.

[0]http://pet-i-supply.com/front.htm


Thanks for the suggestion. This is about $5/dose too - which is the Costco price for Heartgard.


I image you also give your animals nutrient supplements.

If, and that's a big if, as a species we can find the resources to buy these children some cheap pills then it's not necessarily worming tablets.

But it's complex, people love the idea of de-worming kids. It sells well, and once you open up aid to communities then you can do a lot of other stuff. It's not the 50 cent pills it's the $1000s finding them and training someone to get to them, so tomato tomato who pays for that.


I agree, international aid is problematic. Much better would be improving "gene drive" tech to the point that we wipe out helminths completely. That seems a few decades away, and in the meantime maybe lives can be improved via other methods.


Not that I am in favor of parasitic worms or anything but I would be careful to assume that erraticating helminths or any species for that matter would only be beneficial. I don't know where they fall in the food chain. Maybe they are essential for some other species to thrive that we depend on.


...any species...

There are at least 300 species from multiple phyla that feed on humans. We might also consider those species that feed on our livestock, although such an action would have less ethical urgency.

It isn't impossible that other species might eat them, but given their baroque life cycles it seems quite unlikely that any other species depends on them for survival. But sure, if people decide to start with tests on isolated tropical islands, I won't argue.


Compared with the thousands of species that go extinct every year as a normal part of evolution, much less the tens or hundreds of thousands of species currently being wiped out by human activity, surely wiping out small group of species is not that big a price to pay for ridding humanity of a truly horrible affliction?


We might even one day deem essential some parasitic worm when find it's the only mitigation against another animal regarded as a pest. Actually there are many cases in the natural environment where parasites like this are the vector limiting overpopulation. So eradicating the parasite could lead to resources depletion and extinction of the host species, or make disappear other species they feed on, etc.


I genuinely don't know the answer: is there another word for this concept, where a parasite benefits the species as a whole, but not the individual? That would seem to be a form of symbiosis, not parasitism.

>> there are many cases in the natural environment where parasites like this are the vector limiting overpopulation

Can you provide a couple of examples? I'd be interested in looking into this further to see how that works. Obviously, predators are a different category, and fill an important niche in the ecosystem, but I was unaware that species classically considered "parasites" performed a similarly important role. For example, ticks on moose seem very different from wolves hunting them.


Here is the entry point that I read recently:

https://phys.org/news/2020-08-parasites-important.html

This is the link above which made me overconfident to easily find on the web many examples of such natural regulations. But I could not find a lot... what is more easy to find is mathematical studies showing the effect on populations.

Here is one study considering the potential implications of parasites eradication:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222570/

For some particular examples, the red grouse is a bird whose population follows periodic cycles, and the cause is a parasite. Removal of the parasite smoothed out the population variations. You can imagine other species (plants or animals) whose own population cycles would be adapted to the old cycles, and these species would be impacted by the smoothing out of red grouses.

Link: https://www.jstor.org/stable/4694?seq=1

More generally, when a parasitic regulation disappears, the next in line would be resources regulation, that is the species starves when the food is scarce, and thus the population plummets. That could lead to a very different population dynamics (as the red grouse example shows, but there can be situations where the graph is sharpened instead of dampened like here), and because of that one or several species can disappear.


Hmmm, that's really interesting! Thanks for digging into it a little more and posting these resources :)


Deworming may also bring long term detriment [1].

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1618732/

Deworming increases response of immune system [2] and can lead to higher inflammation, more allergies and autoimmune diseases.

[2] https://www.pnas.org/content/113/44/12526.full

Right now I think we have to eat better.


When I was a kid, I remember being dewormed about 3 times and I still remember the medicine, Vermox. The first time I freaked out because I saw the long worms come out And then some in my stool, but after that I was used to it. Now, as an adult I have crazy seasonal allergies, hopefully that wasn’t the cause.


Well the issue raised here in the OP is mostly third world issues and it can be very difficult both in distance, language, as well as local government issues, in assisting people in need.


If this had only been known and treatable 200 years ago, who knows how U.S. history could have been changed.

https://www.pbs.org/wgbh/nova/article/how-a-worm-gave-the-so...


>While the South eventually rid itself of hookworms

The article is incorrect. Hookworm was never eradicated in the US. It was just confined to poor, black folks. [0]

[0]https://www.theguardian.com/us-news/2017/sep/05/hookworm-low...


anonAndOn says:>"The article is incorrect. Hookworm was never eradicated in the US. It was just confined to poor, black folks...

That is incorrect. Worms are endemic to the USA. See the CDC's posting "Parasites - Hookworm" at https://www.cdc.gov/parasites/hookworm/index.html

As a child I was treated regularly for worms, including but not limited to hookworms. Worms infest whites as well as blacks, Hispanics, and everyone else. Both rich and poor get worms. As the CDC posting states: "Hookworm infection is mainly acquired by walking barefoot on contaminated soil. One kind of hookworm can also be transmitted through the ingestion of larvae." And what kind of child doesn't walk barefoot in the mud or eat dirt?

The answer possibly is sickly children! Some hypothesize that exposure to worms may be necessary for a child to develop a proper immune response:

"Are Worms Key to Health?"

https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-hea...


I think it's worth mentioning that almost any public health, education, welfare program for children gives excellent returns on investment, compared to trying to apply that same money to people later in life (unemployment benefits, job retraining, etc).

The amount you can positively change a child's life for the better means that reasonable expenditures on known problems should almost be a no-brainer.

( I'll see if I can dig up an article link about the difference in outcomes per $ spent, versus age of recipient.)

Edit: here are multiple links within the article about the above: https://www.nytimes.com/2020/07/10/business/social-programs-...


This isn’t true in education. I can’t speak to other fields but early childhood interventions are not more effective than later ones in that field. We can’t be sure, statistically, but the opposite is more likely to be the case.

https://offsettingbehaviour.blogspot.com/2018/04/the-heckman...

https://www.nzae.org.nz/wp-content/uploads/2017/07/Rea_and_B...

IS THE HECKMAN CURVE CONSISTENT WITH THE EMPIRICAL EVIDENCE ON PROGRAM RETURNS BY AGE?

The Heckman Curve depicts the empirical evidence on rates of return to public investment in human capital as rapidly diminishing with age. Investment early in the life course is characterised as providing significantly higher rates of return compared to investments targeted at people who are older. In this paper we use the Washington State Institute for Public Policy estimates of program benefit cost ratios to assess whether the Heckman Curve is consistent with the latest evidence. The data does not support the claim that programs targeted earlier in the life course provide the largest returns, or that adult programs will have benefit cost ratios that are less than one. The paper concludes by discussing the various features of both human capital and interventions that might explain why the predictions of the Heckman Curve are not consistent with the evidence.


Isn’t it unfair to compare the overzealous first-world parents who try to push education more at preschool level to those parents targeted by GP, providing a “decent lower school education” to the poor?

I think education is also high ROI, but just like anything else in economics, you can only push it to a certain level after which one gets diminishing returns. For the purpose of the discussion here, we should spent more on education of younger kids.


In particular, we should spend more on education of young, low-income kids.

The idea that "throwing money at" education will yield no benefit is preposterous on the face of it, when so many schools lack such basics as sufficient textbooks, desks, and pencils. This is not even getting into the more modern research on better pedagogical techniques or the other ways in which a school can be a support system for at-risk children (like meals).


Education spending is up 180%, inflation adjusted since 1970, per student. Number of teachers is up ~50%. Student learning it’s basically flat.

https://www.cato.org/blog/there-really-national-teacher-shor...

Practically unlimited school budgets in Kansas City had ~0 impact on student test scores.

https://www.cato.org/publications/commentary/americas-most-c...

Throwing money at education works if money is the limiting factor. That is not the case in any large part of the US, or most of the developed world.


Look, obviously you've provided a couple of sources, and my own experience is anecdotal, but I don't think your statement that "That is not the case for any large part of the US" can be true.

I have a friend who went into Teach for America after college, and my cousin taught in NYC public schools for a bit after her undergrad. I've seen the look in my friend's eyes when I ask about his school's resources (we both went to a fairly good public school). I don't think he'll ever teach in a public school again.

I once bought my cousin classroom supplies for her birthday so she wouldn't have to. I mean, printing paper for assignments, pens, that sort of thing; the bare minimum that she was otherwise paying out of pocket. She cried after receiving them, as a human I don't typically associate with overbearing emotion.

These are Chicago and NYC public schools, respectively. I know it's a big country, but in both cases, we're talking thousands of kids in each of these districts. And it seems unlikely to assume that these two anecdotal experiences are somehow insane outliers among schools in the US, at least according to the experience of (almost) every other public school teacher I've talked to. Money matters, a lot, and if the total amount in schools somehow isn't a problem, then then the process of distributing it to where it's most needed sure as hell is.


They should do what my teachers did. Students are to bring specific types of paper according to teacher preference. That could mean lined paper, plain paper, 1mm graph paper, or even a lab book with a stitched binding. Students who do not come prepared for class get "F" grades.

It's the same for calculators, pencils, pens, gym shorts, closed-toe shoes, and lots of other things.

Teachers should never ever diminish their own pay by buying supplies. That pay is for personal use. Spending it at work creates an ugly competition, especially if the supplies improve teacher ratings. It's an arms race that consumes teacher pay.


You....know that in many of these places, the reasons the teachers have to bring in supplies is the exact same reason the students can't, right? This is basically the education version of "let them eat cake", no exaggeration.

Schools are funded out of local property taxes. Thus, poor areas—where the students and their families can't afford to be paying for specific school supplies that may vary "according to teacher preference"—are exactly the ones that don't have enough money for the school to be providing these things.

I agree that teachers should never be spending out of pocket to provide supplies for their classes. But the solution isn't to force students whose families are already having to choose between food and heat, or rent and a new pair of (second-hand, beat-up) shoes for their rapidly-growing adolescent, to be the ones paying out of pocket.

The solution is to fund all schools adequately so that the supplies necessary for reasonable teaching styles can be properly provided for by the school.


I had to eat cake, like it or not. Nobody gave me the option to show up without school supplies. That would be an "F" grade.

The schools are funded. Some of our best funded schools, the ones in DC for example, are particularly terrible. It's crazy enough to make one wonder if funding makes things worse!

Typical problem: The school buys Chromebooks or iPads for everybody. There is no consequence for property destruction. Kids make a sport of tossing them down stairwells. The school provides replacements at no cost to the student. Maybe the student is "supposed to" reimburse the school, just like the student is "supposed to" not purposely destroy property, but nobody has the will or ability to enforce anything.


Okay, I guess we'll jump through this step-by-step...

>> Nobody gave me the option to show up without school supplies. That would be an "F" grade.

That sucks, I'm sorry you had that experience. In a public school system, that's not the way I think it should be. If your family can't (or even won't, some caregivers are worse than others) afford to provide the basics of school supplies like notebooks and pens, then the community should pitch in the maybe $20/year per student in that situation to make that happen. Failing a minor because they can't obtain simple supplies, and who fundamentally don't have much control over that part (or most other) parts of their life, in a mandatory public school environment, is ridiculous and a failure on behalf of the community.

>> The schools are funded. Some of our best funded schools, the ones in DC for example, are particularly terrible. It's crazy enough to make one wonder if funding makes things worse!

You're going to need to provide multiple, peer-reviewed sources from reputable institutions demonstrating an inverse relationship between funding and performance in primary or secondary schools if you want a chance of getting me to believe this. Alternatively, if you really believe this, school matriculation and funding rates are public record. You could do your own study. Otherwise, the "it's enough to make one wonder" is a lazy rhetorical device commonly used in situations without enough empirical evidence to back up a claim, because it obscures the relevant core aspects of one's argument. I'm going to treat it as such.

>> Typical problem: The school buys Chromebooks or iPads for everybody

Typical where? I'm a millennial, and both iPads and Chromebooks were available for (relatively) cheap. The school didn't supply them, and I went to a well-funded public high school. We had computer labs, with additional access in the library for after-school assignments if we needed it. There wasn't a budget to buy individual devices for everyone--the only laptops available had to be loaned out like a library book for multimedia projects, and (almost, because sometimes stuff happens) came back intact.

Again, I have family and friends who have worked in public schools that have literally had to purchase their own supplies to print out student assignment sheets. Those schools aren't buying markers for whiteboards, let alone iPads and Chromebooks for each student. Maybe somewhere, somehow, this has happened. But your description of "typical problem" and the subsequent attempt to generalize that experience to most everywhere else in the country is so far removed from my own experience (and, to be honest, basically every other person I've known, from Massachusetts to California) that I find it unlikely to be actually true.

>> Maybe the student is "supposed to" reimburse the school [...] but nobody has the will or ability to enforce anything.

Even if there had been the money to buy those devices, if there was the widespread property damage on those devices, you can take it to the bank that there wouldn't have been replacements purchased. Board of Education and city council meetings are brutal, and the money (if it was still kept in the school budget at all) would almost certainly have been diverted to something else. Despite fairly good economic times before COVID-19, there's a lot of districts that still hadn't fully recovered from the Great Recession.


I truly believe there there is very little relationship between funding and performance. Any claim that funding fixes performance problems is destroyed by the DC public schools. (only need one counterexample)

It isn't totally crazy to think that funding could cause some performance problems. Money buys gadgets, and gadgets are distractions. All computing devices are repurposed into game machines.

If teachers "literally had to purchase their own supplies", where was the union? Was the school firing teachers who didn't forego a portion of their pay to get supplies?

Replacements get purchased because it won't be acceptable to have some students without the equipment, particularly if that involves any demographic factors that could cause a scandal. The risk of a civil rights lawsuit, or even just a major unflattering news story, is not going to be taken.


This is something people researched for a long time. Either way, you definitely need more than a single counterexample to wholesale claim that there is little relationship between funding and performance. I've linked a couple of studies below; one is a direct rebuttal to a previously done study claiming what you are.[1] Both sides are a little dated, so I've linked a 2016 Rutgers study which directly states in the conclusion that "The idea that 'money doesn't matter' is no longer defensible." [2] I'm sure you can look for additional primary sources in that paper's references.

I'd also like to know where the union was, although I suspect they were working on it or were fighting for other things. As I mentioned before, recovery to even pre-Recession levels has taken a long time even with educator union action, and even then has been uneven across the country[3]. If you're actually interested, I can reach out to those people in my life for more specifics, but it may be a few days before I hear back.

I disagree about the actions that a school administration would take. To me, it's more likely they'd just say "nope, that didn't work" and use them for in-class-only activities for a few years until the machines gave up, rather than spend money on replacements. Because it's a hypothetical, I don't see much of a way forward here, besides just agreeing to disagree.

[1] https://journals.sagepub.com/doi/abs/10.3102/003465430660033... (may need to use SciHub, etc. for access)

[2] https://files.eric.ed.gov/fulltext/ED596199.pdf

[3] https://www.cbpp.org/sites/default/files/atoms/files/3-6-19s...


Looking at study #2...

I immediately notice that the study is funded by the American Federation of Teachers. That makes it credible like a smoking study funded by tobacco companies. This should not be getting served by a .gov web site! I also see that the authors have highly biased credentials, and that none are related to economics or statistics.

It says "Moreover, using models that estimate the spending levels required to achieve common outcome goals, we find that the vast majority of states spend well under the levels that would be necessary for their higher-poverty districts to achieve national average test scores." which is technically true because the needed funding is beyond infinite. No amount of school funding can fix bad students. The study's comment that this "would likely be a multi-generational effort" can be seen as an admission that the funding won't actually work.

The claim that "there is now widespread agreement" that the schools need more money appears to be an argumentum ad populum.

I see a repeated claim that schools serving students with poverty need more money per student. If true, this proves that money is not the problem. Bad students are the problem.

The "progressivity" idea throughout the document is really disgusting. The idea is that problems unrelated to school funding could be fixed by throwing more money at the problem. There is the assumption that we should prefer spending money to educate people who don't want education over spending money to improve the education of people who actually want it. That is wasteful.

BTW, regarding the actions that a school district would take regarding destroyed property, it's not a hypothetical. I think it was last week that I had a teacher explaining it to me, but I can't find the comment right now. The kids were tossing them down stairwells for fun, but I don't remember the brand of hardware. I've also known teachers, not just from my own childhood but as an adult, and it fits. Schools are horribly mismanaged. Bad management shouldn't be rewarded with larger budgets.


I suppose that's fair--funding bias is surely a thing, and may be valid in this case, although I disagree about the actual authors "highly biased" credentials. If someone was interested in education, those are the kind of credentials one would have. It would be like dismissing a civil engineer's opinion about the stability of a bridge, simply because other civil engineers might make money off the repair.

>> "would likely be a multi-generational effort can be seen as an admission that the funding won't actually work.

I squinted pretty hard, and failed to see that admission. I do see an honest acknowledgement that lack of funding builds systemic issues in areas with poor educational systems, which takes time to resolve. "Give all the money overnight and that will fix everything immediately" is completely different from "some extra money to make sure kids actually have pens and paper".

Also, describing "widespread agreement" isn't a logical fallacy in this case, it's a necessary precursor to public policy. Can you imagine setting policy based on the reverse? "Very few experts agree about this topic, so lets do...." It's as important in education policy as it is for choosing the next large particle physics experiment. The article is largely a meta-analysis anyway--describing the current consensus is sort of the point.

>> I see a repeated claim that schools serving students with poverty need more money per student. If true, this proves that money is not the problem. Bad students are the problem.

This sentence and the following paragraph comes uncomfortably close to being a dog-whistle about poor people (and let's be honest, many of whom are people of color) being fundamentally bad students and not worth spending money on because they don't care about learning anyway. I think your logic about what proves what is shallow and flawed, and the sentiment harmful.

I can't prove or disprove your anecdote about kids destroying computers, or how widespread that is, but it's sort of a sidetrack here anyway. There's a spectrum between "every family must pay for private tutors and materials out of pocket for the their children's entire education" and "let's have public schools give free laptops to students to destroy with no consequences". My point is that having thousands of kids in the "go to school but can't be successful because they lack access to the basic materials" part of that spectrum is the wrong answer, and one that is easily fixed by increasing funding for that purpose.


The supposed "widespread agreement" doesn't include this less-biased source: https://www.cato.org/publications/commentary/do-school-spend...

I suppose the fallacy was not a claim of correctness due to actual popularity. It was a claim of correctness due to non-existent popularity. We don't all agree.

Lack of money for pens and paper seems to be fake. Remember that they are dirt cheap. Blowing the budget on computers, then claiming that you can't afford pens and paper, is a great tactic to fight for an unjustified funding increase. When I see millions of dollars being spent on football stadiums, my blood boils. Clearly, the budget is far too large. It is purposely misallocated. You could increase the budget enough to buy every student a ream of paper and a box of pens every day, and there still wouldn't be enough money for pens and paper.

I know a person who taught in a DC school. There is no teaching. Nobody is willing to cooperate. That's how it goes, and no amount of money will fix it.

Spending all our money on bad students will harm society. We need high achievers. We need the gifted. Money spent on the better students is more productive, leading to great engineers and scientists who will produce the civilization-enabling technology.

If you own a trailer home in a bad trailer park, and you also own a cute townhouse in a fashionable neighborhood, where should you spend the money to install a marble floor? Putting the marble floor in the trailer home is a wasted investment.


Calling an article from the Cato Institute, which was published in the Washington Examiner (you know, the same one that published op-eds claiming that most climate models are worthless, by an author who received hundreds of thousands of dollars in fossil fuel company money?) is hardly a less-biased source. And the author's own funding is hardly independent and unbiased.

Lack of money for pens and paper is not fake. I'll link a few articles below to help you, just from this year, but it's not. I mean, it's just not. That's the reality of public schools. I don't know how else to convince you. Feel free to Google News or DDG "lack of school supplies" and you'll hit a ton of additional links from all over the country [1][2][3].

In any case, your last couple paragraphs are getting a little of base, but yeah, it boils my blood to see that much money spent on football stadiums too. No argument there. Yes, programs for the gifted and high-achieving are needed as well. But refusing to get kids the basics of what they need to even start being successful simply because they come from a poor family isn't just unethical, it prevents kids who would otherwise being high-achievers from even getting in the race. That cuts society off at the knees.

[1] https://www.npr.org/2017/07/30/540448101/nationwide-teachers...

[2] https://investors.thecloroxcompany.com/investors/news-and-ev...

[3] https://www.wsoctv.com/community/family-focus/school-supplie...


Yes, there is "lack of school supplies", but not for lack of money. It's malice or incompetence, probably both.

Imagine that you are a school administrator. If you save money, your budget will get reduced since you obviously don't need it. If you spend the money on pens and paper, things will function OK and people won't vote to increase property taxes. If you blow the money on something else, so that you run out of money for pens and paper, you'll get sympathy and maybe more money.

Well, the solution is obvious. You need to engineer the budget so that you can't afford pens and paper. Buy a new mural. Replace perfectly functional carpeting in your office. Use up the paper by sending junk mail home with the kids. Replace the landscaping. Hire your cousin to seal the pavement.

Paper is $0.011 per page. Pens are $0.0865 each. It costs just $55.17 to give each student a new pen and 20 sheets of paper every single day for the entire school year. California spends over $20,000 per student. DC spends somewhere between $27,000 and $29,000 per student per year.

Just 0.19% to 0.28% of the budget is enough to fund that wasteful amount of pens and paper.

Comparison shouldn't be limited to the USA. Budgets in the USA are way above international norms, even ignoring the poor countries.


You have, once again, completely ignored the well-documented cases of schools whose buildings are falling down, whose desks all date back to 1953 (and show every year of it), who cannot afford basic supplies like pencils and textbooks, and so on, and on, and on.

Tell me, Mr. Cato Institute, how "throwing money at" these problems can't solve them.


Money would fix many problems if the political will were there. Unfortunately, those who make the biggest fuss about education are the ones doing the most to make it worse. ([0]Referring to the teacher's unions trying to conveniently kill off charter schools while they simultaneously remove standardized testing)

The net result of policy like the above is 'grades have gone up (because of no uniform measuring) and our union is receiving record dues!'

We have to push our elected officials towards practical and meaningful improvements and stop letting outside interests influence elections and policy so heavily.

[0] https://www.demandsafeschools.org/demands/


Yeah well half the problem with impoverished schools is rampant truancy. It doesn't matter how awesome the school is if the kids don't go (and the parents don't make them go)


I think education for children is important but I feel that it's certainly not where you get a high ROI today. Right now higher education is the real money maker.


You're not wrong, but we're talking about 50c worth of deworming medicine to change the long term outcomes of someone's life drastically.

Thats just insane.


Yeah but today policy is determined by tie-wearing businessman with Excel spreadsheets and fancy words like "opportunity cost" etc and anyway why spend 50c per person when you can spend the equivalent of $100 in some fancier military gear /s

I'm all for planning and financial outlooks but there's a point where this becomes "let them eat cake"


Some educational programs have excellent results in short term, but the effect disappears in long term. For example, do some extra activities with kids during the first grade, and they will have measurably better outcomes in the second grade, but will be indistinguishable from their peers by the fifth grade.


Education is a ball being rolled up a hill. It’s not a bucket being filled with water.

Super oversimplified but I’ve found it tells the general story: you can’t just come back to it later and expect to find the same progress. Constant nurturing, whether from yourself or a caregiver or an education system, is what has an impact. And I believe this is true for almost any age.


Did they just do the activities in the first grade, then stop? If so, that doesn't seem to reflect real-world conditions. Parents/guardians that are attentive and involved in the first grade are likely to remain so throughout.


If you teach a child good learning habits, it will probably also do good in the fifth grade.

But yes, some less general stuff will get old quick.


I agree, but I think this also applies more to infants -> children.

You can waste money on schooling or get proper care to infants in the first place.


Hasn't GiveWell known this for awhile? More study is always good, of course!

Evidence Action "Deworm the World Initiative" is one of GiveWell's top charities https://www.givewell.org/charities/top-charities


Givewell decided to make this recommendation despite ongoing disputes in the literature. There was so much uncertainty about the long-term effects that at least as of 2016, they actually discounted the expected benefit by 100x. See https://blog.givewell.org/2016/12/06/why-i-mostly-believe-in...


mea culpa! That's fascinating, thanks for the link.


There is a charity doing this I learned about through GiveWell.

https://www.evidenceaction.org/dewormtheworld-2/


Does this coincide well with research on the symbiotic relationship between host and parasite? In general: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140032/

Novel treatment of Multiple Sclerosis with parasitic worms: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666823/


How common are worms in western societies?


Taenia is not uncommon in places like France that have more "small farm" production and sublethal cooking methods. A small risk to take, I suppose.

https://parasitesandvectors.biomedcentral.com/articles/10.11...

Enterobius is quite common across the world. It's also considered to be minimally pathogenic, so it probably is only treated in symptomatic cases.


Enterobius is actually airborne, and highly contagious. But adults usually do not have them.


Pinworms[0] are a lot more common than I think most people (doctors included) realize. Though the symptoms are not as bad (that we know of)

[0]https://en.wikipedia.org/wiki/Pinworm_infection


Doesn't seem too dangerous... at least physically. Hope they don't make you want to smell cat urine.


Extremely... but unfortunately most Western doctors won't test for it, won't prescribe meds for it and are convinced that it's not possible in 1st world countries. In other words, utter quackery.


Can you just take meds for every worm there is or how do you know what kind of worms to test for?


Source? Both for your claim that they are "extremely" common and that doctors won't test


I remember having worming pills as a precaution as a child in Australia, and was also later infected with threadworm at least once so had medicine for that. I did walk around outside without shoes a lot back then.

But from what I've seen in research and been told by doctors, they see no reason to worm adults as a precaution. I'm not sure what the supposed downside is of doing it once a year or so - nasty side effects?



And probably side effects as asthma and allergy

https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-hea...


Old K5 article on hayfever/asthma self medication using hookworms:

https://web.archive.org/web/20080108063512/kuro5hin.org/stor...


It should not really surprise, that there are benefits from removing parasites. The only potential downside I see is, that the childa body does not learn to deal with them on its own.


Is it really not a surprise? If someone told me that there was a magic, 50-cent-a-year pill that would increase my wage by 15% for the next 20 years, I would be skeptical.


The fact that many poor children have worms does not mean the worms cause the poor outcomes. Deworming is cheap and ubiquitous in primary care clinics in poor communities in Africa. Correlation does not imply causation.


In this case, the deworming treatment was allocated randomly (see the paper [0]). Giving the deworming treatment to children make them less poor than those who did not get the treatment, and there should be no baseline differences on average between the two group of children since the allocation was random.

Is going from "deworming children make less poor" to "the worms cause poor outcomes" such a stretch?

[0] http://emiguel.econ.berkeley.edu/research/twenty-year-econom...


There are so many factors here, poor health can exacerbate worm infestations and healthy individuals with a good diet can live with parasites for many years with no adverse symptoms. Then there are the visits to clinics that give default deworming pills as part of any consultation.

Is going from "deworming children make less poor" to "the worms cause poor outcomes" such a stretch?

Sure, it is likely.


All those many factors equally affect both groups, that's the point of running a randomized trial. I am not sure how they are relevant to the claims that worms cause poor outcomes or that deworming children make them less poor adults. Could you please explain?


My problem is how do you run a randomized trial with something as common as a deworming pill that is handed out in clinics by nurses and can be bought over the counter? I am just curious.


I don't see how that would be a problem: even if it was common, handing out pill to one group but not the other would still lead to one group being more "dewormed" than the other, all others things being equal.

Anyway, in this case, I do not believe deworming was as common as you assume:

> Baseline parasitological surveys indicated that helminth infection rates were over 90%, and over a third had a moderate-heavy infection according to a modified WHO infection criteria (Miguel and Kremer 2004)

> Drug take-up rates were high, at approximately 75% in the treatment group, and under 5% in the control group (Miguel and Kremer 2004).

5% of the population taking the drug when >90% should means the drug is not "common".


In South Africa it has always been the default to deworm all children. In schools, clinics. https://www.sanews.gov.za/south-africa/government-launches-d...


This trial was done in Kenya, not South Africa.


I know that, I was relating my own experience of African healthcare since I live in South Africa. Kenya is not that different I imagine.


[flagged]


Please don't do this here.


I thought we were supposed to be encouraging gut flora and fauna, and that deworming and antibiotics was causing all sorts of allergies and disorders.

I mean, faecal transplants are a thing now.

As a species, we spend trillions of dollars a year on armaments and the machinery of war, and can't even definitively answer simple questions about our own bodies. What a disappointment we are.


There is a drug called ivermectin that will kill all invertebrate without harming gut bacteria. I'm not sure what gave you the idea [ ... assumption] that treatment against invertebrate parasites automatically is detrimental to our gut biome. And I definitely don't follow your logic towards the end, but have a look at ivermectin it is a hell of a drug.


Ivermectin is known to have a negative impact on biodiversity: https://www.sciencedirect.com/science/article/abs/pii/S00489...


Consider the fact that it obliterates any and all invertebrate it encounters, of course that is going to lower lower biodiversity.


I agree. Not only does it negatively affect human gut flora and fauna, but the deworming agents have a negative effect in nature especially on certain flies and beetles when administered to live stock. Instead of focusing on medication, I think there is a ton we can do by being more mindful about what we eat and how we prepare our food.


Must be wonderful having the entire "third world" for researchers to test out their pet hypotheses, or at least to trial medications that might not otherwise be worth paying to have put through FDA scrutiny until you've dosed several thousands of innocent children. And who says colonialism is dead?


My understanding is that this is not a clinical trial at all - the question is not whether the treatment works for health purposes, but whether this medicine, that was already tested for its medical effects, also has long lasting economic impact. Hence the FDA is completely irrelevant here.


What exactly do you think is the alternative to giving deworming treatments?




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