Should effective altruists become doctors?

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80,000 hours is the typical length of time you will spend working - so career choice is important.

80,000 hours is also the name of a non-profit, founded by the effective altruists Will MacAskill and Benjamin Todd.

Effective altruism is a movement that aims to maximise the benefits of charitable giving. To this end, it has coined strategies like ‘earning to give’, whereby a person goes into a high paying career for the purposes of giving most of their wealth to highly effective charities. The most high profile proponent of this is Sam Bankman-Fried, the crypto CEO whose net worth is estimated at 11 billion.

I am persuaded by many effective altruism arguments, so I was intrigued to come across their view on medical careers, in which they advise against a career in medicine.

I will make the case for smart young people, who want to maximise their benefit to the world, pursuing a career in medicine.

The case against

80,000 hours states that a doctor has modest direct impact - they can only treat the patient in front of them. I think this is a fair point for the majority of medical doctors, but it obviously doesn’t apply to branches of medicine like public health, virology, microbiology, or medical research.

They state that the marginal benefits of doctors in the developed world is small - we are treating the healthiest people, with least medical need.

Furthermore the ‘social determinants of health’ such as sanitation, education and socioeconomic status are more important than medical intervention.

(Of course it would be remiss not to point out that a key leader of this idea and chair of the WHO’s Commission on Social Determinants of Health, Michael Marmot is himself a medical doctor.)

Another mark against is the competitiveness to get into medical school. This oversubscription means that if one person decided against medicine, there would be someone else right behind, ready to take their place.

They argue that doctors have a limited influence on public policy and limited scope to change careers.

Overall, they recommend young people considering medicine instead go for other fields that may be higher earning, have greater direct impact or better advocacy opportunities.

These arguments are reasonable, particularly with regard to the day-to-day work of most doctors. But the enormous opportunities medicine offers, have been overlooked.

On a more empirical basis, we should also consider the historical successes of medical doctors, as well as the future potential of medical research.

Historical perspectives

Rise in life expectancy and reduction in morbidity over the past hundred years have been great achievements of our time.

What has driven this? According to Our World in Data, better sanitation, vaccinations, antibiotics and publicly funded healthcare. Many key people behind these improvements were doctors, some of whom I’d like to introduce below.

Sanitation, infection, vaccines

John Snow was a physician, regarded as the founder of epidemiology. He is known for shutting down a water pump that was the source of a cholera outbreak in Soho in 1854. His work led to improvements in the water waste system of London which was adopted by cities across the world.

Robert Koch later discovered the vibrio that causes cholera. He was a German physician and microbiologist, the founder of germ theory, who provided a scientific basis to public health.

The discovery of the first antibiotic, penicillin, was by a Scottish doctor named Alexander Fleming. The arrival of antibiotics was incredibly effective in the treatment of infectious disease, previously a major cause of mortality.

The British surgeon, Joseph Lister, pioneered the use of aseptic surgical technique. This greatly reduced post-operative infections, making surgery much safer.

The world’s first vaccine, against smallpox, was created by another British doctor, Edward Jenner. Ultimately this led to the only eradication of a human disease, achieved in 1977. A childhood disease close to eradication is polio, thanks to a vaccine created by Jonas Salk an American virologist (a type of doctor).

Smoking

Smoking is the second leading risk factor for death globally, behind only high blood pressure. Thankfully, there has been a steady reduction in smokers. And who first proved the link between cigarettes and cancer? Richard Doll, a British doctor and epidemiologist (alongside the statistician Austin Bradford Hill).

Insulin

The use of insulin for diabetes is credited by Holden Karnofsky as a great philanthropic success. The pancreatic glands that secrete insulin were discovered by a German medical student, Paul Langerhans. Numerous other doctors were involved in its development as a treatment, most notably the Canadian, Frederick Banting who shared the 1923 Nobel prize in medicine.

Cervical smears

Another of Holden’s success stories is the development of the cervical smear or ‘pap test’. It is an investigation to detect the earliest stage of cervical cancer and is named after Georgios Papanikolaou, a Greek doctor.

Covid-19

A major focus area for effective altruism is pandemic preparedness. We recently had a test run in the form of Covid-19. Many doctors influenced pandemic response, from Chris Witty and Patrick Valance in the UK to Anthony Fauci in the USA.

A great source of success was the quick development of effective vaccines. The first to be approved was Pfizer–BioNTech, developed by two Turkish doctors Uğur Şahin and Özlem Türeci.

Hot on its heals was the Oxford-AstraZeneca vaccine. Two of the leaders of that development (alongside Sarah Gilbert) were Andrew Pollard and Adrian Hill (both doctors).  

Based on past experience, vaccines for future pandemics are highly likely to come from doctors.

Neuroscience

Another focus of effective altruism is in the mitigation of AI risk. I’m not aware of many doctors working directly on AI but the adjacent field of neuroscience has many leading doctors, specifically psychiatrists. Indeed, the discoverer of the neuron and the so-called father of neuroscience was Santiago Ramón y Cajal, a Spanish doctor.

In 2016, semantic scholar found that the two most influential neuroscientists of the modern era were Karl Friston and Ray Dolan - both psychiatrists at UCL.

Other influential neuroscientists include the Nobel-prize winning Eric Kandel, and the developer of optogenetics Karl Deisseroth (again, two psychiatrists).

More than providing a better understanding of the human brain (and by extension intelligence), neuroscience should eventually lead to better treatments for mental illnesses - a major source of global morbidity.

Conclusion

Throughout history, doctors have consistently punched above our collective weight when it comes to discoveries and achievements that benefit humanity.

From infectious disease to public health, a remarkable number of contributions to increased life expectancy come from the medical profession.

What’s more, future innovation in preventing pandemics is likely to come from doctors. Whether doctors will reduce AI risk is less certain but there may be benefits from the many leading neuroscientists who trained in medicine.

The 80,000 hours medical careers advice focusses too much on the day-to-day work of a typical doctor and concludes there were more beneficial career paths.

However, it doesn’t give enough weight to the extensive opportunities to engage in public health, microbiology, medical technology and neuroscience, or the proven track record of achievement.

Of course, the vast majority of doctors, won’t change the world but will still have incredibly satisfying careers helping others.