Avoiding waste in medical research

This article first published in the Financial Times.

The news that Facebook founder Mark Zuckerberg and his wife Priscilla are putting $3bn towards “ending all disease” has renewed the spotlight on the giving of Silicon Valley’s wealthiest. They are not alone in their enthusiasm for medical research: it is also the most popular target of charitable giving in the UK. 

There is a problem, however: about 85 per cent of medical research is wasted. That’s equivalent to 22 of the 26 miles which people run in marathons to raise funds for research into cancer and other conditions. Globally, that waste costs around $170bn every year. Perhaps many of us suffer with conditions which could have been cured if those funds had been spent more productively.

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What would have happened otherwise?

First published in the FT.

Did the charity make it happen, or would it have happened anyway?

The purpose of a charity’s work — and your support for it — is to create a benefit beyond what would have happened anyway. This, of course, sounds obvious but (as my home discipline of physics powerfully attests) it’s fine to state the obvious as it can throw up some unexpected insights.

Charities are under considerable pressure to “demonstrate their impact”, yet few examine or recount what would have happened without them. “What difference does your work make beyond what would have happened anyway?” is perhaps the single most useful question that donors or trustees can ask.

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The evidence system in the mental health charity sector

UK non-profits delivering mental health services are not great at producing or using scientific evidence.

This is the main finding of a new study by Giving Evidence. We interviewed 12 such organisations to understand their ‘evidence system’, i.e., how evidence is:

  • Produced
  • Synthesized
  • Shared, both ‘outbound’ from them and ‘inbound’ to them – and stored.

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Why do so few charities have their meetings in public?

All charities and charitable foundations exist to serve the public good. Most of them are Open Meetings coversubsidised by the public, through various tax breaks. Whereas any company must have a meeting at least annually at which the directors are held to account to the people whose capital they deploy, in over 15 years in this ‘industry’, we’d only encountered two charities /foundations which have meetings at which the people whose capital they deploy – the public – or the intended beneficiaries can what goes on. The 800-year-old City Bridge Trust lets anybody observe its decision-making meetings, and Global Giving UK has an AGM at which anybody can ask anything. Why don’t more?

It’s hard to be accountable to people, or to hear from people, if they’re not in the room. So we wondered how many charities and foundations have public meetings.

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Be a flexible friend

This article first published in the FT.

Toilet roll seems an unlikely emblem of effective philanthropy. Yet I’ve heard of a donor
who specifically funds loo rolls in London museums and galleries on the simple grounds that this kind of donation is both necessary and tough to fund.

Many donors want to fund the glamorous stuff: front-line programmes, identifiable projects and new buildings being prime examples. To do so, many “restrict” their gifts to those items. The main problem with this approach is that donors generally all want to fund the same things — none of which include loos, core staff or rent.

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Results of systematic review about outcomes for young people

Like those of many social programmes, the goals of Sail Training voyages are long-term: In this case, to improve young people’s life chances, involvement in employment and ST report covertraining, and sound mental health. However, many organisations which provide Sail Training cannot conduct or commission high-quality longitudinal studies that demonstrate an impact on these long-term outcomes, because of complexity and cost.

So Giving Evidence was delighted to be asked to identify short-term outcomes that, if ‘produced’ by an intervention, have a beneficial effect on key longer-term outcomes. If future research can show a link between the intervention(s) and certain short-term outcomes, and there is a known link between those short-term outcomes and particular longer-term outcomes, then one can make a coherent and evidence-informed claim about the long-term outcomes produced by the intervention.

Our findings are here.

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How to give it: Why charity should begin in the science lab

This article first published in the Financial Times.

Not all charities are good causes. This may sound surprising, because we’re used to thinking of them all as being somehow virtuous, but they vary in their effectiveness. Smart donors know that good intentions alone aren’t enough.

Take, for example, the important goal of reducing cases of diarrhoea in Kenya — a major cause of child death. One solution is to provide chlorine at the water pump for people to add to their water when they collect it. Another is to deliver chlorine to households so people can add it there.

Both of these sound pretty sensible, but researchers at the Massachusetts Institute of Technology have found that providing chlorine at the water source prevents more than twice as many cases of diarrhoea for a given sum of money. Put another way, a lot of children will get a potentially fatal disease if donors make the wrong call about which programme to fund.

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Oops: we made the non-profit impact revolution go wrong

By Caroline Fiennes and Ken Berger, managing director of Algorhythm. 

The non-profit ‘impact revolution’ – over a decade’s work to increase the impact of non-profits – has gone in the wrong direction. As veterans and cheerleaders of the revolution, we are both part of that. Here we outline the problems, confess our faults, and offer suggestions for a new way forward.

Non-profits and their interventions vary in how good they are. The revolution was based on the premise that it would be a great idea to identify the good ones and get people to fund or implement those at the expense of the weaker ones. In other words, we would create a more rational non-profit sector in which funds are allocated based on impact. But the ‘whole impact thing’ went wrong because we asked the non-profits themselves to assess their own impact. Continue reading

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Science and philanthropy: podcast

A lovely interview on US radio station The Business Of Giving with Denver Frederick. We discussed lessons for philanthropy / nonprofits from Galileo, Zen and the Art of Motorcycle Maintenance; how nonprofits sometimes harm, how we don’t yet have good frameworks for analysing the (likely) effectiveness of (future) campaigns and other systemic work, and much else.


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Making charity & philanthropy more evidence-based

Giving Evidence’s purpose is improving the effectiveness of charitable giving and charitable work by improving the quality of evidence on which they are based. The changes that we need are very analogous to changes which happened in medicine, in terms of vastly improving the quality and use of evidence in decisions. Caroline spoke recently at the Liverpool School of Tropical Medicine, laying out the state of evidence in the three areas of decisions – choosing interventions, choosing non-profit organisations, and choosing between the various ways of giving – and looking at what is needed to enable more evidence-based decisions in each of them.

This is a consultation exercise and we invite your input: admin [at] giving-evidence [dot] com

Click on the picture to watch the seminar (also here).


Giving Evidence has done considerable work looking at what charity / philanthropy can learn from evidence-based medicine (see here, and here), and has a paper out soon about the effects & evidence around various ways of giving (with the University of Chicago, see here).

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