Astral Codex Ten

Alexander Berger

13 min read

Alexander Berger

Article

Alexander Berger is a recurring person in the Astral Codex Ten archive, appearing 2 times across 2 issues between August 25, 2022 and October 27, 2023. The archive places it in contexts such as “11: Alexander Berger writes”; “movement leader Alexander Berger - a guy who can easily direct millions of dollars at whatever cause he wants - had donated his personal kidney as well”; “good arguments in favor by Alexander Berger”. It most often appears alongside 1DaySooner, ACX, Africa.

Metadata

  • Category: People
  • Mention count: 2
  • Issue count: 2
  • First seen: August 25, 2022
  • Last seen: October 27, 2023

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Highlights From The Comments On The Repugnant Conclusion And WWOTF
August 25, 2022 · Original source
11: Alexander Berger writes:
11: Alexander Berger writes: @slatestarcodex gets off the crazy train: ","username":"albrgr","name":"Alexander Berger","profile_image_url":"","date":"Tue Aug 23 22:32:18 +0000 2022","photos":[],"quoted_tweet":{},"reply_count":0,"retweet_count":2,"like_count":50,"impression_count":0,"expanded_url":{"url":"https://astralcodexten.substack.com/p/book-review-what-we-owe-the-future","image":"https://substackcdn.com/image/fetch/w_1200,h_600,c_limit,f_jpg,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F051d8840-77a5-4dfa-8a7c-fe6cd0c626da_535x382.png","title":"Book Review: What We Owe The Future","description":"...","domain":"astralcodexten.substack.com"},"video_url":null,"belowTheFold":true}" data-component-name="Twitter2ToDOM"> You can probably predict my response here - I don’t think I’m doing anything that could be described as “getting off the crazy train”. Like if someone is thinking “Scott believes in so many weird things, like AI risk and deregulating the FDA and so on, it’s weird that this is where he’s choosing to stop believing weird things”, I think you’re drawing the weird-thing category in the wrong place.
My Left Kidney
October 27, 2023 · Original source
So in late September 2023 - ten months after I started the process - I finally got fully cleared to donate, surgery set for October 12. VI. I knew, in theory, that anaesthetics existed. Still, it’s weird. One moment you’re lying on a table in the OR, steeling yourself up for one of the big ordeals of your life. The next, you’re in a bed in the recovery room, feeling fine. The operation - this thing you’ve been thinking about and dreading for months - exists only as a lacuna in your memory. Not even some kind of fancy lacuna, where you remember the darkness closing in on you beforehand, or have to claw yourself back into consciousness afterwards. The most ordinary of lacunas, like a good night sleep. There was no pain, not at first. The painkillers and nerve blocks lasted about a day after the surgery. By the time they wore off, it was more of a dull ache. The hospital offered me Tylenol, and I wanted to protest - really? Tylenol? After major surgery? But the Tylenol worked. Some people will have small complications (I am a doctor, pretty jaded, and my definition of “small” may be different from yours). Dylan Matthews wrote about an issue where his scrotum briefly inflated like a balloon (probably this is one of the ones that doesn’t feel small when it’s happening to you). I missed out on that particular pleasure, but got others in exchange. I had an unusually hard time with the catheter - the nurse taking it out frowned and said the team that put it in had “gone too deep”, as if my urinary tract was the f@#king Mines of Moria - but that was fifteen seconds of intense pain. Then a week afterwards, just when I thought I’d recovered fully, I got bowled over by a UTI which knocked me out for a few days. But overall, I was surprised by the speed and ease of my recovery. A few hours after the surgery, I walked a few steps. After a day, I got the catheter out and could urinate normally again. After two days, I was eating “SmartGel”, a food substitute that has mysteriously failed to catch on outside of the immobilized-hospital-patient market. After three, I was out of the hospital. After four, I started easing myself back into (remote) work. After a week, I flew cross-country. . . . and then I got the UTI. If this section sounds schizophrenic, it’s because it’s a compromise between an original draft where I said nothing went wrong and it was amazing, and a later draft written after a haze of bladder pain. Just don’t develop complications, that’s my advice. Still, I recently heard from the surgeon that my recipient’s side of the surgery was a success, that my kidney was in them and going fine - and that put things back into perspective. To a first approximation, compared to the inherent gravity of taking an organ out of one person and putting it in a second person and saving their life - it was all easy and everything went well. When I look back on this in a decade, I’ll remember it as everything being easy and going well. Even now, with some lingering bladder pain, modern medicine still feels like a miracle. VII. In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in need. This sentence fascinates me because of the hanging “would”. Would, if what? A natural reading is “would if someone needs it”. But there are 100,000 strangers on the waiting list for kidney transplants. Between 5,000 and 40,000 people die each year for lack of sufficient kidneys to transplant. Someone definitely needs it. Yet only about 200 people (0.0001%) donate kidneys to strangers per year. Why the gap between 25-50% and 0.0001%? Some of you will suspect respondents are lying to look good. But these are anonymous surveys. Lying to themselves to feel good, then? Maybe. But I think about myself at age 20, a young philosophy major studying utilitarianism. If someone had asked me a hypothetical about whether I would donate a kidney to a stranger in need, I probably would have said yes. Then I would have continued going about my business, never thinking of it as a thing real-life people could do. Part of this would have been logistics. I wouldn’t have known where to start. Do you need to have special contacts in the surgery industry? Seek out a would-be recipient on your own? Where would you find them? But more of it would have been psychological: it just wasn’t something that the people I knew did, and it would be weird and alienating for me to be the only one. This is going to be the preachy “and you should donate too!” section you were dreading all along, but I’m not going to make a lot of positive arguments. If 90% of the people who answer yes on those surveys are lying to feel good, then only 3 - 5% really want to donate. But bringing the donation rate from 0.0001% of people to 3 - 5% of people would solve the kidney shortage many times over. The point isn’t to drag anti-donation-extremists kicking and screaming to the operating table. The point is to reach the people who already want to do it, and make them feel comfortable starting the process. 20-year-old me was in that category. The process of making him feel comfortable involved fifteen years of meeting people who already done it. During residency, I met a fellow student doctor who had donated. Later, I got involved in effective altruism, and learned that movement leader Alexander Berger - a guy who can easily direct millions of dollars at whatever cause he wants - had donated his personal kidney as well. Some online friends. Some people I met at conferences. And Dylan Matthews, who I kept crossing paths with (most recently at the Manifest journalism panel). After enough of these people, it no longer felt like something that nobody does, and then I felt like I had psychological permission to do it. (obviously saints can do good things without needing psychological permission first, but not everyone has to be in that category, and I found it easier to get the psychological permission than to self-modify into a saint6.) So I’m mostly not going to argue besides saying: this is a thing I did, it’s a thing hundreds of other people do each year, getting started is as simple as filling out a form, and if it works for you, you should go for it7. When I woke up in the recovery room after surgery, I felt great. Amazing. Content, peaceful, proud of myself. Mostly this was because I was on enough opioids to supply a San Francisco homeless encampment for a month. But probably some of it was also the warm glow of having made a difference or something. That could be you! VIII. The ten of you who will listen to this and donate are great. That brings the kidney shortage down from 40,000 to 39,990/year. Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors. But so far they haven’t been able to get together enough of a coalition to overcome the usual cabal of evil bioethicists who thwart every medical advance. My kidney donation “mentor”8 Ned Brooks is starting a new push - the Coalition To Modify NOTA - which proposes a $100,000 refundable tax credit - $10,000 per year for 10 years - for kidney donors. There would be a waiting period and you’d have to get evaluated first, so junkies couldn’t walk in off the street and get $100K to spend on fentanyl. No intermediate company would “profit” off the transaction, and rich people wouldn’t be able to pay directly to jump in line. It would be the same kidney donation system we have now, except the donors get $100,000 back after saving the government $1MM+. (the libertarian in me would normally prefer a free market, but “avoid taxes by selling your organs” also has a certain libertarian appeal) This came up often when I talked to other donors. They all had various motivations, but one of the things they cared about was being able to advocate for these kinds of systemic changes more effectively. I personally have been wanting to push this in an essay here for a while, but it seemed hypocritical to play up the desperate kidney shortage while I still had two kidneys. Now I can support NOTA modification whole-heartedly . . . full-throatedly? . . . it’s weird how many of these adverbs involve claims to still have all of your organs. This is also one of the answers to the question I asked in section IV: how do you balance acts of heroic altruism that everyone will love you for vs. acts of boring autistic altruism that will make everyone hate you, but which will accomplish more good in the end?) Coalition To Modify NOTA is full of previous living kidney donors, who are using the moral clout and recognition they’ve gotten to get attention and change the system in an unglamorous way. I find this an admirable way of squaring the circle: do the flashy heroic things to gain social capital, then spend the social capital on whatever’s ultimately most important. If you get one takeaway from this, let it be that those guys who bought the castle were good guys. Two takeaways, and it’s that plus modify NOTA. Three takeaways, and you should feel permission to (if you want) donate a kidney. You can sign up here.9 Feel free to email me at scott@slatestarcodex.com if you have questions about the process. 1Further perspective: I’m 38, which gives me a 2/million total chance of dying per day. So the likelihood that I would die during my kidney operation equals the likelihood that I would die during a randomly chosen two months of everyday life. 2Maybe, kind of. Our knowledge of how radiation causes cancer comes primarily from Hiroshima and Nagasaki; we can follow survivors who were one mile, two miles, etc, from the center of the blast, calculate how much radiation exposure they sustained, and see how much cancer they got years later. But by the time we’re dealing with CAT scan levels of radiation, cancer levels are so close to background that it’s hard to adjust for possible confounders. So the first scientists to study the problem just drew a line through their high-radiation data points and extended it to the low radiation levels - ie if 1 Sievert caused one thousand extra cancers, probably 1 milli-Sievert would cause one extra cancer. This is called the Linear Dose No Threshold (LDNT) model, and has become a subject of intense and acrimonious debate. Some people think that at some very small dose, radiation stops being bad for you at all. Other people think maybe at low enough doses radiation is good for you - see this claim that the atomic bomb “elongated lifespan” in survivors far enough away from the blast. If this were true, CTs probably wouldn’t increase cancer risk at all. I didn’t consider myself knowledgeable enough to take a firm position, and I noticed eminent scientists on both sides, so I am using the more cautious estimate here. 3I told them I had an aunt who died of radiation-induced cancer. It’s true, but I feel grubby for bringing her into this; I thought doctors would be more likely to listen to an emotional story than cold logic. 4EAs have been debating the exact effectiveness of kidney donations for a long time. You can find good skeptical arguments by Jeff Kaufman and Derek Shiller, and good arguments in favor by Alexander Berger and Tom Ash. 5Outside of Philosophy 101 thought experiments, there’s a nonprofit that will often reimburse you for lost wages from your donation. 6Self-modifying into a person who can act boldly without social permission is a more general solution and has many other advantages. But the long version involves living a full life of accumulating moral wisdom, and the short version starts with removing guardrails that are there for good reasons. 7But here are some practical points you might not already appreciate: You shouldn’t have to pay much money. If, like me, you need to travel (eg to New York), kidney related charities will reimburse your travel costs (in theory, I haven’t yet proven this, and a few costs were illegible and I decided not to submit them).
Inline links: polls, 5,000, 40,000, Manifest journalism panel, 6, filling out a form, 7, usual, 8, the, here, 9, 1, 2, Linear Dose No Threshold, this claim, 3, 4, Jeff Kaufman, Derek Shiller, Alexander Berger, Tom Ash, 5, 6, 7