Full disclosure: I did donate to the ALS (Amyotrophic Lateral Sclerosis) Association. It wasn't much, but it was a good cause, even if my reasons for doing so were partially irrational. On one hand, I thought, I'll enhance a small donation a bit because an offer to match was available [rational], but I am not doing so with due diligence, based on information about the disease or the charity [irrational], though I did head to Charity Navigator afterward to check them out, and I did already know about ALS. Furthermore, I fully anticipated being nominated for the Ice Bucket Challenge eventually, so somewhere deep down in my icky stuff 1 I probably thought, hey, this insulates me from the inevitable inner conflict when I am finally implicated.2 Someone would get around to it, surely, and lo and behold, someone did—a close friend of mine, who also happened to make a pretty hilarious video out of his own Challenge. (He actually anticipated my discomfort, and cited it in his video as the reason for my nomination. I have some respect for this sort of trolling.)

But there is something that doesn't smell right. If it were simply the contrarian impulses that sit in my bowels, I'd be inclined to let the matter go without much more thought. On one hand, I do resent that a person can so easily be made to look like a heartless bastard, simply by not participating in a popular trend or meme, for charity or otherwise. In addition, I don't think we can ignore the oddity of wasting so much water—a back-of-the-envelope calculation by a Washington Post blogger estimates that 5 million gallons have been dumped—or the fact that by pouring ice water over your head you purportedly signal that you'd actually rather give less than the $100 "penalty" assessed in the event of refusal. Granted, many or most people just do both.

Besides the social pressure, though, one might also suggest those partaking in the Challenge are doing so out of sound self-interested decision-making: a person can mitigate both their financial and social losses.

More on that later.

You can, of course, donate whatever the hell you want, whether you decide to freeze your ass off or not. Explicitly calling on others by name to do so, however, puts undue pressure on that person for a number of reasons, not the least of which is that you have no clue what their financial situation might be.

Addressing practical considerations, Vox has an excellent piece about why donating to charity based on viral memes isn't a great idea—namely, because that sort of donation leads to inefficient allocation of resources—and I highly recommend you read this one to get an idea of the health burdens created by various diseases in comparison to ALS. The ALS Association is now going to have to figure out now how to use the unprecedented influx of cash, more than $20 million as of this writing, and I sincerely hope it is allocated well in order to support new and exciting research efforts. I really do.3 The fact that ALS affects such a small number of people, it should be stressed, does not make studying it worthless, nor should we fail to recognize those who have it. They deserve the hope and awareness that this Challenge, in its best iterations, provides. Neither is it heartless, though, to take utilitarian concerns into consideration, as I've seen suggested among acquaintances. Millions of people die every year from malaria, heart disease, lack of access to sanitary water, and a host of other causes. Something tells me Ice Bucketers won't be infusing charities that address those problems with loads of cash, despite the fact that the life-per-dollar ratio is undoubtedly much higher. This, from the Vox article's quoting of William MacAskill, illustrates the reasoning [emphasis mine]:

If you're concerned about the latter [maximizing impact], he suggested giving to diseases that impact the developing world. As a rule, he explained, "donating money to the best developing world health charities will reach at least 100 times as many people than if you donate to developed world health causes." For example, consider the potential public-health impact of your dollars spent, using a measure of disease burden like the quality-adjusted life year. With ALS, he said that $56,000 would provide one quality-adjusted life to a sufferer. On the other hand, he said, "the same amount of money could provide 500 quality-adjusted life years if you give money to bed nets for malaria."

"People can get upset when you say some causes are more effective than others. That's not true, because it's as tragic for someone to die of ALS as it is for someone to die of malaria. But wanting to respect and honor a particular tragedy is different from trying to help as many people as you can."

Also, while most Challenge videos do cite the reason for the stunt, some do not. In case your feeds have been replete with less-than-explicit explanations for why this challenge is going on (ignoring its real roots), please at least read the following passage entitled "What is ALS?" from the ALS Association's website:

Amyotrophic lateral sclerosis (ALS), often referred to as "Lou Gehrig's Disease," is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their death. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, patients in the later stages of the disease may become totally paralyzed.

A-myo-trophic comes from the Greek language. "A" means no or negative. "Myo" refers to muscle, and "Trophic" means nourishment–"No muscle nourishment." When a muscle has no nourishment, it "atrophies" or wastes away. "Lateral" identifies the areas in a person's spinal cord where portions of the nerve cells that signal and control the muscles are located. As this area degenerates it leads to scarring or hardening ("sclerosis") in the region.

As motor neurons degenerate, they can no longer send impulses to the muscle fibers that normally result in muscle movement. Early symptoms of ALS often include increasing muscle weakness, especially involving the arms and legs, speech, swallowing or breathing. When muscles no longer receive the messages from the motor neurons that they require to function, the muscles begin to atrophy (become smaller). Limbs begin to look "thinner" as muscle tissue atrophies.

If you want a really thoughtful post about the social game involved, look no further than the Google+ post below. Before you read it, though, let me stress once again that donating to support ALS research or work on other rare diseases is important. I am certainly not trying to discourage people from giving generously to causes they feel strongly about. More people should give to charity more often, myself included.


ALS is a horrible illness that I cannot myself fathom going through. I feel for those who have it, and I do sincerely hope that these dollars, however wrought, will succeed in pushing ALS research forward. In the meantime, I will also suggest that you donate to a charity I support because of the fantastic work they do across the world in bringing basic medical services to dangerous and poverty-stricken parts of the world: Medecins Sans Frontieres / Doctors Without Borders.


Support Doctors Without Borders

All of the inevitable points and counterpoints have been bandied about, I know. Such are the social media cycles that revolve around hot topics, so if you made it to the end of this one, I thank you.