People often underestimate how brittle attempts to improve the world are.
Altruism, at a large scale, often hinges on a chain of assumptions/requirements, such as:
A & B & C & D & E
One broken link in the chain means it looks like you're doing good but you're not really doing it.
For example, to help the world by delivering medicine, the chain might look like this:
The medicine reliably cures the disease
& the side effects are not worse than being...
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