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Health Dividend

Keywords

war-on-disease, 1-percent-treaty, medical-research, public-health, peace-dividend, decentralized-trials, dfda, dih, victory-bonds, health-economics, cost-benefit-analysis, clinical-trials, drug-development, regulatory-reform, military-spending, peace-economics, decentralized-governance, wishocracy, blockchain-governance, impact-investing

Disease costs humanity $397.4 trillion annually43. That’s more than global GDP ($101 trillion132). The number sounds wrong because economists spent centuries measuring productivity without accounting for the people who stopped being productive on account of being dead.

The missing piece is DALYs (Disability-Adjusted Life Years): healthy years deleted by disease. Die at 40 instead of 80? That’s 40 DALYs. Spend 10 years severely depressed? That’s 5 DALYs. Globally: 2.88 billion DALYs annually32. Using the commonly used $150,000 VSLY (value of a statistical life-year133), that’s $382.5 trillion in lost human potential, plus $8.2 trillion in direct medical costs134 and $6.7 trillion in lost productivity135.

That’s the bill. Here’s the receipt for the fix:

Your decentralized FDA costs $40M/year to run. It saves $58.6B/year in clinical trial waste. That’s 637:1 returns on R&D savings alone. Total societal benefit (including lives saved): 84.8M:1

I know. Those numbers look like someone fell asleep on the keyboard. They didn’t. Here’s the breakdown.

The Math: From $41K to $500

Traditional Phase III trials cost $41K per patient. That’s a Tesla. Per person. To find out if a pill works. The pill costs 37 cents to make. The paperwork weighs more than the patient.

Then the Oxford RECOVERY trial proved you can do the same thing for $500. During a pandemic. While panicking. They tested COVID treatments on 40,000+ patients by:

  • Using existing hospital staff (revolutionary concept: doctors treating patients)
  • Collecting data electronically (instead of sacrificing forests to the paperwork gods)
  • Focusing on what actually matters: does the patient live or die? (not “did they complete form 27-B in triplicate?”)

Your decentralized FDA takes this model global. Up to 44.1x cost reduction. Same data quality. Better real-world applicability. It turns out you don’t need 17 committees to answer the question “did the medicine work?”

Where the $58.6B Comes From

Global clinical trial spending: $60B per year (and growing, because apparently inefficiency scales beautifully).

Baseline estimate: 97.7% efficiency gains across the market (based on pragmatic trial cost estimates). This assumes pragmatic designs scale beyond simple mortality endpoints to most therapeutic areas. Some trial types (complex imaging, rare disease custom endpoints, device trials) won’t hit that reduction. But the majority of spending goes to large therapeutic-area trials where RECOVERY-style designs work, and the estimate is conservative enough that even if a third of the market resists pragmatic redesign, the savings still dwarf the costs.

What $58.6B Buys You

With 58.6 billion, you could run 10,000 trials and address 7,000 rare diseases. Currently you’re spending that much to run far fewer trials for common diseases. Priorities.

With 58.6 billion, you could run 10,000 trials and address 7,000 rare diseases. Currently you’re spending that much to run far fewer trials for common diseases. Priorities.

Each new drug approval is worth an average of $1.62 billion136 in market value. The FDA approves roughly 50 drugs/year. That is the speed at which a species with nuclear weapons and artificial intelligence has chosen to cure itself. Staggering. With 12.3x more trial capacity, you could test far more treatments at once.

With the money saved every year, you could:

  • Fund 10,000 new pragmatic clinical trials (at $5M each, which is still luxurious by RECOVERY standards)
  • Test treatments for 7.00 thousand rare diseases currently ignored (because orphan diseases aren’t profitable enough for your orphan-making economic system)
  • Cut drug development time from 17 years to 3-5 years (most terminal patients don’t have 17 years; this has not occurred to anyone in charge)
  • Make medicines affordable by eliminating $2.60B development costs (roughly 90% of which is lawyers arguing about commas)

Daily Opportunity Cost

Every day without this system costs $161M in wasted trial spending alone. Delayed treatments cost 7.94 billion DALYs healthy life-years over the full lag period (cumulative across all deaths and disability during the delay, not a single year’s burden; yes, that exceeds annual global DALYs, because dead people keep being dead for decades). All because of the regulatory lag period. The lag period is not a safety feature. It is a waiting room where people die. You just gave the waiting room a nicer name.

See Daily Opportunity Cost of Inaction for calculations.

What It Costs to Run

Your decentralized FDA costs $40M/year to operate. Servers, engineers, compliance, global integration. The boring stuff that saves billions. One-time build cost is similar. For context, this is roughly what your species spends annually on Halloween costumes for dogs. I need you to sit with that for a moment.

It’ll cost 40 million to run this per year. Maybe 27 million, maybe 56 million. Either way, less than one fighter jet.

It’ll cost 40 million to run this per year. Maybe 27 million, maybe 56 million. Either way, less than one fighter jet.

Less than one fighter jet. Less than one yacht. Less than what FIFA spends on “hospitality.” See Decentralized FDA Cost-Benefit Analysis for detailed costs.

ROI Scenarios

Scenario ROI What It Counts
Conservative 637:1 R&D savings only (NPV over 10 years)
Recommended 84.8M:1 R&D savings + post-safety efficacy lag elimination
Worst case estimated 66:1 Higher costs, lower adoption

Conservative return on investment versus total return including not letting people die. One number is big, the other is astronomically big. Both beat war.

Conservative return on investment versus total return including not letting people die. One number is big, the other is astronomically big. Both beat war.

Even the worst case (everything goes wrong, adoption is terrible, the engineers quit and the servers catch fire) returns an estimated 66:1. That beats every military investment in human history. Your worst medical outcome is still better than your best military one. Let that sink in while you’re approving next year’s defense budget.