# The Survey to End War and Disease

## 1. Should every patient be able to join a pragmatic clinical trial of any promising treatment through their regular doctor, with informed consent?

**Why we ask:** Most patients cannot join a trial because no trial exists at their hospital. The right to try a treatment you cannot access is the right to board a flight that does not exist. If every provider could enroll patients, every treatment gets a running scorecard: how much it helps, what side effects it causes, and what it costs, ranked against every other treatment for the same condition.

**Prediction:** Before the 2018 federal Right to Try Act, 41 US states had already passed right-to-try laws^([1](../references.llms.md#ref-goldwater-rtt-41-states-2018)).

**If a majority of humanity says yes:** Legislators remove the legal barriers. Hospitals can enroll patients through a shared reporting system, allowing each tested treatment to accumulate a public outcome label: measured changes from baseline across all positive and negative effects, ranked against alternatives.

**Evidence and calculations:** [Ubiquitous Pragmatic Trial Impact Analysis](https://papers.acceleratedmedicine.org/dfda-impact.html)^([2](../references.llms.md#ref-dfda-impact-paper-2025))

## 2. Most promising treatments are never tested, because no company can profit from testing them. Should patients be allowed to fund and join trials of treatments for their own disease?

**Why we ask:** 95% of diseases have zero FDA-approved treatments^([3](../references.llms.md#ref-95-pct-diseases-no-treatment)). At current speed, testing every promising treatment takes [443 years (90% CI: 255 years-841 years)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-status_quo_queue_clearance_years). A trial needs money. If no company can patent the treatment, no company pays, and it stays on a shelf.

**Prediction:** No direct polling exists. Access to unapproved treatments polls between 54% and 90% depending on framing, but those polls did not test patient funding or its equity implications.

**If a majority of humanity says yes:** Regulators can permit patient-funded trials without political risk. Treatments with no patent value get tested.

**Evidence and calculations:** [Appendix: Calculations](#sec-calculations)^([2](../references.llms.md#ref-dfda-impact-paper-2025))

## 3. How should public money be divided between these two uses?

- Weapons and military spending
- Pragmatic clinical trials comparing promising treatments

**Pragmatic clinical trials:** Your doctor enrolls you. The trial runs through ordinary care instead of a special facility. It costs less. Every treatment gets a public outcome label showing all measured effects, positive and negative.

**Why we ask:** Disease costs about [13%](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-disease_burden_gdp_drag_pct) of global GDP. Military, conflict, and security spending consumes [11.5%](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-global_destructive_economy_pct_gdp) of GDP and grows faster than the productive economy^([4](../references.llms.md#ref-gdp-trajectories-paper-2025)). Weapons become obsolete. Treatments compound. Oxford’s RECOVERY trial tested 6 treatments on 48,000 patients at about [\$500 (95% CI: \$400-\$2,500)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-recovery_trial_cost_per_patient) per patient versus roughly [\$41,000 (95% CI: \$20,000-\$120,000)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-traditional_phase3_cost_per_patient) for a conventional Phase III trial. That is a cost reduction of about [82x (90% CI: 21.4x-195x)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-recovery_trial_cost_reduction_factor). After WW2, the US cut military spending by [87.6%](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-post_ww2_military_cut_pct) in two years and stumbled into the largest economic boom in its history. This survey asks about 1%.

**Prediction:** Most people allocate more than the 0.17% that goes to clinical trials today. In US polling, 57% supported cutting the military budget by 10% to fund health and other domestic needs^([5](../references.llms.md#ref-public-support-for-peace-funding-70-pct)).

**If the median allocation gives trials at least 1 percentage point more than today’s share:** That is a global mandate for the 1% reallocation: [\$27.2 billion](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_annual_funding) per year for pragmatic trials, a [12.3x (90% CI: 4.92x-50.8x)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_trial_capacity_multiplier) increase in trial capacity, and a timeline drop from [443 years (90% CI: 255 years-841 years)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-status_quo_queue_clearance_years) to [36 years (90% CI: 8.15 years-106 years)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_queue_clearance_years). Even after discounting for the chance it never happens politically, the reallocation would cost [\$1.99 (90% CI: \$0.37-\$38)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_expected_cost_per_daly) per healthy year of life saved^([6](../references.llms.md#ref-1-pct-treaty-impact-paper-2025)). Vaccinating a child costs [\$30](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-childhood_vaccination_cost_per_daly). A bed net costs [\$184 (90% CI: \$113-\$252)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-bed_nets_cost_per_daly).

**Evidence and calculations:** [Allocation Impact Analysis](https://manual.warondisease.org/knowledge/economics/1-pct-treaty-impact.html)^([6](../references.llms.md#ref-1-pct-treaty-impact-paper-2025))

## 4. Should governments collect and analyze data on how their policies and budgets affect median healthy life years and real after-tax median income, using the natural variation across thousands of jurisdictions to determine which policies work best?

**Why we ask:** Thousands of jurisdictions have adopted different policies at different times: different tax rates, drug laws, education budgets, healthcare systems. The outcomes are recorded. Together, these policy differences provide quasi-experimental evidence that can help estimate which policies improve median healthy life years and real after-tax median income. Governments do not systematically analyze these outcomes to identify better policies.

**Prediction:** In US polling, 91% of voters agree that data and evidence should be a top influence in government policy, bipartisan^([7](../references.llms.md#ref-results-for-america-evidence-2026)). The specific mandate to analyze cross-jurisdictional outcomes has not been polled.

**If a majority of humanity says yes:** The [Optimal Policy Generator](https://manual.warondisease.org/knowledge/appendix/optimal-policy-generator-spec.html) uses causal inference on this cross-jurisdictional data to determine which policies improved median healthy life years and real after-tax median income and which did not, then produces recommendations for any jurisdiction: enact, replace, repeal, or keep^([8](../references.llms.md#ref-opg-paper-2025)). The [Optimal Budget Generator](https://obg.warondisease.org) does the same for spending levels^([9](../references.llms.md#ref-obg-paper-2025)). The recommendations and the votes are both public.

**Evidence and calculations:** [Optimal Policy Generator](https://manual.warondisease.org/knowledge/appendix/optimal-policy-generator-spec.html)^([8](../references.llms.md#ref-opg-paper-2025))

## 5. If government action kills or injures your family, should you have the same right to sue as if a corporation did it?

**Why we ask:** Since 1900, governments have spent [\$170 trillion](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-cumulative_military_spending_fed_era) on the capacity to kill people and used it to kill [310 million](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-war_deaths_since_1900) of them, including [102 million](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-war_children_killed_since_1900) children. The chance of dying from terrorism is 1 in 30 million^([10](../references.llms.md#ref-chance-of-dying-from-terrorism-1-in-30m)). The chance of dying from disease is 100%. Governments built the military around the first number. If a company made this trade, you could sue. [Sovereign immunity](https://manual.warondisease.org/knowledge/solution/court-of-humanity.html) means that when a government does it, you mostly cannot^([11](../references.llms.md#ref-court-of-humanity-paper-2025)).

**Prediction:** In adjacent US polling, 63% favor ending qualified immunity for government officials^([12](../references.llms.md#ref-cato-qualified-immunity-2020)) and 66% favor giving civilians the power to sue officers for misconduct^([13](../references.llms.md#ref-pew-civilians-sue-officers-2020)). The equal-treatment framing in this question has not been directly polled.

**If a majority of humanity says yes:** A global consensus removes the assumption that sustains immunity: that everyone else accepts it. That creates a mandate to establish a court where states face the same liability as corporations.

**Evidence and calculations:** [Appendix: Calculations](#sec-calculations)^([14](../references.llms.md#ref-humanity-v-government-paper-2025))

## Why counting matters

A majority can exist and not know it exists. Pluralistic ignorance^([15](../references.llms.md#ref-kuran-private-truths-1995)) can make a majority believe it is a minority. The uncertainty remains until somebody counts.

Erica Chenoweth studied every major nonviolent campaign of the last century and found that none had ever failed after achieving [3.5% (95% CI: 1%-10%)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-global_population_activism_threshold_pct) sustained participation^([16](../references.llms.md#ref-3-5-rule)). Not one.

## What happens if all five pass

If the 1% reallocation happens, the models project global GDP of [\$322 trillion (90% CI: \$245 trillion-\$404 trillion)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_trajectory_gdp_year_20) and average income of [\$34,972 (90% CI: \$26,587-\$43,903)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_trajectory_avg_income_year_20) in year 20^([4](../references.llms.md#ref-gdp-trajectories-paper-2025)). If every institution the mandate enables works as modeled, year-20 global GDP is [\$10.7 quadrillion (90% CI: \$3.95 quadrillion-\$28 quadrillion)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-wishonia_trajectory_gdp_year_20) and median after-tax income is [\$194,130 (90% CI: \$70,137-\$507,535)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-wishonia_trajectory_median_after_tax_income_year_20)^([4](../references.llms.md#ref-gdp-trajectories-paper-2025)). The second number’s growth assumptions are outside historical precedent.

## Costs

A verified response costs [\$6.5 (90% CI: \$4-\$9.14)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-global_coordination_activation_cost_per_participant): \$1.5 (95% CI: \$1-\$3) for identity verification and processing, \$5 (95% CI: \$2-\$10) for incentives. Organizations that distribute the questions receive compensation per verified response; terms are in the [Organization Kit](../../knowledge/strategy/survey-organization-kit.llms.md). If the treaty passes, each response corresponds to [2.6 lives](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-voter_lives_saved) saved, at [\$2.5 (90% CI: \$1.12-\$4.68)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-survey_cost_per_life_saved) per life.

## Appendix: Calculations

**The 0.17%.** Military spending is [604 (90% CI: 453-888)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-military_to_government_clinical_trials_spending_ratio) times government clinical trial spending, so trials receive roughly 1/604 of what weapons receive:

$$ \begin{gathered} Ratio_{mil:gov} \\ = \frac{Spending_{mil}}{Spending_{trials,gov}} \\ = \frac{\$2.72T}{\$4.5B} \\ = 604 \end{gathered} $$

**The RECOVERY cost reduction:**

$$ \begin{gathered} k_{RECOVERY} \\ = \frac{Cost_{P3,pt}}{Cost_{RECOVERY,pt}} \\ = \frac{\$41K}{\$500} \\ = 82 \end{gathered} $$

**Annual funding from a 1% reallocation:**

$$ \begin{gathered} Funding_{treaty} \\ = Spending_{mil} \times Reduce_{treaty} \\ = \$2.72T \times 1\% \\ = \$27.2B \end{gathered} $$

**The treatment-testing timeline,** including the status quo 443-year estimate and the [12.3x (90% CI: 4.92x-50.8x)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_trial_capacity_multiplier) capacity multiplier it improves on:

$$ \begin{gathered} T_{queue,trial} \\ = \frac{T_{queue,SQ}}{k_{capacity}} \\ = \frac{443}{12.3} \\ = 36 \end{gathered} $$\
where:\
$$ \begin{gathered} T_{queue,SQ} \\ = \frac{N_{untreated}}{Treatments_{new,ann}} \\ = \frac{6{,}650}{15} \\ = 443 \end{gathered} $$\
where:\
$$ \begin{gathered} N_{untreated} \\ = N_{rare} \times 0.95 \\ = 7{,}000 \times 0.95 \\ = 6{,}650 \end{gathered} $$\
where:\
$$ \begin{gathered} k_{capacity} \\ = \frac{N_{fundable,ref}}{Slots_{curr}} \\ = \frac{23.4M}{1.9M} \\ = 12.3 \end{gathered} $$\
where:\
$$ \begin{gathered} N_{fundable,ref} \\ = \frac{Subsidies_{trial,ref}}{Cost_{pragmatic,pt}} \\ = \frac{\$21.8B}{\$929} \\ = 23.4M \end{gathered} $$\
where:\
$$ \begin{gathered} Subsidies_{trial,ref} \\ = Funding_{trial,ref} - OPEX_{trial} \\ = \$21.8B - \$40M \\ = \$21.8B \end{gathered} $$\
where:\
$$ \begin{gathered} OPEX_{trial} \\ = Cost_{platform} + Cost_{staff} + Cost_{infra} \\ + Cost_{regulatory} + Cost_{community} \\ = \$15M + \$10M + \$8M + \$5M + \$2M \\ = \$40M \end{gathered} $$

**Cumulative military spending expressed in years of clinical trial funding:**

$$ \begin{gathered} Years_{mil \to trials,gov} \\ = \frac{Spending_{mil,cum,fed}}{Spending_{trials,gov}} \\ = \frac{\$170T}{\$4.5B} \\ = 37{,}800 \end{gathered} $$

Source citations for all quantities are in the [parameter registry](../../knowledge/appendix/parameters-and-calculations.llms.md).

1\.

Goldwater Institute. [Alaska becomes 41st state to enact right to try legislation](https://www.goldwaterinstitute.org/release-alaska-becomes-41st-state-to-enact-right-to-try-legislation/). (2018).

2\.

Sinn, M. P. *Ubiquitous Pragmatic Trial Impact Analysis*. <https://papers.acceleratedmedicine.org/dfda-impact.html> (2025) doi:[10.5281/zenodo.18243914](https://doi.org/10.5281/zenodo.18243914)

*Only 15 diseases/year get their first treatment each year. With 6,650 diseases lacking effective treatments, the backlog would take 443 years to clear. Integrating pragmatic trials into standard healthcare increases trial capacity 12.3x, cutting that timeline from 443 years to 36 years. The average untreated disease gets a treatment 212 years earlier, saving 10.7 billion deaths at \$9.62 per year of healthy life saved.*

3\.

GAO. 95% of diseases have 0 FDA-approved treatments. *GAO* <https://www.gao.gov/products/gao-25-106774> (2025)

*95% of diseases have no treatment Additional sources: https://www.gao.gov/products/gao-25-106774 \| https://globalgenes.org/rare-disease-facts/*

.

4\.

Sinn, M. P. *Choose Your Own Earth: A World Without the Political Dysfunction Tax, or Terminal Parasitic Load in 15 Years*. <https://manual.warondisease.org/knowledge/economics/gdp-trajectories.html> (2025) doi:[10.5281/zenodo.19076850](https://doi.org/10.5281/zenodo.19076850)

*Your destructive economy (military spending plus cybercrime) is already 11.5% of GDP and growing faster than your productive economy. At current rates, it reaches the Soviet collapse threshold in 8 years and exceeds productive output in 15. This paper models two GDP trajectories: the optimized path under military-to-medical reallocation, and the default path to civilizational collapse.*

5\.

The Nation. Public support for redirecting military spending to health. *The Nation: Americans Want Jobs Not War* <https://www.thenation.com/article/archive/pentagon-military-spending/> (2020).

6\.

Sinn, M. P. *The 1% Treaty: An Incentive-Compatible Approach to Ending War and Disease*. <https://manual.warondisease.org/knowledge/economics/1-pct-treaty-impact.html> (2025) doi:[10.5281/zenodo.18161560](https://doi.org/10.5281/zenodo.18161560)

*6,650 diseases have zero FDA-approved treatments; at current trial capacity, exploring them takes  443 years. Redirecting 1% of military spending scales capacity 12.3x, cutting the timeline to  36 years and preventing 10.7 billion deaths. At \$0.02/DALY, 9.3kx more cost-effective than the best existing interventions. The result holds across every specified adoption pathway.*

7\.

Results for America & Echelon Insights. [Evidence-based policymaking poll](https://results4america.org/evidence-based-policymaking-poll/). (2026).

8\.

Sinn, M. P. *The Optimal Policy Generator: A Causal Inference Protocol for Maximizing Median Health and Wealth Through Public Policy*. <https://manual.warondisease.org/knowledge/appendix/optimal-policy-generator-spec.html> (2025) doi:[10.5281/zenodo.18603834](https://doi.org/10.5281/zenodo.18603834)

*The Optimal Policy Generator (OPG) produces systematic public policy recommendations for jurisdictions at any level (country, state, city), generating prioritized enact/replace/repeal/maintain recommendations to maximize real after-tax median income growth and median healthy life years, based on quasi-experimental evidence from centuries of policy variation data.*

9\.

Sinn, M. P. *The Optimal Budget Generator: A Causal Inference Protocol for Maximizing Median Health and Wealth Through Public Goods Funding*. <https://manual.warondisease.org/knowledge/appendix/optimal-budget-generator-spec.html> (2025) doi:[10.5281/zenodo.18356209](https://doi.org/10.5281/zenodo.18356209)

*The Optimal Budget Generator (OBG) uses causal inference, diminishing returns modeling, and cost-effectiveness evidence to determine optimal public goods funding levels that maximize two welfare metrics: real after-tax median income growth and median healthy life years. For each spending category, OBG estimates an Optimal Spending Level (OSL) and produces a gap analysis showing where current government budgets are over- or underfunded relative to evidence-based benchmarks. The Budget Impact Score (BIS) measures confidence in each recommendation based on the quality of causal evidence.*

10\.

Cato Institute. Chance of dying from terrorism statistic. *Cato Institute: Terrorism and Immigration Risk Analysis* <https://www.cato.org/policy-analysis/terrorism-immigration-risk-analysis>

*Chance of American dying in foreign-born terrorist attack: 1 in 3.6 million per year (1975-2015) Including 9/11 deaths; annual murder rate is 253x higher than terrorism death rate More likely to die from lightning strike than foreign terrorism Note: Comprehensive 41-year study shows terrorism risk is extremely low compared to everyday dangers Additional sources: https://www.cato.org/policy-analysis/terrorism-immigration-risk-analysis \| https://www.nbcnews.com/news/us-news/you-re-more-likely-die-choking-be-killed-foreign-terrorists-n715141*

.

11\.

Sinn, M. P. *The Court of Humanity*. <https://manual.warondisease.org/knowledge/solution/court-of-humanity.html> (2025) doi:[10.5281/zenodo.20075681](https://doi.org/10.5281/zenodo.20075681)

*A decentralized court where 8 billion humans are the jury, sovereign immunity is a choice nobody chose, and  \$104 quadrillion in unliquidated wrongful-death exposure makes the 1% Treaty the most generous settlement offer in legal history.*

12\.

Cato Institute. [Poll: 63% of americans favor eliminating qualified immunity for police](https://www.cato.org/survey-reports/poll-63-americans-favor-eliminating-qualified-immunity-police). (2020).

13\.

Pew Research Center. [Majority of public favors giving civilians the power to sue police officers for misconduct](https://www.pewresearch.org/politics/2020/07/09/majority-of-public-favors-giving-civilians-the-power-to-sue-police-officers-for-misconduct/). (2020).

14\.

Sinn, M. P. *Humanity v. Government*. <https://manual.warondisease.org/knowledge/appendix/humanity-v-government.html> (2025) doi:[10.5281/zenodo.20075757](https://doi.org/10.5281/zenodo.20075757)

*An indictment for negligent mass homicide separating historical body counts from forward-looking treaty-settlement exposure, with a 1% military reallocation as the only remedy commensurate with the offense.*

15\.

Kuran, T. *[Private Truths, Public Lies: The Social Consequences of Preference Falsification](https://www.hup.harvard.edu/books/9780674707580)*. (Harvard University Press, Cambridge, MA, 1995).

*Kuran’s theory of preference falsification: individuals misrepresent their private preferences under perceived social pressure. The book provides a unified theory of how preference falsification shapes collective decisions, sustains social stability, distorts human knowledge, and conceals political possibilities, with applications including the unexpected fall of communism, opposition to affirmative action, and the durability of India’s caste system. Explains why large private majorities can remain invisible until a credible public measurement reveals them.*

16\.

Harvard Kennedy School. 3.5% participation tipping point. *Harvard Kennedy School* <https://www.hks.harvard.edu/centers/carr/publications/35-rule-how-small-minority-can-change-world> (2020)

*The research found that nonviolent campaigns were twice as likely to succeed as violent ones, and once 3.5% of the population were involved, they were always successful. Chenoweth and Maria Stephan studied the success rates of civil resistance efforts from 1900 to 2006, finding that nonviolent movements attracted, on average, four times as many participants as violent movements and were more likely to succeed. Key finding: Every campaign that mobilized at least 3.5% of the population in sustained protest was successful (in their 1900-2006 dataset) Note: The 3.5% figure is a descriptive statistic from historical analysis, not a guaranteed threshold. One exception (Bahrain 2011-2014 with 6%+ participation) has been identified. The rule applies to regime change, not policy change in democracies. Additional sources: https://www.hks.harvard.edu/centers/carr/publications/35-rule-how-small-minority-can-change-world \| https://www.hks.harvard.edu/sites/default/files/2024-05/Erica%20Chenoweth_2020-005.pdf \| https://www.bbc.com/future/article/20190513-it-only-takes-35-of-people-to-change-the-world \| https://en.wikipedia.org/wiki/3.5%25_rule*

.

17\.

Calculated from IHME Global Burden of Disease (2.55B DALYs) and global GDP per capita valuation. \$109 trillion annual global disease burden.

*The global economic burden of disease, including direct healthcare costs (\$8.2 trillion) and lost productivity (\$100.9 trillion from 2.55 billion DALYs × \$39,570 per DALY), totals approximately \$109.1 trillion annually.*

18\.

Oren Cass, Manhattan Institute. RECOVERY trial cost per patient. *Oren Cass* <https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs> (2023)

*The RECOVERY trial, for example, cost only about \$500 per patient... By contrast, the median per-patient cost of a pivotal trial for a new therapeutic is around \$41,000. Additional sources: https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs*

.

19\.

FDA Study via NCBI. Trial costs, FDA study. *FDA Study via NCBI* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248200/>

*Overall, the 138 clinical trials had an estimated median (IQR) cost of \$19.0 million (\$12.2 million-\$33.1 million)... The clinical trials cost a median (IQR) of \$41,117 (\$31,802-\$82,362) per patient. Additional sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248200/*

.