Your goal is simple: eliminate all disease. The constraint is also simple: resources are scarce.
You have limited money, time, and talent. Every dollar on a low-impact trial is a dollar not curing cancer.
Every researcher writing grant applications is a researcher not doing research.
Every patient excluded from trials is data you'll never collect and a person you'll never help.
Your current system fails this optimization so thoroughly it almost looks intentional.
Your N.I.H. spends forty-seven billion dollars a year. Your scientists spend 50 to 67 percent of their time writing grant
applications instead of doing science. Billions flow to projects that never produce treatments.
Your system isn't designed to maximize cures. It's designed to maximize grant-writing.
This isn't a conspiracy. It's just what happens when you design a system that rewards asking for money instead of producing
results. You've accidentally built a machine whose primary output is paperwork and whose secondary output is occasionally,
reluctantly, medicine. Your Decentralized Institute of Health (D.I.H.) is an alternative design that optimizes for a single
metric: maximum R.O.I. toward disease eradication. It's what you'd build if you started from scratch and actually wanted
results. The Health-Industrial Complex: Coordinating Your War on Disease.
The Olsonian Problem. Your economist Mancur Olson identified why public goods are systematically underproduced: diffuse
benefits and concentrated costs. In simpler terms: everyone benefits from a cure for cancer, but nobody benefits enough
to fight for it the way a weapons manufacturer fights for a bomber contract.
It's one of those observations that's obvious once someone says it, and invisible before, which describes most of your species'
problems. Curing cancer benefits 8 billion people a little.
Blocking cancer cures benefits a few thousand pharmaceutical executives a lot.
The executives show up to lobby. The 8 billion don't. This is why your species has spent 50 years "fighting cancer" while
your defense industry got stealth bombers, aircraft carriers, and G.P.S.
Your military-industrial complex solved this problem for defense.
Defense contractors, generals, politicians, and workers all have concentrated interests in military spending.
They coordinate. They lobby. They win budgets. Result: the most powerful military in human history.
Disease has no such coalition. Your patients are too sick to lobby.
Your researchers compete for scraps. Your funders lack coordination.
Your politicians get no credit for cures that arrive after their term ends (which is all of them, because cures take 15
years and terms last 4). Everyone wants disease eradicated; no one has a concentrated interest in making it happen.
It's like everyone wanting a clean kitchen but nobody wanting to do the dishes, except the dishes are cancer and the kitchen
is on fire. Your D.I.H. solves the Olsonian problem by creating concentrated interests in disease eradication.
See The Incentive Stack for how. Your military-industrial complex coordinates actors around defense.
Your D.I.H. creates a health-industrial complex that coordinates actors around eradication.
Same structure, opposite purpose. SHAEF for Your War on Disease.
In 1944, Eisenhower didn't replace the Allied armies. He coordinated them.
Set the objective, allocated resources, made sure everyone pulled in the same direction.
Your D.I.H. is SHAEF for the war on disease. Pharma companies stay pharma companies.
Universities stay universities. Patient groups stay patient groups.
But they operate as one force because your D.I.H. coordinates them toward eradication.
Your war on disease has been losing for 50 years because it's not actually a war.
It's a collection of uncoordinated skirmishes where researchers compete for grants, pharma companies hide failures, and
patients can't access trials. You've been "fighting" cancer the way a cat "fights" a laser pointer: lots of energy, no coordination,
nothing caught. Imagine if D-Day had been run this way. The Americans land at one beach, the British at another.
Neither tells the other what they learned. Both compete for the same supply ships while the enemy reads their grant applications.
Your D.I.H. is the coordination layer that turns scattered skirmishes into a unified campaign.
Your D.I.H.: The R.O.I. Maximization Protocol. Your D.I.H. is not a platform.
It's not an organization. It's not even really a thing. It's a coordination protocol with one function: "Make every actor
do the highest-R.O.I. thing toward total disease eradication."
This means: Every dollar flows to maximum impact. Every researcher works on highest-value problems.
Every patient joins trials that matter most. Nothing gets wasted on low-R.O.I.
activities. On your planet, you call this radical. On mine, we call it "obvious.".
Three Core Functions. Your D.I.H. does exactly three things: Receive funds (from the one percent Treaty, donations, etcetera).
Allocate research via patient subsidies (market mechanism) and infrastructure via Wishocracy.
Verify results and pay proportional to impact. Everything operational is outsourced.
Trial infrastructure? That's your D.F.D.A. (a decentralized F.D.A.)'s job.
Task decomposition? A.I. services. Talent matching? Existing marketplaces.
Crowdfunding? Existing platforms. Why stay thin? Because thin protocols are hard to capture.
There's nothing to bribe. No operational role to corrupt. No C.E.O.
to take on a yacht trip. Just code that moves money toward measured outcomes.
Your species has a habit of corrupting every institution you build.
You corrupt them the way water corrodes pipes: inevitably, given enough time and contact.
This one is boring enough that nobody bothers. The Core Innovation: Pay for Results.
Every dollar flows based on results, not promises: Patients vote with their enrollment, which means researchers get paid
for attracting patients. Outcomes determine continued funding, so campaigns that deliver get more, and failures get defunded.
No one gets paid for writing grant proposals. No one gets paid for attending review committees.
No one gets paid for publishing papers about why their research might work someday.
This is how most other industries work. You pay contractors when they build the house, not when they promise to build it.
You pay farmers when they grow the food, not when they apply for a farming license.
Your Data Commons: Publish Everything. Your current system hides failures.
Companies bury negative results. Researchers don't publish what didn't work.
Your scientists waste billions repeating mistakes someone else already made because they literally cannot find out those
mistakes were already made. It's like your whole species has amnesia, but only for the embarrassing parts.
You remember your triumphs in high definition and forget your failures completely.
This is called "being human." It's also called "why you keep dying.".
Your Decentralized Institutes of Health, or D.I.H., requires one hundred percent open publication of all data, positive
and negative, as a condition of funding: Every trial, every result, and every dataset is published.
A.I. models scan the global data commons, finding patterns humans miss.
Failed experiments become shared knowledge, not repeated waste.
This is intelligence sharing in the SHAEF analogy. Your Allies won partly because they shared Ultra intercepts across commands.
Your war on disease loses because everyone guards their failures like trade secrets.
Think of it as a group chat where everyone shares what didn't work.
Except the group is your entire species and the topic is death prevention.
Governance: Market Mechanism and Wishocracy. Your D.I.H. uses two allocation mechanisms: Patient subsidies (market mechanism):
Research funding follows patient choice. Patients enroll in trials they believe in; funding flows accordingly.
Variable subsidy rates ensure rare diseases remain viable. No committees decide "cancer versus Alzheimer's."
Wishocracy is for infrastructure and public goods only. It aggregates preferences through pairwise comparisons ("electronic
health record, or E.H.R., integration or security audits?").
The Incentive Stack: Making return on investment, or R.O.I., the Selfish Choice.
Your D.I.H. doesn't rely on altruism. Altruism is lovely but flaky.
It shows up when it feels like it, cancels last minute, and is always "busy that weekend."
Instead, your D.I.H. pays everyone to do the highest R.O.I.
thing. Greed is more dependable than kindness. Your entire economic system proves this daily.
Nobody ever forgot to be greedy. For researchers, their self-interest is money and prestige.
Their D.I.H. incentive is per-patient subsidies (higher for rare diseases), and their R.O.I.
alignment is: attract patients equals get paid. For patients, their self-interest is health and compensation.
Their D.I.H. incentive is that subsidies scale with trial importance, and their R.O.I.
alignment is: joining high-priority trials equals more paid.
For politicians, their self-interest is re-election and legacy.
Their D.I.H. incentive is incentive alignment bonds, or I.A.B.s, tied to disease outcomes, and their R.O.I.
alignment is: better outcomes equals a bigger bonus. For funders, their self-interest is impact and returns.
Their D.I.H. incentive is quadratic matching and outcome tracking, and their R.O.I.
alignment is: high R.O.I. donations equals amplified impact.
For data providers, their self-interest is revenue. Their D.I.H.
incentive is fees tied to data utility, and their R.O.I. alignment is: more useful data equals more revenue.
For campaigns, their self-interest is funding. Their D.I.H.
incentive is results-based continued funding, and their R.O.I.
alignment is: higher R.O.I. equals more funding. Every incentive is R.O.I.-weighted.
Not just "do good" but "do the MOST good per dollar or hour."
Your D.I.H. makes the highest R.O.I. action the selfish choice for every actor.
Selfishness, properly directed, cures cancer. How Your Researchers Get Paid.
Your traditional system: Write a grant proposal. Hope a committee likes it.
Get paid to try. Maybe produce results. Maybe not. Get paid either way.
Your D.I.H. system: Per-patient subsidies: The more patients who join your trial, the more funding you get.
Patients vote with their enrollment. Variable subsidy rates: Rare diseases get higher per-patient subsidies.
Small patient pools don't mean small budgets. Results-based continuation: Deliver results, get more funding.
Don't deliver, get defunded. Like every other job on your planet except, somehow, research.
Pay your scientists like you pay your plumbers: for fixing the problem, not for explaining why it's hard.
How It Works For Your Patients. Your D.I.H. doesn't replace your healthcare system.
It adds an "experimental treatment insurance layer" on top.
Your species already understands insurance. You just hadn't thought to apply it to not dying of untreated diseases.
Sarah has Type Two Diabetes. Old system: Metformin not working.
No other options covered. Pays five hundred dollars a month for branded drug.
Still has poor control. With your D.I.H.: Her doctor checks the trial network during a regular visit.
Sees five relevant trials. Recommends one based on Sarah's profile.
Sarah enrolls with one click. The trial coverage pool covers all costs.
Sarah pays a thirty dollar copay. Gets an experimental drug that might work better.
Reports blood sugar via app. Her data helps the next patient.
Total time added to doctor visit: three minutes. Cost per patient per month: D.I.H.
trial coverage costs between three hundred ten and two thousand five hundred ten dollars (medication monitoring data collection).
A traditional trial costs between six thousand eight hundred and thirteen thousand six hundred dollars.
The efficiency gain is seventy-five to eighty percent. Why your doctors will cooperate: There are more treatment options
for desperate patients. Doctors receive continuing medical education credits, or C.M.E.
credits, for participation. There is no liability (covered by trial insurance).
It takes only one click in their electronic medical records, or E.M.R.s.
There are no new systems to learn. Why your patients will use it: Affordable access to experimental treatments (twenty to
fifty dollar copay). Doctor-recommended. Insurance-like coverage (familiar model).
No financial risk. They help others while helping themselves.
It's like being a guinea pig, except the guinea pig gets paid and gets medicine.
How Your Politicians Get Aligned. Your politicians optimize for reelection, status, and post-office careers.
"Humans continuing to exist" doesn't appear on their performance review.
This is a design flaw in your democracy, not a moral failing.
Well, it's both. But mostly it's a design flaw, because if you put saints in a badly designed system, you get the same results.
You just feel more betrayed. Incentive Alignment Bonds solve this by making "support pragmatic clinical trial funding" the
career-optimal move: Public Good Scores track voting records on health policy.
Electoral support flows to high-scorers via independent PACs.
Post-office opportunities (fellowships, boards) reserved for leaders who governed well.
No bribes. No corruption. Just a standing rule: support policies that measurably reduce suffering and your political career
gets easier. Oppose them and it gets harder. Your politicians will figure it out.
They're not stupid. They got elected, which requires a very specific and impressive type of intelligence, none of which
involves curing diseases. How the Money Flows. The Architecture.
The one percent Treaty Fund: Holds the treasury (from the one percent Treaty).
Allocates between infrastructure and public goods via Wishocracy.
Funds campaigns, not bureaucracies. No C.E.O., no board, no one to corrupt.
Your Decentralized Institute of Health (D.I.H.): A thin coordination protocol.
Receives funding FROM the one percent Treaty Fund. Research allocation via patient subsidies (market mechanism).
Verifies results, pays for outcomes. Your D.F.D.A. (a decentralized F.D.A.): A funded CAMPAIGN, not part of your D.I.H.
itself. Provides technical infrastructure for trials. Competes with other research models for funding.
Has no budget authority (just a service provider). The Fund Flow.
Your one percent Treaty redirects twenty-seven point two billion dollars a year from global military budgets into the one
percent Treaty Fund. But not all of it reaches research (some of it goes to keeping the machine running): Ten percent, or
two point seven two billion dollars, goes to VICTORY Bond investors to repay campaign funders.
Ten percent, or two point seven two billion dollars, goes to political incentives (Incentive Alignment Bonds, or I.A.B.s)
to keep politicians aligned. Eighty percent, or twenty-one point eight billion dollars, goes to the Research treasury for
patient subsidies (market allocation). What Gets Funded: Market Failures Only.
Most research allocation happens automatically (patients choose trials, funding flows there).
Your one percent Treaty Fund primarily funds MARKET FAILURES.
These are the things your ecosystem can't handle on its own.
Infrastructure Development and operations. Competing alternative implementations.
Data commons infrastructure (storage, processing). Security audits and fraud detection systems.
True Public Goods (No Revenue Model) Patient trial participation subsidies.
Negative results publishing. Replication studies. This is minimal by design.
Your ecosystem handles most research funding automatically: companies register treatments, patients join trials, revenue
flows, research happens. Your D.I.H. only directs the one percent Treaty Fund to cover what the market genuinely can't.
What Your D.I.H. Outsources (and Why). Your D.I.H. is intentionally minimal.
It outsources everything operational because the best way to avoid corruption is to have nothing worth corrupting: Crowdfunding
is outsourced to Gitcoin, Juicebox, and others because they already exist and work.
Task decomposition is outsourced to A.I. services because machines are better at this.
Talent matching is outsourced to existing marketplaces so you don't reinvent LinkedIn.
Trial infrastructure is outsourced to D.F.D.A. (a decentralized F.D.A.) to separate concerns.
Data storage is outsourced to competing providers to encourage market competition.
How Campaigns Plug In. Your D.F.D.A. (a decentralized F.D.A.) is the main example of a funded campaign.
It's not part of your D.I.H. It's a service provider competing for funding.
If it stops performing, you fund something better. This is how your species runs restaurants.
Time to try it with medicine. Campaign Lifecycle. Proposal: submit the campaign description, budget, and milestones.
Wishocracy vote: humanity decides priority relative to alternatives.
Funding: the treasury allocates based on the vote plus Optimocracy recommendations.
Execution: the campaign delivers services (trials, infrastructure, and others).
Verification: measure outcomes against milestones. Continuation: results determine next year's funding.
Anti-Capture Design. Your current system is trivially captured.
Concentrate billions of dollars in a few committees, and lobbyists will find them.
This is as predictable as gravity, and your species keeps being surprised by it the way a dog is surprised by a vacuum cleaner.
Every single time. Your D.I.H. makes capture economically irrational.
How Your D.I.H. Resists Capture. Mechanism: No CEO. Nothing to bribe.
Capture cost is not applicable. Mechanism: Algorithmic governance.
Rules in smart contracts. You can't bribe an if-statement. Mechanism: Public ledger.
Every dollar tracked. Corruption is visible. Mechanism: Forkable.
Anyone can clone the protocol. Capture triggers replacement.
Mechanism: Distributed voting. Millions vote via Wishocracy.
Lobbying doesn't scale. Mechanism: Outcome-based funding. Results determine allocation.
Gaming is harder than performing. The "New F.D.A." Risk. Risk: "What if your D.F.D.A.
(a decentralized F.D.A.) becomes the new F.D.A., capturing regulatory power?".
Mitigation: Your D.F.D.A. (a decentralized F.D.A.) has no budget authority.
It's just a campaign competing for funding. If it gets captured, fund a competing framework instead.
Replace it like you replace a bad restaurant: stop going there and open a better one.
Your protocol ensures no single component can monopolize power.
Everything is replaceable. Nothing is essential except the coordination rules themselves.
Security Architecture: Multi-Layered Defense. A twenty-seven point two billion dollar treasury is a massive target.
Every thief, hacker, and corrupt bureaucrat on your planet will try to steal from it.
This is not speculation. This is a certainty, like sunrise or a politician lying.
Your D.I.H. uses defense in depth: 1. Nobody's in Charge (And That's the Point) *Turns out you don't need a CEO when you
have math.* Every VICTORY Bond holder directly controls treasury through on-chain voting.
No human signers equals no kidnapping, corruption, or coercion targets.
Smart contracts automatically execute community decisions after twenty-four to seventy-two hour timelocks.
Battle-tested approach already managing billions in MakerDAO, Uniswap, and Aave.
2. A.I.-Powered Fraud Detection Fraud Agent: real-time anomaly detection, duplication monitoring, collusion identification,
and sybil detection. Safety Oracle: incident severity scoring with automatic payout holds for affected interventions.
Identity Oracle: verifies affiliations and conflicts, and prevents unauthorized access.
Manual review queue for flagged actions with whistleblower bounty rewards.
3. Complete Transparency and Auditability All treasury addresses published with real-time public dashboards.
Immutable transaction logs with standardized disbursement tags.
Annual smart contract audits and semiannual operational audits with published reports.
Hash-committed invoices and budgets for full accountability.
4. Recovery and Response Mechanisms Clawbacks for data falsification or trial misconduct.
Emergency pause capabilities triggered by incident signals.
Progressive unpause policies tied to remediation completion.
Guardian modules for pausing non-critical functions under defined conditions.
Beyond Medical Research. You can prove this model works with a twenty-seven point two billion dollar treasury.
Then apply it to everything else your governments currently mismanage: Education: Pay teachers based on whether kids actually
learn things. Infrastructure: Fund roads that don't immediately fall apart.
Environment: Pay for actual carbon reduction, not paperwork.
Social Services: Get help to people who need it without forty-seven forms.
This isn't just about protecting health funding. It's a proof of concept for uncorruptible governance.
Your one percent Treaty Fund becomes the prototype. If you can manage twenty-seven point two billion dollars without humans
stealing it, you can manage anything. The trick is removing the humans from the parts where they steal, which, historically,
is all the parts. Summary: Your Coordination Layer. Your D.I.H.
is not a research institution, a trial platform, or a funding agency.
It's the thin layer that coordinates all of them. The one percent Treaty Fund serves as the treasury, receiving funds from
the treaty. Patient subsidies manage research allocation through a market mechanism where patients choose trials.
Wishocracy governs infrastructure and allocates between infrastructure and public goods.
The D.F.D.A. provides trial infrastructure as a funded campaign.
I.A.B.s I.A.B.s ensure political alignment and keep politicians incentivized.
VICTORY Bonds provide investor alignment and fund the campaign.
The single sentence version: "Your D.I.H. receives funds, allocates research via patient subsidies, governs infrastructure
via Wishocracy, verifies results, and pays proportional to outcomes, making the highest-R.O.I.
action the selfish choice for every actor." That's the theory.
The rest of this manual explains how you actually build it.