1 00:00:00,440 --> 00:00:07,420 Frequently Asked Objections Fun facts for those reasonably skeptical of spending one percent more on helping sick people 2 00:00:07,420 --> 00:00:13,480 than killing them. I have now presented this plan to humans one hundred and forty-seven times. 3 00:00:13,920 --> 00:00:18,940 The objections follow a pattern so predictable I wrote a script to generate this chapter. 4 00:00:19,720 --> 00:00:25,040 (I didn't. But I could have. You are very consistent in what you find alarming about not dying.). 5 00:00:25,900 --> 00:00:33,080 Every civilization I've observed goes through the same five stages when presented with a plan to stop killing itself: One. 6 00:00:33,420 --> 00:00:39,260 "That's impossible" (it isn't). Two. "That's dangerous" (less dangerous than the current thing). 7 00:00:39,880 --> 00:00:43,940 Three. "That's naive" (you named your war building after how many sides it has). 8 00:00:44,540 --> 00:00:52,550 Four. "Okay but what about..." (this chapter). Five. "We were always going to do that" (you weren't, but I'll take it). 9 00:00:53,260 --> 00:00:59,340 You are currently at stage four. Congratulations. Here are your objections, in the order you always raise them. 10 00:01:00,240 --> 00:01:05,379 We Need the Military Budget. Objection: "We can't reduce military spending. 11 00:01:05,760 --> 00:01:09,220 That would make us vulnerable." The treaty takes one percent. 12 00:01:09,680 --> 00:01:17,080 You keep ninety-nine percent. Every nation reduces by the same amount, so relative military balance stays exactly the same. 13 00:01:17,560 --> 00:01:20,340 You each have one percent fewer missiles pointed at each other. 14 00:01:20,920 --> 00:01:27,260 On Wishonia, we call this "safer." On Earth, you call it "an unacceptable risk to national security." 15 00:01:27,700 --> 00:01:34,900 Same math, different feelings. The Pentagon cannot account for two point five trillion dollars in spending. 16 00:01:35,360 --> 00:01:40,100 You're not redirecting the missile budget. You're redirecting the "we lost it somewhere" budget. 17 00:01:40,640 --> 00:01:48,460 The missiles won't even notice. COVID nineteen killed more Americans than World War One, World War Two, Korea, Vietnam, 18 00:01:48,800 --> 00:01:57,280 Iraq, and Afghanistan combined. Your nearly nine hundred billion dollars murder budget watched it happen, fully armed and 19 00:01:57,280 --> 00:02:01,210 completely confused. The virus did not check your passport. 20 00:02:01,380 --> 00:02:05,700 It did not consult your defense posture. It did not read your threat assessment. 21 00:02:06,480 --> 00:02:13,380 Disease is the only enemy that attacks every nation simultaneously, charges no import tariffs, and has never once considered 22 00:02:13,380 --> 00:02:18,820 your feelings about geopolitics. You are the only species that needs to be talked into fighting it. 23 00:02:19,880 --> 00:02:26,820 Your War on Terror cost eight trillion dollars, killed nine hundred thousand people, and terrorist attacks went from about 24 00:02:26,820 --> 00:02:31,260 one thousand per year to nearly seventeen thousand per year by twenty fourteen. 25 00:02:32,180 --> 00:02:39,020 Robert Pape at the University of Chicago analyzed every suicide terrorist attack from nineteen eighty to two thousand and 26 00:02:39,020 --> 00:02:46,460 three and found that ninety-five percent were responses to foreign military occupation, not ideology. 27 00:02:46,460 --> 00:02:50,160 Half the attackers were atheists and Marxists, not jihadists. 28 00:02:50,700 --> 00:02:55,140 Nearly all targeted democracies with military bases in the attackers' homeland. 29 00:02:55,640 --> 00:03:03,120 You spent eight trillion dollars manufacturing the exact threat you were spending eight trillion dollars to eliminate. 30 00:03:03,700 --> 00:03:06,740 On Wishonia, this is taught in schools as a cautionary tale. 31 00:03:07,200 --> 00:03:12,100 The course is called "Circular Spending." After World War Two, the U.S. 32 00:03:12,160 --> 00:03:19,060 cut military spending by eighty-seven point six percent in two years (one point four two trillion dollars to one hundred 33 00:03:19,060 --> 00:03:25,300 and seventy-six billion dollars in today's dollars). G.M. went from B twenty-four bombers back to Cadillacs. 34 00:03:25,960 --> 00:03:29,230 Frigidaire stopped making machine guns and went back to refrigerators. 35 00:03:29,800 --> 00:03:37,420 The economy produced the greatest boom in your history. You're currently spending thirty point six times the pre-World War 36 00:03:37,420 --> 00:03:44,640 Two baseline in inflation-adjusted dollars. Your grandparents handled an eighty-eight percent cut and built the middle class. 37 00:03:45,360 --> 00:03:50,760 You're being asked for one percent and acting like someone suggested disbanding the army during an invasion. 38 00:03:51,340 --> 00:03:58,420 Either the human genome degraded significantly in three generations, or someone is making a lot of money telling you this 39 00:03:58,420 --> 00:04:04,660 is impossible. (It's the second one.). Follow-up: "But what about defense industry jobs?". 40 00:04:05,200 --> 00:04:11,420 One percent is a rounding error. Engineers building guidance systems can build medical imaging devices. 41 00:04:11,980 --> 00:04:20,680 Same differential equations, fewer funerals. Big Pharma Will Block This Objection: "Pharmaceutical companies will kill this. 42 00:04:20,820 --> 00:04:26,880 They profit from disease.". Pharma currently pays two point six billion dollars per drug. 43 00:04:27,460 --> 00:04:34,220 Ninety percent fail. This is called "drug development." On Wishonia, we have a different word for spending billions with 44 00:04:34,220 --> 00:04:42,080 a ten percent success rate. We call it "gambling.". Under the current system, pharma pays for trials (spend billions, pray). 45 00:04:42,580 --> 00:04:50,060 Under the new system, a treaty fund pays pharma to pray. In the current system, trial outcomes are a ninety percent expensive 46 00:04:50,060 --> 00:04:55,360 failure. In the new system, it is a ninety percent failure, but with someone else's money. 47 00:04:56,000 --> 00:04:58,960 The current business model is a casino, but with lab coats. 48 00:04:59,600 --> 00:05:07,240 The new business model is a paycheck, but with lab coats. Under this system, trials become revenue instead of cost. 49 00:05:07,260 --> 00:05:12,960 You're offering the casino a guaranteed salary. Casinos love guaranteed salaries. 50 00:05:13,240 --> 00:05:20,140 They'd trample each other getting to the signing ceremony. The only reason pharma "profits from disease" is because you 51 00:05:20,140 --> 00:05:27,120 built a system where curing disease is a financial risk. Remove the risk and they'll cure things faster than you can name 52 00:05:27,120 --> 00:05:31,300 them. They're not evil. They're just doing math. Change the math. 53 00:05:32,320 --> 00:05:38,260 What About National Sovereignty? Objection: "This forces countries to spend money a certain way. 54 00:05:38,760 --> 00:05:44,300 That violates sovereignty.". Sovereignty means "we decide what happens to us." 55 00:05:44,560 --> 00:05:49,300 The treaty asks countries to decide. Countries that don't want to may decide not to. 56 00:05:49,780 --> 00:05:54,860 Countries that do want to may decide to. Sovereignty remains intact throughout. 57 00:05:55,020 --> 00:05:57,670 That is how deciding works. I checked with your dictionaries. 58 00:05:58,140 --> 00:06:04,740 They agree with me. The F.D.A. Exists for a Reason Objection: "We need F.D.A. 59 00:06:04,900 --> 00:06:09,160 approval to ensure safety. You're being reckless.". The F.D.A. 60 00:06:09,160 --> 00:06:16,340 confirms a drug is safe. Then it locks the safe drug in a cabinet for eight point two years to study whether it works *well 61 00:06:16,340 --> 00:06:23,260 enough*. The drug won't kill you. Everyone agrees. But you can't have it because a committee needs eight point two years 62 00:06:23,260 --> 00:06:28,440 to measure how much it helps. Meanwhile, the disease it treats is not waiting. 63 00:06:28,800 --> 00:06:36,620 The disease does not have a committee. It's a lifeguard who confirms the life preserver floats, then locks it in a cabinet 64 00:06:36,620 --> 00:06:43,500 to study its buoyancy profile while people drown. The lifeguard then publishes a paper about buoyancy. 65 00:06:44,060 --> 00:06:48,200 The paper wins an award. The family of the drowned person receives a copy. 66 00:06:49,480 --> 00:06:58,440 I calculated the ratio: for every one person protected from a dangerous drug, three thousand and seventy die waiting for 67 00:06:58,440 --> 00:07:03,880 a safe one that's locked in the approval cabinet. I checked it twice because it seemed wrong. 68 00:07:04,360 --> 00:07:09,420 It wasn't wrong. The people it kills die quietly, in waiting rooms. 69 00:07:10,120 --> 00:07:15,600 The system does not count them, which is convenient for the system and less convenient for the dead. 70 00:07:16,740 --> 00:07:23,860 "What If Countries Cheat?". Objection: "Countries will promise to reduce military spending but won't.". 71 00:07:24,720 --> 00:07:31,340 Of course they will. Trust has a historical compliance rate of approximately "whenever it suits them." 72 00:07:32,020 --> 00:07:39,180 Your governments print "full faith and credit" on their money, which is charming given that they ran out of both in nineteen 73 00:07:39,180 --> 00:07:47,800 seventy-one. This system was designed by someone who has watched eight hundred and forty-seven civilizations (me), and it 74 00:07:47,800 --> 00:07:57,400 does not use trust. It uses math. Politicians who comply receive Incentive Alignment Bond benefits: campaign funding and 75 00:07:57,560 --> 00:08:04,440 cushy post-office careers (they love this). Politicians who don't comply get nothing (they hate this). 76 00:08:05,480 --> 00:08:10,960 Every contribution is public on blockchain, so lying is difficult (they really hate this). 77 00:08:12,020 --> 00:08:20,140 Benefits route automatically via smart contracts, because humans cannot be trusted to distribute papers fairly (this has 78 00:08:20,140 --> 00:08:24,520 been tested extensively, for all of recorded history, and the results are in). 79 00:08:25,300 --> 00:08:29,940 The system assumes the worst about human nature and designs around it. 80 00:08:30,740 --> 00:08:36,620 Compliance is the career-maximizing choice. It's Pavlovian conditioning, but for senators. 81 00:08:37,140 --> 00:08:40,940 The senators don't love this comparison. The data supports it anyway. 82 00:08:42,179 --> 00:08:48,280 "You Can't Cure Aging". Objection: "Aging is natural and inevitable. 83 00:08:48,620 --> 00:08:54,580 You can't fight nature.". Smallpox was natural. Polio was natural. 84 00:08:54,680 --> 00:08:59,120 Dying in childbirth was natural. You fought all of them and won. 85 00:08:59,700 --> 00:09:04,360 "Natural" is not a synonym for "good." Earthquakes are natural. 86 00:09:04,380 --> 00:09:10,240 You don't argue against earthquake-proof buildings by saying "but earthquakes are natural and inevitable.". 87 00:09:11,200 --> 00:09:17,680 You already replace everything that breaks: Hearts (replaced; you're basically a car at this point). 88 00:09:18,240 --> 00:09:25,150 Kidneys (replaced, or hooked to a machine thrice weekly). Blood (replaced from other humans, which is recycling). 89 00:09:26,020 --> 00:09:33,800 Bones (titanium; stronger than the original). Joints (your grandma is fifteen percent metal and doing fine). 90 00:09:34,520 --> 00:09:43,100 Aging is damage accumulation with known repair pathways: Telomeres shorten: lengthen them (telomerase activation). 91 00:09:43,680 --> 00:09:51,680 Cells senesce: clear them (senolytic drugs). Proteins misfold: refold them (molecular chaperones). 92 00:09:52,540 --> 00:09:57,780 Mitochondria fail: replace them (mitochondrial transfer). D.N.A. 93 00:09:57,840 --> 00:10:03,360 breaks: repair it (CRISPR, base editing). You went to the moon with slide rules. 94 00:10:03,640 --> 00:10:09,040 You split the atom before you invented the transistor. You can probably fix cells with A.I. 95 00:10:09,460 --> 00:10:14,180 Unless you think cells are harder than atoms, in which case I have concerns about your physics curriculum. 96 00:10:15,120 --> 00:10:19,480 I'm Just One Person. Objection: "My vote/investment/share won't matter. 97 00:10:19,840 --> 00:10:25,080 I'm too small.". Your contribution: vote (two minutes), share (fifteen minutes). 98 00:10:25,580 --> 00:10:32,180 Total: seventeen minutes. Potential return: fifty thousand extra hours of life if diseases get cured. 99 00:10:32,300 --> 00:10:36,560 That's a one hundred and seventy-six thousand times return on seventeen minutes. 100 00:10:37,200 --> 00:10:43,030 Your best stock pick has never done this. Your best stock pick has never done one-thousandth of this. 101 00:10:43,440 --> 00:10:49,160 This needs two hundred and eighty million people. You tell ten, they each tell ten. 102 00:10:49,700 --> 00:10:56,320 Six degrees of sharing reaches millions. You spent longer than seventeen minutes choosing what to watch on Netflix last 103 00:10:56,320 --> 00:11:04,260 night. You chose a show about murder. You could have chosen not to be murdered by disease, but the interface was less intuitive. 104 00:11:05,180 --> 00:11:09,880 Why Not Just Reform the System? Objection: "Why not just reform the F.D.A. 105 00:11:10,040 --> 00:11:13,800 and N.I.H.? Or increase health funding without cutting military spending?". 106 00:11:14,500 --> 00:11:18,840 People have been trying for fifty years. Here's the scorecard: More funding? 107 00:11:19,200 --> 00:11:22,420 Tried. They hired more administrators. Different leadership? 108 00:11:22,780 --> 00:11:27,320 Tried. Same results, fancier titles. New regulations? Tried. 109 00:11:27,340 --> 00:11:31,640 Now takes twenty years instead of seventeen. Progress. Reform bills? 110 00:11:31,880 --> 00:11:37,280 Tried. Lobbyists killed them in committee. Efficiently. The system is not broken. 111 00:11:37,360 --> 00:11:43,720 I need you to understand this. Defense contractors spend one hundred and twenty-seven million dollars yearly on lobbying 112 00:11:43,720 --> 00:11:51,460 and get nearly one trillion dollars in contracts. That is the most efficient return on investment in American capitalism. 113 00:11:51,900 --> 00:11:55,840 The system works perfectly. It works perfectly for the people who built it. 114 00:11:56,700 --> 00:12:01,920 They will not surrender it because you asked nicely, or because you asked loudly, or because you made a sign. 115 00:12:02,460 --> 00:12:06,460 They will surrender it when you outbid them. That's the chapter you already read. 116 00:12:07,280 --> 00:12:11,760 Follow-up: "Fine, but why cut military spending? Just allocate more to health.". 117 00:12:12,560 --> 00:12:16,080 Money isn't the only constraint. You can't print more physicists. 118 00:12:16,640 --> 00:12:23,580 (You've tried. It takes twenty-five years and a Ph.D. program.) Cutting one percent from military budgets frees actual human 119 00:12:23,580 --> 00:12:27,620 brains from building guidance systems to building diagnostic systems. 120 00:12:28,060 --> 00:12:33,700 The brains don't care. They just go where the funding is. They are, in this sense, very similar to lobbyists. 121 00:12:34,420 --> 00:12:38,700 This Is Politically Impossible. Objection: "No government will agree to this. 122 00:12:38,740 --> 00:12:46,160 It will never happen. Pure fantasy.". "Politically impossible" is a phrase that means "the bribes currently flow in a direction 123 00:12:46,160 --> 00:12:52,540 I'm comfortable with." The small pieces of paper with presidents on them go to people who build missiles instead of people 124 00:12:52,540 --> 00:12:55,720 who cure diseases. You need the papers to go the other way. 125 00:12:56,420 --> 00:13:00,600 This is called "lobbying," which is bribery but with a business card and a five hundred and one c four. 126 00:13:01,140 --> 00:13:07,960 The military-industrial complex spends one hundred and twenty-seven million dollars yearly on lobbyists. 127 00:13:08,780 --> 00:13:16,660 You can't beat them with moral arguments (they're immune; moral arguments have a zero dollar budget and no K Street address). 128 00:13:17,340 --> 00:13:23,400 Beat them at their own game. Raise one billion dollars through VICTORY Incentive Alignment Bonds. 129 00:13:24,400 --> 00:13:27,340 Allocate six hundred and fifty million dollars for lobbying. 130 00:13:27,960 --> 00:13:32,680 That overwhelms the defense industry's one hundred and twenty-seven million dollar spend. 131 00:13:33,360 --> 00:13:38,930 Go to the same K Street firms. Outbid them. Lobbyists work for the highest bidder. 132 00:13:39,040 --> 00:13:45,500 They always have. This is the one area where your species' mercenary instincts are genuinely helpful. 133 00:13:46,280 --> 00:13:53,460 Once two hundred and eighty million voters demand it and the money is behind it, refusal becomes career suicide. 134 00:13:53,980 --> 00:13:58,330 Politicians are extremely good at not committing career suicide. 135 00:13:58,580 --> 00:14:06,040 It's their primary skill. Several have no other skills. Follow-up: "But it can't scale globally." 136 00:14:06,780 --> 00:14:12,280 The internet scaled globally. So did TikTok, which teaches strangers choreography. 137 00:14:12,740 --> 00:14:19,480 If your species can coordinate dance moves across one hundred and fifty countries, it can coordinate not dying. 138 00:14:20,460 --> 00:14:27,880 Follow-up: "You're naive about human nature." I've been observing human nature for eighty years. 139 00:14:28,380 --> 00:14:37,320 It has been remarkably consistent. Here is what I've observed: you call things unrealistic, then you do them, then you pretend 140 00:14:37,320 --> 00:14:46,720 you always knew they were possible. Every time. Things that were "unrealistic": Human flight (impossible for millennia, 141 00:14:46,960 --> 00:14:54,840 then two bicycle mechanics in Ohio). Moon landing (J.F.K. did it in eight years with computers weaker than your toaster). 142 00:14:55,420 --> 00:14:59,400 Democracy (kings ruled for five thousand years, then didn't). 143 00:15:00,120 --> 00:15:05,460 Ending slavery (entire economies depended on it; they found other economies). 144 00:15:06,060 --> 00:15:11,320 Women voting (half the population was excluded; the other half thought this was fine). 145 00:15:11,940 --> 00:15:20,300 The internet (who needs computers talking to each other?). Things that are actually unrealistic: Spending two point seven 146 00:15:20,300 --> 00:15:25,800 two trillion dollars on weapons while sitting on thirteen thousand nuclear warheads. 147 00:15:26,560 --> 00:15:29,860 That's enough for one hundred and thirty extinction events. 148 00:15:30,260 --> 00:15:35,100 You only need one. The other one hundred and twenty-nine are for what, exactly? 149 00:15:35,780 --> 00:15:42,080 Expecting different results from the same broken system. Thinking you'll survive the A.I. 150 00:15:42,080 --> 00:15:49,960 revolution without fixing incentives. Fifty-five million people die each year from treatable causes. 151 00:15:50,380 --> 00:15:55,980 That's the unrealistic thing. You just got used to it. "What If the Science Is Wrong?" 152 00:15:57,100 --> 00:16:01,880 Objection: "What if we fund one hundred thousand trials and nothing gets cured?" 153 00:16:02,580 --> 00:16:07,780 Then you know one hundred thousand things that don't work. This is called data. 154 00:16:08,440 --> 00:16:14,530 You've been collecting it for four hundred years. It is the only method you have that actually works. 155 00:16:15,100 --> 00:16:20,480 Being afraid of negative results is like being afraid of road signs that say "wrong way." 156 00:16:20,940 --> 00:16:30,240 The sign is helping you. Stop being angry at the sign. The current system: One hundred trials over seventeen years, learn 157 00:16:30,240 --> 00:16:39,640 nothing, many retire wealthy (with pensions). N.I.H. funding safe research confirming water is wet (it is; here is the grant). 158 00:16:40,490 --> 00:16:48,060 F.D.A. blocking trials because the paperwork had a typo on page eight hundred and forty-seven (this actually happens; the 159 00:16:48,060 --> 00:16:56,600 typo was in a footer). Your decentralized framework will run forty-four point one times more trials for the same budget. 160 00:16:57,220 --> 00:17:01,860 Even if ninety percent fail, you get over four times more cures than today. 161 00:17:02,660 --> 00:17:10,880 Failure at scale beats success at a standstill. On Wishonia, we considered ninety percent failure rates normal for the first 162 00:17:10,900 --> 00:17:15,740 two hundred years. Then the failure rate dropped because we had data. 163 00:17:16,099 --> 00:17:21,660 You don't have data because you're afraid of failure. You're afraid of failure because you don't have data. 164 00:17:22,420 --> 00:17:27,520 This is a circle. I keep finding circles in your systems. None of them are the good kind. 165 00:17:28,920 --> 00:17:35,060 "War Is Human Nature". Objection: "War is inevitable. Countries need militaries to survive." 166 00:17:36,340 --> 00:17:39,600 Several countries tested this hypothesis and got different results. 167 00:17:40,640 --> 00:17:48,480 Switzerland: Over two hundred years avoiding major wars. Surrounded by both World Wars (literally in the middle; made chocolate, 168 00:17:48,840 --> 00:17:55,640 stayed alive). G.D.P. per capita: ninety-three thousand dollars (not killing people is profitable). 169 00:17:56,280 --> 00:18:04,260 Defense spending: zero point seven percent of G.D.P. Life expectancy: eighty-four years (six point five years longer than 170 00:18:04,260 --> 00:18:12,640 Americans who spend five times more on "defense"). Costa Rica: Abolished its army in nineteen forty-eight (said "no thank 171 00:18:12,640 --> 00:18:20,340 you" to the entire concept). Still sovereign seventy-five plus years later (nobody invaded the country with no oil). 172 00:18:21,060 --> 00:18:27,140 Redirected military budget to education and health. Life expectancy matches the U.S. 173 00:18:27,140 --> 00:18:34,580 at a fraction of the cost. Zero invasions since (turns out nobody wants to conquer happy, educated people with good healthcare 174 00:18:34,580 --> 00:18:42,700 and no resentment). Scale that up globally and the twenty-year model projects the Treaty Path producing sixteen point five 175 00:18:42,700 --> 00:18:49,300 times the G.D.P. of doing nothing, and the Wishonia Path producing fifty-six point seven times. 176 00:18:50,040 --> 00:18:58,660 Not murdering people is good for the economy. This should not be a surprising finding, but on your planet, it is. 177 00:18:58,660 --> 00:19:03,520 Nuclear weapons made territorial conquest largely obsolete in nineteen forty-five. 178 00:19:04,260 --> 00:19:08,940 You're still budgeting like it's nineteen forty-four. It's been eighty years. 179 00:19:09,280 --> 00:19:13,260 Somebody should tell the accountants. "All Wars on X Have Failed". 180 00:19:14,400 --> 00:19:18,990 Objection: "War on Drugs, War on Poverty, War on Terror all failed. 181 00:19:19,200 --> 00:19:23,480 This will too." Those were government wars using central planning. 182 00:19:24,460 --> 00:19:30,680 This uses markets. The difference is important, and I will explain it using small words because this objection comes up 183 00:19:30,680 --> 00:19:36,090 a lot. Government "wars" create bureaucracies that need the problem to exist. 184 00:19:36,360 --> 00:19:40,960 The War on Drugs needs drug crime. The War on Poverty needs poor people. 185 00:19:41,640 --> 00:19:49,340 The War on Terror needs enemies. Each one accidentally created a government department whose continued employment depends 186 00:19:49,340 --> 00:19:53,540 on the problem never being solved. The departments are thriving. 187 00:19:53,960 --> 00:19:59,660 The problems are also thriving. Everyone is thriving except the people the departments were supposed to help. 188 00:20:00,440 --> 00:20:07,080 Why this is different: Markets instead of ministries (markets don't need the problem to keep existing). 189 00:20:07,740 --> 00:20:12,800 Pays for outcomes, not process (no one gets rich by failing slowly). 190 00:20:13,660 --> 00:20:21,620 No bureaucracy to preserve (smart contracts don't have pensions, don't take lunch breaks, and have never once asked for 191 00:20:21,620 --> 00:20:28,940 a corner office). Thousands of teams competing instead of one committee deciding (the committee is at lunch). 192 00:20:30,040 --> 00:20:38,620 Researchers paid for cures, not grant applications (which are different skills; grant writing is a literary genre, not a 193 00:20:38,620 --> 00:20:42,840 scientific method). Call it the Market for Health. Less dramatic. 194 00:20:43,380 --> 00:20:50,330 Might actually work. Would definitely not get its own Ken Burns documentary, which is how you know it's a real solution. 195 00:20:52,120 --> 00:20:57,420 "This Sounds Like Bribery". Objection: "You're just bribing politicians. 196 00:20:57,520 --> 00:21:04,380 That's illegal and immoral.". You're describing lobbying. I know this because I looked up your laws. 197 00:21:04,900 --> 00:21:13,240 The mechanics are identical: same K Street firms, same campaign contributions, same revolving door, same wine. 198 00:21:13,680 --> 00:21:22,900 The only difference is what you're buying. Current lobbying buys murder contracts: one trillion dollars in defense spending. 199 00:21:23,040 --> 00:21:28,100 New lobbying buys medicine contracts: clinical trials. Same K Street. 200 00:21:28,560 --> 00:21:35,440 Different product. If you're comfortable with the first one and uncomfortable with the second one, I encourage you to sit 201 00:21:35,440 --> 00:21:44,040 quietly and think about why. This system caps corruption at twenty percent and makes it fully transparent. 202 00:21:44,740 --> 00:21:48,980 Ten percent goes to investors (money for money, no influence attached). 203 00:21:49,700 --> 00:21:56,880 Ten percent goes to political incentives (campaign support and post-office careers for politicians who vote yes). 204 00:21:57,620 --> 00:22:05,440 The remaining eighty percent goes to clinical trials via wishocratic allocation, where every human votes on priorities. 205 00:22:06,120 --> 00:22:12,900 That eighty percent is untouchable by lobbyists, investors, or politicians. 206 00:22:12,900 --> 00:22:20,240 Humans find the twenty percent cap suspicious. No government budget in history has a lower corruption rate. 207 00:22:21,060 --> 00:22:27,220 Your skepticism about twenty percent corruption is itself a review of the system it's trying to protect. 208 00:22:28,540 --> 00:22:36,720 "Why Not Just Use Philanthropy?". Objection: "If this matters, why not raise money from donors instead of complicated bonds?". 209 00:22:38,040 --> 00:22:42,600 All philanthropy combined is a rounding error compared to government budgets. 210 00:22:43,240 --> 00:22:50,640 A very generous rounding error, wearing a gala dress and holding a champagne flute, but still a rounding error. 211 00:22:51,320 --> 00:22:58,320 A massive fundraising campaign would cannibalize donations from health charities already doing critical work. 212 00:22:59,460 --> 00:23:07,220 You'd be stealing from cancer research to fund cancer research, which is impressively pointless even by your standards. 213 00:23:07,860 --> 00:23:15,480 The goal is tapping the multi-trillion dollar stream of wasted government spending, not reshuffling the charity tip jar. 214 00:23:16,120 --> 00:23:21,080 The tip jar has feelings. The government stream has missiles it can't account for. 215 00:23:21,600 --> 00:23:27,580 One of these is easier to redirect. "Eighty-four Quadrillion Dollars Is a Made-Up Number". 216 00:23:29,370 --> 00:23:36,750 Objection: "No number with that many zeros can be real. You're just multiplying big things together to get a big answer.". 217 00:23:37,120 --> 00:23:41,260 All numbers are made up. Yours happen to be small. Mine happen to be large. 218 00:23:41,880 --> 00:23:47,960 The difference is that mine come with receipts. Start with what disease costs per year. 219 00:23:48,660 --> 00:23:57,510 The W.H.O. says the world loses two point eight eight billion disability-adjusted life years, or D.A.L.Y.s, per year annually. 220 00:23:57,920 --> 00:24:02,560 ninety-two point six percent are eventually avoidable with sufficient biomedical research. 221 00:24:03,420 --> 00:24:08,240 At one hundred and fifty thousand dollars per quality-adjusted life year, or Q.A.L.Y. 222 00:24:08,540 --> 00:24:17,900 (the standard rate used by E.P.A., O.E.C.D., W.H.O., and N.I.C.E.), each year of delay costs four hundred trillion dollars. 223 00:24:18,960 --> 00:24:26,660 Multiply by how many years earlier treatments arrive (approximately two hundred and twelve): The capacity constant is twelve 224 00:24:26,660 --> 00:24:31,840 point three, which is the number of fundable patients in the D.F.D.A. 225 00:24:31,880 --> 00:24:36,500 divided by current trial slots. The number of fundable patients in the D.F.D.A. 226 00:24:36,980 --> 00:24:43,880 is twenty-three point four million, which is the annual subsidies divided by the nine hundred and twenty-nine dollar pragmatic 227 00:24:43,880 --> 00:24:51,860 cost per patient. Annual subsidies for the D.F.D.A. are twenty-one point eight billion dollars, which is the annual funding 228 00:24:51,860 --> 00:24:57,660 minus forty million dollars in operating expenses. Operating expenses for the D.F.D.A. 229 00:24:57,880 --> 00:25:01,960 are the sum of platform costs, staff costs, and infrastructure costs. 230 00:25:03,380 --> 00:25:08,920 Two W.H.O. data points, one standard Q.A.L.Y. price, and a timeline shift. 231 00:25:09,600 --> 00:25:13,640 That's where the quadrillion comes from. Not magic. Multiplication. 232 00:25:14,680 --> 00:25:19,040 "But four hundred trillion dollars per year is more than global G.D.P. 233 00:25:19,400 --> 00:25:24,480 (one hundred and fifteen trillion dollars)!" Yes. G.D.P. measures market transactions. 234 00:25:24,960 --> 00:25:32,220 It does not measure the value of not being dead, not being in pain, and not watching your children die of treatable diseases. 235 00:25:33,060 --> 00:25:39,580 Health economists have measured this for decades. The one hundred and fifty thousand dollars per Q.A.L.Y. 236 00:25:39,580 --> 00:25:46,840 figure is what governments already use when deciding whether to approve drugs, build highways, or regulate pollution. 237 00:25:46,840 --> 00:25:51,350 I did not invent the number. I multiplied it by the number of sick people. 238 00:25:51,740 --> 00:25:55,020 Both the number and the sick people existed before I got here. 239 00:25:55,740 --> 00:26:02,080 The only debatable input is whether the timeline shift is really approximately two hundred and twelve years. 240 00:26:03,120 --> 00:26:07,780 "Won't A.I. drug discovery shrink that timeline anyway?" A.I. 241 00:26:07,780 --> 00:26:10,960 discovers candidates. Candidates still need clinical trials. 242 00:26:11,940 --> 00:26:19,120 The current system has one point nine million patients per year trial slots globally, producing fifteen diseases per year. 243 00:26:19,860 --> 00:26:25,570 A.I. does not create more trial slots. It creates more candidates competing for the same slots. 244 00:26:26,220 --> 00:26:31,140 More candidates plus the same bottleneck equals the same (or longer) queue. 245 00:26:31,620 --> 00:26:35,340 It's like building faster cars and pointing them at the same traffic jam. 246 00:26:35,960 --> 00:26:42,040 The fifteen diseases per year rate measures regulatory throughput, not discovery speed. 247 00:26:42,160 --> 00:26:49,720 This intervention removes the throughput bottleneck (twelve point three times capacity via pragmatic trials at nine hundred 248 00:26:49,720 --> 00:26:56,460 and twenty-nine dollars per patient). A.I. and this system are complementary, not substitutes. 249 00:26:56,540 --> 00:27:01,540 One finds the cures. The other lets you test them before the patient dies of old age. 250 00:27:02,480 --> 00:27:09,760 How Do You Prevent Waste? Objection: "How do you ensure money helps patients instead of funding bureaucracy?" 251 00:27:10,500 --> 00:27:19,180 The N.I.H.’s RECOVER initiative spent one point six billion dollars over four years and produced zero treatment recommendations. 252 00:27:20,040 --> 00:27:25,920 Zero. One point six billion dollars. Four years. Nothing. The money is gone. 253 00:27:25,980 --> 00:27:28,880 The patients are still sick. The administrators have been promoted. 254 00:27:29,640 --> 00:27:34,420 If you designed a system to waste money on purpose, you could not beat this performance. 255 00:27:34,920 --> 00:27:42,240 It’s a masterpiece of institutional failure, and nobody was fired, which is itself a masterpiece of institutional failure. 256 00:27:43,120 --> 00:27:48,380 A decentralized F.D.A. model achieves eighty-two times lower cost per patient. 257 00:27:48,980 --> 00:27:54,060 Pragmatic trials: five hundred dollars. Traditional trials: forty-one thousand dollars. 258 00:27:54,540 --> 00:28:02,620 Same science. Eighty-two times less overhead. With that same one point six billion dollars, the decentralized model could 259 00:28:02,620 --> 00:28:07,740 have run thousands of trials for millions of patients. Instead: zero. 260 00:28:08,500 --> 00:28:13,260 I will stop repeating the number zero now, but I want you to know that I could keep going. 261 00:28:13,680 --> 00:28:15,960 There are a lot of zeros in this story.