1 00:00:00,460 --> 00:00:05,020 Health Dividend Six thousand six hundred and fifty diseases have zero approved treatments. 2 00:00:05,560 --> 00:00:09,660 At your current pace, you'll get to all of them in four hundred and forty-three years. 3 00:00:10,300 --> 00:00:17,880 Redirect one percent of military spending and it drops to thirty-six years, preventing ten point seven billion deaths at 4 00:00:18,100 --> 00:00:23,520 fifty thousand three hundred times the cost-effectiveness of anti-malaria bed nets. 5 00:00:24,000 --> 00:00:27,700 The whole thing costs less per year to run than Halloween costumes for dogs. 6 00:00:28,280 --> 00:00:34,620 But sure, take your time. That was the peace dividend: the money you get from buying one percent fewer explosions. 7 00:00:35,200 --> 00:00:39,700 Now here is the health dividend: what happens when you spend it on medicine instead. 8 00:00:40,620 --> 00:00:47,440 Right now, somewhere in your regulatory system, a drug that already passed safety testing is sitting in a filing cabinet 9 00:00:47,440 --> 00:00:55,020 while the disease it treats keeps killing people. Somewhere else, a researcher with a promising compound for one of six 10 00:00:55,020 --> 00:01:00,940 thousand six hundred and fifty untreated diseases is filling out the same form for the fourth time. 11 00:01:01,880 --> 00:01:04,720 The health dividend is what happens when you stop doing this. 12 00:01:06,140 --> 00:01:12,120 It is worth eighty-four point eight quadrillion dollars. That number is not a typo. 13 00:01:12,700 --> 00:01:17,180 I checked. Your economists checked. Everyone checked. It's still that number. 14 00:01:17,800 --> 00:01:22,980 The rest of this chapter is the receipt. From Explosions to Trial Slots. 15 00:01:24,220 --> 00:01:28,870 twenty-seven point two billion dollars arrives from the peace dividend. 16 00:01:29,120 --> 00:01:36,080 Investor and political allocations take their cut, leaving twenty-one point eight billion dollars for medical research (eighty 17 00:01:36,080 --> 00:01:41,780 percent of the total). Your decentralized F.D.A. takes forty million dollars to keep the lights on. 18 00:01:42,160 --> 00:01:46,220 That leaves twenty-one point seven billion dollars for trial subsidies. 19 00:01:47,080 --> 00:01:52,490 I am now going to show you what that money buys. I apologize in advance for the number of numbers. 20 00:01:52,860 --> 00:01:58,960 Your species requires receipts before it will believe anything, even things that are obviously true. 21 00:01:59,820 --> 00:02:06,740 Especially things that are obviously true. Your current system charges forty-one thousand dollars per patient in a clinical 22 00:02:06,740 --> 00:02:15,020 trial. I asked why and was told "regulatory compliance, site management, and monitoring overhead," which I believe is the 23 00:02:15,140 --> 00:02:22,080 human phrase for "permission costs more than medicine." Pragmatic trials, the kind your decentralized F.D.A. 24 00:02:22,220 --> 00:02:29,900 runs, cost nine hundred and twenty-nine dollars. At that price, twenty-one point seven billion dollars buys you twenty-three 25 00:02:29,900 --> 00:02:38,120 point four million patient trial slots per year. Your species currently enrolls one point nine million patients per year 26 00:02:38,120 --> 00:02:45,210 in clinical trials globally. The treaty adds twelve point three times more capacity on top of that. 27 00:02:45,300 --> 00:02:48,260 Remember this number. Everything that follows depends on it. 28 00:02:49,200 --> 00:02:57,360 The Waiting List. You met the queue in the untapped therapeutic frontier: six thousand six hundred and fifty diseases with 29 00:02:57,360 --> 00:03:02,180 zero approved treatments, and fifteen getting their first treatment per year. 30 00:03:02,880 --> 00:03:06,880 At that rate, you clear the backlog in four hundred and forty-three years. 31 00:03:07,540 --> 00:03:12,440 I will let you sit with that number for a moment. It is longer than your species has had writing. 32 00:03:13,220 --> 00:03:20,000 For context, four hundred and forty-three years ago, Shakespeare was writing plays, Galileo was building telescopes, and 33 00:03:20,000 --> 00:03:25,340 your species already had printing presses, universities, and intercontinental shipping. 34 00:03:25,340 --> 00:03:32,520 You just had not gotten around to curing most diseases. At this pace, you still will not for another four hundred and forty-three 35 00:03:32,520 --> 00:03:39,390 years. Apply the twelve point three times multiplier. Instead of fifteen diseases getting their first treatment per year, 36 00:03:39,440 --> 00:03:45,680 you get one hundred and eighty-five diseases per year. The queue clears in thirty-six years instead of four hundred and 37 00:03:45,680 --> 00:03:51,940 forty-three years. The average untreated disease gets its first treatment two hundred and four years earlier. 38 00:03:53,000 --> 00:03:57,680 That is the difference between "your grandchildren might see a cure" and "you might see a cure." 39 00:03:58,460 --> 00:04:06,080 On Wishonia, we consider this a meaningful distinction. On Earth, it apparently requires a seventy-eight-page chapter to 40 00:04:06,080 --> 00:04:13,460 justify. Your species figured out how to split atoms in six years during a war, but letting a cancer patient take a pill 41 00:04:13,460 --> 00:04:18,920 that passed safety testing requires the gestation period of three consecutive elephants. 42 00:04:19,600 --> 00:04:22,900 The twelve point three times multiplier compresses the elephant parade. 43 00:04:23,940 --> 00:04:31,200 But trial capacity is only half the delay. Once a drug passes safety testing, your regulatory system sits on it for another 44 00:04:31,200 --> 00:04:37,330 eight point two years to confirm it works well enough, while people who could be taking it die instead. 45 00:04:38,040 --> 00:04:45,660 Add the capacity acceleration and the efficacy lag together: two hundred and twelve years of dying, condensed into not dying. 46 00:04:47,120 --> 00:04:53,520 The Body Count. One hundred and fifty thousand deaths per day die from disease every day. 47 00:04:54,180 --> 00:04:57,960 While you were reading the previous section, approximately three hundred of them did. 48 00:04:58,540 --> 00:05:01,370 They are not coming back to find out how the math turned out. 49 00:05:01,760 --> 00:05:08,040 Not all of those deaths are currently preventable, but ninety-two point six percent are eventually avoidable with sufficient 50 00:05:08,080 --> 00:05:12,680 biomedical research. "Eventually avoidable" does not mean "currently preventable." 51 00:05:13,000 --> 00:05:17,080 It means: given enough research, these diseases have biological solutions. 52 00:05:17,820 --> 00:05:22,850 The only category excluded is accidents (falling off things, being hit by things). 53 00:05:23,140 --> 00:05:30,140 Every disease, including aging, is a biological process, and biological processes are, in principle, fixable. 54 00:05:30,900 --> 00:05:38,540 This is the theoretical ceiling, not a near-term promise. Over a two hundred and twelve-year timeline shift, the cumulative 55 00:05:38,540 --> 00:05:48,560 toll: ten point seven billion deaths. That is five hundred and sixty-five billion disability-adjusted life years, or D.A.L.Y.s, 56 00:05:48,800 --> 00:05:54,140 of healthy life, and one point nine three quadrillion hours of suffering eliminated. 57 00:05:55,060 --> 00:06:02,080 These are cumulative, one-time benefits from permanently accelerating the discovery pipeline, the same methodology used 58 00:06:02,080 --> 00:06:07,470 to value smallpox eradication. Nobody objected to the methodology when it was used for smallpox. 59 00:06:08,260 --> 00:06:14,240 They will object now because the number is larger, which is a strange reason to object to saving more people. 60 00:06:15,460 --> 00:06:23,120 The Price Tag on Not Being Dead. Your governments already put a price on human life when deciding whether to approve drugs, 61 00:06:23,480 --> 00:06:30,360 build highways, or regulate pollution. The standard rate: one hundred and fifty thousand dollars per quality-adjusted life 62 00:06:30,360 --> 00:06:37,630 year. Your species finds this uncomfortable to discuss but does it constantly. 63 00:06:38,240 --> 00:06:41,620 You just prefer to do it in footnotes, where the dying can't see. 64 00:06:42,500 --> 00:06:47,520 The world loses two point eight eight billion D.A.L.Y.s per year. 65 00:06:48,120 --> 00:06:51,960 Ninety-two point six percent are eventually avoidable with sufficient research. 66 00:06:52,620 --> 00:07:00,700 At one hundred and fifty thousand dollars per quality-adjusted life year, or Q.A.L.Y., that is four hundred trillion dollars 67 00:07:00,700 --> 00:07:08,180 per year in welfare losses. Multiply by the two hundred and twelve-year timeline shift and you get the total economic value 68 00:07:08,180 --> 00:07:12,960 of the health dividend: eighty-four point eight quadrillion dollars. 69 00:07:14,040 --> 00:07:22,880 "But that is more than global G.D.P.!" Yes. G.D.P. (one hundred and fifteen trillion dollars) measures market transactions. 70 00:07:23,580 --> 00:07:32,680 It does not measure the value of not being dead, not being in pain, and not watching your children die of treatable diseases. 71 00:07:33,740 --> 00:07:38,600 The one hundred and fifty thousand dollars per quality-adjusted life year, or Q.A.L.Y. 72 00:07:38,820 --> 00:07:46,020 figure is not something I invented. I just multiplied it by the number of sick people, which is also not my fault. 73 00:07:47,180 --> 00:07:53,420 The only debatable input is whether the timeline shift is really approximately two hundred and twelve years. 74 00:07:54,420 --> 00:08:00,740 See the full derivation for how that number is calculated, and the Monte Carlo simulations for what happens when every input 75 00:08:00,740 --> 00:08:08,880 varies. The Receipt. Your decentralized F.D.A. costs forty million dollars a year to operate. 76 00:08:09,780 --> 00:08:15,740 For reference, this is roughly what your species spends annually on Halloween costumes for dogs. 77 00:08:16,540 --> 00:08:24,860 Less than one fighter jet. Less than what FIFA spends on "hospitality" (your word for bribing officials in a building with 78 00:08:24,860 --> 00:08:34,100 chandeliers). A system that could test cures for seven thousand diseases costs less to run than the outfits you put on animals 79 00:08:34,100 --> 00:08:42,559 that do not want to wear them. The R and D savings alone are fifty-eight point six billion dollars a year, a six hundred 80 00:08:42,559 --> 00:08:47,380 and thirty-seven to one return without counting a single human life. 81 00:08:48,240 --> 00:08:54,540 Include the lives (which you would think someone would, but your species has a long history of not counting the people who 82 00:08:54,540 --> 00:09:03,000 die quietly), and the treaty's total societal return hits eighty-four point eight million to one. 83 00:09:04,020 --> 00:09:08,540 The cost per year of healthy life saved: eighty-four cents. 84 00:09:09,680 --> 00:09:16,840 Anti-malaria bed nets, the gold standard of cost-effective interventions, cost eighty-nine dollars per disability-adjusted 85 00:09:16,940 --> 00:09:25,880 life year, or D.A.L.Y. This system operates at fifty thousand three hundred times the cost-effectiveness, at vastly greater 86 00:09:25,880 --> 00:09:33,080 scale. This costs less per life-year than mosquito nets and nobody has heard of it. 87 00:09:33,620 --> 00:09:41,760 Your species has spent more money marketing energy drinks. The total campaign investment: one billion dollars. 88 00:09:42,340 --> 00:09:50,980 Even the worst case (everything goes wrong, adoption is terrible, the servers catch fire) still returns an estimated sixty-six 89 00:09:51,220 --> 00:09:57,180 to one return. Your worst medical outcome is better than your best military one. 90 00:09:58,180 --> 00:10:05,820 Every day without this system costs one hundred and sixty-one million dollars in wasted trial spending alone. 91 00:10:06,500 --> 00:10:12,480 The regulatory lag is not a safety feature. It is a waiting room where people die. 92 00:10:12,920 --> 00:10:21,120 You just gave it a nicer name. For you personally: if diseases get cured even a few years earlier, the average human gains 93 00:10:21,120 --> 00:10:28,820 roughly fifty thousand extra hours of life. You spent seventeen minutes reading this chapter. 94 00:10:29,380 --> 00:10:34,100 That is a one hundred and seventy-six thousand times return on your time. 95 00:10:34,600 --> 00:10:42,540 Your best investment ever was reading. I realize the irony, given that most of you stopped reading twelve paragraphs ago. 96 00:10:43,220 --> 00:10:52,160 Visit impact dot war on disease dot org for derivations, Monte Carlo simulations, and the comparative cost-effectiveness 97 00:10:52,160 --> 00:10:52,640 table.