WEBVTT 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.