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N.I.H. Fails to Institute Health A root cause failure analysis to show why the world's largest medical research institution

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only allocates three point three percent of its budget to testing which of the thousands of known-safe treatments actually

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work in humans. Oxford tested COVID treatments for five hundred dollars per patient and saved a million lives in one hundred

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days. The N.I.H. spent one point six billion dollars and completed zero trials in four years.

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A Tale of Two Trials. The difference between efficient and inefficient trial design isn't theoretical.

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Your species accidentally ran a controlled experiment on itself during COVID.

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Two countries. Same disease. One spent like it was trying to cure death.

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The other actually did. RECOVERY Trial (U.K. Approach). The British spent twenty million dollars over six months.

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Enrolled forty-eight thousand patients. Found multiple effective treatments, including dexamethasone, a steroid that had

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been available since nineteen fifty-seven. It reduced COVID deaths by one-third and saved over one million lives.

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Cost per patient: five hundred dollars. RECOVER Initiative (N.I.H.

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Approach). Nearly six hundred potential treatments for Long COVID have been identified.

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At RECOVERY trial efficiency (five hundred dollars per patient, five thousand five hundred patients per treatment), one

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point six six five billion dollars buys six hundred completed trials.

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The N.I.H. received one point six six five billion dollars.

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Over four years, they completed zero. Only fifteen percent of the budget went to clinical trials; the rest funded observational

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studies, data management, and administration. Of those enrolled, roughly eleven percent were in interventional trials that

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actually tested treatments. The other eighty-nine percent were in observational studies, which is the medical equivalent

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of taking attendance at a funeral. Cost per interventional patient: five hundred and four thousand, five hundred dollars,

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the price of a house. Nobody got a house and nobody got cured.

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They got observed. Expensively. The observation was very thorough.

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It has been peer-reviewed. The peers also observed the patients.

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The patients are still sick, but they are the most well-documented sick people in the history of sickness.

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It gets worse. The treatments RECOVER eventually selected were called "truly absurd" by patient advocates.

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Low-dose naltrexone, the number one patient-requested treatment (generic, cheap, already showing results in independent

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studies), was excluded for over two years before finally being added in round two.

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David Putrino, director of rehabilitation innovation at Mount Sinai, called the spending "largely wasted".

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Researchers outside RECOVER had lists of drugs to test. The system ignored them.

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Six hundred trials were possible with that money. Zero were completed.

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That is the difference between a system that tests treatments and a system that tests patience.

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The Translation Crisis: All Theory, No Medicine. Basic research is not the problem.

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Five decades of N.I.H.-funded science built one of the largest drug candidate pipelines in history.

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Researchers identified targets, characterized molecules, established safety profiles.

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That work was essential, and it succeeded. The problem is what happens after the discoveries are made: almost nothing.

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The pipeline is full. The exit is closed. COVID made this visible for the first time, but it is the institution's default

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setting; the way you don't notice a leaking roof until it rains inside.

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It has been raining inside for fifty years. The N.I.H. has published several papers on indoor rain.

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There are over twenty thousand F.D.A.-approved drugs that are known to be safe in humans.

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Thousands more clinically-tested candidates are gathering dust, including over three thousand marketed drugs that could

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be repurposed for diseases nobody's tried them on. In Alzheimer's alone, researchers have identified hundreds of safe drugs

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worth testing, yet less than ten percent are in active trials.

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And the number of clinical trials available for your grandma in St.

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Louis? Zero. You have a warehouse of safe molecules that have never been systematically tested for new uses.

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The warehouse is full. The testing facility is closed for a team-building retreat.

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This is not hypothetical. In twenty twenty-three, researchers published case reports of severe long COVID patients experiencing

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complete remission within days of receiving monoclonal antibody infusions.

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Previously bedridden patients returned to normal lives, with remissions sustained over two years.

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The U.S. government had spent over five billion dollars purchasing millions of doses of these same antibodies for acute

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COVID. When Omicron rendered them ineffective for acute treatment, millions of unused doses sat in refrigerated storage.

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Long COVID patients, having read the case reports, begged for access.

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They organized petitions. They cited the remissions. The government said no.

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The doses were authorized for acute COVID only, and the authorization had been revoked because they didn't work for acute

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COVID, which meant they could not be given to anyone, for anything, ever.

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The antibodies matched the original variants; the long COVID patients had been infected by the original variants.

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Nobody tested this. Nobody ran trials. Nobody repurposed the stockpile.

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The first formal Phase two trial of monoclonal antibodies for long COVID is scheduled for mid-twenty twenty-six, four years

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after the doses were available and several years after they expired.

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Five billion dollars of medicine. Millions of doses. Patients who wanted them.

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Case reports showing they worked. The doses expired. The patients didn't; they just kept being sick.

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Your government threw away the cure and kept the disease. On Wishonia, we have a word for this, but it is a word I am not

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permitted to use in your language because it is considered a slur against the competence of your entire species, so I will

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simply note that the word exists and move on. Then there's metformin.

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A phase three randomized controlled trial, or R.C.T. (COVID-OUT) showed it reduces long COVID incidence by forty-one percent.

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It costs four dollars a month. It has been generic for decades.

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It is globally available. The N.I.H. guideline response: "insufficient evidence to recommend for or against".

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Long COVID costs one hundred and seventy billion dollars a year.

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The four dollar pill that cuts it by forty-one percent has no corporate sponsor, because nobody profits from a generic.

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This is the entire chapter in one sentence. To appreciate the scale: long COVID costs the U.S.

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an estimated one hundred and seventy billion dollars annually in lost wages alone, with roughly seventeen million Americans

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currently affected. A RECOVERY-style pragmatic trial would have cost approximately twenty-four million dollars and could

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have produced results in months. Instead, your government spent five billion dollars buying the medicine and is now paying

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one hundred and seventy billion dollars a year in economic damage from the disease it didn't bother to treat.

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The ratio of what you're losing to what the trial would have cost is seven thousand and eighty-three to one.

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The N.I.H. is, by its own metrics, a publishing house that occasionally dabbles in medicine.

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It publishes two point five million funded papers annually.

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It produces approximately fifty new drug approvals annually.

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That's a conversion rate from paper to patient of zero point zero zero two percent.

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For every fifty thousand papers, one drug reaches a human. The rest become citations in other papers, which become citations

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in other papers, in an infinite loop of academics reading each other's homework.

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On Wishonia, we call this a "knowledge ouroboros." It looks productive from the inside.

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From the outside, it's a snake eating its own tail and writing a paper about the nutritional content.

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Plenty of Knowledge. No Translation. About five percent of patients have participated in clinical trials.

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About forty-four point eight percent would participate if invited.

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About nine to eleven percent have ever been invited. Nearly half of all patients would join a trial if asked.

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Almost nobody asks. Your species has a room full of volunteers holding their hands up, and a system that looked at the room

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and decided to study the clipboard instead. The clipboard is very well-studied.

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It has been studied for decades. Multiple papers have been written about the clipboard.

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One of them won an award. The volunteers are still holding their hands up.

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Some of them have died. This has been noted on the clipboard.

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Understanding disease and testing treatments in humans are completely different activities.

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One requires microscopes. The other requires giving people medicine and seeing if they stop dying.

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In nineteen seventy, spending heavily on microscopes made sense; you didn't know enough to test intelligently.

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In twenty twenty-five, after two point five million papers a year for five decades, the ratio should have shifted.

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It didn't. The N.I.H. chose microscopes in nineteen seventy and has not reconsidered since, which is the institutional equivalent

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of still crawling because you learned to crawl before you learned to walk.

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The Allocation Problem. Your National Institutes of Health has the word "Health" in its name and an annual budget of forty-seven

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billion dollars. Fifty-five million of you die annually from disease.

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You would think those two facts would be related. They are not.

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Of two hundred and forty-seven billion dollars the N.I.H. spent over a decade, exactly three point three percent went to

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testing which of the thousands of known-safe treatments actually work in humans.

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The other ninety-six point seven percent funded understanding disease mechanisms, translating discoveries toward (but never

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into) clinical use, training scientists, observational programs that spend billions watching disease without treating it,

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and a side quest engineering bat viruses, which is called "research" the way watching someone drown from a boat is called

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"lifeguarding.". Basic research is not the problem. Understanding disease is how you find candidates to test.

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The problem is that after fifty years and a trillion dollars, the ratio hasn't moved.

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The marginal value of the eighty-fifth cent on basic research is near zero when you're spending three cents on the only

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activity that turns research into medicine. You don't have a knowledge deficit.

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You have an allocation deficit. Three point three percent on trials might be defensible if the testing queue were empty.

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It isn't. There are roughly nine thousand five hundred compounds with established safety profiles, and ninety-nine point

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seven percent of their possible disease applications have never been tested.

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Most are off-patent, which means no pharmaceutical company will fund trials for them, which means the N.I.H.

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is the only entity that could, which means it is specifically choosing not to do the one thing only it can do.

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The pipeline is overflowing with candidates. The bottleneck is trials.

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The drugs are sitting there. Safe. Ready. Unpatentable. They've been waiting for decades.

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Some of them have been waiting longer than most of your scientists have been alive.

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It's like spending ninety-six point seven percent of your grocery budget on cookbooks and three point three percent on food,

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then wondering why you're starving. Except the cookbooks are very prestigious and the starving people aren't on the committee

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that decides whether to buy more cookbooks. A J.A.M.A. study broke down two hundred and forty-seven point three billion

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dollars in N.I.H. spending (twenty ten to twenty nineteen).

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I have organized it from "largest amount spent not on clinical trials" to "smallest amount spent not clinical trials," though

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I should note that none of it is labeled "not clinical trials."

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It is labeled "investment in the future." The future has been invested in for fifty years.

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It has not yet arrived. Eighty-four point nine percent, or two hundred and nine point nine billion dollars, is dedicated

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to basic research for understanding disease mechanisms, molecular biology, and genomics; while essential for identifying

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new targets, eighty-five cents of every dollar is a lot of understanding and not much testing.

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Eleven point eight percent, or twenty-nine point three billion dollars, goes to non-trial applied research that translates

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discoveries toward practical use, but without the final step of testing them in patients.

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The Clinical and Translational Science Awards, or C.T.S.A., infrastructure program spends about one billion dollars per

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year in trial infrastructure, coordination, and training. Observational studies for population health data collection (such

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as large-scale observational cohorts costing two point one six billion dollars) are valuable for identifying patterns, but

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observation without intervention doesn't cure anyone. Other applied research includes drug characterization, health services

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research, and epidemiology. Only three point three percent, or eight point one billion dollars, is spent on phased clinical

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trials, which is the only category that directly tests whether treatments work in humans through phases one to three.

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Phase one accounts for one point five billion dollars, or eighteen point five percent of the clinical trial budget.

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Phase two accounts for three point five billion dollars, or forty-three point two percent.

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Phase three accounts for two point six billion dollars, or thirty-two point one percent.

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The N.I.H. covers only three point seven to four point three percent of Phase three costs, leaving completion to industry,

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which only funds trials with patent-protected profit potential.

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Other unclassified spending totals zero point five billion dollars, or six point two percent, for cross-phase overhead,

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pilot studies, and trials not classified to a single phase.

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Pragmatic trials (eighty-two times cheaper per patient) are severely underfunded despite proven efficiency.

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Why This Allocation Exists. This is not the fault of individual researchers.

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Most became scientists because they wanted to cure diseases.

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The system they work in rewards everything except curing diseases, and those rewards were designed by someone else entirely.

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Huge drug companies with political influence love the N.I.H.

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Taxpayers absorb the risk of basic research; industry patents whatever works.

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It's like if your neighbor paid for your kitchen renovation, and then you charged them rent to eat there.

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But independent trials comparing drugs head-to-head? Those are terrifying.

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They might reveal that the eighty thousand dollar drug works about as well as the four dollar generic.

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PhRMA, the pharmaceutical lobby, has consistently opposed comparative effectiveness research.

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When Congress created P.C.O.R.I. (the Patient-Centered Outcomes Research Institute) in twenty-ten, industry successfully

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lobbied to prohibit it from making coverage recommendations based on cost-effectiveness.

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Congress literally passed a law saying "don't fund research that might lower drug prices."

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They wrote it down. In legislation. On purpose. With their names on it.

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And then they went home and told their constituents they were fighting for affordable healthcare, because your species'

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capacity for doublethink is genuinely Olympian. This pattern held during the deadliest pandemic in a century.

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Operation Warp Speed initially selected fourteen vaccine candidates and planned head-to-head comparative studies in primates.

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Then dropped the comparative studies without explanation. Backed five companies with billions, gave others nothing.

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The selection process was opaque enough to draw Senate scrutiny; when Senator Tammy Baldwin asked the Biomedical Advanced

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Research and Development Authority, or BARDA's acting director to name the companies receiving public funds, he refused,

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citing "procurement sensitivity". No published cost-benefit analysis for excluding any candidate.

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The W.H.O. ran a Solidarity Trial for Vaccines doing exactly this kind of head-to-head comparison.

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The U.S. didn't join. Notice the pattern: the Patient-Centered Outcomes Research Institute, or PCORI is banned from comparing

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drug cost-effectiveness. Researching COVID to Enhance Recovery, or RECOVER ignores the treatments patients actually want.

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O.W.S. drops the comparative monkey studies. Every manufacturer has financial interests; Pfizer had them, Moderna had them,

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and that wasn't disqualifying. "Financial interest" only becomes a reason not to test when the treatment is cheap, generic,

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or threatens incumbent revenue. The system tests what's profitable and ignores what isn't.

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The revolving door helps. N.I.H. advisory committees include industry representatives.

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Former N.I.H. officials join pharmaceutical boards. Academic researchers depend on industry grants.

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Everyone's incentives align against cheap, fast trials testing whether expensive drugs outperform generics.

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It's not a conspiracy. Conspiracies require secrecy. This is all public.

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It's just that everyone involved happens to benefit from the same terrible outcome, purely by coincidence, repeatedly, for

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decades. On Wishonia, we have a word for this. The word is "conspiracy."

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The difference between a conspiracy and a system is whether the participants need to meet in a dark room.

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These people meet in conference rooms with catering. The outcome is identical.

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The three point three percent allocation isn't a mystery. It's a business model.

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Basic research produces publications. Publications produce tenure.

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Tenure produces more grants. Individual researchers want cures.

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The system rewards them for everything except producing one.

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Actual treatments are a byproduct that occasionally happens when someone forgets to optimize for papers and accidentally

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optimizes for results instead. It's like a restaurant where the chefs are passionate about food but get promoted based on

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how many menus they print. The menus are exquisite. They have won awards.

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The diners are eating the menus. Nobody has mentioned this.

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You Pay Twice. The N.I.H. claims to produce "public goods" like open science and training.

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What it actually produces is a free R. and D. department for pharmaceutical companies, funded by the same people who then

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pay full price for the drugs. Taxpayers funded research behind ninety-nine percent of new drugs (three hundred and fifty-six

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drugs, twenty-ten to twenty-nineteen). Industry patents the winners.

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The public pays again through high drug prices. When research leads to a dead end, the public eats the loss.

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You pay for the lottery ticket. They cash the winnings. You'd think someone would have mentioned this arrangement before

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now, and someone has, many times, but the people who cash the winnings also fund the campaigns of the people who could change

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the arrangement, so the arrangement continues. The only things the N.I.H.

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*should* fund are things private companies *cannot* profitably fund: open pragmatic trial platforms, repurposing of generic

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drugs where no patent means no profit means no interest, and comparative effectiveness data from head-to-head trials revealing

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which drugs actually work best (pharma's nightmare, your potential salvation).

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Instead, the N.I.H. explicitly avoids them to "not crowd out industry."

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Translation: "We won't run the trials that would lower drug prices, because the people who set drug prices asked us nicely."

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They asked nicely and also spent one hundred and twenty-seven million dollars on lobbying, but the niceness was noted.

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The Patient Disconnect: Zero Correlation with Health Outcomes.

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Correlation between N.I.H. funding priorities and actual disease burden: zero point zero seven.

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That is not a typo. On a scale of zero (random) to one (perfect), the N.I.H.

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scores "basically a coin flip." A dartboard would allocate research funding more rationally.

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A drunk person throwing darts at a list of diseases would produce a funding allocation that correlates more closely with

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actual disease burden than the National Institutes of Health, which employs twenty thousand people and has been doing this

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for fifty years. The dartboard doesn't even need to be in the building.

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Patients want medicine that works, access to experimental therapies, trials they can join, and a cure before they die.

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The N.I.H. funds molecular mechanisms, research empires, and institutional overhead.

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These two lists do not overlap. They don't even live in the same neighborhood.

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Patients don't control the money. Committees do. And committees optimize for the continued existence of committees.

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This is true of all committees, everywhere, since the invention of committees.

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Nobody has ever convened a committee that recommended fewer committees.

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On Wishonia, we have a word for an organism that exists solely to produce copies of itself.

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The word is "virus." You call them "advisory panels.". The Human Cost of Misallocation.

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When you allocate the vast majority of a forty-seven billion dollar annual budget into understanding disease instead of

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testing the safe, unpatentable treatments already gathering dust on the shelf, you get a very well-understood population

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of dead people. Cost Per Quality-Adjusted Life Year. A Quality-Adjusted Life Year is one year of healthy life.

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Lose a leg and live ten years, that's fewer than ten Q.A.L.Y.s.

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Die at forty instead of eighty, that's forty Q.A.L.Y.s lost.

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It's how you measure whether a medical system is keeping people alive and functional, or just keeping itself funded.

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The ADAPTABLE trial proved pragmatic trials cost forty-four point one times less per patient than traditional randomized

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controlled trials, or R.C.T.s (nine hundred and twenty-nine dollars versus forty-one thousand dollars).

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Same science. Fewer catered meetings. Forty-four point one times more patients enrolled.

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Fewer conference rooms rented. The Preventable Deaths. Conservative estimate: the N.I.H.'s misallocation costs approximately

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ten million Q.A.L.Y.s and seven hundred thousand preventable deaths every year.

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The upper bound is far worse (one hundred million Q.A.L.Y.s, seven million deaths), but even the floor is staggering.

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On Wishonia, if an institution's budget allocation was killing seven hundred thousand people a year, we would adjust the

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budget allocation. You adjusted the font on the annual report.

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Traditional clinical trials run at two point two seven percent the efficiency of pragmatic trials.

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And that's the ceiling, because it only accounts for the sliver of the N.I.H.

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budget that goes to trials at all. If your car ran at two point two seven percent efficiency, you would push it faster than

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it drives. If your heart pumped at two point two seven percent efficiency, you'd be dead before finishing this sentence.

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Your clinical trial system runs at two point two seven percent efficiency, and you gave it a raise.

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You gave it a raise and a new building. The building has a cafeteria.

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COVID is the most vivid example of what misallocation costs.

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So let me tell you what happened, and I will try to keep my composure, though I should warn you that I have been told I

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do not have composure. Your government knew this research was dangerous.

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In twenty fourteen, the Obama administration imposed a moratorium on gain-of-function research, specifically because engineering

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novel viruses posed pandemic risk. The government's own assessment: too dangerous to continue.

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In December twenty seventeen, the moratorium was lifted. There is evidence that N.I.H.

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officials may have effectively circumvented the pause the entire time regardless.

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At no point, before the moratorium, during it, or after lifting it, did anyone publish a cost-benefit analysis showing the

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expected benefits of engineering novel coronaviruses exceeded the risk of starting a pandemic.

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The question was never formally asked. It was not even formally avoided.

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It simply did not occur to anyone that the question should exist, which is the kind of oversight that is forgivable when

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you're deciding where to put a mailbox and less forgivable when you're deciding whether to make new viruses.

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Through a grant to EcoHealth Alliance, the N.I.H. sent six hundred thousand dollars to the Wuhan Institute of Virology for

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research engineering novel bat coronaviruses. In twenty eighteen and twenty nineteen, one of those engineered viruses turned

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out to be unexpectedly more infectious in mice. EcoHealth was required to report this immediately; they did not report it

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for nearly two years. The N.I.H. was required to oversee the grant; a federal watchdog found they did not.

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The N.I.H.'s own deputy director later admitted in congressional testimony that this was gain-of-function research.

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I am losing my composure. The F.B.I., the Department of Energy, and the C.I.A.

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(as of January twenty twenty-five) have all assessed that a lab leak is the most likely origin of COVID nineteen.

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A two-year congressional investigation concluded the same. This is not proven beyond doubt; four intelligence agencies still

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lean toward natural origin. But the question is not "who is to blame?"

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It is: what does it cost when an institution allocates six hundred thousand dollars to a side quest creating bat viruses

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instead of testing treatments? If these assessments are correct: fourteen to sixteen trillion dollars in economic damage

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to the United States alone. Seven million confirmed deaths, nineteen to thirty-six million by excess mortality estimates.

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An ongoing one trillion dollars per year in global long COVID costs.

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The N.I.H.'s entire budget over its fifty-year history, inflation-adjusted, is approximately one point one trillion dollars.

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A single unsupervised grant may have cost humanity roughly thirteen times more than everything the N.I.H.

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has ever spent, on everything, combined, since nineteen seventy.

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On Wishonia, we have a unit of measurement for this level of institutional failure.

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we have never had occasion to use it. Nobody intended this outcome.

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The researchers were studying bat coronaviruses to prevent pandemics, which is a goal I would applaud if it had not produced

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the opposite result. The grant administrators were following procedures.

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The system did not fail because of villains. It failed because nobody's job was to ask: "Is engineering novel coronaviruses

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in a city with inadequate biosafety protocols a better use of six hundred thousand dollars than testing whether any of the

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thousands of safe, untested compounds on the shelf might cure a disease that is killing people right now?".

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That question was never asked because the system is not designed to ask it.

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The system is designed to fund research. Whether that research helps anyone is a separate question, handled by a separate

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department, which does not exist. On Wishonia, we had a department like this once.

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It was called "the point." Every other department reported to it.

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Your species appears to have organized the entire building and forgotten to include the point.

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The building is very well organized. Then the pandemic happened.

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Then seven million people died. Then the N.I.H. received one point seven billion dollars to address the long-term damage.

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Then it spent eighty-five percent of that money watching people be sick instead of testing treatments.

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I have now fully lost my composure. In that timeline, the N.I.H.

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is too busy testing cures to fund gain-of-function research in Wuhan.

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There is no COVID nineteen pandemic. There is no sixteen trillion dollars in economic damage.

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There are no seven million dead. There is no long COVID costing one trillion dollars a year.

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The Track Record. You have already seen the numbers: one point one trillion dollars over fifty years, zero diseases eradicated

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(one possibly created). I asked the N.I.H. how many diseases they've eradicated.

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They sent me a forty-page document about their strategic vision.

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I read all forty pages. The number wasn't in it. The word "eradicate" wasn't in it either.

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The word "strategic" was in it thirty-one times. The W.H.O.

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eradicated smallpox for three hundred million dollars. Jonas Salk developed the polio vaccine in a university lab and gave

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it away for free, which is why nobody at the N.I.H. talks about him at parties because he makes everyone look bad by comparison

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and also he's dead, which is the thing they were supposed to be fixing.

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He gave away the patent. I asked an N.I.H. official what would happen if they gave away patents today and they made a sound

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I can only describe as a laugh, but sadder. Veterinarians have eradicated multiple animal diseases on budgets the N.I.H.

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would consider a rounding error. Your veterinarians eradicated hog cholera.

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Pigs. I should note the irony of humanity's failure to eradicate human diseases while more aggressively finding cures for

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animals you lock in metal crates too small to turn around in, standing in their own waste, whose tails you amputate without

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anesthesia because the confinement drives them insane enough to eat each other.

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But fixed that cholera for ya! What Would Actually Work. The RECOVERY trial already proved it.

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Five hundred dollars per patient instead of forty-one thousand dollars.

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First life-saving result in under one hundred days. Over one million lives saved.

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The blueprint exists. It is not theoretical. It happened. In England.

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During a pandemic. While Americans were arguing about horse dewormer.

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The British did not use a special technique. They did not have access to secret technology.

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They used the same drugs, the same disease, the same species of patient.

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They just tested the drugs on the patients instead of writing about the drugs near the patients.

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This is the breakthrough. It took zero breakthroughs. The evidence is right there.

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It's not hiding. It's waving at you. It has been waving at you for years.

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Now imagine the other timeline. Not as an indictment, but as a measure of what was lost.

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If the N.I.H. had allocated even twenty percent of its one point one trillion dollars to pragmatic trials over fifty years

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(the remaining eighty percent still on basic research), that produces four hundred and forty million patient-trials at RECOVERY

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efficiency (five hundred dollars per patient). That is enough to test every safe compound against every major disease, multiple

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times, with replication. The Oxford RECOVERY trial tested forty-eight thousand patients and found a treatment that saved

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over a million lives, in one hundred days, for twenty-four million dollars.

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Multiply that across four hundred and forty million patients and fifty years and the number of lives saved becomes difficult

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to calculate because the diseases start disappearing and the math changes.

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In that timeline, the N.I.H.'s one point one trillion dollars produces what a trillion dollars should produce: the systematic

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eradication of disease after disease after disease, because you finally pointed the money at the thing that actually works.

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The difference between that timeline and this one is not a matter of hindsight.

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The Oxford RECOVERY trial happened. Pragmatic trials existed the entire time.

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The efficiency data was available for decades. The counterfactual is not imaginary.

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It is the road you could see, that was paved, that had signs on it, that other countries were already driving on.

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You chose the other road. It led here. I am told that on your planet, describing this situation accurately is considered

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"rude." On Wishonia, not describing it would be considered "complicity."

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I will risk the rudeness. The recipe is simple enough that I can state it in four sentences: One.

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Pay for results. Treatment equals payment, no treatment equals no payment.

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Two. Publish everything, including failures. Especially failures, because the people who will die if the system fails are

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more motivated than the people who get tenure if the system continues.

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Three. Eliminate gatekeepers and let patients vote with participation.

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The volunteers are still holding their hands up. Four. Automate administration with transparent systems instead of committees.

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Committees cannot be trusted (see above, and also see the entire history of committees, and also see the committee that

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was formed to investigate whether committees can be trusted, which concluded that committees are essential).

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The cost of not doing this is measurable. Over fifty percent of trial results are never published, which means researchers

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unknowingly repeat experiments that already failed. This is how your species wastes an estimated eighty-five percent of

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its two hundred billion dollars annual research investment, and then passes the cost to patients as higher drug prices.

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The blueprint for this system is your decentralized F.D.A. The funding mechanism is the one percent treaty.

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The next chapters explain both.