How to Prevent a Year of Death and Suffering for 84 Cents

Of 9.50M combinations plausible drug-disease pairings, only 0.342% (95% CI: 0.21%-0.514%) have been clinically tested. At the current discovery rate of 15 diseases/year (95% CI: 8 diseases/year-30 diseases/year), clearing this backlog would take ~443 years (95% CI: 324 years-712 years). A decentralized FDA, an open protocol integrating pragmatic clinical trials into standard healthcare at $929 (95% CI: $97-$3K)/patient (vs. $41K (95% CI: $20K-$120K) traditional), increases trial capacity 12.3x (95% CI: 4.19x-61.3x), reducing the backlog clearance time to 36 years (95% CI: 11.6 years-77.2 years). Combined with eliminating the 8.2 years (95% CI: 4.85 years-11.5 years) post-safety efficacy delay through opt-in trial participation after Phase I, treatments arrive 212 years (95% CI: 135 years-355 years) earlier on average. This timeline shift saves 10.7B deaths (95% CI: 7.39B deaths-16.2B deaths), averts 565B DALYs (95% CI: 361B DALYs-877B DALYs), and eliminates 1931T hours (95% CI: 1362T hours-2616T hours) of suffering at $0.841 (95% CI: $0.242-$1.75)/DALY, competitive with bed nets ($89 (95% CI: $78-$100)/DALY) at vastly greater scale. R&D savings alone yield 637:1 (95% CI: 569:1-790:1) ROI ($58.6B (95% CI: $49.2B-$73.1B)/year).