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

Abstract: 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 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 backlog clearance 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. Full impact yields \$84.8 quadrillion (95% CI: \$62.4 quadrillion-\$97.3 quadrillion) in value (178k:1 (95% CI: 110k:1-421k:1) ROI). Summary: At current testing rates, finding treatments for all 6.65k diseases would take 443 years. Pragmatic trials integrated into healthcare increase testing 12.3x, saving 10.7B deaths and eliminating 1931T hours of suffering at \$0.841 per year of healthy life saved.