Source Quotes and References

Keywords

war-on-disease, 1-percent-treaty, medical-research, public-health, peace-dividend, decentralized-trials, dfda, dih, victory-bonds, health-economics, cost-benefit-analysis, clinical-trials, drug-development, regulatory-reform, military-spending, peace-economics, decentralized-governance, wishocracy, blockchain-governance, impact-investing

Sinn, M. P. The 1% Treaty: Harnessing Greed to Eradicate Disease. https://impact.warondisease.org (2025) doi:10.5281/zenodo.18161560

6.65 thousand diseases have zero FDA-approved treatments; at current trial capacity, exploring them takes 443 years. Redirecting 1% of military spending scales capacity 12.3x, cutting the timeline to 36 years and preventing 10.7 billion deaths. At $0.00177/DALY, 50.3kx more cost-effective than the best existing interventions. Incentive Alignment Bonds make adoption politically viable.

Harvard Kennedy School. 3.5% participation tipping point. Harvard Kennedy School https://www.hks.harvard.edu/centers/carr/publications/35-rule-how-small-minority-can-change-world (2020)

The research found that nonviolent campaigns were twice as likely to succeed as violent ones, and once 3.5% of the population were involved, they were always successful. Chenoweth and Maria Stephan studied the success rates of civil resistance efforts from 1900 to 2006, finding that nonviolent movements attracted, on average, four times as many participants as violent movements and were more likely to succeed. Key finding: Every campaign that mobilized at least 3.5% of the population in sustained protest was successful (in their 1900-2006 dataset) Note: The 3.5% figure is a descriptive statistic from historical analysis, not a guaranteed threshold. One exception (Bahrain 2011-2014 with 6%+ participation) has been identified. The rule applies to regime change, not policy change in democracies. Additional sources: https://www.hks.harvard.edu/centers/carr/publications/35-rule-how-small-minority-can-change-world | https://www.hks.harvard.edu/sites/default/files/2024-05/Erica%20Chenoweth_2020-005.pdf | https://www.bbc.com/future/article/20190513-it-only-takes-35-of-people-to-change-the-world | https://en.wikipedia.org/wiki/3.5%25_rule

UNICEF. Annual child deaths statistic. (2024)

15,000 are children (based on 5 million annual child deaths)

CDC. Percentage of preventable deaths. vol. 73 (2024)

80,000 were preventable (53% of deaths are preventable)

GAO. 95% of diseases have 0 FDA-approved treatments. GAO https://www.gao.gov/products/gao-25-106774 (2025)

95% of diseases have no treatment Additional sources: https://www.gao.gov/products/gao-25-106774 | https://globalgenes.org/rare-disease-facts/

ACLED. Active combat deaths annually. ACLED: Global Conflict Surged 2024 https://acleddata.com/2024/12/12/data-shows-global-conflict-surged-in-2024-the-washington-post/ (2024)

2024: 233,597 deaths (30% increase from 179,099 in 2023) Deadliest conflicts: Ukraine (67,000), Palestine (35,000) Nearly 200,000 acts of violence (25% higher than 2023, double from 5 years ago) One in six people globally live in conflict-affected areas Additional sources: https://acleddata.com/2024/12/12/data-shows-global-conflict-surged-in-2024-the-washington-post/ | https://acleddata.com/media-citation/data-shows-global-conflict-surged-2024-washington-post | https://acleddata.com/conflict-index/index-january-2024/

Grabowska, M. E., Huang, A., Wen, Z., Li, B. & Wei, W.-Q. Drug repurposing for alzheimer’s disease from 2012-2022: A 10-year literature review. Frontiers in Pharmacology 14, 1257700 (2023)

573 unique drugs were proposed for repurposing in Alzheimer’s disease over the last 10 years, including drugs acting on the nervous system (17%), antineoplastic and immunomodulating agents (16%), and drugs acting on the cardiovascular system (12%). 61% of reviewed studies performed validation, yet only 4% used real-world data.

Sakaeda et al. FAERS adverse event underreporting rate. PubMed: Empirical estimation of under-reporting in FAERS https://pubmed.ncbi.nlm.nih.gov/28447485/ (2017)

Empirical estimation: Average reporting rate approximately 6%, meaning 94% of adverse events are underreported Variability: 0.01% to 44% for statin events; 0.002% to >100% for biological drugs; 20% to >100% for narrow therapeutic index (NTI) drugs Selective reporting: Serious, unusual events more likely reported than mild or expected ones Newly marketed drugs: Higher reporting rates due to heightened awareness Older drugs: Events often under-reported Note: FAERS voluntary reporting system captures only "tip of the iceberg" of drug safety problems. Under-reporting introduces inherent biases and limitations in pharmacovigilance data Additional sources: https://pubmed.ncbi.nlm.nih.gov/28447485/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC12393772/

Congress.gov. Passage of the affordable care act and pelosi quote. Congress.gov https://www.congress.gov/bill/111th-congress/house-bill/3590/text

The Affordable Care Act: 2,700 pages, "we have to pass it to see what’s in it. Additional sources: https://www.congress.gov/bill/111th-congress/house-bill/3590/text | https://www.snopes.com/fact-check/pelosi-healthcare-pass-the-bill-to-see-what-is-in-it/

10.

PMC. Aging reversal demonstrated in mammals using yamanaka factors. PMC: Chemically Induced Reprogramming to Reverse Aging https://pmc.ncbi.nlm.nih.gov/articles/PMC10373966/ (2023)

Harvard/Sinclair: Loss of epigenetic information causes aging; restoring epigenome integrity reverses aging signs in mice OSK therapy (Oct4, Sox2, Klf4): Ectopic induction can restore youthful DNA methylation patterns, transcript profiles, and tissue function without erasing cellular identity Results in mice: Systemically delivered adeno-associated viruses encoding inducible OSK in 124-week-old mice extended median remaining lifespan by 109% over wild-type controls Vision restored in glaucoma mice - first successful reversal (not just halting progression) Cyclic partial reprogramming (2 days on, 5 days off) showed improvements after just 6 weeks including reduced age-related spinal curvature Human cells: Babraham Institute showed cellular reprogramming reverses epigenetic age of human skin cells by 30 years Chemical alternatives: Six chemical cocktails identified that restore youthful genome-wide transcript profile in less than a week without compromising cellular identity Note: Demonstrates biological aging is reversible, not inevitable; safety testing ongoing before human application Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC10373966/ | https://www.nature.com/articles/s41467-024-46020-5 | https://www.liebertpub.com/doi/10.1089/cell.2023.0072 | https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-021-01158-7

11.

Alzheimer’s Association. Annual deaths from alzheimer’s and other dementias. Alzheimer’s Association https://www.alz.org/alzheimers-dementia/facts-figures (2024)

Alzheimer’s | 2.6M deaths/year Additional sources: https://www.alz.org/alzheimers-dementia/facts-figures | https://www.cdc.gov/nchs/fastats/alzheimers.htm

12.

Review on Antimicrobial Resistance. Antimicrobial resistance deaths projection. Review on Antimicrobial Resistance https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf (2016).

13.

Our World in Data. Animal diseases eradicated by veterinary science. Our World in Data: Rinderpest Eradication https://ourworldindata.org/how-rinderpest-was-eradicated

Rinderpest eradicated in 2011 - only second disease ever eradicated after smallpox Declared globally eradicated by UN FAO and World Organisation for Animal Health Greatest veterinary achievement of our time" - devastating livestock disease for centuries Note: Caused up to 90% mortality in affected herds. Eradication achieved through coordinated international vaccination campaign launched in 1994 Additional sources: https://ourworldindata.org/how-rinderpest-was-eradicated | https://www.woah.org/en/disease/rinderpest/

14.

NIH. Antidepressant clinical trial exclusion rates. Zimmerman et al. https://pubmed.ncbi.nlm.nih.gov/26276679/ (2015)

Mean exclusion rate: 86.1% across 158 antidepressant efficacy trials (range: 44.4% to 99.8%) More than 82% of real-world depression patients would be ineligible for antidepressant registration trials Exclusion rates increased over time: 91.4% (2010-2014) vs. 83.8% (1995-2009) Most common exclusions: comorbid psychiatric disorders, age restrictions, insufficient depression severity, medical conditions Emergency psychiatry patients: only 3.3% eligible (96.7% excluded) when applying 9 common exclusion criteria Only a minority of depressed patients seen in clinical practice are likely to be eligible for most AETs Note: Generalizability of antidepressant trials has decreased over time, with increasingly stringent exclusion criteria eliminating patients who would actually use the drugs in clinical practice Additional sources: https://pubmed.ncbi.nlm.nih.gov/26276679/ | https://pubmed.ncbi.nlm.nih.gov/26164052/ | https://www.wolterskluwer.com/en/news/antidepressant-trials-exclude-most-real-world-patients-with-depression

15.

Armed Conflict Location & Event Data Project. Armed conflict location & event data project (ACLED). (2025).

16.

UN Legal. Arms trade treaty (2013) - campaign and adoption. UN Legal https://legal.un.org/avl/ha/att/att.html

The Arms Trade Treaty (ATT) regulates international trade in conventional arms. Adopted by UN General Assembly April 2, 2013. Campaign duration: 10 years (2003-2013) by Control Arms coalition Started with only 3 governments supporting (Mali, Costa Rica, Cambodia); achieved 130 signatories Coalition published 50+ reports over the campaign period One of the fastest multilateral treaties to enter into force after opening for signature Additional sources: https://legal.un.org/avl/ha/att/att.html | https://controlarms.org/att/ | https://www.oxfamamerica.org/about-us/measuring-impact/global-arms-trade-treaty/the-international-arms-trade-treaty/ | https://www.armscontrol.org/factsheets/arms_trade_treaty

17.

Theodore C. Schneirla. A unique case of circular milling in ants, considered in relation to trail following and the general problem of orientation. American Museum Novitates 1–26 (1944)

First rigorous scientific analysis of circular milling (death spiral) behavior in army ants (Labidus praedator) observed on Barro Colorado Island, Panama. Describes how ants separated from the main column lose pheromone trails and form circular mills, each ant following the one ahead until exhaustion and death.

18.

FDAReview.org. Estimated deaths due to FDA delay in approving beta blockers. FDAReview.org: FDA Harm https://www.fdareview.org/issues/theory-evidence-and-examples-of-fda-harm/ (2011)

Beta blockers approved in Europe mid-1970s, FDA didn’t approve until 1981 FDA estimated the drug could save 17,000 lives/year after approval Estimated 100,000 deaths from secondary heart attacks during 6-7 year delay Note: FDA imposed moratorium due to possible animal carcinogenicity despite human clinical evidence from 1974 Additional sources: https://www.fdareview.org/issues/theory-evidence-and-examples-of-fda-harm/ | https://www.ocregister.com/2011/02/09/walter-williams-death-by-fda-delay-denials/

19.

Biotechnology Innovation Organization (BIO). BIO clinical development success rates 2011-2020. Biotechnology Innovation Organization (BIO) https://go.bio.org/rs/490-EHZ-999/images/ClinicalDevelopmentSuccessRates2011_2020.pdf (2021)

Phase I duration: 2.3 years average Total time to market (Phase I-III + approval): 10.5 years average Phase transition success rates: Phase I→II: 63.2%, Phase II→III: 30.7%, Phase III→Approval: 58.1% Overall probability of approval from Phase I: 12% Note: Largest publicly available study of clinical trial success rates. Efficacy lag = 10.5 - 2.3 = 8.2 years post-safety verification. Additional sources: https://go.bio.org/rs/490-EHZ-999/images/ClinicalDevelopmentSuccessRates2011_2020.pdf

20.

Wikipedia. Examples of biological immortality and extreme longevity in nature. Wikipedia: Biological Immortality https://en.wikipedia.org/wiki/Biological_immortality

Hydra: Biologically immortal - no mortality increase over 4-year study, kept alive 12+ years Planarian worms: Somatically immortal with limitless telomere regeneration, clonal lines >15 years Axolotls: Regrow limbs, brain parts, heart tissue through remarkable regeneration Naked mole rats: Live 37+ years (10x similar rodents), cancer-proof, no age-related mortality increase Bowhead whales: Live 200+ years, unique DNA repair mutations, extra cancer-suppression genes Note: These animals demonstrate enhanced DNA repair, abundant stem cells, telomerase activity, and cancer resistance Additional sources: https://en.wikipedia.org/wiki/Biological_immortality | https://pmc.ncbi.nlm.nih.gov/articles/PMC5807068/

21.

Bordo, M. D. & Filardo, A. Deflation in a Historical Perspective. https://www.bis.org/publ/work186.pdf (2005)

Historical analysis of deflation episodes from the classical gold standard era through the post-WWII period. The "Great Deflation" of 1870-1896 saw prices fall roughly 2% per year while real output grew 2-3% per year. Good deflation occurs when aggregate supply increases faster than aggregate demand due to technological advances and productivity gains.

22.

U.S. Bureau of Labor Statistics. CPI inflation calculator. (2024)

CPI-U (1980): 82.4 CPI-U (2024): 313.5 Inflation multiplier (1980-2024): 3.80× Cumulative inflation: 280.48% Average annual inflation rate: 3.08% Note: Official U.S. government inflation data using Consumer Price Index for All Urban Consumers (CPI-U). Additional sources: https://www.bls.gov/data/inflation_calculator.htm

23.

U.S. Bureau of Labor Statistics. Working wives in married-couple families, 1967–2011. (2014).

24.

Bordo, M. D., Redish, A. & Rockoff, H. Why didn’t canada have a banking crisis in 2008 (or in 1930, or 1907, or ...)? The Economic History Review 68, 218–243 (2015)

Canada did not have a banking crisis in 2008 or during the Great Depression. Examines factors behind Canada’s record of banking stability, finding that the branch banking structure (few large banks with nationwide branches vs. thousands of small unit banks in the US) and regulatory framework were key contributors.

25.

Borio, C., Erdem, M., Filardo, A. & Hofmann, B. The costs of deflations: A historical perspective. BIS Quarterly Review https://www.bis.org/publ/qtrpdf/r_qt1503e.htm (2015)

Tested the historical link between output growth and deflation across 140 years and up to 38 economies. Found the link is "weak" and "derives largely from the Great Depression." The benign output performance during the classical gold standard period characterized those deflations as "good." Property price deflations, not goods price deflations, are the more consistent predictor of economic weakness.

26.

Austin Bradford Hill. The environment and disease: Association or causation? PubMed Central: Hill 1965 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1898525/ (1965)

Original paper establishing the 9 criteria for evaluating causal relationships in epidemiology Criteria: Strength, Consistency, Specificity, Temporality, Biological Gradient, Plausibility, Coherence, Experiment, Analogy Published in Proceedings of the Royal Society of Medicine Most influential framework for assessing causation from observational data Additional sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1898525/ | https://en.wikipedia.org/wiki/Bradford_Hill_criteria

27.

arXiv. Bradley-terry and PageRank models for ranking. arXiv: PageRank and Bradley-Terry Model https://arxiv.org/abs/2402.07811

Bradley-Terry: Probability model for pairwise comparisons (1952, earlier by Zermelo 1920s); maximum likelihood estimation PageRank: Ranks nodes by importance in network via stationary distribution of Markov chain Connection: Under quasi-symmetry, Bradley-Terry scores are equivalent to scaled PageRank; ML estimates can be approximated from limiting distribution Applications: Sports rankings, journal citations, AI model rankings, consumer choice, search engines Additional sources: https://arxiv.org/abs/2402.07811 | https://en.wikipedia.org/wiki/Bradley–Terry_model | https://www.sciencedirect.com/science/article/pii/S0950705122000314

28.

The Electoral Commission. United kingdom european union membership referendum, 2016. The Electoral Commission https://www.electoralcommission.org.uk/who-we-are-and-what-we-do/elections-and-referendums/past-elections-and-referendums/eu-referendum (2016)

On 23 June 2016 the United Kingdom held a referendum on EU membership. Leave won 51.9% to 48.1% on 72.2% turnout (33.6 million votes cast). A complex multidimensional trade and sovereignty question was reduced to a single binary yes/no choice.

30.

Encyclopaedia Britannica. Korean war. (2025)

At least 2.5 million persons lost their lives in the Korean War, encompassing military and civilian casualties across all combatant nations.

31.

Encyclopaedia Britannica. Spanish-american war. (2025)

The Spanish-American War lasted from April to August 1898. American combat deaths totaled 345, though approximately 2,000 more died of disease. The war lasted approximately ten weeks.

32.

Encyclopaedia Britannica. How many people died in the vietnam war? (2025)

Vietnam’s 1995 official estimate: as many as 2 million civilians on both sides, 1.1 million North Vietnamese and Viet Cong fighters, plus nearly 300,000 South Vietnamese and allied soldiers. Total approximately 3.4 million.

33.

Encyclopaedia Britannica. World war i - killed, wounded, and missing. (2025)

Some 8,500,000 soldiers died as a result of wounds and/or disease. Civilian deaths were estimated at around 13,000,000, resulting from starvation, exposure, disease, military encounters, and massacres.

34.

Carnegie Endowment. California direct democracy and ballot proposition overload. Carnegie Endowment: California Direct Democracy https://carnegieendowment.org/posts/2024/11/california-2024-election-propositions-direct-democracy (2024)

2024: 7 measures pulled before election after back-room negotiations (16 since 2014) System designed to curb special interests has instead empowered them Victory is on the side of the biggest purse" (1923 legislative committee) Influx of special interest propositions makes ballots longer, more confusing, less accessible Note: Progressive Era reform meant to curb special interests has had unintended opposite effect Additional sources: https://carnegieendowment.org/posts/2024/11/california-2024-election-propositions-direct-democracy | https://www.davispoliticalreview.com/article/hijacking-the-ballot-the-problem-with-californias-ballot-initiative-system

35.

The Lancet. Annual deaths from cancer (10 million). The Lancet: Global Cancer Deaths 2023 https://www.hematologyadvisor.com/news/globally-18-5-million-incident-cancer-cases-and-10-4-million-deaths-reported-in-2023/ (2023)

Cancer deaths: 10.4 million globally in 2023 (9.7 million in 2022) 18.5 million new cancer cases in 2023 65.8% of deaths occur in low- to upper-middle-income countries Note: Cancer is the second leading cause of death globally after cardiovascular diseases. Projected to reach 18.6 million deaths by 2050 (74.5% increase) Additional sources: https://www.hematologyadvisor.com/news/globally-18-5-million-incident-cancer-cases-and-10-4-million-deaths-reported-in-2023/ | https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing–amidst-mounting-need-for-services

36.

CBO. The 2024 Long-Term Budget Outlook. https://www.cbo.gov/publication/60039 (2024).

37.

CBS News. Study: Bank bonuses far exceeded profits. (2009)

Goldman Sachs earned $2.3 billion and paid out $4.8 billion in bonuses. Morgan Stanley earned $1.7 billion and paid $4.475 billion in bonuses. Citigroup and Merrill Lynch lost a combined $54 billion yet paid $9 billion in combined bonuses.

38.

CA Attorney General. California consumer privacy act (CCPA) and california privacy rights act (CPRA). CA Attorney General: CCPA https://oag.ca.gov/privacy/ccpa

CCPA effective January 1, 2020; CPRA (Prop 24) approved November 2020, effective January 1, 2023 Consumer rights: Know/access personal data; Delete data; Opt-out of sale/sharing; Non-discrimination; Correct inaccurate data (CPRA); Limit sensitive data use (CPRA) Enforcement: California Privacy Protection Agency (CPRA created); Previously CA Attorney General Penalties: Up to $7,500 per intentional violation; $2,500 per unintentional violation Additional sources: https://oag.ca.gov/privacy/ccpa | https://cppa.ca.gov/regulations/ | https://pro.bloomberglaw.com/insights/privacy/california-consumer-privacy-laws/

39.

NPR. Contamination of early CDC COVID-19 tests in 2020. NPR: CDC Test Flawed https://www.npr.org/2020/11/06/929078678/cdc-report-officials-knew-coronavirus-test-was-flawed-but-released-it-anyway (2020)

CDC distributed flawed test kits Feb 6, 2020 - contaminated reagents caused false positives 24 of 26 public health labs found contamination, CDC recalled kits by Feb 10 Tests made in CDC lab (not manufacturing facility), violated sound manufacturing practices Contamination occurred in Respiratory Virus Diagnostic Lab during processing Note: Delays had significant consequences for early pandemic tracking and response Additional sources: https://www.npr.org/2020/11/06/929078678/cdc-report-officials-knew-coronavirus-test-was-flawed-but-released-it-anyway | https://www.cnn.com/2020/04/18/politics/cdc-coronavirus-testing-contamination/index.html

40.

National Center for Health Statistics. Drug poisoning deaths in the united states, 1980–2008. (2011)

The number of drug poisoning deaths increased sixfold from about 6,100 in 1980 to 36,500 in 2008.

41.

National Center for Health Statistics. Drug overdose deaths in the united states, 2003–2023. (2025)

Drug overdose deaths in the United States exceeded 100,000 annually beginning in 2021, with a peak of approximately 111,000 in 2023.

42.

Centers for Disease Control and Prevention. Changes in suicide rates in the united states from 2022 to 2023. (2024).

43.

Scientific American. Cellular turnover and repair rates in the human body. HowStuffWorks: Body Replace Every 7 Years https://www.scientificamerican.com/article/our-bodies-replace-billions-of-cells-every-day/

330 billion cells replaced daily ( 1% of all cells, 3.8 million/second) 80 grams of cellular mass turnover per day, dominated by blood cells (86%) and gut epithelial cells (12%) Complete body cell replacement in 80-100 days (average cell age: 7 years) Note: Despite constant regeneration, we age due to DNA mutations that accumulate as cells replicate Produce 2 million red blood cells per second Generate new stomach lining every 3-5 days Replace your entire skin every 28 days (surface cells every 2-4 weeks) Rebuild your skeleton every 10 years Additional sources: https://www.scientificamerican.com/article/our-bodies-replace-billions-of-cells-every-day/ | https://wis-wander.weizmann.ac.il/life-sciences/cell-replacement-numbers | https://science.howstuffworks.com/life/cellular-microscopic/does-body-really-replace-seven-years.htm | https://www.livescience.com/33179-does-human-body-replace-cells-seven-years.html | https://www.sanitas.com/en/magazine/body/about-body/how-our-body-regenerates.html

44.

U.S. Census Bureau. Money income in 1972 of families and persons in the united states. (1973)

The median family money income of the 54.4 million families in the United States was $11,120 in 1972, an increase of 8.1 percent over the 1971 median family income of $10,290.

45.

U.S. Census Bureau. Historical census of housing tables: homeownership. (2024)

Homeownership rates by decade from decennial census data. 1940: 43.6%. 1950: 55.0%. 1960: 61.9%. 1970: 62.9%. The aggregate US homeownership rate increased by 20 percentage points from 1940 to 1960, the largest change in American homeownership in the past 100 years.

46.

US Census Bureau. US median household income 2023. (2024)

US median household income was $77,500 in 2023 Real median household income declined 0.8% from 2022 Gini index: 0.467 (income inequality measure) Additional sources: https://www.census.gov/library/publications/2024/demo/p60-282.html

47.

Cato Institute. Chance of dying from terrorism statistic. Cato Institute: Terrorism and Immigration Risk Analysis https://www.cato.org/policy-analysis/terrorism-immigration-risk-analysis

Chance of American dying in foreign-born terrorist attack: 1 in 3.6 million per year (1975-2015) Including 9/11 deaths; annual murder rate is 253x higher than terrorism death rate More likely to die from lightning strike than foreign terrorism Note: Comprehensive 41-year study shows terrorism risk is extremely low compared to everyday dangers Additional sources: https://www.cato.org/policy-analysis/terrorism-immigration-risk-analysis | https://www.nbcnews.com/news/us-news/you-re-more-likely-die-choking-be-killed-foreign-terrorists-n715141

48.

Reymond, J. L. Total drug-like chemical space (10²³ - 10⁶⁰). Reymond https://pubs.acs.org/doi/10.1021/ar500432k (2015)

Estimated 10²³ to 10⁶⁰ drug-like molecules exist in chemical space, dwarfing the number of compounds ever synthesized. Additional sources: https://pubs.acs.org/doi/10.1021/ar500432k

49.

CDC. Childhood vaccination (US) ROI. CDC https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm (2017).

50.

Wikipedia. Cost of china’s military parades. Wikipedia: 2015 China Victory Day Parade https://en.wikipedia.org/wiki/2015_China_Victory_Day_Parade (2015)

2015 Victory Day (70th anniversary): 12,000 PLA troops, 1,000 foreign troops, 850,000 "Citizen Guards 2025 parade estimated >36 billion yuan ($5 billion, 1.5% of military budget) - Taiwan estimate Beijing rarely discloses parade costs; estimates cannot be independently verified Note: Massive mobilization for propaganda purposes; costs remain state secret Additional sources: https://en.wikipedia.org/wiki/2015_China_Victory_Day_Parade | https://www.nbcnews.com/world/asia/live-blog/china-parade-putin-kim-jong-un-xi-military-live-updates-rcna228503

51.

Dilanian, K. CIA shifts assessment on Covid origins, saying lab leak likely caused outbreak. NBC News (2025).

52.

Supreme Court of the United States. Impact of citizens united supreme court decision on campaign finance. Citizens United v. FEC https://supreme.justia.com/cases/federal/us/558/310/

Citizens United v. FEC (2010): 5-4 Supreme Court decision allowing unlimited corporate/union political spending Overruled restrictions on independent expenditures, citing First Amendment Led to creation of super PACs and massive increases in dark money Dramatically expanded influence of wealthy donors, corporations, special interest groups Note: Overwhelming majorities of Americans disapprove; 22+ states voted to support constitutional amendment to overturn Additional sources: https://supreme.justia.com/cases/federal/us/558/310/ | https://www.brennancenter.org/our-work/research-reports/citizens-united-explained

53.

UN News. Clean water & sanitation (LMICs) ROI. UN News https://news.un.org/en/story/2014/11/484032 (2014).

54.

JAMA Internal Medicine. Cost breakdown of traditional clinical trials. JAMA Internal Medicine: Clinical Trial Costs Study https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2702287

Median clinical trial cost: $19.0 million (range: $12.2M - $33.1M) Cost per patient varies by phase: Phase 1: $137K, Phase 2: $130K, Phase 3: $113K Note: Based on analysis of 138 clinical trials. Actual costs can vary significantly based on disease area, trial complexity, and patient population Additional sources: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2702287

55.

Clinical Trials Arena. Clinical trial enrollment timelines. Clinical Trials Arena https://www.clinicaltrialsarena.com/marketdata/featureclinical-trial-patient-recruitment/.

56.

ACS CAN. Clinical trial patient participation rate. ACS CAN: Barriers to Clinical Trial Enrollment https://www.fightcancer.org/policy-resources/barriers-patient-enrollment-therapeutic-clinical-trials-cancer

Only 3-5% of adult cancer patients in US receive treatment within clinical trials About 5% of American adults have ever participated in any clinical trial Oncology: 2-3% of all oncology patients participate Contrast: 50-60% enrollment for pediatric cancer trials (<15 years old) Note: 20% of cancer trials fail due to insufficient enrollment; 11% of research sites enroll zero patients Additional sources: https://www.fightcancer.org/policy-resources/barriers-patient-enrollment-therapeutic-clinical-trials-cancer | https://hints.cancer.gov/docs/Briefs/HINTS_Brief_48.pdf

57.

PMC. Only 12% of human interactome targeted. PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC10749231/ (2023)

Mapping 350,000+ clinical trials showed that only 12% of the human interactome has ever been targeted by drugs. Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC10749231/

58.

Convention on Cluster Munitions. Convention on cluster munitions (2008) - oslo process. Convention on Cluster Munitions https://www.clusterconvention.org/oslo-process/

The Convention on Cluster Munitions bans the use, production, stockpiling, and transfer of cluster munitions. Oslo Process timeline: February 2007 to December 2008 ( 2 years) 46 states signed Oslo Declaration (Feb 2007); 94 states signed convention (Dec 2008) Core Group: Norway, Austria, Ireland, Mexico, New Zealand, Peru, Holy See Results: 29 States Parties destroyed nearly 1.4 million stockpiled cluster munitions containing 172.9 million submunitions Additional sources: https://www.clusterconvention.org/oslo-process/ | https://unidir.org/files/publication/pdfs/unacceptable-harm-a-history-of-how-the-treaty-to-ban-cluster-munitions-was-won-en-258.pdf | https://www.stopclustermunitions.org/en-gb/the-treaty/global-ban.aspx

59.

George A. Miller. Cognitive limit in short-term memory (miller’s law). George A. Miller https://doi.org/10.1037/h0043158 (1956)

Short-term memory capacity: 7 ± 2 items (Miller’s Law) The "magical number seven" - humans can hold approximately 7 chunks of information in working memory Note: This classic psychology paper has been cited over 40,000 times and fundamentally shaped our understanding of human cognitive limitations Additional sources: https://doi.org/10.1037/h0043158

60.

Shortell, D. Reading every word of every bill. Government Executive https://www.govexec.com/federal-news/2009/09/reading-every-word-of-every-bill/39321/ (2009)

In the 110th Congress, the House dealt with 7,441 bills and joint resolutions averaging 16.7 pages per law, totaling approximately 125,000 pages. At 300 words per minute (average college graduate reading speed), reading just the 1,427-page Waxman-Markey bill would take 12 hours. Cites Washington Post editorial on impossibility of legislators reading all proposed legislation.

61.

CBS 60 Minutes. Percentage of time members of congress spend fundraising. CBS 60 Minutes: Congressional Telemarketers https://www.cbsnews.com/news/60-minutes-are-members-of-congress-becoming-telemarketers/

Recommended: 4 hours "call time" + 1 hour "strategic outreach" = 5 hours/day out of 9-10 hour workday New members told to spend 30 hours/week on fundraising calls since Citizens United Tom Daschle: 67% of schedule is money-gathering in 2 years before election Only 3-4 hours/day for actual Congressional work (hearings, votes, constituents) Note: By law, members cannot fundraise from offices; parties set up call centers near Capitol Additional sources: https://www.cbsnews.com/news/60-minutes-are-members-of-congress-becoming-telemarketers/ | https://www.huffpost.com/entry/call-time-congressional-fundraising_n_2427291

62.

Issue One. Congressional committee assignments have explicit fundraising price tags. Issue One: The Price of Power https://www.issueone.org/wp-content/uploads/2017/05/price-of-power-final.pdf (2017)

DCCC (Democratic): Speaker $31 million, "A" Committee Chairs $1.8 million, Regular members $150,000 minimum NRCC (Republican): Speaker $20 million, Power Committee Chairs $1.2 million, Transportation Chair $875,000 Members display "giant tally sheet" showing who has/hasn’t paid their party dues Members who don’t pay dues get bills killed, amendments ignored, worse offices Rep. Brett Guthrie: Paid $2.5 million (53% of campaign funds) for Energy & Commerce Chair Rep. Rosa DeLauro: Paid $690,000 (39% of campaign funds) for Appropriations Note: System criticized as "recipe for corruption" disconnecting members from constituents Additional sources: https://www.issueone.org/wp-content/uploads/2017/05/price-of-power-final.pdf | https://theintercept.com/2019/09/03/dccc-house-committees-dues/ | https://www.brookings.edu/articles/problems-with-the-committee-tax-in-congress/ | https://rollcall.com/2023/02/09/gavels-for-top-house-committees-dont-always-come-cheap/

63.

U.S. Senate. Salary of a u.s. congressman. U.S. Senate: Salaries https://www.senate.gov/senators/SenateSalariesSince1789.htm

Members of Congress: $174,000/year (2009-present) Speaker of the House: $223,500/year Majority/Minority Leaders: $193,400/year Note: Congressional salary has been frozen at $174,000 since 2009, unchanged for over 15 years Additional sources: https://www.senate.gov/senators/SenateSalariesSince1789.htm | https://crsreports.congress.gov

64.

ScienceDaily. Conscious mind controls 5% of decisions. ScienceDaily: Unconscious Decision Making https://www.sciencedaily.com/releases/2008/04/080414145705.htm (2008)

Conscious of only 5% of cognitive activity; 95% is unconscious/subconscious Brain signals predict decisions up to 7 seconds before conscious awareness 90% of buying decisions made subconsciously Most of what we do every minute is unconscious" - neuroscientist Paul Whelan Note: All decisions made unconsciously first, then we "fool ourselves" into believing we consciously made them Additional sources: https://www.sciencedaily.com/releases/2008/04/080414145705.htm | https://pmc.ncbi.nlm.nih.gov/articles/PMC2440575/

65.

Wikipedia. Control arms coalition - arms trade treaty campaign. Wikipedia https://en.wikipedia.org/wiki/Control_Arms_Campaign

Coalition of 100+ organizations including Amnesty International, Oxfam, and International Action Network on Small Arms (IANSA) Campaign duration: 10 years (October 2003 - April 2013) Published 50+ reports over the campaign period on various aspects of arms trade regulation Campaign tactics: Publicity stunts, mass public actions, Million Faces petition, worldwide consultations, lobbying Achievement: Arms Trade Treaty adopted by UN General Assembly April 2013, entered into force December 2014 Additional sources: https://en.wikipedia.org/wiki/Control_Arms_Campaign | https://frompoverty.oxfam.org.uk/how-did-a-global-campaign-bring-about-a-un-arms-trade-treaty/ | https://policy-practice.oxfam.org/resources/power-and-change-the-arms-trade-treaty-338471/

66.

Copenhagen Consensus. Halftime for SDGs: Child immunization. (2023).

67.

FTC. Children’s online privacy protection act (COPPA). FTC: COPPA Rule https://www.ftc.gov/legal-library/browse/rules/childrens-online-privacy-protection-rule-coppa

Federal law effective April 21, 2000; applies to websites/services collecting data from children under 13 Requirements: Privacy policy; Verifiable parental consent before collecting data; Data security; Parental review/deletion rights Applies to: For-profit businesses collecting personal info from US children under 13 Penalties: Up to $50,120 per violation Enforcement: FTC and State Attorneys General Additional sources: https://www.ftc.gov/legal-library/browse/rules/childrens-online-privacy-protection-rule-coppa | https://en.wikipedia.org/wiki/Children’s_Online_Privacy_Protection_Act | https://www.ecfr.gov/current/title-16/chapter-I/subchapter-C/part-312

68.

USA TODAY, The Arizona Republic & Center for Public Integrity. You elected them to write new laws. They’re letting corporations do it instead. Center for Public Integrity https://publicintegrity.org/politics/state-politics/copy-paste-legislate/you-elected-them-to-write-new-laws-theyre-letting-corporations-do-it-instead/ (2019)

Investigation of nearly 1 million bills across all 50 states found at least 10,000 bills almost entirely copied from model legislation introduced over eight years, with more than 2,100 signed into law. Sources: 4,301 from industry (42%), 4,012 from conservative groups (40%), 1,602 from liberal groups (16%), 248 other (2%).

69.

ScienceDirect. How campaign contributions influence politicians. ScienceDirect: Campaign Contributions & Legislative Behavior https://www.sciencedirect.com/science/article/pii/S0047272725000179 (2010)

Research: Only 1 in 4 studies support notion that contributions directly "buy votes Influence mechanism: Access, agenda-setting, keeping bills off floor, earmarks, key language in legislation (not direct votes) Average winner costs (2022): House $2.79M, Senate $26.53M; Competitive races much higher Internal party fundraising requirements: $100K-$30M annually; Committee positions cost $450K 95% of House races since 2004 won by highest spender Contribution limits: $3,300 per candidate per election (individuals); PACs gave $289.3M total (2021-2022) Additional sources: https://www.sciencedirect.com/science/article/pii/S0047272725000179 | https://slate.com/news-and-politics/2010/10/how-much-does-it-cost-to-buy-a-vote.html | https://www.opensecrets.org/elections-overview/cost-of-election | https://issueone.org/articles/the-118th-congress-fundraising-treadmill/

70.

Crawford, N. C. Human costs of post-9/11 wars. (2024)

Over 940,000 people killed by direct war violence. An estimated 3.6-3.8 million died indirectly in post-9/11 war zones. Total: at least 4.5-4.7 million and counting.

71.

Crawford, N. C. & Lutz, C. Blood and treasure: United states budgetary costs and human costs of 20 years of war. (2023)

The total costs of the post-9/11 wars in Iraq, Afghanistan, Pakistan, and Syria are expected to exceed $8 trillion. This includes $2.89 trillion for Iraq/Syria, veterans care through 2050 projected at more than $2 trillion, and interest on war debt adding $6.5 trillion through 2050.

72.

USC Schaeffer Center. COVID-19’s total cost to the U.S. Economy will reach $14 trillion by end of 2023. USC Schaeffer Center for Health Policy and Economics https://schaeffer.usc.edu/research/covid-19s-total-cost-to-the-economy-in-us-will-reach-14-trillion-by-end-of-2023-new-research/ (2023).

73.

Cutler, D. M. & Summers, L. H. The COVID-19 pandemic and the $16 trillion virus. JAMA 324, 1495–1496 (2020).

74.

Statista. Comparison of u.s. Deaths from COVID-19 vs. Major wars. Statista: COVID vs War Deaths https://www.statista.com/chart/24252/us-covid-19-deaths-compared-to-deaths-in-major-wars/

COVID-19 US deaths: 1.2+ million total (as of 2024) WWII: 405,000 | Korea: 36,000 | Vietnam: 58,000 = 499,000 combined By March 2021: COVID deaths (527,726) exceeded WWI, WWII, Vietnam, 9/11 combined By Oct 2021: 704,233 deaths exceeded ALL US foreign conflict deaths ( 685,000 total) Note: COVID killed more Americans than Revolutionary War, War of 1812, WWI, WWII, Korea, Vietnam, and other conflicts combined Additional sources: https://www.statista.com/chart/24252/us-covid-19-deaths-compared-to-deaths-in-major-wars/ | https://www.snopes.com/fact-check/americans-covid-foreign-conflicts/

75.

Bramante, C. T. et al. Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): A multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial. The Lancet Infectious Diseases 23, 1119–1129 (2023).

76.

Select Subcommittee on the Coronavirus Pandemic. Final report: COVID select concludes 2-year investigation, issues 500+ page final report. (2024).

77.

Crestmont Research. Real GDP growth by decade. (2024)

Average real GDP growth by decade. 1950s: 4.2% per year. 1960s: 4.5% per year. 1970s: 3.2%. 1980s: 3.1%. 1990s: 3.2%. 2000s: 1.9%. 2010s: 2.3%.

78.

Daggett, S. Costs of major u.s. wars. (2010)

Congressional Research Service estimates of the costs of major U.S. wars from the American Revolution through post-9/11 operations, in both current-year and constant FY2011 dollars.

79.

UBS. Credit suisse global wealth report 2023. Credit Suisse/UBS https://www.ubs.com/global/en/family-office-uhnw/reports/global-wealth-report-2023.html (2023)

Total global household wealth: USD 454.4 trillion (2022) Wealth declined by USD 11.3 trillion (-2.4%) in 2022, first decline since 2008 Wealth per adult: USD 84,718 Additional sources: https://www.ubs.com/global/en/family-office-uhnw/reports/global-wealth-report-2023.html

80.

ABC News. Bailed-out banks gave millions in exec bonuses, NY AG report shows. (2009)

Citigroup lost $18.7 billion in 2008 and received $45 billion in TARP bailout funds, yet paid $5.33 billion in bonuses, with 738 employees receiving at least $1 million. Bank of America received $45 billion in TARP and paid $3.3 billion in bonuses. Merrill Lynch lost $30.48 billion and paid $3.6 billion in bonuses with 696 million-dollar recipients. Across nine major banks, nearly 4,800 employees received bonuses of $1 million or more.

81.

Cybersecurity Ventures. Cybercrime economy projected to reach $10.5 trillion. Cybersecurity Ventures: $10.5T Cybercrime https://cybersecurityventures.com/hackerpocalypse-cybercrime-report-2016/ (2016)

Global cybercrime costs: $3T (2015) → $6T (2021) → $10.5T (2025 projected) 15% annual growth rate If measured as country, would be 3rd largest economy after US and China Greatest transfer of economic wealth in history Note: More profitable than global trade of all major illegal drugs combined. Includes data theft, productivity loss, IP theft, fraud Additional sources: <https://cybersecurityventures.com/hackerpocalypse-cybercrime-report-2016/> | https://www.boisestate.edu/cybersecurity/2022/06/16/cybercrime-to-cost-the-world-10-5-trillion-annually-by-2025/

82.

CSO Online. 96% of cybercrimes go unpunished. CSO Online: Why Internet Crime Goes Unpunished https://www.csoonline.com/article/2618598/why-internet-crime-goes-unpunished.html

Less than 1% of cybercrimes prosecuted (UK: 65 prosecutions vs 17,900 reported cases in 2018) 99% of cybercrimes go unpunished Perpetrators extremely difficult to identify and pursue Cross-national boundaries make prosecution nearly impossible Note: Rules of evidence and international jurisdiction make cybercrime possibly harder to prosecute than any other area of law enforcement Additional sources: https://www.csoonline.com/article/2618598/why-internet-crime-goes-unpunished.html | https://informationsecuritybuzz.com/expert-comments/only-1-of-cybercrimes-prosecuted/

83.

MobiHealthNews, Aug. Other DCT platform company funding. MobiHealthNews https://www.mobihealthnews.com/news/exo-raises-40m-handheld-ultrasound-decentralized-trial-platforms-raise-nearly-100m-and-more (2020)

Science 37: $40M raised Thread: up to $50M raised uMotif: $25.5M raised These companies show that you can achieve significant traction and platform development with investments in the tens of millions. Additional sources: https://www.mobihealthnews.com/news/exo-raises-40m-handheld-ultrasound-decentralized-trial-platforms-raise-nearly-100m-and-more | https://www.pharmasalmanac.com/articles/umotif-the-patient-first-data-capture-and-decentralized-clinical-trials-platform-announces-25.5m-of-new-investment-from-a-fund-managed-by-athyrium-capital-management

84.

IHME. Death causes vs fear (heart disease vs terrorism). IHME: CVD Deaths 2023 https://www.healthdata.org/news-events/newsroom/news-releases/report-cardiovascular-diseases-caused-1-3-global-deaths-2023 (2023)

Cardiovascular disease: 19.2-20.5 million deaths annually (2023 data) Terrorism: approximately 25,000 deaths per year CVD accounts for 1 in 3 global deaths - the leading cause for over 30 years Note: CVD deaths increased 60% from 12.1M (1990) to 20.5M (2021). 4 in 5 CVD deaths occur in low- and middle-income countries Additional sources: https://www.healthdata.org/news-events/newsroom/news-releases/report-cardiovascular-diseases-caused-1-3-global-deaths-2023 | https://world-heart-federation.org/wp-content/uploads/World-Heart-Report-2023.pdf

85.

Delaware Division of Corporations. Delaware has more corporate entities than residents. Delaware Division of Corporations: 2020 Annual Report https://corp.delaware.gov/stats/2020-annual-report/ (2020)

Delaware population: <1 million residents Business entities: 1.6 million+ (2020) - 2:1 ratio over residents 2019: 1.5 million entities vs <1M people 66% of Fortune 500 incorporated in Delaware 93% of US IPOs are Delaware entities Note: 249,427 new business entities added in 2020 alone. Unique 2:1 corporation-to-resident ratio Additional sources: https://corp.delaware.gov/stats/2020-annual-report/ | https://press.princeton.edu/ideas/hal-weitzman-on-whats-the-matter-with-delaware

86.

Sinn, M. P. Ubiquitous Pragmatic Trial Impact Analysis: How to Prevent a Year of Death and Suffering for 84 Cents. https://dfda-impact.warondisease.org (2025) doi:10.5281/zenodo.18243914

Only 15 diseases/year get their first treatment each year. With 6.65 thousand diseases lacking effective treatments, the backlog would take 443 years to clear. Integrating pragmatic trials into standard healthcare increases trial capacity 12.3x, cutting that timeline from 443 years to 36 years. The average untreated disease gets a treatment 212 years earlier, saving 10.7 billion deaths at $0.842 per year of healthy life saved.

87.

Sinn, M. P. The Continuous Evidence Generation Protocol: Two-Stage Validation (RWE → Pragmatic Trials). https://dfda-spec.warondisease.org (2025) doi:10.5281/zenodo.18203375

We present the Predictor Impact Score (PIS), a novel composite metric operationalizing Bradford Hill causality criteria for automated signal detection from aggregated N-of-1 observational studies. Combined with pragmatic trial confirmation (based on evidence from 108+ embedded trials), this two-stage framework would generate validated outcome labels at 44.1x lower cost than traditional Phase III trials. This enables continuous, population-scale pharmacovigilance and precision dosing recommendations.

88.

International Diabetes Federation. Annual deaths from diabetes. International Diabetes Federation https://diabetesatlas.org/ (2024)

Diabetes | 2M deaths/year Additional sources: https://diabetesatlas.org/ | https://www.who.int/news-room/fact-sheets/detail/diabetes

89.

NYU Stern. Lobbying spending and returns for disease advocacy groups. NYU Stern: Lobbying Influences NIH Funding https://www.stern.nyu.edu/experience-stern/news-events/new-research-finds-special-interest-lobbying-does-influence-nih-research-funding (2024)

Each $1,000 spent on lobbying correlated with $25,000 funding increase following year (53 diseases, 19 years) Rare disease advocates increased NIH rare-disease funding 3-15%/year (1998-2008) via millions in lobbying Specific examples: Alzheimer’s Association secured $100M NIH increase (FY2024); ME/CFS Initiative helped secure >$1B for long-COVID General ratio: Disease advocacy lobbying yields significant ROI, though specific "$100M → $1.8B" not verified Additional sources: https://www.stern.nyu.edu/experience-stern/news-events/new-research-finds-special-interest-lobbying-does-influence-nih-research-funding | https://www.nature.com/articles/515019a | https://www.alz.org/news/2024/congress-bipartisan-funding-alzheimers-research

90.

WHO. Annual global economic burden of alzheimer’s and other dementias. WHO: Dementia Fact Sheet https://www.who.int/news-room/fact-sheets/detail/dementia (2019)

Global cost: $1.3 trillion (2019 WHO-commissioned study) 50% from informal caregivers (family/friends, 5 hrs/day) 74% of costs in high-income countries despite 61% of patients in LMICs $818B (2010) → $1T (2018) → $1.3T (2019) - rapid growth Note: Costs increased 35% from 2010-2015 alone. Informal care represents massive hidden economic burden Additional sources: https://www.who.int/news-room/fact-sheets/detail/dementia | https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12901

91.

JAMA Oncology. Annual global economic burden of cancer. JAMA Oncology: Global Cost 2020-2050 https://jamanetwork.com/journals/jamaoncology/fullarticle/2801798 (2020)

2020-2050 projection: $25.2 trillion total ($840B/year average) 2010 annual cost: $1.16 trillion (direct costs only) Recent estimate: $3 trillion/year (all costs included) Top 5 cancers: lung (15.4%), colon/rectum (10.9%), breast (7.7%), liver (6.5%), leukemia (6.3%) Note: China/US account for 45% of global burden; 75% of deaths in LMICs but only 50.0% of economic cost Additional sources: https://jamanetwork.com/journals/jamaoncology/fullarticle/2801798 | https://www.nature.com/articles/d41586-023-00634-9

92.

Diabetes Care. Annual global economic burden of diabetes. Diabetes Care: Global Economic Burden https://diabetesjournals.org/care/article/41/5/963/36522/Global-Economic-Burden-of-Diabetes-in-Adults

2015: $1.3 trillion (1.8% of global GDP) 2030 projections: $2.1T-2.5T depending on scenario IDF health expenditure: $760B (2019) → $845B (2045 projected) 2/3 direct medical costs ($857B), 1/3 indirect costs (lost productivity) Note: Costs growing rapidly; expected to exceed $2T by 2030 Additional sources: https://diabetesjournals.org/care/article/41/5/963/36522/Global-Economic-Burden-of-Diabetes-in-Adults | https://doi.org/10.1016/S2213-8587(17)30097-9

93.

Cook, C., Cole, G., Asaria, P., Jabbour, R. & Francis, D. P. Annual global economic burden of heart disease. International Journal of Cardiology https://www.internationaljournalofcardiology.com/article/S0167-5273(13)02238-9/abstract (2014)

Heart failure alone: $108 billion/year (2012 global analysis, 197 countries) US CVD: $555B (2016) → projected $1.8T by 2050 LMICs total CVD loss: $3.7T cumulative (2011-2015, 5-year period) CVD is costliest disease category in most developed nations Note: No single $2.1T global figure found; estimates vary widely by scope and year Additional sources: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001258

94.

Calculated from IHME Global Burden of Disease (2.55B DALYs) and global GDP per capita valuation. $109 trillion annual global disease burden.

The global economic burden of disease, including direct healthcare costs ($8.2 trillion) and lost productivity ($100.9 trillion from 2.55 billion DALYs × $39,570 per DALY), totals approximately $109.1 trillion annually.

95.

Barabási et al. Disease network overlap (network medicine). Barabási et al. https://www.nature.com/articles/nrg2918 (2011)

Diseases cluster on shared biological networks, meaning drugs for one condition may plausibly affect many others. Additional sources: https://www.nature.com/articles/nrg2918

96.

ScienceDaily. Global prevalence of chronic disease. ScienceDaily: GBD 2015 Study https://www.sciencedaily.com/releases/2015/06/150608081753.htm (2015)

2.3 billion individuals had more than five ailments (2013) Chronic conditions caused 74% of all deaths worldwide (2019), up from 67% (2010) Approximately 1 in 3 adults suffer from multiple chronic conditions (MCCs) Risk factor exposures: 2B exposed to biomass fuel, 1B to air pollution, 1B smokers Projected economic cost: $47 trillion by 2030 Note: 2.3B with 5+ ailments is more accurate than "2B with chronic disease." One-third of all adults globally have multiple chronic conditions Additional sources: https://www.sciencedaily.com/releases/2015/06/150608081753.htm | https://pmc.ncbi.nlm.nih.gov/articles/PMC10830426/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC6214883/

97.

Calculated from Orphanet Journal of Rare Diseases (2024). Diseases getting first effective treatment each year. Calculated from Orphanet Journal of Rare Diseases (2024) https://ojrd.biomedcentral.com/articles/10.1186/s13023-024-03398-1 (2024)

Under the current system, approximately 10-15 diseases per year receive their FIRST effective treatment. Calculation: 5% of 7,000 rare diseases ( 350) have FDA-approved treatment, accumulated over 40 years of the Orphan Drug Act = 9 rare diseases/year. Adding 5-10 non-rare diseases that get first treatments yields 10-20 total. FDA approves 50 drugs/year, but many are for diseases that already have treatments (me-too drugs, second-line therapies). Only 15 represent truly FIRST treatments for previously untreatable conditions.

98.

SIPRI. 36:1 disparity ratio of spending on weapons over cures. SIPRI: Military Spending https://www.sipri.org/commentary/blog/2016/opportunity-cost-world-military-spending (2016)

Global military spending: $2.7 trillion (2024, SIPRI) Global government medical research: $68 billion (2024) Actual ratio: 39.7:1 in favor of weapons over medical research Military R&D alone: $85B (2004 data, 10% of global R&D) Military spending increases crowd out health: 1% ↑ military = 0.62% ↓ health spending Note: Ratio actually worse than 36:1. Each 1% increase in military spending reduces health spending by 0.62%, with effect more intense in poorer countries (0.962% reduction) Additional sources: https://www.sipri.org/commentary/blog/2016/opportunity-cost-world-military-spending | https://pmc.ncbi.nlm.nih.gov/articles/PMC9174441/ | https://www.congress.gov/crs-product/R45403

99.

DOT. DOT value of statistical life ($13.6M). DOT: VSL Guidance 2024 https://www.transportation.gov/office-policy/transportation-policy/revised-departmental-guidance-on-valuation-of-a-statistical-life-in-economic-analysis (2024)

Current VSL (2024): $13.7 million (updated from $13.6M) Used in cost-benefit analyses for transportation regulations and infrastructure Methodology updated in 2013 guidance, adjusted annually for inflation and real income VSL represents aggregate willingness to pay for safety improvements that reduce fatalities by one Note: DOT has published VSL guidance periodically since 1993. Current $13.7M reflects 2024 inflation/income adjustments Additional sources: https://www.transportation.gov/office-policy/transportation-policy/revised-departmental-guidance-on-valuation-of-a-statistical-life-in-economic-analysis | https://www.transportation.gov/regulations/economic-values-used-in-analysis

100.

Tufts CSDD. Cost of drug development.

Various estimates suggest $1.0 - $2.5 billion to bring a new drug from discovery through FDA approval, spread across 10 years. Tufts Center for the Study of Drug Development often cited for $1.0 - $2.6 billion/drug. Industry reports (IQVIA, Deloitte) also highlight $2+ billion figures.

101.

Drugs.com. Time to develop one drug: 17 years. Drugs.com https://www.drugs.com/fda-approval-process.html

Time to develop one drug: 17 years Additional sources: https://www.drugs.com/fda-approval-process.html | https://www.fdareview.org/issues/the-drug-development-and-approval-process/

102.

Wikipedia. Drug price competition and patent term restoration act of 1984. Wikipedia: Hatch-Waxman Act https://en.wikipedia.org/wiki/Drug_Price_Competition_and_Patent_Term_Restoration_Act

Also known as: Hatch-Waxman Act (Public Law 98-417) Signed by Reagan: September 24, 1984 Sponsors: Rep. Henry Waxman (CA) and Sen. Orrin Hatch (UT) Created modern generic drug regulation system via Abbreviated New Drug Applications (ANDAs) Patent term extension: Up to 5 years (max 14 years total from approval) Generic incentive: 180 days market exclusivity for first paragraph IV certification 5-year data exclusivity for new chemical entities Note: Landmark legislation balancing generic access with innovation incentives. Generic manufacturers only need to show bioequivalence, not repeat clinical trials Additional sources: https://en.wikipedia.org/wiki/Drug_Price_Competition_and_Patent_Term_Restoration_Act | https://www.congress.gov/bill/98th-congress/house-bill/3605 | https://www.everycrsreport.com/reports/R44643.html

103.

Broad Institute. Drug repurposing hub (broad institute). Broad Institute https://www.broadinstitute.org/drug-repurposing-hub (2017)

The Drug Repurposing Hub contains 4,707 hand-curated compounds (later expanded to 6,801), including 3,422 drugs that are marketed or have been in clinical trials. The collection includes 1,988 approved/marketed drugs and 1,348 compounds that cleared at least phase 1 clinical testing. Additional sources: https://www.broadinstitute.org/drug-repurposing-hub | https://pmc.ncbi.nlm.nih.gov/articles/PMC5568558/

104.

Nature Medicine. Drug repurposing rate ( 30%). Nature Medicine https://www.nature.com/articles/s41591-024-03233-x (2024)

Approximately 30% of drugs gain at least one new indication after initial approval. Additional sources: https://www.nature.com/articles/s41591-024-03233-x

105.

Nature Reviews Drug Discovery. Drug trial success rate from phase i to approval. Nature Reviews Drug Discovery: Clinical Success Rates https://www.nature.com/articles/nrd.2016.136 (2016)

Overall Phase I to approval: 10-12.8% (conventional wisdom 10%, studies show 12.8%) Recent decline: Average LOA now 6.7% for Phase I (2014-2023 data) Leading pharma companies: 14.3% average LOA (range 8-23%) Varies by therapeutic area: Oncology 3.4%, CNS/cardiovascular lowest at Phase III Phase-specific success: Phase I 47-54%, Phase II 28-34%, Phase III 55-70% Note: 12% figure accurate for historical average. Recent data shows decline to 6.7%, with Phase II as primary attrition point (28% success) Additional sources: https://www.nature.com/articles/nrd.2016.136 | https://pmc.ncbi.nlm.nih.gov/articles/PMC6409418/ | https://academic.oup.com/biostatistics/article/20/2/273/4817524

106.

Drug Policy Alliance. The drug war by the numbers. (2021)

Since 1971, the war on drugs has cost the United States an estimated $1 trillion in enforcement. The federal drug control budget was $41 billion in 2022. Mass incarceration costs the U.S. at least $182 billion every year, with over $450 billion spent to incarcerate individuals on drug charges in federal prisons.

107.

Drutman, L. The Business of America Is Lobbying. (Oxford University Press, 2015). doi:10.1093/acprof:oso/9780190215514.001.0001.

108.

Dunbar, R. I. M. Dunbar’s number. Dunbar https://doi.org/10.1016/0047-2484(92)90081-J (1992)

The cognitive limit to the number of people with whom one can maintain stable social relationships is approximately 150. Additional sources: https://doi.org/10.1016/0047-2484(92)90081-J

109.

EPI. Education investment economic multiplier (2.1). EPI: Public Investments Outside Core Infrastructure https://www.epi.org/publication/bp348-public-investments-outside-core-infrastructure/

Early childhood education: Benefits 12X outlays by 2050; $8.70 per dollar over lifetime Educational facilities: $1 spent → $1.50 economic returns Energy efficiency comparison: 2-to-1 benefit-to-cost ratio (McKinsey) Private return to schooling: 9% per additional year (World Bank meta-analysis) Note: 2.1 multiplier aligns with benefit-to-cost ratios for educational infrastructure/energy efficiency. Early childhood education shows much higher returns (12X by 2050) Additional sources: https://www.epi.org/publication/bp348-public-investments-outside-core-infrastructure/ | https://documents1.worldbank.org/curated/en/442521523465644318/pdf/WPS8402.pdf | https://freopp.org/whitepapers/establishing-a-practical-return-on-investment-framework-for-education-and-skills-development-to-expand-economic-opportunity/

110.

Ramsberg, J. & Platt, R. Opportunities and barriers for pragmatic embedded trials: Triumphs and tribulations. Harvard Medical School/Harvard Pilgrim Health Care Institute https://pmc.ncbi.nlm.nih.gov/articles/PMC6508852/ (2018)

Meta-analysis of 108 embedded pragmatic clinical trials (2006-2016). The median cost per patient was $97 (mean $478) across all trials reviewed. 25% of studies cost less than $19 per patient. US studies had higher median costs ($187 vs $27 non-US). Registry-based trials were less expensive than EHR-based trials. Traditional RCT comparison: $16,600/patient (Berndt & Cockburn 2014). The 108 trials had median enrollment of 5,540 patients with broad eligibility criteria. 81% used cluster randomization. Trials spanned 15 countries, infectious diseases (25%), cardiovascular (18%), diabetes (12%). Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC6508852/

111.

Costs of War Project, Brown University Watson Institute. Environmental cost of war ($100B annually). Brown Watson Costs of War: Environmental Cost https://watson.brown.edu/costsofwar/costs/social/environment

War on Terror emissions: 1.2B metric tons GHG (equivalent to 257M cars/year) Military: 5.5% of global GHG emissions (2X aviation + shipping combined) US DoD: World’s single largest institutional oil consumer, 47th largest emitter if nation Cleanup costs: $500B+ for military contaminated sites Gaza war environmental damage: $56.4B; landmine clearance: $34.6B expected Climate finance gap: Rich nations spend 30X more on military than climate finance Note: Military activities cause massive environmental damage through GHG emissions, toxic contamination, and long-term cleanup costs far exceeding current climate finance commitments Additional sources: https://watson.brown.edu/costsofwar/costs/social/environment | https://earth.org/environmental-costs-of-wars/ | https://transformdefence.org/transformdefence/stats/

112.

EPA. EPA value of statistical life ($9.6M). EPA: Mortality Risk Valuation https://www.epa.gov/environmental-economics/mortality-risk-valuation (2017)

EPA 2010 Guidelines: $7.9M (2008 dollars) → $9.7M (2013 dollars/income adjusted) Current EPA VSL: $10 million (highest among federal agencies) Based on 1997 Clean Air Act analysis; updated for inflation/income but not methodology Uses wage-risk literature (21 studies) and stated preference studies (5 studies) Used in cost-benefit analyses for environmental, health, and safety regulations Note: $9.6-9.7M represents EPA’s VSL with inflation/income adjustments. Base methodology hasn’t been updated since 1997 Additional sources: https://www.epa.gov/environmental-economics/mortality-risk-valuation | https://www.rff.org/publications/working-papers/revisiting-the-environmental-protection-agencys-value-of-statistical-life/ | https://www.epa.gov/sites/default/files/2017-12/documents/ee-0483_all.pdf

113.

Economic Policy Institute. The productivity-pay gap. (2024)

Since 1979, net productivity has grown 64.6% while hourly compensation of production and nonsupervisory workers grew just 14.8%. If workers’ pay had kept pace with productivity, the median worker would earn approximately $10,000 more per year.

114.

e-Residency. Estonia e-residency statistics. e-Residency https://www.e-resident.gov.ee/dashboard/ (2024)

Estonia’s e-Residency program has issued digital identities to over 100,000 people from 170+ countries, demonstrating global-scale digital identity verification. Additional sources: https://www.e-resident.gov.ee/dashboard/

115.

EMA. EU compassionate use program for experimental drugs. EMA: Compassionate Use https://www.ema.europa.eu/en/human-regulatory-overview/research-development/compassionate-use

Established by: Article 83 of Regulation (EC) No 726/2004 Eligibility: Life-threatening, long-lasting, or seriously debilitating illnesses Requires: No satisfactory authorized treatment; medicine in trials or approval process EMA role: CHMP provides recommendations; national authorities implement programs Pan-European programs rare: Only 6 approved by EMA in last 10 years vs hundreds of national programs Each EU member state sets own rules and procedures Note: Pan-European framework exists but rarely used due to complex navigation across varying national regulations. Most programs remain country-specific Additional sources: https://www.ema.europa.eu/en/human-regulatory-overview/research-development/compassionate-use | https://pmc.ncbi.nlm.nih.gov/articles/PMC5116859/ | https://www.eurordis.org/information-support/compassionate-use/

116.

EU Digital Strategy. EU eIDAS network for electronic identification. EU Digital Strategy: eIDAS Regulation https://digital-strategy.ec.europa.eu/en/policies/eidas-regulation (2014)

eIDAS = Electronic IDentification, Authentication and trust Services Regulation (EU) No 910/2014 - establishes framework for digital identity/authentication Mutual recognition: Member states must recognize each other’s national eID schemes Interoperability: Technology-neutral framework enabling seamless cross-border authentication Levels of Assurance (LoA): Low, substantial, or high confidence in identification eIDAS 2.0: Introduces European Digital Identity Wallets (EUDI Wallets) - standardized throughout EU Citizens/businesses can use eIDs from one member state to access services in another Note: eIDAS 2.0 enhances original framework with digital identity wallets operating seamlessly across all EU member states. Crucial for secure cross-border electronic transactions Additional sources: https://digital-strategy.ec.europa.eu/en/policies/eidas-regulation | https://eur-lex.europa.eu/eli/reg/2014/910/oj/eng | https://en.wikipedia.org/wiki/EIDAS

117.

Lieberman, D. Evolutionary mismatch and modern disease. Lieberman https://www.penguinrandomhouse.com/books/206671/the-story-of-the-human-body-by-daniel-e-lieberman/ (2013)

Many modern diseases result from a mismatch between our evolutionary adaptations and current environments, particularly regarding diet and physical activity. Additional sources: https://www.penguinrandomhouse.com/books/206671/the-story-of-the-human-body-by-daniel-e-lieberman/

118.

Environmental Working Group. US farm subsidy database and analysis. Environmental Working Group https://farm.ewg.org/ (2024)

US agricultural subsidies total approximately $30 billion annually, but create much larger economic distortions. Top 10% of farms receive 78% of subsidies, benefits concentrated in commodity crops (corn, soy, wheat, cotton), environmental damage from monoculture incentivized, and overall deadweight loss estimated at $50-120 billion annually. Additional sources: https://farm.ewg.org/ | https://www.ers.usda.gov/topics/farm-economy/farm-sector-income-finances/government-payments-the-safety-net/

119.

PMC. Estimated excess deaths attributed to FDA’s COVID-19 response. PMC: EUAs vs FDA Approval Implications https://pmc.ncbi.nlm.nih.gov/articles/PMC8101583/

FDA regulations restricted clinician/patient access to COVID-19 testing, remdesivir, vaccines General drug delay estimate: 37,000-76,000 deaths per one-year delay Testing delays: By May 2020, 400+ applications awaiting FDA review Seattle lab ordered to stop testing Feb 16 for lack of FDA approval Gates Foundation partnership instructed to discontinue testing May 2020 until authorization EUA process prevented months of vaccine/testing delays Note: Specific "500,000+" figure not found in sources. Research shows FDA testing restrictions caused weeks-to-months of critical delays (Feb-March 2020). One-year drug delay = 37-76K deaths Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC8101583/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC8012986/ | https://www.yalelawjournal.org/forum/deadly-delay-the-fdas-role-in-americas-covid-testing-debacle

120.

Responsible Statecraft. F-35 cost compared to global rare disease research funding. Responsible Statecraft: F-35 Cost $2T https://responsiblestatecraft.org/f35-cost/

Single F-35 cost: $82M (flyaway) to $110-136M (with ancillary costs) NIH rare disease funding (FY2023): $6.9 billion (world’s largest public biomedical research funder) NIH rare disease funding = <0.1% of NIH’s $48B annual budget Comparison: 63 F-35s = 1 year of US rare disease research funding F-35 total program cost: $2.1 trillion lifetime (2,456 aircraft through 2088) Note: One F-35 ($110-136M) doesn’t exceed annual rare disease funding ($6.9B), but claim illustrates stark military vs medical research disparity. 63 F-35s = entire year of rare disease research Additional sources: https://responsiblestatecraft.org/f35-cost/ | https://www.statista.com/statistics/713320/rare-diseases-funding-by-the-national-institutes-for-health/ | https://armscontrolcenter.org/f-35-joint-strike-fighter-costs-challenges/

121.

Drugs.com. FDA drug approval timeline. Drugs.com: FDA Drug Approval Process https://www.drugs.com/fda-approval-process.html

Full timeline (preclinical to market): 12-15 years average (10-15 years common range) Preclinical phase: 3-7 years Clinical development + NDA review: 9 years NDA review alone: 10 months average (standard); 6 months (priority review) Historical (pre-PDUFA): 21-29 months for NDA review Note: "10 years" is accurate for total development timeline (10-15 year range). Modern FDA review is faster (10 months) thanks to PDUFA, but overall timeline remains 12-15 years Additional sources: https://www.drugs.com/fda-approval-process.html | https://www.fdareview.org/issues/the-drug-development-and-approval-process/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC6113340/

122.

FDA. FDA-approved prescription drug products (20,000+). FDA https://www.fda.gov/media/143704/download

There are over 20,000 prescription drug products approved for marketing. Additional sources: https://www.fda.gov/media/143704/download

123.

CNN. FDA delay in approving rapid COVID-19 tests. CNN: How Government Delayed Testing https://www.cnn.com/2020/04/09/politics/coronavirus-testing-cdc-fda-red-tape-invs/index.html (2020)

Feb 16, 2020: Seattle research lab ordered to stop COVID testing without FDA approval May 2020: Gates Foundation partnership instructed to discontinue testing until authorization Feb 29, 2020: U. Nebraska finally got FDA permission after Feb 4 special permission Timeline: Critical delays measured in weeks-to-months (Feb-March 2020), not specific "6 months FDA guidance suggested EUAs needed for laboratory-developed tests (LDTs), causing delays By May 2020: 400+ test applications awaiting FDA review Note: Delays were weeks-to-months during critical Feb-March 2020 period, not continuous "6 months." FDA intervention added minimal value while contributing to deadly delays Additional sources: https://www.cnn.com/2020/04/09/politics/coronavirus-testing-cdc-fda-red-tape-invs/index.html | https://www.yalelawjournal.org/forum/deadly-delay-the-fdas-role-in-americas-covid-testing-debacle | https://oig.hhs.gov/oei/reports/OEI-01-20-00380.asp

124.

FDA. FDA GRAS list count ( 570-700). FDA https://www.fda.gov/food/generally-recognized-safe-gras/gras-notice-inventory

The FDA GRAS (Generally Recognized as Safe) list contains approximately 570–700 substances. Additional sources: https://www.fda.gov/food/generally-recognized-safe-gras/gras-notice-inventory

125.

Stone, W. FDA advisers reject MDMA as treatment for PTSD. NPR https://www.npr.org/sections/shots-health-news/2024/06/04/nx-s1-4991112/mdma-therapy-ptsd-fda-advisors (2024).

126.

U.S. Food and Drug Administration. FDA declines to approve MDMA-assisted therapy for PTSD. (2024).

127.

CRS. Evidence of FDA regulatory capture by pharmaceutical industry. CRS: FDA Human Medical Product User Fees https://www.congress.gov/crs-product/R44750

FY2023: User fees = 75% of PDUFA program costs (vs 7% in FY1993) FY2022: User fees = 66% ($1.4B) of human drugs program budget FY2022: User fees = 46% ($2.9B) of FDA’s total $6.2B budget Pharma finances 75% of FDA’s drug division (New York Times) Concerns: Budgetary dependence, urgency of PDUFA reauthorizations, required industry participation in negotiations Most PDUFA policy changes favor industry: decreased regulatory standards, shorter approval times, increased industry involvement FDA maintains decisions based on science, not fee collection ability Note: Regulatory capture concerns well-documented. Industry funding grew from 7% (1993) to 75% (2023) of drug review program. No evidence found for "10x government salary" claim for FDA reviewers Additional sources: https://www.congress.gov/crs-product/R44750 | https://aspe.hhs.gov/sites/default/files/documents/e4a7910607c0dd76c40aa61151d154f9/FDA-User-Fee-Issue-Brief.pdf | https://pmc.ncbi.nlm.nih.gov/articles/PMC8917050/

128.

Wikipedia. Number of key FDA drug reviewers. Wikipedia: Center for Drug Evaluation and Research https://en.wikipedia.org/wiki/Center_for_Drug_Evaluation_and_Research

CDER review teams: 1,300 employees evaluate and approve new drugs CDER safety team: 72 employees monitor 3,000+ prescription drugs for 200 million people ($15M/year budget) FDA Advisory Committees (all 3 centers): 300 individuals serve on 40 committees Advisory committees stable in recent years Note: " 200" may refer to advisory committee members ( 300 actual) or be approximation. CDER has 1,300 review staff total. Safety monitoring: 72 people for 200M patients Additional sources: https://en.wikipedia.org/wiki/Center_for_Drug_Evaluation_and_Research | https://www.ncbi.nlm.nih.gov/books/NBK236088/

129.

Ballentine, C. The sulfanilamide disaster. FDA Consumer https://www.fda.gov/files/about%20fda/published/The-Sulfanilamide-Disaster.pdf (1981).

130.

FDA. FDA clinical trial launch timeline. FDA: IND Application Procedures https://www.fda.gov/drugs/investigational-new-drug-ind-application/ind-application-procedures-overview (2012)

IND application: FDA has 30 days to object or allow trials to begin NDA/BLA preparation after Phase 3: 6-12 months to assemble safety/effectiveness data Standard NDA review: 10-12 months median (standard review) Priority review: 6 months (vs 10 months standard) Overall development (first human testing to approval): 12-15 years full timeline Expedited programs: 7.1 years median vs 8.0 years nonexpedited Note: "6-12 months" likely refers to NDA/BLA preparation time post-Phase 3, not total trial launch timeline. IND review: 30 days. Full approval timeline: 10-15 years Additional sources: https://www.fda.gov/drugs/investigational-new-drug-ind-application/ind-application-procedures-overview | https://www.drugs.com/fda-approval-process.html | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820715/

131.

FDA. FDA trial patient exclusion criteria. FDA: Evaluating Inclusion & Exclusion Criteria https://www.fda.gov/media/134754/download

Most frequent exclusions: Pregnancy, lactation/breastfeeding, renal/hepatic abnormalities, specific infectious diseases Pregnant/lactating women: >90% of trials exclude Older adults: 27% exclude based on age (arbitrary upper limits) Patients with organ dysfunction: Excluded due to adverse impact concerns from comorbidities/concomitant meds Multiple chronic conditions: Often exclusion criterion despite being common in target population Children/adolescents: Excluded due to ethical considerations High-risk patients: Prior malignancy history, active brain metastases, suboptimal hepatic/renal function, HIV+ FDA guidance: Working to broaden eligibility; "exclusions based on age alone rarely appropriate Note: Exclusion criteria often eliminate patients who would actually use the drug, reducing real-world applicability of trial results Additional sources: https://www.fda.gov/media/134754/download | https://www.sciencedirect.com/science/article/abs/pii/S1551714421002512 | https://ascopubs.org/doi/10.1200/EDBK_155880

132.

PMC. Paperwork comparison between FDA trials and RECOVERY trial. PMC: Making Trials Part of Good Clinical Care - RECOVERY https://pmc.ncbi.nlm.nih.gov/articles/PMC8285150/

RECOVERY trial paperwork: One-page consent form, one-page case report form, single follow-up form Randomisation form: Simple, collecting few baseline characteristics and ensuring eligibility Follow-up: Single form completed at earliest of discharge, death, or 28 days Eligibility criteria: Simple; trial processes (including paperwork) minimized Philosophy: "Avoid additional burden on busy clinicians, so trial procedures streamlined as far as possible FDA Form 1572: Statement of Investigator form required for IND trials (specific form, not total page count) Note: Specific "1,572 pages vs 24 pages" comparison not found in sources. RECOVERY used 1-page forms. FDA Form 1572 is a specific required form, not total paperwork count. RECOVERY’s streamlined approach demonstrated feasibility of simplified trial documentation Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC8285150/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC9293394/ | https://www.fda.gov/media/71816/download

133.

Batty, M., Deeken, E. & Henriques Volz, A. Wealth inequality and COVID-19: Evidence from the distributional financial accounts. (2021)

Nearly 90% of top 1% wealth gain during the COVID-19 rebound (2020Q1 to 2021Q1) came from corporate equities. Only one-third of bottom 50% households own any public equity. Households gained over $18 trillion in wealth since the beginning of 2020, with asset-price increases accounting for nearly 80% of wealth accumulation.

134.

Smith, A. D. Dendreon files for bankruptcy, provenge still available. (2014).

135.

Forbes. Forbes world’s billionaires list 2024. (2024)

Forbes identified a record 2,781 billionaires worldwide with combined net worth of $14.2 trillion, 141 more than 2023. Bernard Arnault (LVMH) topped the list at $233 billion.

136.

Ford, I. & Norrie, J. Pragmatic clinical trials - ALLHAT evidence. Ford https://www.nejm.org/doi/full/10.1056/NEJMra1510059 (2016)

Pragmatic trials are designed to determine the effects of an intervention under the usual conditions in which it will be applied. The ALLHAT trial (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) demonstrated that pragmatic designs can identify superior treatments while reducing healthcare costs by billions annually.

137.

Bureau of Economic Analysis. Value added by industry: Finance and insurance as a percentage of GDP. (2026)

Finance and insurance value added as share of GDP. Q3 2025: 8.0%. Historical low approximately 4% in early 1970s.

138.

Board of Governors of the Federal Reserve System. Net worth held by the top 1% (99th to 100th wealth percentiles). (2026)

Net worth held by the top 1% of households. Q4 2019: $33.4 trillion. Q4 2020: $37.6 trillion. Increase of $4.2 trillion during 2020.

139.

Board of Governors of the Federal Reserve System. Assets: Total assets: Total assets (less eliminations from consolidation): Wednesday level. (2026)

Federal Reserve total assets (WALCL). Pre-QE March 2020: $4.2 trillion. Peak mid-2022: $8.97 trillion. Approximately $4 trillion created beginning March 2020.

140.

Friedman, M. & Schwartz, A. J. A Monetary History of the United States, 1867–1960. (Princeton University Press, 1963).

141.

Washington Post. Deaths from furniture accidents compared to terrorism. Washington Post: More Likely Crushed by Furniture https://www.washingtonpost.com/news/monkey-cage/wp/2015/11/23/youre-more-likely-to-be-fatally-crushed-by-furniture-than-killed-by-a-terrorist/ (2015)

Since 9/11/2001: Americans no more likely to die from terrorism than being crushed by unstable TVs/furniture Furniture tip-over fatalities (2000-present): 581 total; 4 in 5 deaths were children 2013-2023: 217 reported tip-over fatalities (23% TV, 25% TV+furniture, 46% furniture only, 7% appliance) Comparison: Even in Israel (intensive terror campaign), weekly terror casualties almost never match traffic deaths US terrorism: Deaths so low they barely register on graphs except 9/11/2001 Note: Post-9/11, furniture tip-overs have caused comparable/greater fatalities than terrorism for Americans. Highlights media attention vs actual risk disparity Additional sources: https://www.washingtonpost.com/news/monkey-cage/wp/2015/11/23/youre-more-likely-to-be-fatally-crushed-by-furniture-than-killed-by-a-terrorist/ | https://www.cpsc.gov/s3fs-public/2023_Annual_Tip_Over_Report_Posted_2024Feb_FINAL_0.pdf | https://ourworldindata.org/is-it-fair-to-compare-terrorism-and-disaster-with-other-causes-of-death

142.

U.S. Government Accountability Office. Accelerated COVID-19 Vaccine Development Status and Efforts to Address Manufacturing Challenges (Operation Warp Speed). https://www.gao.gov/products/gao-21-319 (2021).

143.

Kaiser, J. Federal watchdog finds problems with NIH oversight of grant funding bat virus research in China. Science (2023).

144.

Gates, D. The Napoleonic Wars 1803-1815. (Pimlico, 2003).

Estimates approximately 5 million total deaths in the Napoleonic Wars, including military and civilian casualties across all belligerents.

146.

FEE. Patients and doctors vs FDA. FEE: Patients and Doctors vs FDA https://fee.org/articles/patients-and-doctors-vs-the-fda

Dale Gieringer (1985): 21,000-120,000 lives lost per decade from FDA delay Gieringer: "Loss of life from delay alone in the hundreds of thousands" (not millions) Beta-blockers alone: William Wardell estimated "10,000 lives/year" if allowed; FDA delay 1965-1976 Sam Peltzman: Post-1962 death toll from regulatory delay "easily number in thousands per year Practolol (beta-blocker): "Could save 10,000 lives/year" (Wardell estimate) FDA allowed propranolol 1968 (3 years after Europe); for hypertension/angina not until 1978 Note: "4-10 million" figure not found in sources. Gieringer’s estimates: 21K-120K deaths per decade, "hundreds of thousands" total (not millions). Specific drug delays (beta-blockers): 100K deaths estimated Additional sources: https://fee.org/articles/patients-and-doctors-vs-the-fda | https://www.econlib.org/library/Enc/DrugLag.html | https://www.fdareview.org/issues/theory-evidence-and-examples-of-fda-harm/

147.

Gilens, M. & Page, B. I. Testing theories of american politics: Elites, interest groups, and average citizens. Perspectives on Politics 12, 564–581 (2014).

148.

Gitcoin. Gitcoin passport for digital identity scoring. Gitcoin: Intro to Passport https://www.gitcoin.co/blog/intro-to-passport

Now: Human Passport (acquired by human.tech late 2024); >2M users Purpose: Sybil resistance solution for web3, privacy-preserving identity verification How it works: "Stamps" from web2/web3 identifiers (Twitter, Google, BrightID, Proof of Humanity) aggregated into unique identity score Scoring: Weights based on "cost of forgery" and ability to signal unique humanity Privacy: Verifiable credentials check identity without viewing PII Customizable: Communities create custom "entry visa" with participation requirements Use cases: Governance voting, gaming, airdrops, bot prevention Gitcoin Grants Round 15: 35,000+ donors created Passports; limited Sybil activity, ensured fair fund distribution Note: Leading web3 identity/Sybil resistance tool. Now operates as Human Passport after acquisition. Proven at scale with millions of users Additional sources: https://www.gitcoin.co/blog/intro-to-passport | https://passport.human.tech/ | https://www.gitcoin.co/blog/cost-of-forgery

149.

GiveWell. GiveWell cost per life saved for top charities (2024). GiveWell: Top Charities https://www.givewell.org/charities/top-charities

General range: $3,000-$5,500 per life saved (GiveWell top charities) Helen Keller International (Vitamin A): $3,500 average (2022-2024); varies $1,000-$8,500 by country Against Malaria Foundation: $5,500 per life saved New Incentives (vaccination incentives): $4,500 per life saved Malaria Consortium (seasonal malaria chemoprevention): $3,500 per life saved VAS program details: $2 to provide vitamin A supplements to child for one year Note: Figures accurate for 2024. Helen Keller VAS program has wide country variation ($1K-$8.5K) but $3,500 is accurate average. Among most cost-effective interventions globally Additional sources: https://www.givewell.org/charities/top-charities | https://www.givewell.org/charities/helen-keller-international | https://ourworldindata.org/cost-effectiveness

150.

GiveWell. How much does it cost to save a life? (2024).

151.

Chalmers, I. & Glasziou, P. Avoidable waste in the production and reporting of research evidence. The Lancet 374, 86–89 (2009)

An estimated 85% of research investment is wasted. Over 50% of studies are never published. Of $200 billion spent annually on biomedical research globally, approximately $170 billion is wasted through problems in research design, conduct, and reporting.

152.

Our World in Data. Global armed forces size and average salary. Our World in Data: Military Personnel & Spending https://ourworldindata.org/military-personnel-spending (2024)

Largest forces: China (2.0M active), India (1.4M), Russia (1.3M active, 3.5M total), US (1.3M active) Global military spending 2024: US $1T (next 12 countries combined); NATO 32 members: $1.5T (55% of world) Military spending per personnel: Tracked by SIPRI, World Bank (includes personnel, O&M, procurement, R&D, infrastructure, aid) Average varies widely: US military much higher per-personnel spending than most countries Note: Specific "28.4M global armed forces" and "$24,000 average salary" not confirmed in sources. Data available but highly variable by country. Major forces total 10M+ personnel among largest militaries Additional sources: https://ourworldindata.org/military-personnel-spending | https://data.worldbank.org/indicator/MS.MIL.TOTL.P1 | https://www.sipri.org/sites/default/files/2025-04/2504_fs_milex_2024.pdf

153.

The Conversation. Global cancer research spending ( $51.4B, 2016-2023). The Conversation https://theconversation.com/billions-spent-on-cancer-research-globally-but-is-it-money-well-spent-201407 (2023).

154.

Research and Markets. Global clinical trials market 2024. Research and Markets https://www.globenewswire.com/news-release/2024/04/19/2866012/0/en/Global-Clinical-Trials-Market-Research-Report-2024-An-83-16-Billion-Market-by-2030-AI-Machine-Learning-and-Blockchain-will-Transform-the-Clinical-Trials-Landscape.html (2024)

Global clinical trials market valued at approximately $83 billion in 2024, with projections to reach $83-132 billion by 2030. Additional sources: https://www.globenewswire.com/news-release/2024/04/19/2866012/0/en/Global-Clinical-Trials-Market-Research-Report-2024-An-83-16-Billion-Market-by-2030-AI-Machine-Learning-and-Blockchain-will-Transform-the-Clinical-Trials-Landscape.html | https://www.precedenceresearch.com/clinical-trials-market

155.

The Global Fund. The global fund. The Global Fund https://www.theglobalfund.org/en/about-the-global-fund/.

156.

Global Fund. Lives saved by the global fund. Global Fund: Results Report 2025 https://www.theglobalfund.org/en/results/ (2025)

2025: 70 million lives saved (current figure) Oct 2024: 65 million lives saved Sep 2022: 50 million lives saved over 20 years Death rate reduction: 63% combined death rate from AIDS, TB, malaria (61% since 2002) Since inception (2002): Partnership saved 70M lives fighting HIV, TB, malaria across 100+ countries Note: 50M was Sept 2022 figure. Current (2025): 70M lives saved. One of world’s most effective global health partnerships Additional sources: https://www.theglobalfund.org/en/results/ | https://www.theglobalfund.org/en/news/2022/2022-09-12-new-global-fund-report-shows-50-million-lives-saved-over-20-years-in-fight-against-hiv-tb-malaria/

157.

Statista. Global GDP ($101T, 2022). Statista https://www.statista.com/statistics/268750/global-gross-domestic-product-gdp/ (2023)

The global economy is projected to grow from about 101 trillion U.S. dollars in 2022 to about 139 trillion U.S. dollars in 2027. Additional sources: https://www.statista.com/statistics/268750/global-gross-domestic-product-gdp/

158.

World Bank. Global GDP in 2023 ($89.5 trillion). World Bank https://data.worldbank.org/indicator/NY.GDP.MKTP.CD (2023).

159.

Component country budgets. Global government medical research spending ($67.5B, 2023–2024). See component country budgets: NIH Budget https://www.nih.gov/about-nih/what-we-do/budget.

160.

Applied Clinical Trials. Global government spending on interventional clinical trials: $3-6 billion/year. Applied Clinical Trials https://www.appliedclinicaltrialsonline.com/view/sizing-clinical-research-market

Estimated range based on NIH ( $0.8-5.6B), NIHR ($1.6B total budget), and EU funding ( $1.3B/year). Roughly 5-10% of global market. Additional sources: https://www.appliedclinicaltrialsonline.com/view/sizing-clinical-research-market | https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30357-0/fulltext

161.

World Health Organization. Global health spending as a share of GDP (9.8%, 2020). World Health Organization https://www.who.int/publications/i/item/9789240064929 (2022).

162.

Wikipedia. Number of major global military facilities (4,435). Wikipedia: List of American Military Installations https://en.wikipedia.org/wiki/List_of_American_military_installations

US military bases worldwide: 750-877 (varies by source/definition) Conservative count: 128 military bases in 55 countries/territories (Feb 2025) Broader count: 750+ bases in 80+ countries; some sources cite 877 Large bases (>4 hectares or >$10M, >200 personnel): 439 (60% of US foreign bases) Small bases/"Lily Pads" (<4 hectares or <$10M): Remaining 40% Other nations: At least 18 other nations operate foreign military bases; NATO countries (France, UK): +200 locations Note: "4,435" not found in sources. US operates 750-877 bases overseas. May include domestic + all nations’ bases combined, but specific figure not verified Additional sources: https://en.wikipedia.org/wiki/List_of_American_military_installations | https://www.visualcapitalist.com/mapped-every-known-u-s-military-base-overseas/ | https://worldbeyondwar.org/military-empires/

163.

SIPRI. Global military spending ($2.72T, 2024). SIPRI https://www.sipri.org/publications/2025/sipri-fact-sheets/trends-world-military-expenditure-2024 (2025).

164.

C&EN. Annual number of new drugs approved globally: 50. C&EN https://cen.acs.org/pharmaceuticals/50-new-drugs-received-FDA/103/i2 (2025)

50 new drugs approved annually Additional sources: https://cen.acs.org/pharmaceuticals/50-new-drugs-received-FDA/103/i2 | https://www.fda.gov/drugs/development-approval-process-drugs/novel-drug-approvals-fda

165.

UN. Global population reaches 8 billion. UN: World Population 8 Billion Nov 15 2022 https://www.un.org/en/desa/world-population-reach-8-billion-15-november-2022 (2022)

Milestone: November 15, 2022 (UN World Population Prospects 2022) Day of Eight Billion" designated by UN Added 1 billion people in just 11 years (2011-2022) Growth rate: Slowest since 1950; fell under 1% in 2020 Future: 15 years to reach 9B (2037); projected peak 10.4B in 2080s Projections: 8.5B (2030), 9.7B (2050), 10.4B (2080-2100 plateau) Note: Milestone reached Nov 2022. Population growth slowing; will take longer to add next billion (15 years vs 11 years) Additional sources: https://www.un.org/en/desa/world-population-reach-8-billion-15-november-2022 | https://www.un.org/en/dayof8billion | https://en.wikipedia.org/wiki/Day_of_Eight_Billion

166.

National Consortium for the Study of Terrorism and Responses to Terrorism (START). Global terrorism database (GTD). (2022).

167.

IQVIA Report. Global trial capacity. IQVIA Report: Clinical Trial Subjects Number Drops Due to Decline in COVID-19 Enrollment https://gmdpacademy.org/news/iqvia-report-clinical-trial-subjects-number-drops-due-to-decline-in-covid-19-enrollment/

1.9M participants annually (2022, post-COVID normalization from 4M peak in 2021) Additional sources: https://gmdpacademy.org/news/iqvia-report-clinical-trial-subjects-number-drops-due-to-decline-in-covid-19-enrollment/

168.

Department of Health and Human Services. U.S. Government monoclonal antibody purchases for COVID-19 treatment. (2022).

169.

Acquisition Talk. Grant writing time for top researchers (50%). Acquisition Talk https://acquisitiontalk.com/2021/12/top-researchers-spend-50-of-their-time-writing-grants-how-to-fix-it-and-what-it-means-for-dod/ (2021)

Top researchers can spend up to 50% of their time writing grants. Additional sources: https://acquisitiontalk.com/2021/12/top-researchers-spend-50-of-their-time-writing-grants-how-to-fix-it-and-what-it-means-for-dod/

170.

Our World in Data. Terror attack deaths (8,300 annually). Our World in Data: Terrorism https://ourworldindata.org/terrorism (2024)

2023: 8,352 deaths (22% increase from 2022, highest since 2017) 2023: 3,350 terrorist incidents (22% decrease), but 56% increase in avg deaths per attack Global Terrorism Database (GTD): 200,000+ terrorist attacks recorded (2021 version) Maintained by: National Consortium for Study of Terrorism & Responses to Terrorism (START), U. of Maryland Geographic shift: Epicenter moved from Middle East to Central Sahel (sub-Saharan Africa) - now >50% of all deaths Additional sources: https://ourworldindata.org/terrorism | https://reliefweb.int/report/world/global-terrorism-index-2024 | https://www.start.umd.edu/gtd/ | https://ourworldindata.org/grapher/fatalities-from-terrorism

171.

Hacker, J. D. A census-based count of the civil war dead. Civil War History 57, 307–348 (2011)

Revised estimate of Civil War deaths to approximately 750,000, significantly higher than the traditional estimate of 620,000.

172.

Hamilton, W. D. The genetical evolution of social behaviour. I. Journal of Theoretical Biology 7, 1–16 (1964)

A genetical mathematical model allowing for interactions between relatives on one another’s fitness. Introduces inclusive fitness and shows that genes causing altruistic behaviour can spread if rB > C.

173.

Harrison, M. The Economics of World War II: Six Great Powers in International Comparison. (Cambridge University Press, 2000).

174.

Harrison, M. How much did the soviets really spend on defence? New evidence from the close of the brezhnev era. Warwick Economic Research Papers https://warwick.ac.uk/fac/soc/economics/staff/mharrison/public/ (2003)

Estimates of Soviet military spending as share of GDP ranged from 10-20%, with Harrison’s analysis settling on approximately 15-18% of GDP in the late Brezhnev era (late 1970s to early 1980s). Even within the Soviet Union itself, reliable figures were difficult to produce because the military budget involved multiple government ministries and official statistics systematically understated defense outlays.

175.

Walsh, C. Understanding venezuela’s collapse. Harvard Gazette https://news.harvard.edu/gazette/story/2019/02/harvard-expert-tries-to-make-sense-of-venezuelas-collapse/ (2019).

176.

Hayek, F. A. The use of knowledge in society. American Economic Review 35, 519–530 (1945)

The knowledge of the circumstances which we must make use of never exists in concentrated or integrated form but solely as dispersed bits of incomplete and frequently contradictory knowledge which all the separate individuals possess.

177.

PMC. Healthcare investment economic multiplier (1.8). PMC: California Universal Health Care https://pmc.ncbi.nlm.nih.gov/articles/PMC5954824/ (2022)

Healthcare fiscal multiplier: 4.3 (95% CI: 2.5-6.1) during pre-recession period (1995-2007) Overall government spending multiplier: 1.61 (95% CI: 1.37-1.86) Why healthcare has high multipliers: No effect on trade deficits (spending stays domestic); improves productivity & competitiveness; enhances long-run potential output Gender-sensitive fiscal spending (health & care economy) produces substantial positive growth impacts Note: "1.8" appears to be conservative estimate; research shows healthcare multipliers of 4.3 Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC5954824/ | https://cepr.org/voxeu/columns/government-investment-and-fiscal-stimulus | https://ncbi.nlm.nih.gov/pmc/articles/PMC3849102/ | https://set.odi.org/wp-content/uploads/2022/01/Fiscal-multipliers-review.pdf

178.

US Inflation Calculator. Historical healthcare inflation rate (6.2%). US Inflation Calculator: Health Care 1948-2025 https://www.usinflationcalculator.com/inflation/health-care-inflation-in-the-united-states/ (1948)

Long-term average (1935-2025): 4.59% annual (per Consumer Price Index for Medical Care, BLS) 2000-2023: 3.5% average annual medical care cost inflation Medical Care Price Index (MCPI): 3.7% compound annual growth (past 2 decades) vs 2.6% for Personal Health Care (PHC) & PCE health indexes Recent (Aug 2025): 3.4% year-over-year health care price increase Additional sources: https://www.usinflationcalculator.com/inflation/health-care-inflation-in-the-united-states/ | https://www.in2013dollars.com/Medical-care/price-inflation | https://pmc.ncbi.nlm.nih.gov/articles/PMC5785315/ | https://ycharts.com/indicators/us_health_care_inflation_rate

179.

Our World in Data. Historical life expectancy around 30 years. Our World in Data: Life Expectancy https://ourworldindata.org/life-expectancy (2022)

Average life expectancy at birth: 30 years for most of human history until 1800s 1820: Global average still 30 years; 1800-2000: Rose from 30 to 67 years Context: Low life expectancy driven primarily by high infant mortality ( 1/3 of children died before age 5) Medieval England: Life expectancy at birth = 31.3 years, but life expectancy at age 25 = 25.7 additional years (total 50.7) Roman Egypt: Average in 20s, but many lived into 40s+ if they survived childhood Additional sources: https://ourworldindata.org/life-expectancy | https://pmc.ncbi.nlm.nih.gov/articles/PMC2625386/ | https://sc.edu/uofsc/posts/2022/08/conversation-old-age-is-not-a-modern-phenomenon.php | https://www.discovermagazine.com/the-sciences/what-was-the-life-expectancy-of-ancient-humans

180.

Hsieh, C.-T. & Moretti, E. Housing constraints and spatial misallocation. American Economic Journal: Macroeconomics https://www.aeaweb.org/articles?id=10.1257/mac.20170388 (2019)

We quantify the amount of spatial misallocation of labor across US cities and its aggregate costs. Tight land-use restrictions in high-productivity cities like New York, San Francisco, and Boston lowered aggregate US growth by 36% from 1964 to 2009. Local constraints on housing supply have had enormous effects on the national economy. Additional sources: https://www.aeaweb.org/articles?id=10.1257/mac.20170388

181.

NHGRI. Human genome project and CRISPR discovery. NHGRI https://www.genome.gov/11006929/2003-release-international-consortium-completes-hgp (2003)

Your DNA is 3 billion base pairs Read the entire code (Human Genome Project, completed 2003) Learned to edit it (CRISPR, discovered 2012) Additional sources: https://www.genome.gov/11006929/2003-release-international-consortium-completes-hgp | https://www.nobelprize.org/prizes/chemistry/2020/press-release/

182.

Sinn, M. P. Incentive Alignment Bonds: Making Public Goods Financially and Politically Profitable. https://iab.warondisease.org (2025) doi:10.5281/zenodo.18203221

Government spending is optimized for lobbying intensity, not net societal value. Programs with 100:1 benefit-cost ratios get billions while programs with negative returns get hundreds of billions. Incentive Alignment Bonds flip this by creating a capital pool that rewards politicians (via campaign support and post-office opportunities) for funding high-NSV programs over low-NSV alternatives. The result: public good becomes private profit for both investors and elected officials.

183.

ICAN. International campaign to abolish nuclear weapons (ICAN) - treaty on the prohibition of nuclear weapons (2017). ICAN https://www.icanw.org/ican_history (2017)

ICAN: Founded 2007, headquartered in Geneva, coordinating 468+ partner organizations across 100+ countries (as of 2017) Staff: 3 full-time + 2 part-time in Geneva office (when Nobel Prize awarded) Funding: Initial grant from Poola Foundation (Australia); Norwegian government grant to establish Geneva office (2011) Treaty on the Prohibition of Nuclear Weapons (TPNW): Adopted July 7, 2017 by vote of 122-1 at UN Achievement: Nobel Peace Prize 2017 "for its work to draw attention to the catastrophic humanitarian consequences of any use of nuclear weapons Additional sources: https://www.icanw.org/ican_history | https://en.wikipedia.org/wiki/International_Campaign_to_Abolish_Nuclear_Weapons | https://www.nobelprize.org/prizes/peace/2017/ican/facts/ | https://www.icanw.org/the_treaty

184.

ICRC. International campaign to ban landmines (ICBL) - ottawa treaty (1997). ICRC https://www.icrc.org/en/doc/resources/documents/article/other/57jpjn.htm (1997)

ICBL: Founded 1992 by 6 NGOs (Handicap International, Human Rights Watch, Medico International, Mines Advisory Group, Physicians for Human Rights, Vietnam Veterans of America Foundation) Started with ONE staff member: Jody Williams as founding coordinator Grew to 1,000+ organizations in 60 countries by 1997 Ottawa Process: 14 months (October 1996 - December 1997) Convention signed by 122 states on December 3, 1997; entered into force March 1, 1999 Achievement: Nobel Peace Prize 1997 (shared by ICBL and Jody Williams) Government funding context: Canada established $100M CAD Canadian Landmine Fund over 10 years (1997); International donors provided $169M in 1997 for mine action (up from $100M in 1996) Additional sources: https://www.icrc.org/en/doc/resources/documents/article/other/57jpjn.htm | https://en.wikipedia.org/wiki/International_Campaign_to_Ban_Landmines | https://www.nobelprize.org/prizes/peace/1997/summary/ | https://un.org/press/en/1999/19990520.MINES.BRF.html | https://www.the-monitor.org/en-gb/reports/2003/landmine-monitor-2003/mine-action-funding.aspx

185.

ID.me. ID.me digital identity verification service. ID.me: Government Services https://www.id.me/individuals/government

Trusted technology partner to multiple US government agencies for secure digital identity verification Scale: Serves 20 federal agencies, 44 state government agencies, 66 healthcare organizations Use cases: Unemployment, Tax, Retirement, Centers for Medicare/Medicaid 2013: Awarded 2-year grant by US Chamber for President’s National Strategy for Trusted Identities in Cyberspace (NSTIC) 2014: Won contract with General Services Administration for Connect.gov digital identity credentials COVID-19 pandemic: Contracted by several state unemployment agencies to verify claimants Standards: NIST 800-63-3 establishes guidelines for identity verification providers serving federal agencies Privacy concerns: IRS announced (Feb 2022) new authentication option without biometric data including facial recognition Additional sources: https://www.id.me/individuals/government | https://en.wikipedia.org/wiki/ID.me | https://www.id.me/about | https://www.id.me/business/government

186.

Institute for Economics & Peace. Global peace index 2024. (2024)

Institute for Economics and Peace Global Peace Index 2024. The economic impact of violence on the global economy reached nearly $20 trillion, with military spending and internal security costs accounting for 74% of the total.

187.

Institute for Health Metrics and Evaluation (IHME). IHME global burden of disease (2.55B DALYs, 2019). Institute for Health Metrics and Evaluation (IHME) https://vizhub.healthdata.org/gbd-compare/ (2020)

Globally, in 2019, the total number of DALYs from all causes was 2.55 billion. Additional sources: https://vizhub.healthdata.org/gbd-compare/ | https://www.healthdata.org/research-analysis/about-gbd | https://pubmed.ncbi.nlm.nih.gov/33069326/

188.

Institute for Health Metrics and Evaluation (IHME). IHME global burden of disease 2021 (2.88B DALYs, 1.13B YLD). Institute for Health Metrics and Evaluation (IHME) https://vizhub.healthdata.org/gbd-results/ (2024)

In 2021, global DALYs totaled approximately 2.88 billion, comprising 1.75 billion Years of Life Lost (YLL) and 1.13 billion Years Lived with Disability (YLD). This represents a 13% increase from 2019 (2.55B DALYs), largely attributable to COVID-19 deaths and aging populations. YLD accounts for approximately 39% of total DALYs, reflecting the substantial burden of non-fatal chronic conditions. Additional sources: https://vizhub.healthdata.org/gbd-results/ | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00757-8/fulltext | https://www.healthdata.org/research-analysis/about-gbd

189.

ACLU Illinois. Illinois biometric information privacy act (BIPA). ACLU Illinois: BIPA https://www.aclu-il.org/en/campaigns/biometric-information-privacy-act-bipa

Enacted: October 3, 2008 (introduced Feb 14, 2008 by State Sen. Terry Link; passed both Houses July 10, 2008; signed by Gov. Rod Blagojevich) Purpose: Regulate collection, use, and handling of biometric identifiers and information by private entities in Illinois Requirements: Written notice of what data is collected/stored, specific purpose & duration, obtain written consent Covered biometrics: Retina/iris scans, fingerprints, voiceprints, hand scans, facial geometry, DNA, other unique biological info Prohibitions: Selling or profiting from consumers’ biometric information Penalties: $1,000 per violation; $5,000 per intentional/reckless violation Private right of action: Any aggrieved individual can sue 2024 update (SB2979): Multiple collections from same person = single violation (single recovery per individual) Additional sources: https://www.aclu-il.org/en/campaigns/biometric-information-privacy-act-bipa | https://en.wikipedia.org/wiki/Biometric_Information_Privacy_Act | https://securiti.ai/privacy-laws/us/illinois/ | https://www.winston.com/en/legal-glossary/what-is-bipa

190.

International Monetary Fund. IMF fossil fuel subsidies data: 2023 update. (2023)

Globally, fossil fuel subsidies were $7 trillion in 2022 or 7.1 percent of GDP. The United States subsidies totaled $649 billion. Underpricing for local air pollution costs and climate damages are the largest contributor, accounting for about 30 percent each.

191.

PMC. Indian aadhaar national identity system. PMC: Aadhaar Failure to Do No Harm https://pmc.ncbi.nlm.nih.gov/articles/PMC5741784/

Largest biometric identity system in history: 1 billion registered users (nearly all of India’s 1.4B population) 12-digit unique identification number issued by Unique Identification Authority of India (UIDAI) Biometric data: Fingerprints, facial images, iris scans stored in Central Identities Repository (national centralized database) Privacy concerns: Deployed without direct legislative privacy/ethics constraints; comprehensive data protection legislation not yet passed Security issues: High-ranking official’s Aadhaar number shared on Twitter led to hackers accessing personal info (mobile, tax ID) 2017: Supreme Court enshrined privacy rights Supreme Court ruling: 4 of 5 judges allowed program to continue with limited scope & restrictions on data storage Threats: Potential for 360-degree profiling; viewed by many as mass surveillance tool infringing privacy rights Note: "with privacy protections" is questionable - significant privacy concerns remain despite Supreme Court restrictions Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC5741784/ | https://time.com/5388257/india-aadhaar-biometric-identification/ | https://privacyinternational.org/case-study/4698/id-systems-analysed-aadhaar | https://insights.som.yale.edu/insights/what-happens-when-billion-identities-are-digitized

192.

Sinn, M. P. Private industry clinical trial spending estimate. (2025)

Estimated private pharmaceutical and biotech clinical trial spending is approximately $75-90 billion annually, representing roughly 90% of global clinical trial spending.

193.

World Bank. Infrastructure investment economic multiplier (1.6). World Bank: Infrastructure Investment as Stimulus https://blogs.worldbank.org/en/ppps/effectiveness-infrastructure-investment-fiscal-stimulus-what-weve-learned (2022)

Infrastructure fiscal multiplier: 1.6 during contractionary phase of economic cycle Average across all economic states: 1.5 (meaning $1 of public investment → $1.50 of economic activity) Time horizon: 0.8 within 1 year, 1.5 within 2-5 years Range of estimates: 1.5-2.0 (following 2008 financial crisis & American Recovery Act) Italian public construction: 1.5-1.9 multiplier US ARRA: 0.4-2.2 range (differential impacts by program type) Economic Policy Institute: Uses 1.6 for infrastructure spending (middle range of estimates) Note: Public investment less likely to crowd out private activity during recessions; particularly effective when monetary policy loose with near-zero rates Additional sources: https://blogs.worldbank.org/en/ppps/effectiveness-infrastructure-investment-fiscal-stimulus-what-weve-learned | https://www.gihub.org/infrastructure-monitor/insights/fiscal-multiplier-effect-of-infrastructure-investment/ | https://cepr.org/voxeu/columns/government-investment-and-fiscal-stimulus | https://www.richmondfed.org/publications/research/economic_brief/2022/eb_22-04

194.

Snopes. History of insulin patent and modern price disparities. Snopes: Insulin Patent Dollar https://www.snopes.com/fact-check/insulin-patent-dollar/ (2019)

1923: Frederick Banting, Charles Best, James Collip sold insulin patent to U. of Toronto for $1 each (total $3) Banting: Unethical for doctor to profit from life-saving discovery; wanted everyone to afford it Manufacturing cost: $6 per vial US retail price: $300-332 per vial (Humalog: $21 in 1999 → $332 in 2019 = 1,000%+ increase) Price increases: 600% over 20 years; 200% between 2007-2018 Patients without insurance: Up to $1,000/month Contributing factors: Patent evergreening, barriers to biosimilar entry, market concentration (Eli Lilly, Novo Nordisk, Sanofi) Additional sources: https://www.snopes.com/fact-check/insulin-patent-dollar/ | https://www.t1international.com/100years/ | https://pnhp.org/news/why-insulin-is-overpriced/ | https://www.npr.org/2019/06/18/733742630/desperate-measures-the-skyrocketing-price-of-insulin-in-america

195.

US Government Info. Intelligence spending as percentage of military budgets. US Government Info: Cost of Intelligence https://www.govinfo.gov/content/pkg/GPO-INTELLIGENCE/html/int017.html

US: Military-related budget lines (DoE, State Dept, National Intelligence Program) = 11% of US spending (2024) Intelligence funding: Grew faster than military when military spending increased; decreased slower when military spending decreased Historical trend: Intelligence funding reached level 80% above 1980 baseline US National Intelligence Program + Military Intelligence Program ≈ 10-11% of total military-related spending Additional sources: https://www.govinfo.gov/content/pkg/GPO-INTELLIGENCE/html/int017.html | https://sgp.fas.org/crs/intel/R44381.pdf | https://en.wikipedia.org/wiki/United_States_intelligence_budget

196.

Statista. Number of global internet users. Statista: Internet Users Worldwide 2024 https://www.statista.com/statistics/273018/number-of-internet-users-worldwide/ (2024)

2022: Surpassed 5 billion users worldwide 2024 (Oct): 5.52 billion (67.5% of global population); year-end: 5.5B 2025 (start): 5.560 billion (67.9% of population); Oct 2025: 6.04 billion (73.2% of population) Growth: +136M in 2024 (+2.5%), +294M over 12 months to Oct 2025 (+5.1%) Still disconnected: 2.630 billion people at start of 2025 Additional sources: https://www.statista.com/statistics/273018/number-of-internet-users-worldwide/ | https://www.digitalinformationworld.com/2025/02/global-internet-users-surpass-offline-556-billion-2025.html | https://datareportal.com/global-digital-overview | https://www.sganalytics.com/blog/global-internet-usage-statistics/

197.

Wikipedia. Journal of the american medical association (JAMA) founded in 1883. Wikipedia: JAMA https://en.wikipedia.org/wiki/JAMA

Founded: 1883 by American Medical Association Founding editor: Nathan Smith Davis Superseded: Transactions of the American Medical Association 1960: Obtained current title "JAMA: The Journal of the American Medical Association Evolution: Late 1800s resembled general journalism; 1910s-1920s "turndown era" began rejecting submissions based on quality; routine peer review instituted after WWII Current: Peer-reviewed medical journal published 48 times/year covering all aspects of biomedicine Additional sources: https://en.wikipedia.org/wiki/JAMA | https://jamanetwork.com/journals/jama/fullarticle/291201 | https://onlinebooks.library.upenn.edu/webbin/serial?id=jama

198.

Nobel Prize. James buchanan nobel prize in economics, 1986. Nobel Prize: 1986 Economic Sciences https://www.nobelprize.org/prizes/economic-sciences/1986/press-release/ (1986)

James McGill Buchanan: 1986 Nobel Memorial Prize in Economic Sciences Citation: "for his development of the contractual and constitutional bases for the theory of economic and political decision-making Field: Public choice theory (leading researcher & cofounder with Gordon Tullock) Key work: "The Calculus of Consent" (with Tullock) - now considered a classic, started the field Contribution: Transferred concept of gain from mutual exchange between individuals to political decision-making; applied economic analysis to public sector Inspiration: Swedish economist Knut Wicksell (described as "most exciting intellectual moment" of career) Additional sources: https://www.nobelprize.org/prizes/economic-sciences/1986/press-release/ | https://en.wikipedia.org/wiki/James_M._Buchanan | https://www.britannica.com/money/James-M-Buchanan | https://www.econlib.org/library/Enc/bios/Buchanan.html

199.

FDLI. Japan’s regenerative medicine act and conditional approval pathway. FDLI: Japan’s Regen Med Pathways https://www.fdli.org/2019/02/global-focus-japans-regenerative-medicine-regulatory-pathways-encouraging-innovation-and-patient-access/ (2019)

Act on Safety of Regenerative Medicine (RM Act) + amended Pharmaceuticals and Medical Devices Act (PMD Act): passed Nov 2013, effective Nov 2014 Conditional and time-limited approval pathway: Obtain approval after exploratory trials demonstrate probable benefit and proven safety 7-year conditional approval period to confirm clinical benefit (e.g., using surrogate endpoints) SAKIGAKE designation (April 2015): Expedited pathway for innovative products targeting serious/life-threatening diseases without effective treatment Benefits: Prioritized consultation, accelerated review, extended re-examination period, premium pricing Examples: Terumo’s HeartSheet and Stemirac obtained conditional approval; Stemirac also SAKIGAKE-designated Additional sources: https://www.fdli.org/2019/02/global-focus-japans-regenerative-medicine-regulatory-pathways-encouraging-innovation-and-patient-access/ | https://www.insights.bio/cell-and-gene-therapy-insights/journal/article/310/Experiences-from-Japan-SAKIGAKE-Designation-System-for-Regenerative-Medical-Products | https://pmc.ncbi.nlm.nih.gov/articles/PMC6696404/

200.

Kahneman, D. & Tversky, A. Prospect theory: An analysis of decision under risk. Econometrica 47, 263–292 (1979).

201.

GovTrack. Kefauver harris amendment of 1962. GovTrack https://www.govtrack.us/congress/bills/87/s1552 (1962)

regulating efficacy testing via the 1962 Kefauver Harris Amendment. The 1962 regulations made these large real-world efficacy trials illegal. Additional sources: https://www.govtrack.us/congress/bills/87/s1552 | https://www.fda.gov/about-fda/histories-product-regulation/promoting-safe-effective-drugs-100-years | https://pmc.ncbi.nlm.nih.gov/articles/PMC4101807/

202.

National Kidney Foundation. Annual deaths from kidney disease. National Kidney Foundation: Global Facts https://www.kidney.org/global-facts-about-kidney-disease (2022)

Direct CKD deaths: 1.2M (2017), 1.53M (2021); increased from 591,800 (1990) to 1,425,670 (2019) CKD-attributable cardiovascular deaths: Additional 1.4M deaths from CVD attributable to impaired kidney function (7.6% of all CVD deaths, 2017) Combined impact: 4.6% of total global mortality CKD: 12th leading cause of death globally; one of few NCDs showing increased deaths over past 2 decades Additional sources: https://www.kidney.org/global-facts-about-kidney-disease | https://pmc.ncbi.nlm.nih.gov/articles/PMC9073222/ | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30045-3/fulltext | https://www.healthdata.org/news-events/newsroom/news-releases/chronic-kidney-disease-global-killer-plain-sight

203.

BioPharma Dive. Approval of landmark gene therapies (luxturna, zolgensma, CAR-t). BioPharma Dive: Luxturna https://www.biopharmadive.com/news/luxturna-gene-therapy-eye-leber-lca/609832/ (2017)

Luxturna (Dec 2017): First in vivo gene therapy approved by US FDA; treats biallelic RPE65 mutation-associated retinal dystrophy (inherited blindness); $850,000 one-time therapy CAR-T therapies (2017): Kymriah and Yescarta approved same year as Luxturna Zolgensma (May 2019): Spinal muscular atrophy treatment; second gene therapy for inherited disease in US; $2.1M (one of most expensive medicines at the time) Described as "landmark moment for a field riddled with ups and downs" and "landmark achievements in history of modern science Additional sources: https://www.biopharmadive.com/news/luxturna-gene-therapy-eye-leber-lca/609832/ | https://cen.acs.org/articles/95/web/2017/12/First-gene-therapy-genetic-disease.html | https://www.npr.org/sections/health-shots/2017/12/19/571962226/first-gene-therapy-for-inherited-disease-gets-fda-approval | https://pmc.ncbi.nlm.nih.gov/articles/PMC7123914/

204.

Sir Martin Landray. Landray, sir martin, on the RECOVERY trial. Sir Martin Landray https://www.ox.ac.uk/news/features/recovery-trial-two-years

In 2019, I had no idea that I would be setting up a trial of treatments for an infectious disease, let alone a pandemic virus. I certainly would not have thought it possible to go from a blank piece of paper to enrolling the first patient in nine days, to finding the first life-saving treatment within ten weeks, and for it to be made standard NHS policy within three hours. Additional sources: https://www.ox.ac.uk/news/features/recovery-trial-two-years

205.

London Bullion Market Association. Gold during periods of conflict. (2019)

During wartime, almost all belligerent nations would go off the gold standard in order to conceal the staggering costs of war from their citizens by printing money rather than raising taxes.

206.

Source: US Life Expectancy FDA Budget 1543-2019 CSV. US life expectancy growth 1880-1960: 3.82 years per decade. (2019)

Pre-1962: 3.82 years/decade Post-1962: 1.54 years/decade Reduction: 60% decline in life expectancy growth rate Additional sources: https://ourworldindata.org/life-expectancy | https://www.mortality.org/ | https://www.cdc.gov/nchs/nvss/mortality_tables.htm

207.

Responsible Statecraft. Lobbying ROI calculation ($1,813 per $1). Responsible Statecraft https://responsiblestatecraft.org/2021/09/02/top-defense-firms-see-2t-return-on-1b-investment-in-afghan-war/ (2021).

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OpenSecrets. Lobbying spend (defense). OpenSecrets https://www.opensecrets.org/industries/lobbying?ind=D (2024).

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OpenSecrets. Lobbyist statistics for washington d.c. OpenSecrets: Lobbying in US https://en.wikipedia.org/wiki/Lobbying_in_the_United_States

Registered lobbyists: Over 12,000 (some estimates); 12,281 registered (2013) Former government employees as lobbyists: 2,200+ former federal employees (1998-2004), including 273 former White House staffers, 250 former Congress members & agency heads Congressional revolving door: 43% (86 of 198) lawmakers who left 1998-2004 became lobbyists; currently 59% leaving to private sector work for lobbying/consulting firms/trade groups Executive branch: 8% were registered lobbyists at some point before/after government service Additional sources: https://en.wikipedia.org/wiki/Lobbying_in_the_United_States | https://www.opensecrets.org/revolving-door | https://www.citizen.org/article/revolving-congress/ | https://www.propublica.org/article/we-found-a-staggering-281-lobbyists-whove-worked-in-the-trump-administration

210.

NPR. When lobbyists literally write the bill. NPR: It’s All Politics https://www.npr.org/sections/itsallpolitics/2013/11/11/243973620/when-lobbyists-literally-write-the-bill (2013)

House bill to weaken Dodd-Frank financial regulations: 70 of 85 lines reflected Citigroup lobbyist recommendations. Two paragraphs copied almost word for word, with only two words changed to make them plural. Bill sought to eliminate push-out rule preventing banks from using customer deposits for derivative trading.

211.

OpenSecrets. Lockheed martin’s political donations, contracts, and state operations in 2022. OpenSecrets: Lockheed Martin Summary https://www.opensecrets.org/orgs/lockheed-martin/summary?id=d000000104 (2022)

Political contributions 2022: $3,946,639 (PAC + individuals); PAC alone: $1,542,500 to federal candidates (2021-2022 cycle) Lobbying 2022: $13.6M expenditure (focused on military appropriations, foreign military sales) Geographic footprint: Operations in over half of states; employs 1,000-20,000+ per state Additional sources: https://www.opensecrets.org/orgs/lockheed-martin/summary?id=d000000104 | https://www.opensecrets.org/political-action-committees-pacs/lockheed-martin/C00303024/candidate-recipients/2022 | https://www.taxpayer.net/wp-content/uploads/2024/10/Oct-2024-Political-Footprint-of-the-Military-Industry.pdf

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Cutler, D. M. The economic cost of long COVID: An update. Harvard Kennedy School, Mossavar-Rahmani Center for Business and Government https://www.hks.harvard.edu/centers/mrcbg/programs/growthpolicy/economic-cost-long-covid-update-david-cutler (2022).

213.

CIDRAP. Long COVID takes $1 trillion global economic toll each year, analysis suggests. CIDRAP News https://www.cidrap.umn.edu/covid-19/long-covid-takes-1-trillion-global-economic-toll-each-year-analysis-suggests (2024).

214.

Wikipedia. The collapse of long-term capital management (LTCM) in 1998. Wikipedia: LTCM https://en.wikipedia.org/wiki/Long-Term_Capital_Management (2013)

Founded 1994 by John Meriwether (former Salomon Brothers vice-chairman) Board included Nobel Prize winners: Myron Scholes & Robert C. Merton (1997 Nobel in Economics for Black-Scholes model) Initial success: 21% (year 1), 43% (year 2), 41% (year 3) annualized returns after fees 1998 collapse: Lost $4.6B in <4 months due to high leverage + 1997 Asian crisis + 1998 Russian crisis Extreme leverage: $30 debt per $1 capital (end of 1997) Bailout: $3.6B ($3.625B) from 14 banks, brokered by Federal Reserve Bank of NY (Fed didn’t lend own funds) By early 2000: Fund liquidated, creditors repaid Additional sources: https://en.wikipedia.org/wiki/Long-Term_Capital_Management | https://www.federalreservehistory.org/essays/ltcm-near-failure | https://www.wallstreetmojo.com/long-term-capital-management/ | https://blogs.cfainstitute.org/investor/2013/11/04/the-incredible-untold-story-about-how-the-financial-world-almost-ended/

215.

Think by Numbers. Lost human capital due to war ($270B annually). Think by Numbers https://thinkbynumbers.org/military/war/the-economic-case-for-peace-a-comprehensive-financial-analysis/ (2021)

Lost human capital from war: $300B annually (economic impact of losing skilled/productive individuals to conflict) Broader conflict/violence cost: $14T/year globally 1.4M violent deaths/year; conflict holds back economic development, causes instability, widens inequality, erodes human capital 2002: 48.4M DALYs lost from 1.6M violence deaths = $151B economic value (2000 USD) Economic toll includes: commodity prices, inflation, supply chain disruption, declining output, lost human capital Additional sources: https://thinkbynumbers.org/military/war/the-economic-case-for-peace-a-comprehensive-financial-analysis/ | https://www.weforum.org/stories/2021/02/war-violence-costs-each-human-5-a-day/ | https://pubmed.ncbi.nlm.nih.gov/19115548/

216.

Mackay, C. Memoirs of Extraordinary Popular Delusions and the Madness of Crowds. (Richard Bentley, London, 1841).

Classic study of crowd psychology, financial bubbles, and mass delusions. Documents how groups of individually rational people can collectively produce irrational outcomes when independence of judgment breaks down. Covers the South Sea Bubble, Tulip Mania, and other episodes where the wisdom of crowds became the madness of crowds.

217.

Macrotrends. Gold prices - 100 year historical chart. (2026)

Historical gold prices from 1915 to present. Average annual gold price in 1972: $58.17 per troy ounce. Gold price in early March 2026: over $5,400 per ounce.

218.

WHO. Annual deaths from malaria. WHO https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2024 (2024)

600,000 people per year die from malaria (a disease spread by a bug we can’t figure out how to properly swat) Additional sources: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2024

219.

Doblin, R. FDA decision, redoubling of MAPS efforts, and lykos board resignation. (2024).

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Mitchell, J. M. et al. MDMA-assisted therapy for moderate to severe PTSD: A randomized, placebo-controlled phase 3 trial. Nature Medicine 29, 2473–2480 (2023).

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Wikipedia. Pharmaceutical lobby influence on medicare modernization act of 2003. Wikipedia: Medicare Modernization Act https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act

Medicare Prescription Drug, Improvement, and Modernization Act (P.L. 108-173): Signed Dec 8, 2003 by President Bush; created voluntary Part D prescription drug benefit Noninterference provision": Prohibits HHS Secretary from negotiating drug prices or establishing preferred drug list Instead: Drug prices negotiated between manufacturers & insurance companies administering Part D plans Pharma industry role in writing: "Noninterference clause" written with major industry involvement; drug manufacturers had major role writing & getting it through Congress Industry lobbying: $231M spent on lobbying in 2003 (more than any other industry since 1998) Rep. Billy Tauzin example: 2004 appointed PhRMA chief lobbyist ($2M/year rumored); responsible for including price negotiation prohibition 2022 change: Inflation Reduction Act removed ban; Medicare can negotiate starting 2026 Additional sources: https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act | https://www.healthaffairs.org/content/forefront/politics-medicare-and-drug-price-negotiation-updated | https://www.congress.gov/crs-products/product/pdf/R/R47872

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Benson, K. & Hartz, A. J. A comparison of observational studies and randomized, controlled trials. New England Journal of Medicine https://doi.org/10.1056/NEJM200006223422506 (2000) doi:10.1056/NEJM200006223422506.

226.

Mercatus. Military spending economic multiplier (0.6). Mercatus: Defense Spending and Economy https://www.mercatus.org/research/research-papers/defense-spending-and-economy

Ramey (2011): 0.6 short-run multiplier Barro (1981): 0.6 multiplier for WWII spending (war spending crowded out 40¢ private economic activity per federal dollar) Barro & Redlick (2011): 0.4 within current year, 0.6 over two years; increased govt spending reduces private-sector GDP portions General finding: $1 increase in deficit-financed federal military spending = less than $1 increase in GDP Variation by context: Central/Eastern European NATO: 0.6 on impact, 1.5-1.6 in years 2-3, gradual fall to zero Ramey & Zubairy (2018): Cumulative 1% GDP increase in military expenditure raises GDP by 0.7% Additional sources: https://www.mercatus.org/research/research-papers/defense-spending-and-economy | https://cepr.org/voxeu/columns/world-war-ii-america-spending-deficits-multipliers-and-sacrifice | https://www.rand.org/content/dam/rand/pubs/research_reports/RRA700/RRA739-2/RAND_RRA739-2.pdf

227.

Wikipedia. Michael milken and the development of the high-yield bond market. Wikipedia: Michael Milken https://en.wikipedia.org/wiki/Michael_Milken

Michael Milken ("Junk Bond King"): Pioneered high-yield "junk bond" market with Drexel Burnham Lambert (1970s-1980s) Original-issue high-yield debt innovation provided hostile bidders & LBO firms enormous capital for multi-billion-dollar deals Mid-1980s: Milken’s high-yield bond buyer network enabled rapid large-scale fundraising, facilitated LBOs (e.g., KKR) Market growth: End of 1980s = $150B junk-bond market; Drexel became leading US financial firm with 50% market share Milken compensation: >$1B over 4 years (late 1980s) - US income record at the time 1989: Indicted for racketeering/securities fraud; plea bargain to securities/reporting violations (not racketeering/insider trading) 1990: Drexel bankruptcy & liquidation Additional sources: https://en.wikipedia.org/wiki/Michael_Milken | https://www.hbs.edu/faculty/Pages/item.aspx?num=50852 | https://www.britannica.com/money/Michael-R-Milken | https://www.sechistorical.org/museum/galleries/wwr/wwr05d-markets-milken.php

228.

The National WWII Museum. War bonds. (2024).

229.

The National WWII Museum. Research starters: Worldwide deaths in world war II. (2025)

Battle deaths: 15,000,000. Civilian deaths: 45,000,000. Total: approximately 60,000,000. Estimates range from 60 to 85 million including war-related famine and disease.

230.

USAFacts. NATO o&m ratios for global spending. USAFacts: US Military Spending https://usafacts.org/articles/how-much-does-the-us-spend-on-the-military/ (2024)

Operations & Maintenance (O&M): 38-50% of military spending US FY2024: O&M cost $332B (38% of military spending), up from 28% in 1974 2005-2015 trend: O&M represented 40-50% of DoD total budget NATO 2024: $1.47T total spending across 32 member countries; US $967B (66%), European members $454B (30%) NATO equipment investment guideline: At least 20% of military expenditures for major equipment/R&D Additional sources: https://usafacts.org/articles/how-much-does-the-us-spend-on-the-military/ | https://www.cbo.gov/publication/52156 | https://www.nato.int/cps/en/natohq/topics_49198.htm | https://www.statista.com/statistics/1293301/combined-military-expenditures-nato/

231.

All of Us. NIH all of us research program outcomes and spending. All of Us: Program Overview https://allofus.nih.gov/article/program-overview (2026)

Total authorized funding: $2.16B (not $4B) - $1.02B allocated since 2015, $1.14B authorized through 2026 via 21st Century Cures Act Budget cut 71% over 2 years: $500M+ (2023) → $150M (2025) Enrolled: 860,000 participants from all 50 states; 633,000+ participants with data available for research Clinical trials completed: Zero (program is observational cohort study, not a clinical trial program) Purpose: Collect prospective data to inform future clinical trials, provide recruitment infrastructure Additional sources: https://allofus.nih.gov/article/program-overview | https://www.nejm.org/doi/full/10.1056/NEJMsr1809937 | https://www.genomeweb.com/sequencing/all-us-research-program-unfazed-funding-cuts-lays-out-plans-through-2026

232.

NSF. Annual number of papers published from NIH-funded research. NSF: Publications Output https://ncses.nsf.gov/pubs/nsb20206

Global scientific output: 2.5-2.6 million research papers published annually (all sources, not just NIH) Worldwide S&E publication growth: 1.8M (2008) → 2.6M articles (2018), averaging 4% annual growth NIH-specific output example (2000): 4,451 R01 grants ($1.3B) produced 55,000 publications, 3.7M citations Total active journals: 46,736 peer-reviewed journals (2020) publishing 3M+ articles annually Additional sources: https://ncses.nsf.gov/pubs/nsb20206 | https://ourworldindata.org/grapher/scientific-publications-per-million | https://pmc.ncbi.nlm.nih.gov/articles/PMC8738817/

233.

NIH. NIH budget (FY 2025). NIH https://www.nih.gov/about-nih/organization/budget (2024)

The budget total of $47.7 billion also includes $1.412 billion derived from PHS Evaluation financing... Additional sources: https://www.nih.gov/about-nih/organization/budget | https://officeofbudget.od.nih.gov/

234.

Bentley et al. NIH spending on clinical trials: 3.3%. Bentley et al. https://pmc.ncbi.nlm.nih.gov/articles/PMC10349341/ (2023)

NIH spent $8.1 billion on clinical trials for approved drugs (2010-2019), representing 3.3% of relevant NIH spending. Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC10349341/ | https://catalyst.harvard.edu/news/article/nih-spent-8-1b-for-phased-clinical-trials-of-drugs-approved-2010-19-10-of-reported-industry-spending/

235.

National Center for Advancing Translational Sciences. Clinical and translational science awards (CTSA) program. (2025).

236.

Kaiser, J. NIH says grantee failed to report experiment in Wuhan that created a bat virus that made mice sicker. Science (2021).

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238.

PMC. Number of diseases eradicated by the NIH. PMC: Six Challenges in Eradication https://pmc.ncbi.nlm.nih.gov/articles/PMC7612385/

Diseases eradicated globally: Only 2 (smallpox in 1979 via $300M WHO effort over <10 years; rinderpest) NIH role: Contributor to research/vaccine development but not sole eradicator Near-eradication: Polio (close to achievement); measles, rubella targeted for eradication Major achievements via vaccination: Smallpox eradicated, polio nearly eliminated, diphtheria/tetanus/measles greatly reduced Impact: Vaccination eliminated disease in populations with high implementation rates; past 2 centuries saw enormous infectious disease control via sanitation, vaccines, antibiotics, nutrition Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC7612385/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC4024226/ | https://www.ncbi.nlm.nih.gov/books/NBK98117/

239.

HHS. FY2016 budget in brief - NIH. HHS https://www.hhs.gov/about/budget/budget-in-brief/nih/index.html (2020)

NIH funding contributed to published research associated with every one of the 356 new drugs approved by the FDA from 2010–2019." Total NIH spending on this research was $187 billion, while industry spending on clinical development for these drugs was significantly higher. Approximately 54% of the NIH research budget is devoted to basic biomedical and behavioral research, while about one-third (33%) is allocated to clinical research including patient-oriented research, clinical trials, and health services research. Categories overlap so totals exceed 100%. Additional sources: https://www.pnas.org/doi/10.1073/pnas.1920929117 | https://marianamazzucato.com/books/the-entrepreneurial-state | https://www.hhs.gov/about/budget/budget-in-brief/nih/index.html | https://www.hhs.gov/about/budget/budget-in-brief/nih/index.html

240.

Silicon Valley Business Journal. NIH funding cuts and brain drain. Silicon Valley Business Journal https://www.bizjournals.com/sanjose/news/2025/08/15/nih-funding-cuts-science-brain-drain-berkeley.html (2025)

Following a proposed 29% cut to NIH funding in 2025, 75% of scientists are considering leaving the U.S. due to funding instability. Additional sources: https://www.bizjournals.com/sanjose/news/2025/08/15/nih-funding-cuts-science-brain-drain-berkeley.html

241.

ScienceDirect. Correlation between NIH funding priorities and disease burden. ScienceDirect: Persistence of Very Low Correlations https://www.sciencedirect.com/science/article/pii/S2666535224001174

Very weak correlations: R² < 0.03 between NIH funding and 5 disease burden measures for 27 diseases Historical (1996): r=0.62 correlation with DALYs, but explained only 39% of variance Recent (2008-2019): Simple correlation 0.08 between disease burden increases and funding increases 2019 analysis: Only 29% of variance in NIH funding explained by disease burden Strongest predictor of 2019 funding: 2008 funding levels (r=0.88), revealing long-standing inefficiencies Additional sources: https://www.sciencedirect.com/science/article/pii/S2666535224001174 | https://www.nejm.org/doi/full/10.1056/NEJM199906173402406 | https://pmc.ncbi.nlm.nih.gov/articles/PMC3044706/

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PMC. NIH phased trial spending for approved drugs 2010-2019. PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC10349341/

NIH spent $8.1 billion on phased clinical trials of 387 drugs that were approved between 2010 and 2019. Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC10349341/

245.

RECOVER Initiative & News Reports. NIH RECOVER initiative inefficiency. RECOVER Initiative & News Reports https://recovercovid.org/about (2025).

246.

National Institute of Mental Health. Post-traumatic stress disorder (PTSD) statistics. (2023).

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Nobel, P. The nobel family dissociates itself from the economics prize. (2010)

Peter Nobel, Alfred Nobel’s great-grandnephew, called the economics prize "a PR coup by economists to improve their reputation" and stated that Nobel "despised people who cared more about profits than society’s well-being." Originally published on SVT Debatt, October 11, 2010.

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Nobel Prize Organization. The prize in economic sciences. (2026)

The Nobel Prize website states: "The prize in economic sciences is not a Nobel Prize." The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel was established in 1968 by Sweden’s central bank, 67 years after the original Nobel Prizes.

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Firth, N. E. & Noren, J. H. Soviet Defense Spending: A History of CIA Estimates, 1950–1990. (Texas A&M University Press, 1998).

Comprehensive history of CIA estimates of Soviet defense spending from 1950 to 1990. Since the mid-1980s, the Soviet Union devoted between 15 and 17 percent of its annual GNP to military spending according to US government sources. Outside estimates ranged between 10 and 20 percent of GDP. Soviet official statistics had lied for at least a quarter century about the true size of the military budget, reporting only a small fraction of defense outlays. Defense expenditures rose 4-7% per year until the early 1980s, then slowed as GNP growth slipped to about 3%.

250.

Federal Bureau of Investigation. North korea responsible for $1.5 billion bybit hack. (2025).

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Wikipedia. The nuclear disarmament "freeze" movement of the 1980s. Wikipedia: Nuclear Freeze Campaign https://en.wikipedia.org/wiki/Nuclear_Freeze_campaign (2010)

Mass U.S. movement (1980s) to halt testing, production, deployment of nuclear weapons between U.S. and Soviet Union Origins: Proposed by Randall Forsberg (Dec 1979); Nuclear Weapons Freeze Campaign formed March 1981 at Georgetown University June 12, 1982: 1 million people rallied in NYC (largest peacetime rally in U.S. history) 1983: Congress passed nuclear freeze resolution Impact: Reagan administration reversed rhetoric ("nuclear war cannot be won and must never be fought") Major support: Religious community (National Council of Churches, Protestant denominations, progressive evangelicals, African-American churches) 1987: Merged with Committee for a Sane Nuclear Policy → formed Peace Action Additional sources: https://en.wikipedia.org/wiki/Nuclear_Freeze_campaign | https://www.armscontrol.org/act/2010-12/nuclear-freeze-and-its-impact | https://disarmament.blogs.pace.edu/nyc-nuclear-archive/nuclear-freeze-campaign-1970s-1980s/

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Nuffield Department of Population Health, University of Oxford. RECOVERY trial celebrates two-year anniversary of life-saving dexamethasone result. (2022).

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The Optimal Budget Generator (OBG) uses causal inference, diminishing returns modeling, and cost-effectiveness evidence to determine optimal public goods funding levels that maximize two welfare metrics: real after-tax median income growth and median healthy life years. For each spending category, OBG estimates an Optimal Spending Level (OSL) and produces a gap analysis showing where current government budgets are over- or underfunded relative to evidence-based benchmarks. The Budget Impact Score (BIS) measures confidence in each recommendation based on the quality of causal evidence.

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Wikipedia. Occupy wall street movement (2011). Wikipedia: Occupy Wall Street https://en.wikipedia.org/wiki/Occupy_Wall_Street

Left-wing populist movement against economic inequality, capitalism, corporate greed, big finance, money in politics September 17 - November 15, 2011 (59 days) in Zuccotti Park, NYC Financial District Slogan "We are the 99%" highlighted income/wealth inequality: Top 1% owned 40% of wealth, earned 20% of income (2011) Organized by Adbusters (Kalle Lasn, Micah White); ended November 15 when police cleared park ( 200 arrested) Legacy: Successfully reframed national conversation about economic inequality in simple, effective terms Additional sources: https://en.wikipedia.org/wiki/Occupy_Wall_Street | https://www.britannica.com/topic/Occupy-Wall-Street | https://history.com/this-day-in-history/occupy-wall-street-begins-zuccotti-park

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Columbia/NBER. Odds of a single vote being decisive in a u.s. Presidential election. Columbia/NBER: What Is the Probability Your Vote Will Make a Difference? https://sites.stat.columbia.edu/gelman/research/published/probdecisive2.pdf (2012)

National average: 1 in 60 million chance (2008 election analysis by Gelman, Silver, Edlin) Swing states (NM, VA, NH, CO): 1 in 10 million chance Non-competitive states: 34 states >1 in 100 million odds; 20 states >1 in 1 billion Washington DC: 1 in 490 billion odds Methodology: Probability state is necessary for electoral college win × probability state vote is tied Additional sources: https://sites.stat.columbia.edu/gelman/research/published/probdecisive2.pdf | https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1465-7295.2010.00272.x

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Grand View Research. Open-source and platform-as-a-service multi-trillion dollar market. Grand View Research: Open Source Services Market https://www.grandviewresearch.com/industry-analysis/open-source-services-market-report

Open source services market: $30.2B (2023) → $81.4B (2030) at 16.5% CAGR; other estimates $135.9B by 2033 Open source cloud platform: $6.23B (2024) → $18.12B (2033) at 12.8% CAGR Platform as a Service (PaaS): Growing at 12.6% CAGR Broader cloud computing market: Projected $1.5 trillion by 2033 at 15% CAGR Current market in tens of billions, approaching multi-trillion valuations in long term Additional sources: https://www.grandviewresearch.com/industry-analysis/open-source-services-market-report | https://www.precedenceresearch.com/open-source-services-market

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Total federal lobbying reached record $4.4 billion in 2024. The $150 million increase in lobbying continues an upward trend that began in 2016. Additional sources: https://www.opensecrets.org/news/2025/02/federal-lobbying-set-new-record-in-2024/

259.

Sinn, M. P. The Optimal Policy Generator: A Causal Inference Protocol for Maximizing Median Health and Wealth Through Public Policy. https://opg.warondisease.org (2025) doi:10.5281/zenodo.18603834

The Optimal Policy Generator (OPG) produces systematic public policy recommendations for jurisdictions at any level (country, state, city), generating prioritized enact/replace/repeal/maintain recommendations to maximize real after-tax median income growth and median healthy life years, based on quasi-experimental evidence from centuries of policy variation data.

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Sinn, M. P. Optimocracy: Causal Inference on Cross-Jurisdictional Policy Data to Maximize Median Health and Wealth. https://optimocracy.warondisease.org (2025) doi:10.5281/zenodo.18356213

Thousands of jurisdictions have made different policy and budget choices over decades, creating a natural experiment. Optimocracy applies causal inference to this cross-jurisdictional time-series data to identify which policies predict above-average median income and healthy life years. It then publishes evidence-based recommendations for every major vote, tracks politician alignment, and funds aligned candidates via SuperPAC, making suboptimal policy politically expensive while preserving democratic structures.

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Cohen, J. Saying human trials aren’t enough, researchers call for comparison of COVID-19 vaccines in monkeys. Science https://doi.org/10.1126/science.370.6513.154 (2020) doi:10.1126/science.370.6513.154.

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Cohen, J. Operation Warp Speed’s opaque choices of COVID-19 vaccines draw Senate scrutiny. Science https://www.science.org/content/article/operation-warp-speed-s-opaque-choices-covid-19-vaccines-draw-senate-scrutiny (2020).

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Our World in Data. Pandemic vs. War deaths comparison. Our World in Data https://ourworldindata.org/covid-deaths (2024)

COVID-19 deaths: over 7 million confirmed deaths" vs. annual conflict deaths typically under 100,000. Additional sources: https://ourworldindata.org/covid-deaths

264.

Papanicolas, Irene et al. Health care spending in the united states and other high-income countries. Papanicolas et al. https://jamanetwork.com/journals/jama/article-abstract/2674671 (2018)

The US spent approximately twice as much as other high-income countries on medical care (mean per capita: $9,892 vs $5,289), with similar utilization but much higher prices. Administrative costs accounted for 8% of US spending vs 1-3% in other countries. US spending on pharmaceuticals was $1,443 per capita vs $749 elsewhere. Despite spending more, US health outcomes are not better. Additional sources: https://jamanetwork.com/journals/jama/article-abstract/2674671

265.

Pape, R. A. Dying to Win: The Strategic Logic of Suicide Terrorism. (Random House, 2005).

Pape analyzed every suicide terrorist attack worldwide from 1980 to 2003, finding that 95 percent were in response to foreign military occupation. The data contradicts narratives attributing suicide terrorism primarily to religious fundamentalism.

266.

House of Commons Health Committee. The Influence of the Pharmaceutical Industry. https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/4207.htm (2005).

267.

Trials. Patient willingness to participate in clinical trials. Trials: Patients’ Willingness Survey https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-1105-3

Recent surveys: 49-51% willingness (2020-2022) - dramatic drop from 85% (2019) during COVID-19 pandemic Cancer patients when approached: 88% consented to trials (Royal Marsden Hospital) Study type variation: 44.8% willing for drug trial, 76.2% for diagnostic study Top motivation: "Learning more about my health/medical condition" (67.4%) Top barrier: "Worry about experiencing side effects" (52.6%) Additional sources: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-1105-3 | https://www.appliedclinicaltrialsonline.com/view/industry-forced-to-rethink-patient-participation-in-trials | https://pmc.ncbi.nlm.nih.gov/articles/PMC7183682/

268.

Wikipedia. Passage of the USA PATRIOT act. Wikipedia: Patriot Act https://en.wikipedia.org/wiki/Patriot_Act (2001)

Introduced: October 23, 2001 by Rep. Jim Sensenbrenner (R-WI) as H.R. 3162 Passed House: October 24, 2001 (357-66 vote, Democrats majority of "no" votes) Passed Senate: October 25, 2001 (98-1 vote, only Russ Feingold D-WI voted "no") Signed into law: October 26, 2001 by President George W. Bush Length: 342 pages, passed hastily without public opportunity for review ACLU concern: Senate forced to vote on legislation it hadn’t had opportunity to read (offices closed, staff couldn’t access papers) Additional sources: https://en.wikipedia.org/wiki/Patriot_Act | https://www.britannica.com/topic/USA-PATRIOT-Act | https://www.ala.org/advocacy/chronology-usa-patriot-act-2001

269.

U.S. Congress. 42 u.s. Code § 1320e-1 - limitations on certain uses of comparative clinical effectiveness research. (2010)

Exact statutory text: "The Patient-Centered Outcomes Research Institute established under section 1320e(b)(1) of this title shall not develop or employ a dollars-per-quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended." The Secretary also cannot use such thresholds for Medicare coverage or reimbursement decisions.

270.

The Commune. Pentagon audit failures ($2.46T unaccounted). The Commune https://thecommunemag.com/the-pentagon-misplaced-2-46-trillion-an-in-depth-look-at-the-financial-audit-failures (2024)

In the most recent audit, the Department of Defense (DoD) could not account for approximately 60% of its 4.1trillioninassets, amountingto2.46 trillion unaccounted for. Alternative title: Pentagon unsupported accounting adjustments (6.5T, singleyear, USArmy)In2015, theDepartmentofDefense′sInspectorGeneralreportedthattheArmycouldnotadequatelysupport6.5 trillion in year-end adjustments, indicating severe accounting discrepancies. Additional sources: https://thecommunemag.com/the-pentagon-misplaced-2-46-trillion-an-in-depth-look-at-the-financial-audit-failures | https://accmag.com/audit-pentagon-cannot-account-for-6-5-trillion-dollars-is-taxpayer-money/

271.

Value in Health. Average lifetime revenue per successful drug. Value in Health: Sales Revenues for New Therapeutic Agents https://www.sciencedirect.com/science/article/pii/S1098301524027542

Study of 361 FDA-approved drugs from 1995-2014 (median follow-up 13.2 years): Mean lifetime revenue: $15.2 billion per drug Median lifetime revenue: $6.7 billion per drug Revenue after 5 years: $3.2 billion (mean) Revenue after 10 years: $9.5 billion (mean) Revenue after 15 years: $19.2 billion (mean) Distribution highly skewed: top 25 drugs (7%) accounted for 38% of total revenue ($2.1T of $5.5T) Additional sources: https://www.sciencedirect.com/science/article/pii/S1098301524027542

272.

OpenSecrets. Pharmaceutical industry lobbying statistics. OpenSecrets: Pharmaceuticals/Health Products https://www.opensecrets.org/industries/indus?ind=H04

Pharmaceutical and health products industry spent $388 million on federal lobbying in 2024 ($6.1 billion since 1999) Employs roughly 3 lobbyists for every member of Congress Note: The industry has consistently been among the top spenders on lobbying in Washington D.C., with major pharmaceutical companies like Pfizer, AbbVie, and PhRMA leading expenditures Additional sources: https://www.opensecrets.org/industries/indus?ind=H04

273.

PMC. Pharmaceutical industry annual profits. PMC: Profitability of Large Pharmaceutical Companies https://pmc.ncbi.nlm.nih.gov/articles/PMC7054843/

Net income (2000-2018): 35 large pharma companies earned $1.9T cumulative net income on $11.5T revenue 2022 profits: Major pharma companies made >$112B in profits Profit margins: Pharma companies 13.8% median vs 7.7% for other S&P 500 companies Largest 25 companies: 15-20% annual average profit margin vs 4-9% for non-drug companies globally Profitability: Pharma significantly more profitable than most S&P 500 companies Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC7054843/ | https://www.bentley.edu/news/new-research-shows-pharma-companies-are-more-profitable-most-sp-500-companies | https://www.gao.gov/products/gao-18-40

274.

Deloitte. Pharmaceutical r&d return on investment (ROI). Deloitte: Measuring Pharmaceutical Innovation 2025 https://www.deloitte.com/ch/en/Industries/life-sciences-health-care/research/measuring-return-from-pharmaceutical-innovation.html (2025)

Deloitte’s annual study of top 20 pharma companies by R&D spend (2010-2024): 2024 ROI: 5.9% (second year of growth after decade of decline) 2023 ROI: 4.3% (estimated from trend) 2022 ROI: 1.2% (historic low since study began, 13-year low) 2021 ROI: 6.8% (record high, inflated by COVID-19 vaccines/treatments) Long-term trend: Declining for over a decade before 2023 recovery Average R&D cost per asset: $2.3B (2022), $2.23B (2024) These returns (1.2-5.9% range) fall far below typical corporate ROI targets (15-20%) Additional sources: https://www.deloitte.com/ch/en/Industries/life-sciences-health-care/research/measuring-return-from-pharmaceutical-innovation.html | https://www.prnewswire.com/news-releases/deloittes-13th-annual-pharmaceutical-innovation-report-pharma-rd-return-on-investment-falls-in-post-pandemic-market-301738807.html | https://hitconsultant.net/2023/02/16/pharma-rd-roi-falls-to-lowest-level-in-13-years/

275.

Wikipedia contributors. Phases of clinical research: Phase i. (2025).

276.

Philippon, T. & Reshef, A. Wages and human capital in the U.S. Finance industry: 1909–2006. The Quarterly Journal of Economics 127, 1551–1609 (2012)

Financial sector wages were similar to other sectors from 1940s–1980, then rose to a 50% premium by 2006. Rents accounted for 30–50% of the wage differential.

277.

Peterson Institute for International Economics. Income growth for the typical american family has slowed since the early 1970s. (2018)

From 1948 to 1973, the typical American family’s income grew by 3 percent annually, doubling roughly once a generation. Since 1973, the median family income has risen just 0.6 percent per year.

278.

Ramsberg, J. & Platt, R. Pragmatic trial cost per patient (median $97). Learning Health Systems https://pmc.ncbi.nlm.nih.gov/articles/PMC6508852/ (2018)

Meta-analysis of 108 embedded pragmatic clinical trials (2006-2016). The median cost per patient was $97 (IQR $19–$478), based on 2015 dollars. 25% of trials cost <$19/patient; 10 trials exceeded $1,000/patient. U.S. studies median $187 vs non-U.S. median $27. Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC6508852/

279.

Sinn, M. P. The Political Dysfunction Tax. https://political-dysfunction-tax.warondisease.org (2025) doi:10.5281/zenodo.18603840

Quantifying the gap between current global governance and theoretical maximum welfare, estimating a 31-53% efficiency score and $97 trillion in annual opportunity costs.

280.

Kinch, M. S. & Griesenauer, R. H. Lost medicines: A longer view of the pharmaceutical industry with the potential to reinvigorate discovery. Drug Discovery Today 24, 875–880 (2019)

Research identified 1,600+ medicines available in 1962. The 1950s represented industry high-water mark with >30 new products in five of ten years; this rate would not be replicated until late 1990s. More than half (880) of these medicines were lost following implementation of Kefauver-Harris Amendment. The peak of 1962 would not be seen again until early 21st century. By 2016 number of organizations actively involved in R&D at level not seen since 1914.

281.

Tufts Center for Study of Drug Development. Post-1962 explosion in drug development costs. Tufts Center for Study of Drug Development https://csdd.tufts.edu/cost-study (2014)

Cost to develop a new prescription drug: $2.6 billion (2014 Tufts study), increasing to $2.9 billion with post-approval development Represents 145% increase (inflation-adjusted) from 2003 estimate of $802 million Based on 106 drugs from 10 pharmaceutical companies tested between 1995-2007 Note: This study has been controversial; some organizations like Doctors Without Borders suggest actual costs may be substantially lower. Deloitte 2023 report shows costs continuing to rise Additional sources: https://csdd.tufts.edu/cost-study | https://cen.acs.org/articles/92/web/2014/11/Tufts-Study-Finds-Big-Rise.html

282.

Source: US Life Expectancy FDA Budget 1543-2019 CSV. Post-1962 slowdown in life expectancy gains. (2019)

Pre-1962 (1880-1960): 3.82 years/decade Post-1962 (1962-2019): 1.54 years/decade Reduction: 60% decline Temporal correlation: Slowdown occurred immediately after 1962 Kefauver-Harris Amendment Additional sources: https://ourworldindata.org/life-expectancy | https://www.mortality.org/ | https://www.cdc.gov/nchs/nvss/mortality_tables.htm

283.

NIH Common Fund. NIH pragmatic trials: Minimal funding despite 30x cost advantage. NIH Common Fund: HCS Research Collaboratory https://commonfund.nih.gov/hcscollaboratory (2025)

The NIH Pragmatic Trials Collaboratory funds trials at $500K for planning phase, $1M/year for implementation-a tiny fraction of NIH’s budget. The ADAPTABLE trial cost $14 million for 15,076 patients (= $929/patient) versus $420 million for a similar traditional RCT (30x cheaper), yet pragmatic trials remain severely underfunded. PCORnet infrastructure enables real-world trials embedded in healthcare systems, but receives minimal support compared to basic research funding. Additional sources: https://commonfund.nih.gov/hcscollaboratory | https://pcornet.org/wp-content/uploads/2025/08/ADAPTABLE_Lay_Summary_21JUL2025.pdf | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604499/

284.

Baily, M. N. Pre-1962 drug development costs (baily 1972). Baily (1972) https://samizdathealth.org/wp-content/uploads/2020/12/hlthaff.1.2.6.pdf (1972)

Pre-1962: Average cost per new chemical entity (NCE) was $6.5 million (1980 dollars) Inflation-adjusted to 2024 dollars: $6.5M (1980) ≈ $22.5M (2024), using CPI multiplier of 3.46× Real cost increase (inflation-adjusted): $22.5M (pre-1962) → $2,600M (2024) = 116× increase Note: This represents the most comprehensive academic estimate of pre-1962 drug development costs based on empirical industry data Additional sources: https://samizdathealth.org/wp-content/uploads/2020/12/hlthaff.1.2.6.pdf

285.

Think by Numbers. Pre-1962 drug development costs and timeline (think by numbers). Think by Numbers: How Many Lives Does FDA Save? https://thinkbynumbers.org/health/how-many-net-lives-does-the-fda-save/ (1962)

Historical estimates (1970-1985): USD $226M fully capitalized (2011 prices) 1980s drugs: $65M after-tax R&D (1990 dollars), $194M compounded to approval (1990 dollars) Modern comparison: $2-3B costs, 7-12 years (dramatic increase from pre-1962) Context: 1962 regulatory clampdown reduced new treatment production by 70%, dramatically increasing development timelines and costs Note: Secondary source; less reliable than Congressional testimony Additional sources: https://thinkbynumbers.org/health/how-many-net-lives-does-the-fda-save/ | https://en.wikipedia.org/wiki/Cost_of_drug_development | https://www.statnews.com/2018/10/01/changing-1962-law-slash-drug-prices/

286.

Think by Numbers. Pre-1962 physician-led clinical trials. Think by Numbers: How Many Lives Does FDA Save? https://thinkbynumbers.org/health/how-many-net-lives-does-the-fda-save/ (1966)

Pre-1962: Physicians could report real-world evidence directly 1962 Drug Amendments replaced "premarket notification" with "premarket approval", requiring extensive efficacy testing Impact: New regulatory clampdown reduced new treatment production by 70%; lifespan growth declined from 4 years/decade to 2 years/decade Drug Efficacy Study Implementation (DESI): NAS/NRC evaluated 3,400+ drugs approved 1938-1962 for safety only; reviewed >3,000 products, >16,000 therapeutic claims FDA has had authority to accept real-world evidence since 1962, clarified by 21st Century Cures Act (2016) Note: Specific "144,000 physicians" figure not verified in sources Additional sources: https://thinkbynumbers.org/health/how-many-net-lives-does-the-fda-save/ | https://www.fda.gov/drugs/enforcement-activities-fda/drug-efficacy-study-implementation-desi | http://www.nasonline.org/about-nas/history/archives/collections/des-1966-1969-1.html

287.

arXiv. Preferential target attachment in clinical trials. arXiv https://arxiv.org/abs/2301.10709 (2023)

Clinical trials overwhelmingly test the same few biological targets due to preferential attachment dynamics. Additional sources: https://arxiv.org/abs/2301.10709

288.

Bowles, S. Prehistoric violence rates. Bowles https://www.science.org/doi/10.1126/science.1168112 (2009)

Archaeological evidence suggests that approximately 15% of prehistoric humans died from violence, compared to less than 1% in modern developed nations. Additional sources: https://www.science.org/doi/10.1126/science.1168112

289.

Princeton. Princeton study on policy outcomes and influence of elites vs. Average citizens. Princeton: Testing Theories of American Politics (PDF) https://archive.org/details/gilens_and_page_2014_-testing_theories_of_american_politics.doc (2014)

Study by Martin Gilens (Princeton) and Benjamin I. Page (Northwestern): Analyzed 1,779 policy outcomes (1981-2002) Finding: "Economic elites and organized groups representing business interests have substantial independent impacts on U.S. government policy, while average citizens have little or no independent influence Rich, well-connected individuals steer the country’s direction, regardless of or even against the will of the majority of voters Note: Specific "78 percent" and "zero percent correlation" statistics not found in sources Additional sources: https://scholar.princeton.edu/sites/default/files/mgilens/files/gilens_and_page_2014_-testing_theories_of_american_politics.doc.pdf | https://act.represent.us/sign/usa-oligarchy-research-explained | https://archive.org/details/gilens_and_page_2014_-testing_theories_of_american_politics.doc

290.

PubMed. Psychological impact of war cost ($100B annually). PubMed: Economic Burden of PTSD https://pubmed.ncbi.nlm.nih.gov/35485933/

PTSD economic burden (2018 U.S.): $232.2B total ($189.5B civilian, $42.7B military) Civilian costs driven by: Direct healthcare ($66B), unemployment ($42.7B) Military costs driven by: Disability ($17.8B), direct healthcare ($10.1B) Exceeds costs of other mental health conditions (anxiety, depression) War-exposed populations: 2-3X higher rates of anxiety, depression, PTSD; women and children most vulnerable Note: Actual burden $232B, significantly higher than "$100B" claimed Additional sources: https://pubmed.ncbi.nlm.nih.gov/35485933/ | https://news.va.gov/103611/study-national-economic-burden-of-ptsd-staggering/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC9957523/

291.

Fox, V. et al. Suicide risk in people with post-traumatic stress disorder: A cohort study of 3.1 million people in sweden. Journal of Affective Disorders 279, 609–616 (2021).

292.

R. H. Bruskin Associates. The 14 worst human fears. (1973).

293.

AllTrials. Publication rate of clinical trial results. AllTrials: Half of Trials Unreported https://www.alltrials.net/news/half-of-all-trials-unreported/ (2013)

50.0% of clinical trials never publish results (NHS-funded systematic review, 2010) Schmucker et al (2014): 53% of trials published (analyzing 39 studies, >20,000 trials) Munch et al (2014): 46% of pain treatment trials published Chang et al (2015): 49% of high-risk cardiac device trials published Positive findings: 3X more likely to be published than negative results Antidepressant example: Published literature showed 94% positive trials; FDA analysis showed only 51% positive Additional sources: https://www.alltrials.net/news/half-of-all-trials-unreported/ | https://www.nature.com/articles/nature.2013.14286 | https://pmc.ncbi.nlm.nih.gov/articles/PMC8276556/

294.

Keitner, G. I., Posternak, M. A. & Ryan, C. E. How many subjects with major depressive disorder meet eligibility requirements of an antidepressant efficacy trial? Journal of Clinical Psychiatry https://www.ncbi.nlm.nih.gov/pubmed/14628985 (2003).

295.

ICER. Value per QALY (standard economic value). ICER https://icer.org/wp-content/uploads/2024/02/Reference-Case-4.3.25.pdf (2024)

Standard economic value per QALY: $100,000–$150,000. This is the US and global standard willingness-to-pay threshold for interventions that add costs. Dominant interventions (those that save money while improving health) are favorable regardless of this threshold. Additional sources: https://icer.org/wp-content/uploads/2024/02/Reference-Case-4.3.25.pdf

296.

Orphanet Journal of Rare Diseases (2024). Rare disease treatment gap. Orphanet Journal of Rare Diseases (2024) https://ojrd.biomedcentral.com/articles/10.1186/s13023-024-03398-1 (2024)

Most patients wait 5 to 10 years to get an accurate diagnosis - and only about 5% of rare diseases have an FDA-approved treatment. Over the 40 years of the ODA, 6,340 orphan drug designations were granted, representing drug development for 1,079 rare diseases out of 7,000-10,000 known rare conditions.

297.

staff, R. Is donald trump to blame for a COVID lab leak? Reason https://reason.com/2025/05/22/is-donald-trump-to-blame-for-a-covid-lab-leak/ (2025).

298.

IMF. Reconstruction costs from active conflicts. IMF: Cost of Conflict https://www.imf.org/external/pubs/ft/fandd/2017/12/imus.htm (2017)

Individual conflict examples: Libya, Syria, Yemen $300B combined (World Bank) Syria alone: $250B-$1T estimates Ukraine: >€500B reconstruction costs Gaza: $18.5B infrastructure damage Global conflict/violence cost: $14.3T/year (2016, includes military spending, security, losses) Note: Specific "$1,875B for 47 conflicts" figure not verified in sources Additional sources: https://www.imf.org/external/pubs/ft/fandd/2017/12/imus.htm | https://www.weforum.org/stories/2018/01/conflict-costs-global-economy-14-trillion-a-year/ | https://fortune.com/2022/04/21/ukraine-reconstruction-cost-rebuild-economists-plan-russia-foot-trillion-bill/

299.

RECOVER Initiative. RECOVER initiative budget update (>$2.3B). RECOVER Initiative https://recovercovid.org/news/nih-adds-funds-long-covid-research-advances-work-new-clinical-trials (2024).

300.

RECOVER Initiative. Funding | RECOVER COVID initiative. (2024).

301.

NIH. NIH RECOVER initiative patient enrollment numbers. NIH: RECOVER Initiative Enrollment https://www.nih.gov/news-events/news-releases/nih-builds-large-nationwide-study-population-tens-thousands-support-research-long-term-effects-covid-19

Enrolled: 30,000 people in ongoing studies and clinical trials Goal: 40,000 adults and children $1.15B effort (including American Rescue Plan Act 2021 support) One of largest, most diverse Long COVID cohorts in world Additional sources: https://www.nih.gov/news-events/news-releases/nih-builds-large-nationwide-study-population-tens-thousands-support-research-long-term-effects-covid-19 | https://recovercovid.org/news/nih-launches-long-covid-clinical-trials-through-recover-initiative-opening-enrollment

302.

Ladyzhets, B. ’Underwhelming’: NIH trials fail to test meaningful long Covid treatments – after 2.5 years and $1 billion. STAT News https://www.statnews.com/2023/08/09/long-covid-nih-trials/ (2023)

Patient advocates called RECOVER’s treatment selections ‘truly absurd’ (Jaime Seltzer, #MEAction). David Putrino (Mount Sinai) said funding ‘has been largely wasted.’ Low-dose naltrexone, the top patient-requested treatment, was excluded for over 2 years before being added in round 2.

303.

Oren Cass, Manhattan Institute. RECOVERY trial cost per patient. Oren Cass https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs (2023)

The RECOVERY trial, for example, cost only about $500 per patient... By contrast, the median per-patient cost of a pivotal trial for a new therapeutic is around $41,000. Additional sources: https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs

304.

University of Oxford. RECOVERY trial time to first cure. University of Oxford https://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications (2020)

100 days to first cure Additional sources: https://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications | https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19

305.

NHS England; Águas et al. RECOVERY trial global lives saved ( 1 million). NHS England: 1 Million Lives Saved https://www.england.nhs.uk/2021/03/covid-treatment-developed-in-the-nhs-saves-a-million-lives/ (2021)

Dexamethasone saved 1 million lives worldwide (NHS England estimate, March 2021, 9 months after discovery). UK alone: 22,000 lives saved. Methodology: Águas et al. Nature Communications 2021 estimated 650,000 lives (range: 240,000-1,400,000) for July-December 2020 alone, based on RECOVERY trial mortality reductions (36% for ventilated, 18% for oxygen-only patients) applied to global COVID hospitalizations. June 2020 announcement: Dexamethasone reduced deaths by up to 1/3 (ventilated patients), 1/5 (oxygen patients). Impact immediate: Adopted into standard care globally within hours of announcement. Additional sources: https://www.england.nhs.uk/2021/03/covid-treatment-developed-in-the-nhs-saves-a-million-lives/ | https://www.nature.com/articles/s41467-021-21134-2 | https://pharmaceutical-journal.com/article/news/steroid-has-saved-the-lives-of-one-million-covid-19-patients-worldwide-figures-show | https://www.recoverytrial.net/news/recovery-trial-celebrates-two-year-anniversary-of-life-saving-dexamethasone-result

306.

Manhattan Institute. RECOVERY trial 82× cost reduction. Manhattan Institute: Slow Costly Trials https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs

RECOVERY trial: $500 per patient ($20M for 48,000 patients = $417/patient) Typical clinical trial: $41,000 median per-patient cost Cost reduction: 80-82× cheaper ($41,000 ÷ $500 ≈ 82×) Efficiency: $50 per patient per answer (10 therapeutics tested, 4 effective) Dexamethasone estimated to save >630,000 lives Additional sources: https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs | https://pmc.ncbi.nlm.nih.gov/articles/PMC9293394/

307.

RECOVERY Trial. RECOVERY trial cost reduction. RECOVERY Trial https://www.recoverytrial.net/

Oxford RECOVERY trial achieved $500 per patient cost, compared to traditional Phase III trial costs of $40,000-120,000+ per patient. This represents an 80-100x+ cost reduction. Key strategies: embedding trial protocols within routine hospital care, minimizing overhead by leveraging existing staff/resources and electronic data capture, and focused pragmatic trial designs. Additional sources: https://www.recoverytrial.net/

308.

RECOVERY Trial. RECOVERY trial dexamethasone results. RECOVERY Trial https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19

Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; $p=0.0003$) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; $p=0.0021$) Additional sources: https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19

309.

Professor Martin Landray (co-chief investigator), quoted in Oren Cass, Manhattan Institute. RECOVERY trial efficiency. Professor Martin Landray (co-chief investigator) https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs (2023)

At a cost of $20 million for 48,000 patients, the RECOVERY trial cost about $500 per patient... that is about $50 per patient per answer. Additional sources: https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs

310.

RECOVERY Collaborative Group. RECOVERY trial cost-effectiveness ( $4/QALY, global impact methodology). RECOVERY Trial Results https://www.recoverytrial.net/results

RECOVERY trial (UK) cost $20M total and discovered that dexamethasone reduces COVID mortality by 1/3 in severe cases, saving 1 million lives globally. Using global impact methodology (research discovery value): $20M / (1M lives × 5 QALYs/life) = $4/QALY. This is 12,500× more cost-effective than standard NIH research allocation ($50,000/QALY). Additional sources: https://www.recoverytrial.net/results

311.

Oxford University News. RECOVERY trial summary quote. Oxford University News https://www.ox.ac.uk/news/features/recovery-trial-two-years

One trial. Over 47,000 participants. Nearly 200 hospital sites, across six countries. Ten results. Four effective COVID-19 treatments... Through discovering four treatments that effectively reduce deaths from COVID-19, it is certain that the study has saved thousands – if not millions – of lives worldwide. Additional sources: https://www.ox.ac.uk/news/features/recovery-trial-two-years

312.

ASPE. Refugee lost annual earning potential ($23,400). ASPE: Fiscal Impact of Refugees https://aspe.hhs.gov/reports/fiscal-impact-refugees-asylees

Refugee economic impact: Net positive $123.8B fiscal impact (2005-2019, 15 years) Refugees pay $21K more in taxes than benefits received over first 20 years in U.S. Earnings gap: Refugees work at higher rates than natives but earn less; never reach U.S.-born earning levels Income progression: <5 years in U.S. = $30,500 median; 20+ years = $71,400 (exceeds national $67,100 median) Note: Specific "$23,400 lost earning potential" figure not verified in sources Additional sources: https://aspe.hhs.gov/reports/fiscal-impact-refugees-asylees | https://www.americanimmigrationcouncil.org/sites/default/files/research/05.23_refugee_report_v3_0.pdf | https://www.nber.org/system/files/working_papers/w23498/w23498.pdf

313.

Wake Forest. Milestones in regenerative medicine and tissue engineering. Wake Forest: Record of Firsts https://school.wakehealth.edu/research/institutes-and-centers/wake-forest-institute-for-regenerative-medicine/research/a-record-of-firsts

1999: First 3D-printed organ (bladder) transplanted into human (Wake Forest Institute, still functioning 20+ years later) Windpipes (trachea): 3D-printed windpipe transplants performed; patient received biodegradable 5-year windpipe Blood vessels, skin: Mobile bioprinters can print skin directly onto wounds at patient bedside Tubular organs: Urine conduits engineered and implanted in patients 3D-printed ear implant: World’s first successfully transplanted Current status: Can print flat structures (skin), tubular (blood vessels), hollow non-tubular (bladder); complex life-sized organs 20-30 years away Additional sources: https://school.wakehealth.edu/research/institutes-and-centers/wake-forest-institute-for-regenerative-medicine/research/a-record-of-firsts | https://builtin.com/articles/3d-printed-organs | https://pmc.ncbi.nlm.nih.gov/articles/PMC5313259/

314.

JAMA. Research to practice gap (17 years). JAMA https://pubmed.ncbi.nlm.nih.gov/37018006/ (2023)

It takes an average of 17 years for new scientific evidence to be implemented into clinical practice. Additional sources: https://pubmed.ncbi.nlm.nih.gov/37018006/

315.

WHO. Annual deaths from respiratory disease. WHO: COPD Fact Sheet) https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd (2019)

Chronic respiratory diseases: 4.0 million deaths annually (2019) COPD specifically: 3.5 million deaths (2021) - 4th leading cause of death globally Pneumonia: 2.5 million deaths including 672,000 children (2019) Combined respiratory deaths: 6.5 million annually Note: 90% of COPD deaths in those under 70 occur in low- and middle-income countries. COPD affects over 380 million people globally Additional sources: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd | https://www.healthdata.org/research-analysis/library/global-burden-chronic-respiratory-diseases-and-risk-factors-1990-2019

316.

Congress.gov. Right to try act (2018). Congress.gov https://www.congress.gov/bill/115th-congress/house-bill/2368 (2018)

Right to Try Act (2018) Additional sources: https://www.congress.gov/bill/115th-congress/house-bill/2368 | https://pmc.ncbi.nlm.nih.gov/articles/PMC7416898/

317.

PMC. Number of patients helped by the u.s. Right to try act. PMC: Understanding Right to Try https://pmc.ncbi.nlm.nih.gov/articles/PMC7416898/ (2024)

2018-2022: Supported access to only 12 products total; 4 products in 2023 Number of people treated: Not publicly reported, "likely only in the hundreds Specific documented cases: 75+ neuroendocrine cancer patients (LU-177); at least 1 ALS patient (NurOwn); 7 glioblastoma patients (Gliovac) Minimal safety reporting: Only annual basis, no requirement to publish results/outcomes Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC7416898/ | https://www.statnews.com/2024/08/02/trump-gave-patients-right-to-try-it-hasnt-helped-them/ | https://www.healio.com/news/hematology-oncology/20200303/right-to-try-a-wellintentioned-but-misguided-law

318.

Scheidel, W. State revenue and expenditure in the han and roman empires. in State power in ancient china and rome (Oxford University Press, 2015).

Comparative analysis of state fiscal capacity in the Han and Roman empires. The Roman army accounted for 60-80% of total state expenditure, making it the dominant fiscal commitment throughout Roman history. Military spending was described as ‘massively redistributive in both spatial and social terms.’ Both empires were essentially low-tax regimes (estimated 5-7% of GDP in taxes), but the Roman Empire allocated a far larger share of state revenue to its military than did the Han.

319.

Richard Dawkins. The selfish gene quote. Richard Dawkins https://en.wikipedia.org/wiki/The_Selfish_Gene (1976)

We are survival machines, robot vehicles blindly programmed to preserve the selfish molecules known as genes. Additional sources: https://en.wikipedia.org/wiki/The_Selfish_Gene

320.

Stockholm International Peace Research Institute. Trends in world military expenditure, 2024. (2025).

321.

Stockholm International Peace Research Institute. Trends in world military expenditure, 2023. (2024).

322.

CSIS. Smallpox eradication ROI. CSIS https://www.csis.org/analysis/smallpox-eradication-model-global-cooperation.

323.

Yahoo Finance. George soros’s 1992 bet against the british pound. Yahoo Finance: British Pounding https://finance.yahoo.com/news/british-pounding-george-soros-made-160033593.html

Black Wednesday (September 16, 1992): Soros assembled $10 billion short position against British pound Increased position from $1.5B to $10B that morning; bought German marks while selling pounds Profit: Over £1 billion ($1-1.5 billion) in single day UK Treasury cost: £3.3 billion; Bank of England spent $29 billion trying to defend pound Pound fell 15% vs. German mark, 25% vs. dollar; UK forced to exit European Exchange Rate Mechanism Earned Soros title "the man who broke the Bank of England Additional sources: https://finance.yahoo.com/news/british-pounding-george-soros-made-160033593.html | https://en.wikipedia.org/wiki/Black_Wednesday | https://www.thebalancemoney.com/black-wednesday-george-soros-bet-against-britain-1978944

324.

Historic UK. The south sea bubble of 1720. Historic UK: South Sea Bubble https://www.historic-uk.com/HistoryUK/HistoryofEngland/South-Sea-Bubble/

South Sea Company founded 1711 as public-private partnership to consolidate national debt Granted monopoly (Asiento de Negros) to supply African slaves to South America (1713) Stock price explosion: £128 (Jan 1720) → £175 (Feb) → £330 (Mar) → £550 (May) → £1,000 (Aug) Reality: No realistic prospect of trade; Company never realized significant profit from monopoly Collapse: By September market crashed; December shares down to £124 Called world’s first financial crash, first Ponzi scheme, classic "group think" speculation mania Story disconnected from actual (negligible) profits Additional sources: https://www.historic-uk.com/HistoryUK/HistoryofEngland/South-Sea-Bubble/ | https://en.wikipedia.org/wiki/South_Sea_Company | https://www.britannica.com/money/South-Sea-Bubble

325.

Composite estimate based on Orphanet. Average time to cure under current system.

Queue-based calculation: 7,000 diseases without effective treatment ÷ 15 diseases getting first treatment per year = 467 years for the average disease to receive a cure under the status quo system. This is consistent with the fact that only 5% of rare diseases have treatments after 40+ years of the Orphan Drug Act. Well-funded diseases may take 30-50 years; underfunded diseases 100-500+ years; and neglected diseases effectively never within human planning horizons.

326.

GAO. Annual cost of u.s. Sugar subsidies. GAO: Sugar Program https://www.gao.gov/products/gao-24-106144

Consumer costs: $2.5-3.5 billion per year (GAO estimate) Net economic cost: $1 billion per year 2022: US consumers paid 2X world price for sugar Program costs $3-4 billion/year but no federal budget impact (costs passed directly to consumers via higher prices) Employment impact: 10,000-20,000 manufacturing jobs lost annually in sugar-reliant industries (confectionery, etc.) Multiple studies confirm: Sweetener Users Association ($2.9-3.5B), AEI ($2.4B consumer cost), Beghin & Elobeid ($2.9-3.5B consumer surplus) Additional sources: https://www.gao.gov/products/gao-24-106144 | https://www.heritage.org/agriculture/report/the-us-sugar-program-bad-consumers-bad-agriculture-and-bad-america | https://www.aei.org/articles/the-u-s-spends-4-billion-a-year-subsidizing-stalinist-style-domestic-sugar-production/

327.

WHO. Global suicide deaths vs. Combat deaths. WHO https://www.who.int/publications/i/item/9789240110069 (2021)

Suicide deaths: 727,000 annually (2021), over 700,000 per year on average One person dies by suicide every 40 seconds 3rd leading cause of death among 15-29 year olds globally 73% of suicides occur in low- and middle-income countries Combat deaths: 89,000 annually (significantly lower than suicide) Note: Link between suicide and mental disorders (depression, alcohol use) is well-established. With timely, evidence-based interventions, suicides can be prevented Additional sources: https://www.who.int/publications/i/item/9789240110069 | https://www.who.int/news-room/fact-sheets/detail/suicide

328.

James Surowiecki. The Wisdom of Crowds. (Surowiecki, 2004).

Explores the aggregation of information in groups, arguing that decisions are often better than could have been made by any single member of the group. The opening anecdote relates Francis Galton’s surprise that the crowd at a county fair accurately guessed the weight of an ox when the median of their individual guesses was taken. The three conditions for a group to be intelligent are diversity, independence, and decentralization. Additional sources: https://archive.org/details/wisdomofcrowds0000suro | https://en.wikipedia.org/wiki/The_Wisdom_of_Crowds | https://www.amazon.com/Wisdom-Crowds-James-Surowiecki/dp/0385721706

329.

Suskind, R. Confidence Men: Wall Street, Washington, and the Education of a President. (Harper, 2011).

Chapter 12, p. 289: Volcker quote on civil engineers vs. financial engineers.

330.

World Bank. Swiss military budget as percentage of GDP. World Bank: Military Expenditure https://data.worldbank.org/indicator/MS.MIL.XPND.GD.ZS?locations=CH

2023: 0.70272% of GDP (World Bank) 2024: CHF 5.95 billion official military spending When including militia system costs: 1% GDP (CHF 8.75B) Comparison: Near bottom in Europe; only Ireland, Malta, Moldova spend less (excluding microstates with no armies) Additional sources: https://data.worldbank.org/indicator/MS.MIL.XPND.GD.ZS?locations=CH | https://www.avenir-suisse.ch/en/blog-defence-spending-switzerland-is-in-better-shape-than-it-seems/ | https://tradingeconomics.com/switzerland/military-expenditure-percent-of-gdp-wb-data.html

331.

Ballotpedia. Swiss referendum bans construction of minarets. Ballotpedia https://ballotpedia.org/Swiss_Minaret_Construction_Ban,_2009 (2009)

On 29 November 2009 Swiss voters approved a constitutional ban on minaret construction by 57.5% on 53.4% turnout. Pre-election polls had predicted only 35% support. Highest support: Appenzell Innerrhoden (71%). Only 3 of 26 cantons opposed. Cited as example of direct democracy enabling majority prejudice against minority rights.

332.

World Bank. Switzerland vs. US GDP per capita comparison. World Bank: Switzerland GDP Per Capita https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=CH

2024 GDP per capita (PPP-adjusted): Switzerland $93,819 vs United States $75,492 Switzerland’s GDP per capita 24% higher than US when adjusted for purchasing power parity Nominal 2024: Switzerland $103,670 vs US $85,810 Additional sources: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=CH | https://tradingeconomics.com/switzerland/gdp-per-capita-ppp | https://www.theglobaleconomy.com/USA/gdp_per_capita_ppp/

333.

KFF Health System Tracker. Switzerland vs. US life expectancy comparison. KFF Health System Tracker: Life Expectancy Comparison https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/

Switzerland: 84 years | United States: 78.4 years (2023) U.S. has lowest life expectancy among comparable developed countries (average: 82.5 years) Gap driven by preventable causes: cardiovascular disease, drug overdoses, firearm violence, motor vehicle crashes Note: U.S. spends nearly twice as much on healthcare per person as comparable countries despite lower life expectancy. The disadvantage began in 1950s and has worsened over past 4 decades Additional sources: https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/

334.

SWI swissinfo.ch. Women’s suffrage in switzerland: The last canton to grant women the vote. SWI swissinfo.ch https://www.swissinfo.ch/eng/politics/a-visit-to-appenzell-inner-rhodes-the-last-canton-to-grant-women-the-right-to-vote-in-switzerland/46328984 (2021)

Switzerland granted women national voting rights on 7 February 1971, among the last European nations to do so. Appenzell Innerrhoden’s all-male Landsgemeinde rejected women’s suffrage three times. On 26 November 1990 the Federal Court overruled the canton. Women first participated in the Landsgemeinde on 28 April 1991.

335.

Wikipedia. Switzerland’s last military conflict. Wikipedia: Sonderbund War https://en.wikipedia.org/wiki/Sonderbund_War (2019)

Sonderbund War (November 3-29, 1847): Last armed conflict on Swiss soil Civil war between 7 Catholic cantons vs. federal government over centralization Duration: 26 days; Casualties: 93 deaths total (60 federal, 33 Sonderbund), 510 wounded Federal army (100,000) led by General Guillaume Henri Dufour defeated Sonderbund forces Resulted in emergence of Switzerland as federal state; entered period of peace lasting to present Battle of Gisikon: Last battle Swiss ever fought Additional sources: https://en.wikipedia.org/wiki/Sonderbund_War | https://militaryhistorynow.com/2019/02/27/charm-offensive-switzerlands-polite-war-of-1847/ | https://www.zeit-fragen.ch/en/archives/2018/no-1-10-january-2018/the-sonderbund-war-the-last-armed-conflict-on-swiss-soil

336.

House Committee on Oversight and Government Reform. Hearing wrap up: NIH refutes EcoHealth’s testimony, Tabak reveals federal grant procedures in need of serious reform. (2024).

337.

Treasury. Troubled asset relief program (TARP) of 2008. Treasury: TARP About https://home.treasury.gov/data/troubled-assets-relief-program/about-tarp

Authorized: $700 billion (later reduced to $475 billion by Dodd-Frank) Actual disbursed: $443.5 billion to stabilize financial institutions Bank rescue: $236 billion to 707 financial institutions in 48 states Breakdown: $250B banking, $82B auto industry, $70B AIG, $46B foreclosure programs Net lifetime cost: $31.1 billion (after repayments, sales, dividends, interest); most attributable to foreclosure programs Passed October 3, 2008 (signed by President Bush); Emergency Economic Stabilization Act Additional sources: https://home.treasury.gov/data/troubled-assets-relief-program/about-tarp | https://en.wikipedia.org/wiki/Troubled_Asset_Relief_Program | https://www.propublica.org/article/the-bailout-was-11-years-ago-were-still-tracking-every-penny

338.

Tax Foundation. Tax compliance costs the US economy $546 billion annually. https://taxfoundation.org/data/all/federal/irs-tax-compliance-costs/ (2024)

Americans will spend over 7.9 billion hours complying with IRS tax filing and reporting requirements in 2024. This costs the economy roughly $413 billion in lost productivity. In addition, the IRS estimates that Americans spend roughly $133 billion annually in out-of-pocket costs, bringing the total compliance costs to $546 billion, or nearly 2 percent of GDP.

339.

Jones, S. G. Terrorism before and during the war on terror: A look at the numbers. War on the Rocks https://warontherocks.com/2017/12/terrorism-war-terror-look-numbers/ (2017)

Analysis of terrorism trends showing dramatic increase in global terrorist attacks after 2001, with attacks rising from roughly 1,000 per year in 2004 to nearly 17,000 by 2014, driven primarily by proliferation of jihadist organizations in Iraq, Afghanistan, Pakistan, Nigeria, and Syria.

340.

FDA. Thalidomide caused thousands of birth defects. FDA https://www.fda.gov/about-fda/fda-history-exhibits/frances-oldham-kelsey-medical-reviewer-famous-averting-public-health-tragedy

it resulted in thousands of horrific congenital disabilities. Additional sources: https://www.fda.gov/about-fda/fda-history-exhibits/frances-oldham-kelsey-medical-reviewer-famous-averting-public-health-tragedy | https://www.smithsonianmag.com/science-nature/woman-who-stood-between-america-and-epidemic-birth-defects-180963165/

341.

FDA. FDA dr. Kelsey prevented widespread thalidomide birth defects in the US. FDA: Frances Oldham Kelsey https://www.fda.gov/about-fda/fda-history-exhibits/frances-oldham-kelsey-medical-reviewer-famous-averting-public-health-tragedy

Dr. Frances Kelsey (FDA reviewer) resisted pressure to approve thalidomide September 1960-November 1961 Worldwide: 8,000 infants born with missing/malformed limbs; 5,000-7,000 perished in utero United States: 17 confirmed phocomelia cases + 9 likely cases (vs. 8,000 worldwide) Kelsey insisted on hard evidence, refused to be browbeaten; repeatedly requested more information every 60 days Merrell complained to her bosses, calling her "petty bureaucrat" - she persisted Recognition: President’s Award for Distinguished Federal Civilian Service (JFK, 1962) Led to 1962 Kefauver-Harris Amendments requiring drugs prove both safety AND effectiveness Additional sources: https://www.fda.gov/about-fda/fda-history-exhibits/frances-oldham-kelsey-medical-reviewer-famous-averting-public-health-tragedy | https://www.uchicagomedicine.org/forefront/biological-sciences-articles/courageous-physician-scientist-saved-the-us-from-a-birth-defects-catastrophe | https://www.smithsonianmag.com/science-nature/woman-who-stood-between-america-and-epidemic-birth-defects-180963165/

342.

Wikipedia. Thalidomide scandal: Worldwide cases and mortality. Wikipedia https://en.wikipedia.org/wiki/Thalidomide_scandal

The total number of embryos affected by the use of thalidomide during pregnancy is estimated at 10,000, of whom about 40% died around the time of birth. More than 10,000 children in 46 countries were born with deformities such as phocomelia. Additional sources: https://en.wikipedia.org/wiki/Thalidomide_scandal

343.

PLOS One. Health and quality of life of thalidomide survivors as they age. PLOS One https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210222 (2019)

Study of thalidomide survivors documenting ongoing disability impacts, quality of life, and long-term health outcomes. Survivors (now in their 60s) continue to experience significant disability from limb deformities, organ damage, and other effects. Additional sources: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210222

344.

Pessoa-Amorim, G., Peto, L. & Campbell, M. The inside story of RECOVERY: How the world’s largest COVID-19 trial transformed treatment. (2022).

345.

Nieuwenhuijs, J. How france secretly repatriated all its gold before nixon’s dollar devaluation. https://www.thegoldobserver.com/p/how-france-secretly-repatriated-all (2023).

346.

Lichtenberg, F. R. How many life-years have new drugs saved? A three-way fixed-effects analysis of 66 diseases in 27 countries, 2000–2013. International Health https://pubmed.ncbi.nlm.nih.gov/30912800 (2019).

347.

UNDP. Tobacco control ROI. UNDP https://www.undp.org/asia-pacific/blog/how-raising-tobacco-taxes-can-save-lives-and-cut-poverty-across-asia-pacific-0

In our study of six Asia-Pacific countries, we found that for every unit of local currency invested in increasing tobacco taxes, the countries would gain between 20 and 1,057 units in return over 15 years. That’s a remarkable return on investment ratio of between 20:1 and 1,057:1. Additional sources: https://www.undp.org/asia-pacific/blog/how-raising-tobacco-taxes-can-save-lives-and-cut-poverty-across-asia-pacific-0

348.

Alternatives Investor. Top performing private equity & hedge funds. Alternatives Investor https://alternativesinvestor.com/top-performing-private-equity-funds-2016-2019 (2021)

Top-performing private equity funds, such as Spectrum’s VIII-A Program, have achieved net IRRs as high as 98.91% for a single vintage year (2017). Renaissance Technologies’ Medallion Fund is famed for achieving an average annualized gross return of 66%, and a net return of 39%, from 1988 to 2021. Additional sources: https://alternativesinvestor.com/top-performing-private-equity-funds-2016-2019 | https://www.traderslog.com/top-hedge-funds

349.

Moore, T. J., Zhang, H., Anderson, G. & Alexander, G. C. Traditional trial cost per patient. JAMA Internal Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295430/ (2020)

The median cost of a pivotal trial was estimated to be $19 million... the median cost per patient was $41,413. Additional sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295430/

350.

FDA Study via NCBI. Trial costs, FDA study. FDA Study via NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248200/

Overall, the 138 clinical trials had an estimated median (IQR) cost of $19.0 million ($12.2 million-$33.1 million)... The clinical trials cost a median (IQR) of $41,117 ($31,802-$82,362) per patient. Additional sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248200/

351.

WHO. Annual deaths from tuberculosis. WHO https://www.who.int/news-room/fact-sheets/detail/tuberculosis (2024)

Tuberculosis | 1.3 million Additional sources: https://www.who.int/news-room/fact-sheets/detail/tuberculosis | https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024

352.

UCDP. State violence deaths annually. UCDP: Uppsala Conflict Data Program https://ucdp.uu.se/

Uppsala Conflict Data Program (UCDP): Tracks one-sided violence (organized actors attacking unarmed civilians) UCDP definition: Conflicts causing at least 25 battle-related deaths in calendar year 2023 total organized violence: 154,000 deaths; Non-state conflicts: 20,900 deaths UCDP collects data on state-based conflicts, non-state conflicts, and one-sided violence Specific "2,700 annually" figure for state violence not found in recent UCDP data; actual figures vary annually Additional sources: https://ucdp.uu.se/ | https://en.wikipedia.org/wiki/Uppsala_Conflict_Data_Program | https://ourworldindata.org/grapher/deaths-in-armed-conflicts-by-region

353.

UK Research and Innovation. The RECOVERY trial: Identifying COVID-19 treatments. (2020).

354.

UNESCO. Education. (2025).

355.

UNESCO. UNESCO cost for universal education coverage. UNESCO https://news.un.org/en/story/2023/04/1135697 (2023)

The largest financing gap is in sub-Saharan Africa: $70 billion per year. An additional $77 billion is needed annually for African countries to reach their national education targets and provide quality education for all. Additional sources: https://news.un.org/en/story/2023/04/1135697 | https://unesdoc.unesco.org/ark:/48223/pf0000192186

356.

UNHCR. UNHCR forcibly displaced people 2023. UNHCR https://www.unhcr.org/global-trends-report-2023 (2023)

At the end of 2023, 117.3 million people worldwide were forcibly displaced. Additional sources: https://www.unhcr.org/global-trends-report-2023

357.

CGDev. UNHCR average refugee support cost. CGDev https://www.cgdev.org/blog/costs-hosting-refugees-oecd-countries-and-why-uk-outlier (2024)

The average cost of supporting a refugee is $1,384 per year. This represents total host country costs (housing, healthcare, education, security). OECD countries average $6,100 per refugee (mean 2022-2023), with developing countries spending $700-1,000. Global weighted average of $1,384 is reasonable given that 75-85% of refugees are in low/middle-income countries. Additional sources: https://www.cgdev.org/blog/costs-hosting-refugees-oecd-countries-and-why-uk-outlier | https://www.unhcr.org/sites/default/files/2024-11/UNHCR-WB-global-cost-of-refugee-inclusion-in-host-country-health-systems.pdf

358.

US Census Bureau. Historical world population estimates. US Census Bureau https://www.census.gov/data/tables/time-series/demo/international-programs/historical-est-worldpop.html

US Census Bureau historical estimates of world population by country and region (1950-2050). US population in 1960: 180 million of 3 billion worldwide (6%). Additional sources: https://www.census.gov/data/tables/time-series/demo/international-programs/historical-est-worldpop.html

359.

Sinn, M. P. United States Efficiency Audit. https://us-efficiency-audit.warondisease.org (2025) doi:10.5281/zenodo.18447476

Systems audit estimating an annual U.S. efficiency gap of $4.9T, with $2.45T recoverable at OECD-median performance across direct spending waste, compliance burden, policy-induced GDP loss, and system inefficiency.

360.

NASA. U.s. Government use of prize and bounty programs. NASA https://www.nasa.gov/news-release/nasa-and-x-prize-announce-winners-of-lunar-lander-challenge/

NASA’s Centennial Challenge, initiated in 2005, has paid out more than $7.6 million. The Ansari XPRIZE demonstrated significant leverage: $10 million was awarded to the winner, but more than $100 million was invested in new technologies in pursuit of the prize. NASA launched its own incentive scheme in 2005 called Centennial Challenges. Additional sources: https://www.nasa.gov/news-release/nasa-and-x-prize-announce-winners-of-lunar-lander-challenge/ | https://www.xprize.org/past-challenges | https://www.herox.com/blog/985-prize-challenges-governments-secret-weapon-for-inn

361.

Statista. US military budget as percentage of GDP. Statista https://www.statista.com/statistics/262742/countries-with-the-highest-military-spending/ (2024)

U.S. military spending amounted to 3.5% of GDP in 2024. In 2024, the U.S. spent nearly $1 trillion on its military budget, equal to 3.4% of GDP. Additional sources: https://www.statista.com/statistics/262742/countries-with-the-highest-military-spending/ | https://www.sipri.org/sites/default/files/2025-04/2504_fs_milex_2024.pdf

362.

Manuel, D. U.s. Defense spending history: 100 years of military budgets. DaveManuel.com https://www.davemanuel.com/us-defense-spending-history-military-budget-data.php (2025)

US military spending in constant 2024 dollars: 1939 $29B (pre-WW2 baseline), 1940 $37B, 1944 $1,383B, 1945 $1,420B (peak), 1946 $674B, 1947 $176B, 1948 $117B, 2024 $886B. The post-WW2 demobilization cut spending 88% in two years (1945-1947). Current peacetime spending ($886B) is 30x the pre-WW2 baseline and 62% of peak WW2 spending, in inflation-adjusted dollars.

363.

Wikipedia. US GDP growth rate post-WWII. Wikipedia https://en.wikipedia.org/wiki/Post–World_War_II_economic_expansion

US GDP increased from $228 billion in 1945 to just under $1.7 trillion in 1975. Average real GDP growth from 1950 to 1980 was around 4.1% annually, compared to 3.1% from 1981 to 2008. Additional sources: https://en.wikipedia.org/wiki/Post–World_War_II_economic_expansion | https://www.stlouisfed.org/timely-topics/house-prices-homeownership-rise

364.

St. Louis Fed. US home ownership rate increase post-WWII. St. Louis Fed https://www.stlouisfed.org/timely-topics/house-prices-homeownership-rise

The homeownership rate increased nearly 20 percentage points between 1940 and 1960, from 43.6% to 61.9%, the largest change in American homeownership in the past 100 years. Additional sources: https://www.stlouisfed.org/timely-topics/house-prices-homeownership-rise | https://www.census.gov/data/tables/time-series/dec/coh-owner.html

365.

Wikipedia. US military spending reduction after WWII. Wikipedia https://en.wikipedia.org/wiki/Demobilization_of_United_States_Armed_Forces_after_World_War_II (2020)

Peaking at over $81 billion in 1945, the U.S. military budget plummeted to approximately $13 billion by 1948, representing an 84% decrease. The number of personnel was reduced almost 90%, from more than 12 million to about 1.5 million between mid-1945 and mid-1947. Defense spending exceeded 41 percent of GDP in 1945. After World War II, the US reduced military spending to 7.2 percent of GDP by 1948. Defense spending doubled from the 1948 low to 15 percent at the height of the Korean War in 1953. Additional sources: https://en.wikipedia.org/wiki/Demobilization_of_United_States_Armed_Forces_after_World_War_II | https://www.americanprogress.org/article/a-historical-perspective-on-military-budgets/ | https://www.stlouisfed.org/on-the-economy/2020/february/war-highest-military-spending-measured | https://www.usgovernmentspending.com/defense_spending_history

366.

Institute of Medicine (US). US clinical trial enrollment targets (2009). Institute of Medicine (US) https://www.ncbi.nlm.nih.gov/books/NBK50886/

As of August 2009, 10,974 ongoing interventional clinical trials with at least one U.S. center were collectively seeking to enroll 2.8 million subjects. Additional sources: https://www.ncbi.nlm.nih.gov/books/NBK50886/

367.

US Census Bureau. Number of registered or eligible voters in the u.s. US Census Bureau https://www.census.gov/newsroom/press-releases/2025/2024-presidential-election-voting-registration-tables.html (2024)

73.6% (or 174 million people) of the citizen voting-age population was registered to vote in 2024 (Census Bureau). More than 211 million citizens were active registered voters (86.6% of citizen voting age population) according to the Election Assistance Commission. Additional sources: https://www.census.gov/newsroom/press-releases/2025/2024-presidential-election-voting-registration-tables.html | https://www.eac.gov/news/2025/06/30/us-election-assistance-commission-releases-2024-election-administration-and-voting

368.

VA. Veteran healthcare cost projections. VA https://department.va.gov/wp-content/uploads/2025/06/2026-Budget-in-Brief.pdf (2026)

VA budget: $441.3B requested for FY 2026 (10% increase). Disability compensation: $165.6B in FY 2024 for 6.7M veterans. PACT Act projected to increase spending by $300B between 2022-2031. Costs under Toxic Exposures Fund: $20B (2024), $30.4B (2025), $52.6B (2026). Additional sources: https://department.va.gov/wp-content/uploads/2025/06/2026-Budget-in-Brief.pdf | https://www.cbo.gov/publication/45615 | https://www.legion.org/information-center/news/veterans-healthcare/2025/june/va-budget-tops-400-billion-for-2025-from-higher-spending-on-mandated-benefits-medical-care

369.

U.S. Department of Veterans Affairs. 2024 national veteran suicide prevention annual report. (2024).

370.

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Graham testimony (2004): 88,000-139,000 U.S. heart attacks/strokes from Vioxx; up to 55,000 deaths (40% fatality rate) Lancet study estimate: 88,000 Americans had heart attacks from Vioxx; 38,000 died FDA memo (2004): Vioxx contributed to 27,785 heart attacks and sudden cardiac deaths (1999-2003) High-dose Vioxx: Tripled risk of heart attacks and sudden cardiac death Prescriptions: 92.8 million U.S. prescriptions 1999-2003 Withdrawn: September 30, 2004 after APPROVE trial showed cardiovascular risks Note: Vioxx case demonstrates failure of passive post-market surveillance (FAERS) to detect safety signals in time. Voluntary reporting missed cardiovascular risks for years despite millions of prescriptions Additional sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC534432/ | https://www.npr.org/2007/11/10/5470430/timeline-the-rise-and-fall-of-vioxx | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67712-4/fulltext

371.

U.S. Department of Transportation. Value of a statistical life (VSL). U.S. Department of Transportation https://www.transportation.gov/office-policy/transportation-policy/revised-departmental-guidance-on-valuation-of-a-statistical-life-in-economic-analysis (2021)

U.S. agencies use $10M per life saved as the Value of a Statistical Life. Additional sources: https://www.transportation.gov/office-policy/transportation-policy/revised-departmental-guidance-on-valuation-of-a-statistical-life-in-economic-analysis

372.

Brown University. War on terror cost and unintended consequences. Brown University https://www.brown.edu/news/2021-09-01/costsofwar (2021)

20 years of post-9/11 wars cost the U.S. an estimated $8 trillion and killed more than 900,000 people. Breakdown: $2.1T DOD operations, $1.1T homeland security, $1.1T interest on borrowing, $884B DOD base budget increases, $465B veterans’ care, $2.3T Afghanistan/Pakistan, $2.1T Iraq/Syria. Future: $2.2T for veteran care already set aside. Additional sources: https://www.brown.edu/news/2021-09-01/costsofwar | https://watson.brown.edu/costsofwar/costs/economic

373.

CNBC. Warren buffett’s career average investment return. CNBC https://www.cnbc.com/2025/05/05/warren-buffetts-return-tally-after-60-years-5502284percent.html (2025)

Berkshire’s compounded annual return from 1965 through 2024 was 19.9%, nearly double the 10.4% recorded by the S&P 500. Berkshire shares skyrocketed 5,502,284% compared to the S&P 500’s 39,054% rise during that period. Additional sources: https://www.cnbc.com/2025/05/05/warren-buffetts-return-tally-after-60-years-5502284percent.html | https://www.slickcharts.com/berkshire-hathaway/returns

374.

Uppsala University. Number of armed conflicts since 1945. Uppsala University https://ucdp.uu.se/

The AKUF dataset documents 218 wars and violent conflicts since 1945. The Uppsala Conflict Data Program (UCDP) recorded 40 armed conflicts in 2014 (highest since 1999, with 11 defined as wars). Peak year 1991 saw 51 active conflicts. Additional sources: https://ucdp.uu.se/ | https://en.wikipedia.org/wiki/Uppsala_Conflict_Data_Program

375.

Science/AAAS. Estimated annual cost of repeating failed experiments due to non-publication of results. Science/AAAS https://www.science.org/content/article/study-claims-28-billion-year-spent-irreproducible-biomedical-research (2020)

Up to 50.0% of published preclinical research is irreproducible, with an estimated annual cost of $28 billion in the U.S. alone. This is based on $56B annual spending on preclinical research × 50.0% irreproducibility rate. Main causes: reagents/materials (36%), study design (28%), data analysis (25%), protocols (11%). Additional sources: https://www.science.org/content/article/study-claims-28-billion-year-spent-irreproducible-biomedical-research | https://www.idbs.com/2020/11/replicating-science-28-billion-is-wasted-every-year-in-the-us-alone/

376.

World Economic Forum and Harvard School of Public Health. WEF/harvard NCD cost ($47T, 2011-2030). World Economic Forum and Harvard School of Public Health https://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf (2011)

The cumulative output loss due to non-communicable diseases (NCDs) under a ’business as usual’ scenario is estimated to be US47trillion.Thislossrepresents75%ofglobalGDPin2010(US 63 trillion). Additional sources: https://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf

377.

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The WHO’s annual budget of US$2.1 billion is equivalent to global military expenditure every eight hours. WHO Director-General noted that US$2.1 billion is the price of one stealth bomber. A 1% increase in military spending results in a 0.62% decrease in health spending globally. Additional sources: https://sharing.org/information-centre/news/world-health-organisations-annual-budget-equivalent-global-military/ | https://pmc.ncbi.nlm.nih.gov/articles/PMC9174441/

378.

World Health Organization. World Health Organization https://www.who.int/activities/choosing-interventions-that-are-cost-effective-(who-choice

In the CHOICE project, we have used a threshold of three times GDP per capita for an intervention to be considered ’cost-effective’ and a threshold of one times GDP per capita to be considered ’very cost-effective’. Additional sources: https://www.who.int/activities/choosing-interventions-that-are-cost-effective-(who-choice

379.

World Health Organization. WHO dashboard: COVID-19 deaths. (2026).

380.

World Health Organization. The top 10 causes of death. WHO Fact Sheets https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death (2024)

Approximately 150,000 people die every day worldwide. The majority of these deaths (over 100,000) are from non-communicable diseases including cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.

381.

WHO & UNICEF. Progress on Household Drinking Water, Sanitation and Hygiene 2000–2022. https://washdata.org/reports/jmp-2023-wash-households (2023).

382.

World Health Organization. WHO global health estimates 2024. World Health Organization https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates (2024)

Comprehensive mortality and morbidity data by cause, age, sex, country, and year Global mortality: 55-60 million deaths annually Lives saved by modern medicine (vaccines, cardiovascular drugs, oncology): 12M annually (conservative aggregate) Leading causes of death: Cardiovascular disease (17.9M), Cancer (10.3M), Respiratory disease (4.0M) Note: Baseline data for regulatory mortality analysis. Conservative estimate of pharmaceutical impact based on WHO immunization data (4.5M/year from vaccines) + cardiovascular interventions (3.3M/year) + oncology (1.5M/year) + other therapies. Additional sources: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates

383.

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Representative democracy suffers from an inescapable principal-agent problem where elected officials’ incentives diverge from citizen welfare. Wishocracy introduces RAPPA (Randomized Aggregated Pairwise Preference Allocation), which aggregates citizen preferences through cognitively tractable pairwise comparisons and creates accountability via Citizen Alignment Scores that channel electoral resources toward politicians who actually represent what citizens want.

389.

Global Policy Journal. World bank cost to eradicate extreme poverty. Global Policy Journal https://www.globalpolicyjournal.com/blog/25/07/2024/new-estimates-cost-ending-poverty (2024)

Jeffrey Sachs estimated $175 billion per year for 20 years (less than 1% of combined income of richest countries). Recent UNU-WIDER research: $70B/year for extreme poverty ($2.15/day threshold) or $325B/year for absolute poverty ($3.65/day). This is only 0.1-0.6% of OECD high-income countries’ GNI. Additional sources: https://www.globalpolicyjournal.com/blog/25/07/2024/new-estimates-cost-ending-poverty | https://borgenproject.org/how-much-does-it-cost-to-end-poverty/

390.

World Bank. World bank trade disruption cost from conflict. World Bank https://www.worldbank.org/en/topic/trade/publication/trading-away-from-conflict

Estimated $616B annual cost from conflict-related trade disruption. World Bank research shows civil war costs an average developing country 30 years of GDP growth, with 20 years needed for trade to return to pre-war levels. Trade disputes analysis shows tariff escalation could reduce global exports by up to $674 billion. Additional sources: https://www.worldbank.org/en/topic/trade/publication/trading-away-from-conflict | https://www.nber.org/papers/w11565 | http://blogs.worldbank.org/en/trade/impacts-global-trade-and-income-current-trade-disputes

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Federation of American Scientists. World nuclear forces. Federation of American Scientists https://fas.org/issues/nuclear-weapons/status-world-nuclear-forces/ (2024)

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393.

World Bank, Bureau of Economic Analysis. US GDP 2024 ($28.78 trillion). World Bank https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US (2024)

US GDP reached $28.78 trillion in 2024, representing approximately 26% of global GDP. Additional sources: https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US | https://www.bea.gov/news/2024/gross-domestic-product-fourth-quarter-and-year-2024-advance-estimate

394.

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395.

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396.

World Foundation. Worldcoin identity verification scale. World Foundation https://world.org/blog/announcements/world-year-two (2025)

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397.

Federation of American Scientists. Cost of world war II in today’s dollars. Federation of American Scientists https://fas.org/publication/costs_of_war/

WWII cost $4 trillion (today’s dollars). Additional sources: https://fas.org/publication/costs_of_war/ | https://online.norwich.edu/online/about/resource-library/cost-us-wars-then-and-now

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U.S. Treasury. WWII war bonds. U.S. Treasury https://en.wikipedia.org/wiki/War_bond.

399.

Yale Budget Lab. The fiscal, economic, and distributional effects of all u.s. tariffs. (2025)

Accounting for all the 2025 US tariffs and retaliation implemented to date, the level of real GDP is persistently -0.6% smaller in the long run, the equivalent of $160 billion 2024$ annually.

400.

Nobel Prize. Discovery of induced pluripotent stem cells (yamanaka factors). Nobel Prize https://www.nobelprize.org/prizes/medicine/2012/press-release/ (2012)

In 2006, Shinya Yamanaka and Kazutoshi Takahashi showed that introducing four specific genes (Myc, Oct3/4, Sox2, Klf4), known as Yamanaka factors, could convert somatic cells into pluripotent stem cells. Yamanaka was awarded the 2012 Nobel Prize with Sir John Gurdon for the discovery that mature cells can be reprogrammed to become pluripotent. Additional sources: https://www.nobelprize.org/prizes/medicine/2012/press-release/ | https://en.wikipedia.org/wiki/Induced_pluripotent_stem_cell

401.

ACS. ZINC-22 database (billions of compounds). ACS https://pubs.acs.org/doi/10.1021/acs.jcim.2c01253

ZINC-22 contains tens of billions of purchasable virtual molecules for drug discovery. Additional sources: https://pubs.acs.org/doi/10.1021/acs.jcim.2c01253