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How to Not Build Most of It

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

The infrastructure for a dFDA157,158 won’t cost billions to build. Because you’re not building most of it. Your species already figured out how to get strangers to build software for free. You call it “open source.” It runs most of the internet. You just forgot to point it at medicine.

The strategy: build the foundation (core API and data standards), pay bounties for the parts nobody wants to build first, and let strangers build everything else for free. Because some of them are dying.

The Open Platform Model

Linux started as one person in Finland writing a kernel. Today it runs most of the internet, every Android phone, and the world’s fastest supercomputers. WordPress: a small core, 60,000+ plugins built by other people. Open-source platform models are a multi-trillion-dollar economic reality159. Combined value of Linux, WordPress, Android, and Chrome: trillions. Combined cost to build the cores: billions. You used this method to build the infrastructure for cat videos. You have not used it to build the infrastructure for clinical trials.

A dFDA follows the same structure. Build the core (APIs, data standards, identity, consent). Developers build everything else (trial matching, analysis dashboards, EHR connectors, patient apps). Except these developers are also dying of the diseases, so they’re more motivated than the average WordPress contributor.

Bounties: Paying for Results, Not Promises

An open platform mostly builds itself, but sometimes you need specific features that nobody’s volunteering to create.

Your traditional approach is grants: “Here’s money. Build something. Let us know how it goes.” The bounty approach: “Build this specific thing. If it works, you get paid. If it doesn’t, you don’t.” One of these has produced the NIH’s track record. The other has produced the internet. I’ll let you figure out which is which.

The “Right to Trial160 & FDA Upgrade Act” mandates a public bounty and prize program: post bounties for critical features nobody’s building yet (pay on delivery, not on promise); pay hackers to find security vulnerabilities and report them instead of exploiting them (cheaper than getting hacked); fund connectors to major EHR systems where everyone benefits but nobody wants to go first; and offer major prizes for breakthrough components. This is how your species built private spaceflight. It’s also how you keep your military’s computers from being hacked. You just haven’t tried it on the thing that kills 150,000 of you every day.

This Already Works

Governments already use bounties and prizes161 to solve complex problems, and they consistently outperform traditional procurement. XPRIZE produced private spaceflight. NASA Centennial Challenges produced lunar landers and space robotics. The Department of Defense pays hackers to break into its own systems. All succeeded. All cost less than the traditional “hire a contractor and hope” approach.

The alternative is the one your species defaults to: build everything from scratch, slowly, expensively, and badly. Then hold an awards dinner about it. I have attended your awards dinners. The food is adequate and nobody mentions the dead.