Only 15 diseases/year get their first treatment each year. With 6,650 diseases (90% CI: 5,700 diseases-8,232 diseases) lacking effective treatments, the backlog would take 443 years (90% CI: 255 years-841 years) to clear. Integrating pragmatic trials into standard healthcare increases trial capacity 12.3x (90% CI: 4.92x-50.8x), cutting that timeline from 443 years (90% CI: 255 years-841 years) to 36 years (90% CI: 8.15 years-106 years). The average untreated disease gets a treatment 212 years (90% CI: 124 years-398 years) earlier, saving 10.7 billion deaths (90% CI: 6.24 billion deaths-20.3 billion deaths) at $0.842 (90% CI: $0.264-$1.49) per year of healthy life saved.

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.

The Price of Apocalypse is $752 million (90% CI: $464 million-$2.16 billion) per year. Your governments spend $2.72 trillion. That is an 3.6kx (90% CI: 1.3kx-5.9kx) markup on the end of civilization.

The US spends $886 billion per year on military hegemony. The only quantifiable benefit is $20-200 billion in dollar privilege. The net is negative $674 billion to $1.38 trillion per year. Switzerland spends $7 billion and has better outcomes by every measure.

What's the maximum cost to achieve any policy change through legal democratic channels? $25B for the US, $200B globally. For high-value reforms like military-to-health reallocation, this yields a benefit-cost ratio exceeding 400,000:1.

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 publishes evidence-based recommendations for every major vote and scores every legislator against them. Getting anyone to act on the scoreboard is a separate question with several answers, none of which require a government's permission.

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 (90% CI: 12.8x-210x) lower cost than traditional Phase III trials. This enables continuous, population-scale pharmacovigilance and precision dosing recommendations.

A diagnostic survey of the systems that allocate your species' resources to killing instead of curing

The annual bill for letting your bodies fall apart. It's more than all the money on Earth, which is impressive in a terrible way.

Your government spends 604 times more on weapons than on testing which medicines work. You could elect 535 Gandhis and within two years they'd be funding nuclear weapons programs, because the system requires it. Princeton studied 1,779 of your policy decisions and found that public opinion has the same effect on legislation as a houseplant. This chapter explains why you can't vote your way out, and why that's actually fine, because the solution was never better politicians.