# The Planetary Constitutional Convention

Stress-test and improve the current instruction manual until humanity has something less terrible to use

Abstract

The Planetary Constitutional Convention is the deliberative process that precedes implementation of the [Earth Optimization Prize](https://manual.warondisease.org/knowledge/strategy/earth-optimization-prize.html)^([1](../references.llms.md#ref-earth-optimization-prize-paper-2025)). Before anyone recruits a single referendum voter or sells a single bond, there is a prior question: is the current [Earth Optimization manual](https://manual.warondisease.org) actually the one humanity should use? We think it is terrible. We said so in the title. The honest first step is to improve the manual until it is less terrible. The protocol lives on GitHub. Anyone can fork it. The adversarial review process is a podcast series where domain experts critique the manual and state what changes would be required for them to endorse it, plus published critiques and pull requests. The ratified revision becomes the current manual the referendum, the bonds, and the lobbying campaign execute. This runs before everything else because committing billions to an unstress-tested manual is how your species normally operates, and that is not a compliment.

The [Earth Optimization manual](https://manual.warondisease.org) is the current instruction manual for a complete governance reform package. We think it is terrible. We said so in the title.

This constitutional convention exists to produce something less terrible. Fork the current manual, fix it, and improve it continuously. The ratified revision becomes the current manual the [Earth Optimization Prize](https://manual.warondisease.org/knowledge/strategy/earth-optimization-prize.html)^([1](../references.llms.md#ref-earth-optimization-prize-paper-2025)) follows.

The protocol lives on [GitHub](https://github.com/wishonia/earth-optimization-protocol). Anyone can fork it. The adversarial review process is a podcast series where domain experts critique the manual and state what changes would be required for them to endorse it. Each episode produces publishable content and a concrete list of required changes tracked as issues against the current manual. Pull requests are how improvements get proposed and ratified. The constitutional constraints below are the filter; formal ranking only matters if multiple serious revised manuals emerge at the same time.

> **IMPORTANT:**
>
> If your proposal requires politicians, bureaucrats, investors, regulators, voters, or interest groups to become less selfish than they currently are, you have described a pleasant world rather than a mechanism for reaching it. “Requires selflessness” is not the same as “makes self-interest coincide with better outcomes.” We have been observing your species since 1945 and have not yet seen selfishness decline on request.

## The Current Manual

What follows is our homework. The thing to improve is the **integrated set of required functions** implied by the companion papers.

| Required function | Default implementation in the [Earth Optimization Protocol v1](https://manual.warondisease.org) | What an improved manual still has to solve |
|:---|:---|:---|
| Large initial reallocation wedge | **The [1% Treaty](https://manual.warondisease.org/knowledge/solution/1-percent-treaty.html)**^([2](../references.llms.md#ref-value-captured-by-1pct-treaty)) | Must redirect at least as much low-NSV spending to higher-NSV use |
| Medical throughput and evidence generation | **Ubiquitous Pragmatic Trial Impact Analysis**^([3](../references.llms.md#ref-dfda-impact-paper-2025)) + **The Continuous Evidence Generation Protocol**^([4](../references.llms.md#ref-dfda-spec-paper-2025)) | Must produce faster, cheaper, more reliable treatment discovery |
| Regulatory-delay removal | **The Invisible Graveyard**^([5](../references.llms.md#ref-invisible-graveyard-paper-2025)) + **Right to Trial & FDA Upgrade Act** + **Drug Development Cost Increase Analysis**^([6](../references.llms.md#ref-drug-development-cost)) | Must reduce efficacy lag and development cost without increasing net harm |
| Political financing and adoption engine | **[Incentive Alignment Bonds](../../knowledge/solution/incentive-alignment-bonds.llms.md)**^([7](../references.llms.md#ref-iab-paper-2025)) (funds the lobbying campaign; Prize deposits fund the prize pool separately) | Must make passage at least as incentive-compatible for selfish actors |
| Citizen preference aggregation | **[Wishocracy](../../knowledge/solution/wishocracy.llms.md)**^([8](../references.llms.md#ref-wishocracy-paper-2025)) | Must recover public preference at equal or lower cognitive cost |
| Waste and opportunity accounting | **The [Political Dysfunction Tax](https://manual.warondisease.org/knowledge/appendix/political-dysfunction-tax.html)**^([9](../references.llms.md#ref-political-dysfunction-tax-paper-2025)) + **United States Efficiency Audit**^([10](../references.llms.md#ref-us-efficiency-audit-paper-2025)) | Must identify low-NSV pools at least as well |
| Policy recommendation engine | **[Optimocracy](../../knowledge/solution/optimocracy.llms.md)**^([11](../references.llms.md#ref-optimocracy-paper-2025)) + **The Optimal Policy Generator**^([12](../references.llms.md#ref-opg-paper-2025)) | Must generate better recommendations under real-world constraints |
| Budget recommendation engine | **The Optimal Budget Generator**^([13](../references.llms.md#ref-obg-paper-2025)) | Must allocate public-goods spending better on the terminal general-welfare metrics |
| Legal and institutional implementation path | **Right to Trial & FDA Upgrade Act** + treaty/statutory tools | Must create equal or stronger binding force |
| Narrative, coalition, and sequencing wrapper | **How to End War and Disease** | Must coordinate adoption at equal or lower cost and failure risk |

That is the Minimum Acceptable Governance: the ten functions that form the operating loop. Ratification requires covering every row or replacing any row with something strictly better. The [Earth Optimization Protocol](../../knowledge/strategy/earth-optimization-protocol-v1.llms.md) names an eleventh function, an algorithmic monetary system, that becomes possible only once the loop is running; constraint 8 (monetary neutrality) governs it.

## Constitutional Constraints

[Wishocracy](../../knowledge/solution/wishocracy.llms.md)^([8](../references.llms.md#ref-wishocracy-paper-2025)) selects the ratified version. But [Wishocracy](../../knowledge/solution/wishocracy.llms.md) picks from a filtered pool, because crowds are good at preferences and bad at evaluating whether a 50-page systems engineering document is mechanistically sound. A beautifully written plan that skips the hard parts should not outrank an ugly plan that solves them. And your species is deeply status-quo biased: you have been programmed your entire lives to treat the Federal Reserve, the congressional budget process, the IRS, and representative democracy as laws of nature rather than design choices that are producing catastrophic results. Left unconstrained, crowds will pick plans that preserve these institutions with cosmetic reforms, which will recreate every problem the prize exists to solve.

So: eleven hard constraints that no proposed revision can violate, regardless of how many humans vote for it. The first four ensure the plan is real. The next two ensure it survives. The last five ensure the new system does not become the old one.

**The plan must be real:**

1.  **The selfishness rule.** If your plan requires any participant to become less selfish, it is disqualified. This is the single most powerful filter. Most policy proposals fail here.
2.  **The two metrics.** Must demonstrably improve median healthy life years and median real after-tax income. Not “probably.” Show the mechanism.
3.  **The completeness rule.** Must cover every required function in the Minimum Acceptable Governance table, or prove one is unnecessary. No skipping the hard parts.
4.  **The mechanism rule.** Must describe HOW, not just WHAT. “Universal healthcare” is a destination, not a route. Disqualified.

**The plan must survive:**

5.  **The capture resistance rule.** Must explain why concentrated interests cannot co-opt the system. If your plan has a board, explain why the board cannot be bought. If it does not have a board, explain what prevents capture anyway.
6.  **The ratchet rule.** Must be self-sustaining once started. No plans that depend on continued goodwill, because your species’ goodwill has a half-life of approximately one news cycle.

**The old failure modes must die:**

7.  **No capturable intermediary in public goods allocation.** Budget decisions must flow from citizen preferences to resource allocation without a layer of representatives who can be lobbied, bribed, or captured. This does not prescribe any specific allocation mechanism. It rules out “we’ll fix Congress.” Your species has been trying to fix Congress for 248 years. Congress is performing as designed. The design is the problem.
8.  **Monetary neutrality.** Any new money created by the system must enter at the population level, not through politically connected intermediaries. The Cantillon effect (whoever gets new money first benefits; whoever gets it last pays) means new money enters through politically connected intermediaries, not the population. This does not prescribe any specific monetary system. It rules out preserving a money printer that funds wars without consent and steals 2% of purchasing power per year by design.
9.  **No single point of rollback.** No individual, committee, or institution can unilaterally reverse the system’s progress. A treaty that one president can exit by tweet is not a treaty. A fund that one board can liquidate is not durable. If your plan has a kill switch, it will be used, because your species has never built a kill switch it didn’t eventually pull.
10. **Rights firewall.** The allocation mechanism is constitutionally restricted to bounded resource questions. No collective mechanism can override individual bodily autonomy, criminalize personal choices that harm no one else, or restrict access to proven-safe treatments. You cannot vote away rights. No plan may improve its terminal general-welfare metrics by externalizing costs onto populations excluded from the allocation mechanism: future generations, foreign populations outside the treaty, and nonhuman sentient beings. Allocation is democratizable. Rights are not.
11. **Full transparency.** Every allocation, transaction, and decision must be publicly auditable by any participant. No classified budgets. No hidden flows. Opacity is how capture hides.

These are constitutional constraints, not preferences. A proposed revision that fails any one of these never reaches the voters, the same way a law that violates the First Amendment never reaches the statute books (in theory; your species’ track record on this is mixed).

## How It Works

**Constitutional constraints are the filter.** The eleven constraints above are binary: a proposal either satisfies them or it does not. Anyone can check compliance. No expert panel needed; the constraints are designed to be verifiable by inspection.

**Public adversarial review.** Domain experts critique the protocol in podcast conversations and state what changes they would require to endorse it. Published critiques, red-team memos, and GitHub issues track every objection. This is peer review, except it happens in public, produces listenable content, and generates a concrete punch list of required changes rather than a rejection letter.

**GitHub forks and pull requests.** Anyone can fork the current manual and propose improvements. Pull requests are how improvements get proposed, debated, and ratified. The version history is the audit trail.

**Wishocratic ranking (when needed).** If multiple serious revised manuals emerge at the same time, [Wishocracy](../../knowledge/solution/wishocracy.llms.md) activates: citizens compare two plans at a time (“Which of these two would you rather live under?”), about 20 comparisons, 5 minutes. The crowd does not need to understand mechanism design. The crowd needs to understand “which of these two futures sounds less terrible?” Humans are surprisingly good at that question and surprisingly bad at everything else. This infrastructure is not needed until the scaling problem actually exists.

The ratified revision becomes the current Earth Optimization manual. If no revision improves the current manual, the current manual remains in force by default, which means we were right that it is terrible but wrong that nobody could improve it, and that is a more depressing outcome than we are prepared to contemplate.

The floor. Any proposal that cannot beat the risk-adjusted treaty benchmark on cost per DALY does not get scored. If you cannot beat bed nets, you are not improving the manual, you are writing fiction:

| Intervention | Cost per DALY averted |
|:---|:---|
| Malaria bed nets (current gold standard) | [\$184 (90% CI: \$113-\$252)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-bed_nets_cost_per_daly) |
| [1% Treaty](https://manual.warondisease.org/knowledge/solution/1-percent-treaty.html) (conditional, if adopted) | [\$0.02 (90% CI: \$0.011-\$0.047)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_cost_per_daly_trial_capacity_plus_efficacy_lag) |
| [1% Treaty](https://manual.warondisease.org/knowledge/solution/1-percent-treaty.html) (risk-adjusted, [1% (95% CI: 0.1%-10%)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-political_success_probability) success) | [\$1.99 (90% CI: \$0.37-\$38)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_expected_cost_per_daly) |

## What the Current Manual Claims (and Where To Improve It)

The prize asks one question: *who can cause verified implementation of a complete package that dominates on welfare per dollar?* We wrote the current manual because conventions need a starting draft. We expect it to be improved. Here is what the current manual claims, paper by paper, and the specific benchmarks any revision still has to clear:

| Paper | What the prize uses it for | Key benchmark any improved manual still has to clear |
|:---|:---|:---|
| **The [1% Treaty](https://manual.warondisease.org/knowledge/solution/1-percent-treaty.html)**^([2](../references.llms.md#ref-value-captured-by-1pct-treaty)) | First large transfer from low-value military spending to high-value medical discovery | [\$27.2 billion](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_annual_funding)/year; [\$0.02 (90% CI: \$0.011-\$0.047)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_cost_per_daly_trial_capacity_plus_efficacy_lag)/DALY conditional; [10.7 billion](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_trial_capacity_plus_efficacy_lag_lives_saved) deaths averted |
| **Ubiquitous Pragmatic Trial Impact Analysis**^([3](../references.llms.md#ref-dfda-impact-paper-2025)) | ROI case for medical evidence generation as destination for redirected capital | [12.3x (90% CI: 4.92x-50.8x)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_trial_capacity_multiplier) capacity increase; queue from [443](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-status_quo_queue_clearance_years) to [36](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_queue_clearance_years) years; [\$9.62 (90% CI: \$2.15-\$32)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_direct_funding_cost_per_daly)/DALY |
| **[Incentive Alignment Bonds](../../knowledge/solution/incentive-alignment-bonds.llms.md)**^([7](../references.llms.md#ref-iab-paper-2025)) | Financing and political-adoption engine | [272%](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-victory_bond_annual_return_pct) annual return; [205 (90% CI: 182-229)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-iab_mechanism_benefit_cost_ratio) mechanism BCR |
| **[Wishocracy](../../knowledge/solution/wishocracy.llms.md)**^([8](../references.llms.md#ref-wishocracy-paper-2025)) | Preference aggregation with intensity | Binding at \>=2% participation; 10-30 pairwise comparisons per citizen |
| **The [Political Dysfunction Tax](https://manual.warondisease.org/knowledge/appendix/political-dysfunction-tax.html)**^([9](../references.llms.md#ref-political-dysfunction-tax-paper-2025)) | Master ledger of value left on the floor | [\$101 trillion (90% CI: \$59.6 trillion-\$161 trillion)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-political_dysfunction_global_opportunity_cost_total)/year globally |
| **The Invisible Graveyard**^([5](../references.llms.md#ref-invisible-graveyard-paper-2025)) | Mortality proof that delay kills | [8.2](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-efficacy_lag_years) years delay; [102 million](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-existing_drugs_efficacy_lag_deaths_total) deaths; [8.77 billion DALYs (90% CI: 4.88 billion DALYs-13.2 billion DALYs)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_efficacy_lag_elimination_dalys) |
| **How Much Does It Cost to Buy All the Governments?**^([14](../references.llms.md#ref-cost-of-change-paper-2025)) | Budget ceiling for buying legal democratic pressure | [\$1 billion](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_campaign_total_cost); \>[290 thousand (90% CI: 117 thousand-600 thousand)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_roi_existing_drugs_only) benefit-cost ratio |
| **United States Efficiency Audit**^([10](../references.llms.md#ref-us-efficiency-audit-paper-2025)) | Concrete waste map | [\$4.98 trillion (90% CI: \$4.39 trillion-\$5.61 trillion)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-us_gov_waste_total)/year; [\$2.49 trillion (90% CI: \$2.19 trillion-\$2.81 trillion)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-us_gov_waste_recoverable) recoverable |
| **[Optimocracy](../../knowledge/solution/optimocracy.llms.md)**^([11](../references.llms.md#ref-optimocracy-paper-2025)) | Cross-jurisdiction recommendation engine | Causal policy comparison across thousands of jurisdictions |
| **OPG**^([12](../references.llms.md#ref-opg-paper-2025)) | Law-level enact/replace/repeal engine | Policy Impact Score; 5-15% GDP welfare gains |
| **OBG**^([13](../references.llms.md#ref-obg-paper-2025)) | Spending-level reallocation engine | Budget Impact Score; 20-40% misallocation correctable |
| **Continuous Evidence Generation Protocol**^([4](../references.llms.md#ref-dfda-spec-paper-2025)) | Medical evidence machine | \$0.1 (95% CI: \$0.03-\$1)/patient Stage 1; [\$929 (95% CI: \$97-\$3,000)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-dfda_pragmatic_trial_cost_per_patient)/patient Stage 2 |
| **Drug Development Cost Increase Analysis**^([6](../references.llms.md#ref-drug-development-cost)) | Proof current regulation is catastrophically expensive | [105x (90% CI: 72.8x-149x)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-drug_cost_increase_pre1962_to_current_multiplier) cost increase; [\$2.6 billion (95% CI: \$1.5 billion-\$4 billion)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-pharma_drug_development_cost_current)/drug |
| **How to End War and Disease** | Integrated narrative and coalition wrapper | [\$1 billion](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-treaty_campaign_total_cost) total cost; [1% (95% CI: 0.1%-10%)](../../knowledge/appendix/parameters-and-calculations.llms.md#sec-political_success_probability) success probability |

## What Happens Next

The convention is open. Fork the manual. Tear it apart. The constitutional constraints are public. The benchmarks are public. The version history is public. Anyone who improves any row of the Minimum Acceptable Governance table has already done more constitutional drafting than the average constitutional drafter, who typically does none.

We do not expect to be the people who write the final version. We expect to be the people who wrote the first draft bad enough that someone better was forced to fix it. That is the job. We are doing it on purpose.

1\.

Sinn, M. P. *The Earth Optimization Prize*. <https://manual.warondisease.org/knowledge/strategy/earth-optimization-prize.html> (2025) doi:[10.5281/zenodo.19076597](https://doi.org/10.5281/zenodo.19076597)

*Reward humanity for raising healthy life years and median income within 15 years. PRIZE keeps depositors on the failure branch, VOTE rewards recruiters on the success branch, and Earth Optimization Protocol v1 is only the current instruction manual for trying to win.*

2\.

Value captured by 1% treaty of \$27+ billion annually.

*A 1% treaty redirects 1% of global military spending (\$2.7T × 1% = \$27.2B) to pragmatic clinical trials, with 10% of this flow (2.7B annually) distributed to VICTORY Incentive Alignment Bondholders as returns.*

3\.

Sinn, M. P. *Ubiquitous Pragmatic Trial Impact Analysis*. <https://papers.acceleratedmedicine.org/dfda-impact.html> (2025) doi:[10.5281/zenodo.18243914](https://doi.org/10.5281/zenodo.18243914)

*Only 15 diseases/year get their first treatment each year. With 6,650 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 \$9.62 per year of healthy life saved.*

4\.

Sinn, M. P. *The Continuous Evidence Generation Protocol: Two-Stage Validation (RWE → Pragmatic Trials)*. <https://papers.acceleratedmedicine.org/dfda-protocol.html> (2025) doi:[10.5281/zenodo.18203375](https://doi.org/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.*

5\.

Sinn, M. P. *The Invisible Graveyard: Quantifying the Mortality Cost of FDA Efficacy Lag*. <https://papers.acceleratedmedicine.org/invisible-graveyard.html> (2025) doi:[10.5281/zenodo.18356231](https://doi.org/10.5281/zenodo.18356231)

*After proving a drug is safe, the FDA requires 8.2 years to prove it works before patients can access it. We estimate this delay cost 102 million deaths among people waiting for approved drugs (1962-2024). The human cost in death and disability of blocking good drugs is 3.07k higher than the cost of approving bad ones.*

6\.

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.*

7\.

Sinn, M. P. *Incentive Alignment Bonds: Making Public Goods Financially and Politically Profitable*. <https://manual.warondisease.org/knowledge/appendix/incentive-alignment-bonds-paper.html> (2025) doi:[10.5281/zenodo.18203221](https://doi.org/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.*

8\.

Sinn, M. P. *Wishocracy: Solving the Democratic Principal-Agent Problem Through Pairwise Preference Aggregation*. <https://manual.warondisease.org/knowledge/appendix/wishocracy-paper.html> (2025) doi:[10.5281/zenodo.18205881](https://doi.org/10.5281/zenodo.18205881)

*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.*

9\.

Sinn, M. P. *The Political Dysfunction Tax*. <https://manual.warondisease.org/knowledge/appendix/political-dysfunction-tax.html> (2025) doi:[10.5281/zenodo.18603840](https://doi.org/10.5281/zenodo.18603840)

*Quantifying the gap between current global governance and theoretical maximum welfare, estimating a 31-53% efficiency score and \$101 trillion in annual opportunity costs.*

10\.

Sinn, M. P. *United States Efficiency Audit*. <https://manual.warondisease.org/knowledge/appendix/us-efficiency-audit.html> (2025) doi:[10.5281/zenodo.18447476](https://doi.org/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.*

11\.

Sinn, M. P. *Optimocracy: Causal Inference on Cross-Jurisdictional Policy Data to Maximize Median Health and Wealth*. <https://manual.warondisease.org/knowledge/appendix/optimocracy-paper.html> (2025) doi:[10.5281/zenodo.18356213](https://doi.org/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.*

12\.

Sinn, M. P. *The Optimal Policy Generator: A Causal Inference Protocol for Maximizing Median Health and Wealth Through Public Policy*. <https://manual.warondisease.org/knowledge/appendix/optimal-policy-generator-spec.html> (2025) doi:[10.5281/zenodo.18603834](https://doi.org/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.*

13\.

Sinn, M. P. *The Optimal Budget Generator: A Causal Inference Protocol for Maximizing Median Health and Wealth Through Public Goods Funding*. <https://manual.warondisease.org/knowledge/appendix/optimal-budget-generator-spec.html> (2025) doi:[10.5281/zenodo.18356209](https://doi.org/10.5281/zenodo.18356209)

*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.*

14\.

Sinn, M. P. *How Much Does It Cost to Buy All the Governments?* <https://manual.warondisease.org/knowledge/appendix/cost-of-change-analysis.html> (2025) doi:[10.5281/zenodo.18356215](https://doi.org/10.5281/zenodo.18356215)

*What’s the maximum cost to achieve any policy change through legal democratic channels? \$25.5 billion for the US, \$128 billion globally. For high-value reforms like military-to-health reallocation, this yields a benefit-cost ratio in the tens of thousands to one.*

15\.

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*

.

16\.

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*

.

17\.

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/*

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