We weren’t planning this episode

Hello friends,

We weren’t planning to release another episode this week.

Then our own co-host launched a petition that helped bring a troubling
new development into the national conversation.

When prediction markets began allowing people to bet on the outcomes of clinical trials and drug approvals, David Tsai decided he couldn’t remain silent.

Within weeks, his petition had caught the attention of The New York Times and NPR.

Colleagues warned him that he was taking on a powerful and rapidly growing company. He went ahead anyway.  That decision felt deeply connected to why we created
Before the Cure.

David is a biotech leader whose career spans clinical research, drug development, and clinical-trial strategy and operations. Early in his career, he spent five years working directly with cancer patients at a hematology-oncology research site.

He saw what patients bring to clinical trials: their time, their trust, and often their hope for themselves and the people who will come after them.

David has spent our first episodes helping me tell the stories of people trying to change medicine. In this surprise bonus episode, I get to tell his.

We also examine the larger debate. Supporters argue that prediction markets could make drug development more transparent. David believes they could introduce dangerous financial incentives into a system built on patient trust.

And beneath that debate is a question at the heart of this show:

What happens when someone decides that staying quiet is no longer an option?

A prediction market allows participants to buy and sell contracts based on whether a future event will happen. In healthcare, those events can include whether a clinical trial succeeds or whether the FDA approves a drug. The market price reflects what traders collectively believe is the likelihood of that outcome.

Yes. Prediction market platforms have offered contracts tied to clinical trial results and regulatory decisions about new drugs. This has created a debate about whether these markets provide useful information or turn decisions affecting patients and families into opportunities for financial speculation.

Patients participate in clinical trials by contributing their time, accepting medical risks, and placing trust in researchers. Critics argue that allowing people to profit from trial outcomes could create troubling incentives, encourage trading on sensitive information, and weaken trust in medical research.

Supporters believe prediction markets could combine information from many participants and reveal expectations about whether a drug will succeed. Critics, including David Tsai, argue that any possible informational value must be weighed against conflicts of interest, patient privacy, research integrity, and the risk of gambling on life-changing medical outcomes.

David Tsai is a biotech leader with experience in clinical research, drug development, and clinical trial strategy and operations. After prediction markets began offering contracts tied to clinical trials and drug approvals, he launched a petition calling for the practice to stop.

Help bring more people into this conversation.
Send this episode with someone who should hear it::
a patient, caregiver, researcher, or someone working to change medicine.
Sharing it is one way to keep that conversation growing.

If you share David’s concerns and want to support his effort, you can also
read and sign his petition.

We’ll return next week with our regularly scheduled episode.
But this conversation couldn’t wait.

Onward,

Timothy Wheeler
Co-host, Before the Cure

More on the story:
The New York Times · NPR reporting ·The Philip DeFranco Show