This three part series describes systems to augment existing scientific practices. These incentives structures are made practical by distributed networks, more commonly known as blockchains.

This first part focuses on incentivizing participation in clinical trials.

Decentralized Clinical Trials

Definition

For decades, decentralized trials have referred to experiments that are conducted without a singular clinic site. Perhaps a federation of clinic sites located across multiple geographic regions administered the treatment and collected blood samples. Alternatively, participants might be mailed a biological compound, and their responses would be collected by mail or phone.

Decentralized trials need not have a ‘blockchain’ component, but the right incentives might drive consistency and adherence, which are typically challenging relative to traditional clinical trials.

Problem

In all human research, participants drop out. Perhaps they move; perhaps they grow bored and then simply forget. Perhaps they have a negative reaction to the treatment, but do not want to seem “mean”, and rather than reporting the adverse event, they simply stop showing up or responding to the clinicians.

This problem is even worse in ‘decentralized trials’.

In decentralized trials, there is often less of a human connection to the clinical staff. Participants tend to have less ‘skin in the game’. They may be eager to receive the treatment for ‘free’, but are often not very motivated to actually supply results to the researchers.

This drives costs up, and creates added difficulty for estimating how many participants will be needed for the study to have statistical significance.

Solution A: Escrow

When a participant signs up (and is deemed eligible to participate in a trial) they must then put some currency into an ‘escrow’ account before they receive the treatment.

Upon the study’s conclusion, if the participant is found to have submitted their data, they receive their currency held in escrow back.

An added twist: adherent participants receive a cut of the drop outs’ currency; making participation in the study profitable.

*This solution is ideal for ‘low risk’ trials, in which dropping out is more likely to be driven by inattention rather than adverse events. *

Caveat: Participants are motivated to submit ANY data, and not necessarily true data. Consequently, it is important that participants have a way to ‘exit’ the study and still receive their escrow back; perhaps by having a call with a researcher. There must be SOME friction to leave the trial, but not enough that they would rather submit fake data than lose their currency held in escrow.

Solution B: Tokens

Upon completion of the trial, participants that were satisfactorily adherent receive a share of tokens. These tokens represent equity or royalties for future commercialization of the treatment.

This solution is more ethical for ‘high risk’ trials, in which participants may experience harmful effects.

Caveat: Bad actors may seek to make multiple accounts, or coordinate between participants, to supply fake data. This conspiracy may, for instance, inflate the treatment’s effect. Such actors would likely sell their tokens at the first chance, potentially wrecking the project’s chance of ever making it to market. Anti-sybil and reputation mechanisms will likely alleviate this risk.

Conclusion

Decentralized trials are one of the solutions for the ‘valley of death’ facing new biomedical therapies. By adding ‘crypto incentives’ to decentralized trials, participation and adherence can be increased, allowing more therapies to be validated.

Calls to Action

Interested in participating in a decentralized clinical trial, or finding other biohackers? Fill out this brief survey to join the community.

Are you a researcher yourself? Consider adding one of these incentives to an upcoming study; potentially as an added condition to document their effect on adherence.

Are you also building in DeSci? Let’s coordinate on implementing these mechanisms into emerging platforms, like POAP or DeSci Labs.

Email address: contact@researchcollective.io

Twitter: ResearchDAO

Voiceover with a Video Overlay

The film American Psycho was released in 2000. This sketch is imagining what the movie would've looked like had it been made in 2021.

Digital Auction:

https://opensea.io/assets/0x495f947276749ce646f68ac8c248420045cb7b5e/52177191260495391802590070422504774445269288061660369362278009269084787572737

Original Context:

https://twitter.com/PatrickJBlum/status/1476731931643588625

auction://0xabEFBc9fD2F806065b4f3C237d4b59D9A97Bcac7?network=mainnet&tokenId=8622&auctionId=0x8da397f19d1e7d5c93fa301b970ff93ef3b3dc11db82df6f3ef11a3acb52bc00

These three pieces depict a series of experiments, undertaken from 2017 to 2021, intended to transfer the N6 antibody gene using a plasmid vector. The N6 antibody was discovered in a patient that was naturally resistant to HIV. The antibody’s corresponding gene sequence was published online by the NIH.

N6 V2 (2019)

The second experiment used a modified version of the plasmid vector, designed to last for months within the body. Direct quantification of the antibody proved difficult, however, Tristan’s blood serum seemed to bind to HIV’s envelope (GP120) relatively better after the injection via an ELISA.

N6 V1 (2017)

The initial version was a basic plasmid which had had the N6 gene inserted into it. The recipient, Tristan Roberts, was off of ART at the time. The first experiment did not yield meaningful results - subsequent viral load & CD4 tests were within historical ranges.

https://zora.co/collections/zora/8620

V1: Andreas Stuermer suggested that N6 might be suitable for a plasmid therapy; David Ishee was contracted by Aaron Traywick to make the first version, which was injected by Tristan Roberts in 2017. The majority of the funds are going towards a multi-sig wallet for future HIV research.

V2: Walter designed the plasmid, Tristan subjectively evaluated it, Jessica performed analysis on the samples, and Mac provided financial and emotional support. Similarly to V1, the majority of the proceeds from this auction will go towards a multi-sig wallet for future HIV research.

Entities included in the ‘Partners’ split include the multisig behind Desci.Eth, which is supporting travel to #DeSci conferences, the Foresight Institute, which funds radical new science, and the nascent Science Fund.

If the plasmid antibody delivery method later proves successful, this combination treatment anti-patent will be editioned and auctioned to fund a phase 1 study.

Maxon 3D suite, Adobe After Effects

License for Future IP

For Molecule’s second IP-NFT, we illustrated a key concept from the Korolchuk Lab’s research proposal. Using a “before” and “after” approach, this piece demonstrates how the compounds being investigated might reinvigorate a diseased cell’s dysfunctional autophagy pathways. Compared with the disease state on the left-hand side, the right-hand side shows the impact of these compounds, which are represented by the glowing blue particles in suspension. Color was used to distinguish the disease scenario (red tones typically suggest danger) from the solution scenario (blue and greens typically suggest health or resolve). When the compounds are present, many changes take place in the scene including mitochondria ‘boosting’, reinvigorated autophagy pathways, fusion of the lysosome and autophagosome, and degradation of damaging cellular contents.

https://opensea.io/assets/0x42d2354ef0b54279516f5799791086f2f499086e/34665775699924936448837419249216092913194045172233235244409387707174841393875

See it on OpenSea with the above link.