enshittify everything

In July 2026, the prediction market platform Kalshi announced it would host betting on the outcomes of clinical trials and US Food and Drug Administration (FDA) regulatory reviews, creating the first public odds on drug development.1 One listed wager asks whether POLARIS-AD, an ongoing phase 3 trial of mirodenafil in early Alzheimer disease, will meet its primary end point. Kalshi has built in safeguards for such “contracts”: betting opens only after trial enrollment closes, users must attest they are not trial personnel, and trading on material nonpublic information is prohibited. These safeguards are meant to prevent misconduct. Instead, they expose the fundamental flaw in the platform’s premise: enrollment completion is not trial completion. For trials like POLARIS-AD, which depend on months of follow-up data collection after the last participant enrolls, the exact period during which Kalshi prices a public, financially incentivized probability is the period during which that outcome is still being generated. Participants in POLARIS-AD enrolled under an explicit set of protections, including informed consent, risk minimization, and data confidentiality, that never contemplated the possibility of their treatment course being turned into public bets by outsiders with direct financial interest in the results. Introducing those financial interests while follow-up data are still accruing changes the environment in which the trial is conducted, allowing the prediction market to become part of the experiment it claims only to forecast.