TruthCert > The Warning
Have you not heard the tale of the physicians
who, certain of their cure,
killed more patients than the disease itself?
who, certain of their cure,
killed more patients than the disease itself?
The Year Was 1989
UNITED STATES
Every cardiologist in America knew the logic: irregular heartbeats after a heart attack
were dangerous. Drugs that suppressed these arrhythmias would surely save lives.
The reasoning was sound. The mechanism was clear. The drugs were prescribed to 200,000 Americans every year.
No one demanded proof. The logic was enough.
The reasoning was sound. The mechanism was clear. The drugs were prescribed to 200,000 Americans every year.
No one demanded proof. The logic was enough.
Echt DS et al. NEJM 1991; Moore TJ. Deadly Medicine, 1995
And then came the trial called CAST...
50,000
Americans killed by "the cure" each year
IN SIMPLE WORDS
Doctors gave medicine that made sense but had never been tested properly.
The medicine killed more people than the Vietnam War. Every year.
"And the numbers were naked—
without witness, without proof, without certification.
And the people perished."
without witness, without proof, without certification.
And the people perished."
This is why TruthCert exists.
Do you think such catastrophes happen only in America?
Consider Africa.
Consider Africa.
The Burden of Borrowed Evidence
90%
of clinical trials
outside Africa
outside Africa
13%
of global disease
burden in Africa
burden in Africa
<2%
of global health
research funding
research funding
IN SIMPLE WORDS
Africa has many sick people but very few studies about how to treat them.
Doctors must use treatments tested on people in other countries.
But what works in London may not work in Lagos.
Have you not seen the thirteen nations
where mothers die giving life,
where children fall to fever,
where decisions are made in the dark?
where mothers die giving life,
where children fall to fever,
where decisions are made in the dark?
Thirteen Nations
Maternal deaths per 100,000 live births (WHO 2020)
NGA
Nigeria
917
GHA
Ghana
308
KEN
Kenya
342
TZA
Tanzania
524
UGA
Uganda
284
ZAF
South Africa
127
SLE
Sierra Leone
1,120
LBR
Liberia
652
CIV
Cote d'Ivoire
617
BEN
Benin
523
BFA
Burkina Faso
320
GMB
The Gambia
458
SWZ
Eswatini
240
Compare: UK = 10, USA = 21, Sweden = 4
SIERRA LEONE
In Freetown, a woman giving birth is 112 times more likely to die
than a woman in London.
The health minister must decide: Which interventions deserve the limited budget? Which treatments will save the most mothers?
She has studies from Europe. She has models from America.
But does she have proof that applies to her people?
The health minister must decide: Which interventions deserve the limited budget? Which treatments will save the most mothers?
She has studies from Europe. She has models from America.
But does she have proof that applies to her people?
WHO Maternal Mortality Report, 2023
Seven Disease Groups
HIV
25.6M in Africa
MAL
95% of deaths
MCH
Mother & Child
NCD
Chronic Disease
CVD
Heart Disease
NTD
Tropical Disease
HSP
Health Systems
13 countries x 7 disease groups = 91 configuration packs
"And they took the evidence from afar,
without testing if it fit their land,
without certifying if it fit their people.
And the numbers were naked."
without testing if it fit their land,
without certifying if it fit their people.
And the numbers were naked."
But what if every number had to show its face?
What if every statistic had to name its witness?
What if naked numbers were forbidden?
What if every statistic had to name its witness?
What if naked numbers were forbidden?
TruthCert
Clothing the naked numbers
🔒
The Core Rule
No number shall be shown to decision-makers
unless it carries proof of its origin,
proof of its transformation,
and proof of its validity for this context.
IN SIMPLE WORDS
Every number must answer: "Where did you come from?" and "Can I trust you here?"
What Is Proof?
1
Evidence Locator
The exact study, database, or source where this number came from
2
Content Hash
A digital fingerprint proving the data hasn't been changed
3
Transformation Trail
Every calculation step from raw data to final number
4
Validation Status
Did automated checks pass? What were the warnings?
What TruthCert Output Looks Like
TRUTHCERT CERTIFIED CLAIM
claim: "Misoprostol reduces PPH by 24%"
grade: STABLE
context: NGA (Nigeria)
african_studies: k = 6 # meets GO threshold
effect_size: RR 0.76 [95% CI: 0.68-0.84]
evidence_locator: doi:10.1016/S0140-6736(10)60348-7
hash: sha256:a3f2c9...
cost_per_dose: NGN 450 # local currency
icer: NGN 12,400 per DALY averted
validated: PASS # all checks passed
Four Grades of Certainty
STABLE
Strong evidence. Proceed with confidence.
MODERATE
Good evidence with gaps. State uncertainty.
EXPOSED
Structural uncertainty. Scenarios only.
UNCERTAIN
Refuse false precision. Bounds only.
How Grades Are Assigned
Grade
African Studies (k)
What You Can Do
STABLE
k >= 4 with low heterogeneity (I² < 50%)
Full HTA, PSA, VOI, point estimates
MODERATE
k >= 4 with high heterogeneity, OR k = 2-3
Full HTA with widened CIs, emphasize uncertainty
EXPOSED
k = 1, OR significant transportability concerns
Scenario analysis only, no point estimates
UNCERTAIN
k = 0, OR evidence from memory/unverified
Bounds only, worst-case, value-of-research
What Is Forbidden
MEMORY-LEAK = BLOCK
If someone says "I remember the statistic was about 30%"—
that cannot be certified.
Memory is not evidence. Recollection is not proof.
that cannot be certified.
Memory is not evidence. Recollection is not proof.
IN SIMPLE WORDS
You cannot say "I think I heard..." or "Someone told me..."
You must show exactly where the number came from.
When a government has only $50 per person per year for health,
how do you decide which treatments to fund?
how do you decide which treatments to fund?
Health Technology Assessment
THE CORE QUESTION
For every Naira, Cedi, or Shilling spent,
how much health do we gain?
And what else could we have done with that money?
The Threshold Trap
A WARNING FROM HISTORY
For years, economists said: "Cost-effective if it costs less than 3x GDP per capita."
By this logic, a $3,000 treatment would be "worth it" in America (GDP $76,000) but "not worth it" in Sierra Leone (GDP $500).
The same treatment. The same benefit. Different verdicts based on where you were born.
By this logic, a $3,000 treatment would be "worth it" in America (GDP $76,000) but "not worth it" in Sierra Leone (GDP $500).
The same treatment. The same benefit. Different verdicts based on where you were born.
Woods B et al. Lancet Global Health 2016; Revill P et al. Health Policy Plan 2018
A Better Way
A
Affordability Analysis
Can the health system actually pay? What else gets cut?
N
Net Health Benefit
Health gained minus health lost by diverting resources
V
Value of Information
Is it worth doing more research before deciding?
Local Currency. Always.
NGN
Nigerian Naira
GHS
Ghana Cedi
KES
Kenyan Shilling
XOF
CFA Franc
WHY THIS MATTERS
A minister in Accra budgets in Cedis.
She shouldn't have to convert from dollars.
Her budget, her currency, her decision.
"And when the numbers were clothed in proof,
when every claim showed its source,
when the currency matched the land—
then the decision-makers could see clearly."
when every claim showed its source,
when the currency matched the land—
then the decision-makers could see clearly."
In 2012, scientists at Amgen tried to reproduce
53 landmark cancer studies.
How many could they replicate?
53 landmark cancer studies.
How many could they replicate?
6
Only 6 of 53 landmark studies could be reproduced.
IN SIMPLE WORDS
89% of "breakthrough" studies were wrong or couldn't be repeated.
Treatments given to patients. Based on findings that failed.
Begley CG & Ellis LM. Nature 2012;483:531-533
The Discipline of the Seed
THE REQUIREMENT
Every TruthCert analysis must be exactly reproducible.
An analyst in Nairobi and an analyst in Geneva must get identical results.
786888
Master Seed
Fixed
All Random Processes
Logged
Every Step
Designed for Reality
THE CONSTRAINT
A health economist in Freetown has an ordinary laptop, maybe unreliable internet.
TruthCert must run on what she actually has.
60s
Core Analysis
45s
Uncertainty (5K draws)
Offline
Works Without Internet
"And the same seed was planted in Accra and in Geneva,
and the same fruit grew in both places.
And anyone could plant the seed again,
and harvest the same truth."
and the same fruit grew in both places.
And anyone could plant the seed again,
and harvest the same truth."
For Ministers & Directors
What you need to know in 3 minutes
What Each Grade Means for You
When TruthCert Says... You Should...
STABLE
Proceed with confidence. Present point estimates. Defend the numbers.
MODERATE
Proceed with caution. Show ranges. Say "between X and Y."
EXPOSED
Show scenarios. "If A, then X. If B, then Y." No single number.
UNCERTAIN
Say "we don't know." Request more research before committing.
When Politics Conflicts with Evidence
THE DIFFICULT SITUATION
A popular program has UNCERTAIN evidence. Constituents demand it. What do you do?
TruthCert gives you a shield:
"I want to help our people. But the evidence says we don't know if this works here. Let me fund a pilot study first—so we can be sure we're helping, not harming."
You're not saying no. You're saying "let's be sure."
TruthCert gives you a shield:
"I want to help our people. But the evidence says we don't know if this works here. Let me fund a pilot study first—so we can be sure we're helping, not harming."
You're not saying no. You're saying "let's be sure."
Your One-Page Summary
1
Numbers must have sources
If staff can't show where a number came from, don't use it
2
Look for African evidence
Ask "How many studies were done in Africa?" (need 4+ for confidence)
3
Demand local currency
Costs should be in Naira/Cedi/Shilling, not USD
4
Embrace uncertainty
"We don't know" is more honest than a fake precise number
Running Your First Analysis
A practical walkthrough
What You Need
Browser
Chrome/Firefox/Edge
Data
Your input YAML
~2 hrs
Training time
NO SPECIAL SOFTWARE NEEDED
TruthCert runs in your browser. No installation. Works offline after first load.
Five Steps
1
Select Country + Disease
Choose from 13 countries, 7 disease groups. Example: NGA + MCH
2
Input Local Data
Unit costs, target population, budget. In NGN (local currency).
3
Select Evidence
Link to studies. System counts African studies (k) automatically.
4
Run Analysis
Click "Certify." Wait ~60 seconds. System assigns grade.
5
Export Results
Download PDF report. All claims have evidence locators + hashes.
Where to Get Data
1
Unit Costs
WHO-CHOICE database, iDSI costing studies, local MOH price lists
2
Disease Burden
GBD (Global Burden of Disease), DHS surveys, local HMIS
3
Effect Sizes
Cochrane reviews, published meta-analyses, WHO guidelines
4
Budget Data
National health accounts, MOF budget documents, donor reports
When African Evidence is Sparse
IF k < 4 (LESS THAN 4 AFRICAN STUDIES)
TruthCert won't give you a fake confident answer. Instead:
1
Pivot to broader group
If "CVD in Ghana" has k=1, try "NCD in West Africa"
2
Use scenario analysis
Show best-case, worst-case, and middle scenarios
3
Calculate Value of Information
Would a new local study be worth funding?
Sustainability
How TruthCert survives long-term
📁
Open Source
Code is public. Anyone can run, modify, improve.
🎓
Train Locals
Each country builds own HTA capacity. Not dependent on outsiders.
💻
Offline-First
Works without internet. No cloud subscription needed.
What TruthCert Cannot Do
⚠
Cannot create evidence. If no studies exist, TruthCert can't invent them.
⚠
Cannot guarantee political acceptance. Evidence is necessary but not sufficient for policy change.
⚠
Cannot replace judgment. It informs decisions, doesn't make them.
⚠
Cannot fix bad data. If your input costs are wrong, outputs will be wrong.
⚠
Cannot account for implementation. A cost-effective intervention badly implemented may fail.
"TruthCert does not promise certainty.
It promises honesty about uncertainty.
And that honesty saves lives."
It promises honesty about uncertainty.
And that honesty saves lives."
References
Key Sources Cited in This Course
- Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: The CAST. NEJM 1991;324:781-788.
- Moore TJ. Deadly Medicine: Why Tens of Thousands of Heart Patients Died in America's Worst Drug Disaster. Simon & Schuster, 1995.
- Begley CG, Ellis LM. Drug development: Raise standards for preclinical cancer research. Nature 2012;483:531-533.
- Woods B, Revill P, Sculpher M, Claxton K. Country-level cost-effectiveness thresholds: initial estimates and the need for further research. Lancet Global Health 2016;4:e594-e601.
- WHO. Trends in maternal mortality 2000-2020. Geneva: World Health Organization, 2023.
- WHO. World Malaria Report 2022. Geneva: World Health Organization, 2022.
- UNAIDS. Global HIV Statistics 2023. Geneva: UNAIDS, 2023.
- Revill P, Ochalek J, Lomas J, et al. Cost-effectiveness thresholds: guiding health care spending for population health improvement. Health Policy Plan 2018;33:707-716.
In the story of the physicians who "knew" their cure would work, what did the CAST trial reveal?
The drugs worked as expected
The drugs killed more people than they saved
The drugs had no effect
The trial was inconclusive
When the numbers are "naked," what does this mean?
They are displayed without formatting
They are approximations
They have no proof of where they came from
They are in the wrong currency
A minister receives a TruthCert report marked "EXPOSED." What should she do?
Reject the program completely
Proceed as if evidence were strong
Present scenarios ("if A then X, if B then Y") and consider a pilot
Wait for more international studies
Why does TruthCert insist on local currency?
To make calculations easier
Because ministers budget in local currency and shouldn't have to convert
To avoid exchange rate fluctuations
It's an arbitrary requirement
✔
Course Complete
"And when the numbers were clothed,
when every claim carried its proof,
when the evidence was tested in the land where it would be used—
then the mothers lived,
and the children thrived,
and the decision-makers could sleep at night."
when every claim carried its proof,
when the evidence was tested in the land where it would be used—
then the mothers lived,
and the children thrived,
and the decision-makers could sleep at night."
This is TruthCert.
What if history had given us warnings—
written in spreadsheets, hidden in data,
buried in files no one thought to check?
written in spreadsheets, hidden in data,
buried in files no one thought to check?
These are the stories of certainty, error, and the price of not verifying.
What if a spreadsheet error
shapes the fate of nations?
shapes the fate of nations?
The Spreadsheet That Changed History
THE REAL DATA
In 2010, Harvard economists Reinhart and Rogoff published "Growth in a Time of Debt".
Their claim: when a country's debt exceeds 90% of GDP, economic growth collapses.
Politicians worldwide cited this to justify austerity measures—cutting public spending, reducing services, freezing wages.
Then in 2013, a graduate student named Thomas Herndon asked for their spreadsheet. He found: an Excel error that excluded 5 countries, selective data weighting, and unconventional methods. The true relationship was much weaker.
Politicians worldwide cited this to justify austerity measures—cutting public spending, reducing services, freezing wages.
Then in 2013, a graduate student named Thomas Herndon asked for their spreadsheet. He found: an Excel error that excluded 5 countries, selective data weighting, and unconventional methods. The true relationship was much weaker.
Herndon, Ash & Pollin (2014). Cambridge Journal of Economics.
The Two Paths
You are a policy advisor. Reinhart-Rogoff is on your desk. What do you do?
Path A: Trust the Result
Accept the 90% threshold as fact
↓
Advocate austerity policies
↓
Millions suffer from unnecessary budget cuts, unemployment rises, recovery stalls
Path B: Request the Data
Ask for the spreadsheet and methods
↓
Discover the Excel error
↓
Make evidence-based policy that actually serves citizens
THE REVELATION
The Excel spreadsheet error is why we need reproducibility.
If Reinhart and Rogoff had been required to share their spreadsheet,
the error would have been found in 2010, not 2013.
Three years of policy built on a formula that missed five cells.
Three years of policy built on a formula that missed five cells.
THE LESSON
Reproducibility is not bureaucracy. It is the difference between
discovering an error before nations act on it—and after.
What happens when genomic signatures
are built on sand?
are built on sand?
The Trials Built on Fraud
THE REAL DATA
Dr. Anil Potti at Duke University published genomic predictors claiming to match
cancer patients to the chemotherapy most likely to help them.
Clinical trials enrolled patients. Treatments were selected based on his algorithms. The promise: personalized medicine that could revolutionize cancer care.
Then investigations revealed: fabricated data, impossible results, manipulated figures. The trials were halted. Patients had received treatments based on fraud.
Clinical trials enrolled patients. Treatments were selected based on his algorithms. The promise: personalized medicine that could revolutionize cancer care.
Then investigations revealed: fabricated data, impossible results, manipulated figures. The trials were halted. Patients had received treatments based on fraud.
Baggerly & Coombes (2009). Annals of Applied Statistics. IOM Report (2012).
The Two Paths
You are a cancer patient in 2010. You are offered a Potti-guided treatment. What do you do?
Path A: Trust the Publication
Accept the prestigious journal's findings
↓
Enroll in the clinical trial
↓
Receive treatment based on fraud—potentially harmful, definitely not personalized
Path B: Ask About Validation
Request evidence of independent replication
↓
Discover none exists
↓
Avoid harmful treatment—wait for properly validated approaches
THE REVELATION
Reproducibility is not bureaucracy. It is patient protection.
The Duke scandal led to the Institute of Medicine recommending that omics-based tests require independent validation before clinical use.
The policy came too late for patients in those trials.
The Duke scandal led to the Institute of Medicine recommending that omics-based tests require independent validation before clinical use.
The policy came too late for patients in those trials.
THE LESSON
Independent validation saves lives. A prestigious institution,
a famous researcher, a top journal—none of these replace the simple act
of having someone else check the work.
Can dead trials
be brought back to life?
be brought back to life?
The Resurrection of Buried Evidence
THE REAL DATA
The RIAT initiative (Restoring Invisible and Abandoned Trials)
identified clinical trials with unpublished or misreported results.
Study 329 (paroxetine for adolescent depression): The original 2001 publication claimed the drug was "safe and effective." For 14 years, doctors prescribed it based on this claim.
RIAT researchers obtained the full data. Their 2015 reanalysis found: the drug was neither safe nor effective for this population. The original authors had selectively reported outcomes.
Study 329 (paroxetine for adolescent depression): The original 2001 publication claimed the drug was "safe and effective." For 14 years, doctors prescribed it based on this claim.
RIAT researchers obtained the full data. Their 2015 reanalysis found: the drug was neither safe nor effective for this population. The original authors had selectively reported outcomes.
Le Noury et al. (2015). BMJ. RIAT Project: riat-support.org
The Two Paths
You discover that a trial was misreported 15 years ago. Harm may still be occurring. What do you do?
Path A: Accept It Is Too Late
Assume the moment has passed
↓
The flawed study remains the record
↓
Old harms continue—doctors keep prescribing based on false evidence
Path B: Seek the Original Data
Obtain raw data through legal/regulatory means
↓
Reanalyze and publish the correction
↓
Prevent future harm—update guidelines, change practice
THE REVELATION
It is never too late to correct the record.
RIAT proved that with determination and data access, even decades-old deceptions can be overturned.
The truth does not expire. Neither does the obligation to seek it.
RIAT proved that with determination and data access, even decades-old deceptions can be overturned.
The truth does not expire. Neither does the obligation to seek it.
THE LESSON
Data access enables justice. When original data is locked away,
errors and fraud become permanent. When data is accessible,
the scientific record can always be corrected.
What fraction of published findings
are actually true?
are actually true?
The Replication Crisis
THE REAL DATA
The Open Science Collaboration (2015) attempted to replicate
100 published psychology studies.
Original studies: 97% reported statistically significant results.
Replications: Only 36% achieved significance. Effect sizes dropped by half on average.
The "replication crisis" went mainstream. What we thought we knew— about priming, ego depletion, power posing—was far less certain than published.
Original studies: 97% reported statistically significant results.
Replications: Only 36% achieved significance. Effect sizes dropped by half on average.
The "replication crisis" went mainstream. What we thought we knew— about priming, ego depletion, power posing—was far less certain than published.
Open Science Collaboration (2015). Science. doi:10.1126/science.aac4716
The Numbers
97%
Original studies
significant
significant
36%
Replications
significant
significant
50%
Average effect
size drop
size drop
WHAT THIS MEANS
For every 3 psychology findings you read about, 2 may not replicate.
Not because of fraud—but because of noise, flexibility in analysis,
and the pressure to publish positive results.
The Two Paths
You are designing a clinical program based on published psychology research. What do you do?
Path A: Trust Original Publications
Build your program on published findings
↓
Invest resources in implementation
↓
Discover the foundation is unreliable—program fails to produce expected outcomes
Path B: Check for Replications
Search for independent replications first
↓
Find the 36% replication rate
↓
Demand stronger evidence—pilot test, require multi-site replication before scale
THE REVELATION
"Published" does not mean "true."
Replication is not doubt—it is the scientific method working as intended.
The crisis was not that science failed. The crisis was that we discovered how rarely we had been checking.
Replication is not doubt—it is the scientific method working as intended.
The crisis was not that science failed. The crisis was that we discovered how rarely we had been checking.
THE LESSON
Single studies are hypotheses, not facts. Before building policy
on research, ask: Has this been replicated? By whom? With what result?
Four Stories, One Truth
1
Reinhart-Rogoff
Share your data. An Excel error shaped austerity policy for years.
2
Duke Cancer Scandal
Require independent validation. Prestige does not equal truth.
3
RIAT Initiative
It is never too late. Buried evidence can be resurrected.
4
Replication Crisis
Published does not mean true. Replication is how science works.
"And when they did not verify,
when they trusted without checking,
when they assumed the prestigious were infallible—
the numbers remained naked,
and the people paid the price."
when they trusted without checking,
when they assumed the prestigious were infallible—
the numbers remained naked,
and the people paid the price."
"But when they demanded proof,
when they shared their data,
when they replicated before they trusted—
the truth emerged,
and the harm was prevented,
and knowledge advanced."
when they shared their data,
when they replicated before they trusted—
the truth emerged,
and the harm was prevented,
and knowledge advanced."
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