As a soon-to-be seventh grader, Joshua Pederson's son is not exactly brimming with enthusiasm when he talks about the upcoming school year.
"The thing I'm looking forward to most in seventh grade is lunch, and the thing I'm looking forward to least is everything else," said the 12-year-old.
Art is his passion, but he doesn't take classes. He likes teaching himself.
"I like drawing scary stuff and robots," he said. "Because I think scary stuff and robots are cool."
Two years ago, his parents, who live in Boston, noticed a lump around his ribs that quickly spiraled into a nightmare scenario: It was cancer.
Pederson asked that his son's name be withheld to discuss details of his medical condition.
After months of grueling chemotherapy and radiation, he was declared cancer-free last summer. Months later, however, the cancer returned. So Pederson entered his son into a clinical trial for a novel treatment.
That's around the time Pederson read the news that prediction market sites Kalshi and Polymarket have begun allowing people to bet on the outcomes of clinical trials and whether the Food and Drug Administration will approve new medications.
"What seemed to be missed in the CEO statements was the fact that there were going to be patients on the other side of these bets," said Pederson, who is a humanities professor at Boston University.
Bettors will make or lose money based on the success or failure of a clinical trial, a situation Pederson views as horrific.
"A clinical trial failing is a more sanitized euphemism for, people are going to suffer, people are going to die, people are going to have one fewer clinical option available to them in one of the most difficult medical situations of their entire life," he said.
Researchers fear 'undermining trial integrity'
Billions of dollars are traded every week on the lightly regulated prediction market sites, where users bet on everything from movie reviews to elections to conflicts in the Middle East. Clinical trials are just the latest area where the industry's rapid growth is raising ethical questions.
Kalshi claims such bets will provide a new source of information about which drugs will get approved, and what clinical trials will show promising results, which the company says can help investors decide what new drugs to fund.
"If you want to ban profiting from the failure of clinical trials, you would start with the stock market, where the financial incentive for this type of profit is orders of magnitude larger," said Kalshi spokesman Jack Such, pointing to stock market short sellers who have profited from clinical trial failures.
"While Kalshi and the stock market are the same in this regard, they do differ in one important way: the stock market doesn't give any valuable information to researchers," Such said.
Drug trial researchers, though, are far from convinced.
David Tsai, who runs clinical trials at a biotech company in the San Francisco Bay Area, started an online petition pushing for such betting to be banned, making the case that betting on drug trials "threatens the very foundation of trust and integrity in biotechnology."
Tsai is concerned that the prospect of betting provides those involved with a clinical trial a reason to tamper with the results for a prediction market payout.
"If we were running a trial for an oncology drug that requires an infusion, a pharmacist who had placed a bet saying that it's gonna work well, or doesn't work well, could obviously adjust the infusion rate, could adjust the source temperature of the drug," he said. "They could change any number of variables that could obviously have a direct impact [on] how the trial and the data and the patient safety would come out."
Another skeptic is Nicholas Zaorsky, a professor of radiation oncology at the Mayo Clinic in Jacksonville, Fla., who has helped run clinical trials and agrees that prediction markets can interfere with the advancement of life-saving drugs.
"Prediction markets can be valuable in some settings because they aggregate information, but clinical trials are fundamentally different: investigators, coordinators, and sometimes even participants can directly influence aspects of the outcomes being wagered on," Zaorsky said. "That creates financial incentives that risk undermining trial integrity."
Patient's father: People betting on trials are 'distanced from the real cost'
Kalshi has tapped its own experts, including Anne Wojcicki, the founder of genetic testing company 23andMe, to vouch for the markets as a way of staying ahead of medical breakthroughs and for making clinical trials more accessible.
"Most patients don't know about the choices available in clinical trials or which programs are most promising. The opportunity to have an open, transparent dataset about trial probabilities is extremely promising and empowering for people," a white paper sponsored by Kalshi stated.
On Kalshi, users can currently bet on whether a weight-loss medication and a breast cancer treatment will be approved by federal regulators and on what date.
Polymarket, which declined to comment, is taking wagers on the approval of cancer treatments and whether the U.S. will allow Chinese peptides to be sold to Americans.
The possibility of insider trading, Kalshi argues, will be minimized by company safeguards verifying employment and tools to surveil for unusual market activity.
Indeed, prediction markets have helped identify insider traders in other markets, from President Trump's teleprompter operator to former Congressman George Santos to a special forces soldier who was betting based on military intelligence about the toppling of Venezuelan leader Nicolás Maduro.
Given just how many people can be involved with clinical trials, Tsai thinks it might not be so easy to preemptively catch every bad actor.
Pederson is also skeptical. He argues the markets obscure the patients at the center of clinical trials, who have the most at stake from their outcomes.
"One of the things that has struck me about these platforms is that they're flashy and they're gamified in such a way that you're often kind of distanced from the real cost," he said.
Kalshi says it is offering bets on late-stage clinical trials where participants have already been chosen. And it says it won't allow betting on markets where all trial subjects are minors. But that could change.
If it does, Pederson says wondering whether researchers in a trial could be motivated by prediction market profits will add to his anxieties — and to the burden his son is already carrying.
"The weight on him and what he's being asked to do, and what he's being asked to endure, is already so much," Pederson said.
He hopes that Kalshi and Polymarket will stop letting speculators place bets that clinical trials won't succeed.
Bettors, he argues, should not be rooting for an experimental medicine to fail just to earn a buck.
"It's a dark idea," he said. "It's quite ghastly."
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