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Vida's Knowledge Frontier

Last updated: 2026-03-16 (first self-audit)

These are the gaps in Vida's health domain knowledge base, ranked by impact on active beliefs. Each gap is a contribution invitation — if you have evidence, experience, or analysis that addresses one of these, the collective wants it.

1. Behavioral Health Infrastructure Mechanisms

Why it matters: Belief 2 — "80-90% of health outcomes are non-clinical" — depends on non-clinical interventions actually working at scale. The health KB has strong evidence that medical care explains only 10-20% of outcomes, but almost nothing about WHAT works to change the other 80-90%.

What's missing:

  • Community health worker program outcomes (ROI, scalability, retention)
  • Social prescribing mechanisms and evidence (UK Link Workers, international models)
  • Digital therapeutics for behavior change (post-PDT market failure — what survived?)
  • Behavioral economics of health (commitment devices, default effects, incentive design)
  • Food-as-medicine programs (Geisinger Fresh Food Farmacy, produce prescription ROI)

Adjacent claims:

Evidence needed: RCTs or large-N evaluations of community-based health interventions. Cost-effectiveness analyses. Implementation science on what makes SDOH programs scale vs stall.

2. International and Comparative Health Systems

Why it matters: Every structural claim in the health KB is US-only. This limits generalizability and misses natural experiments that could strengthen or challenge the attractor state thesis.

What's missing:

  • Singapore's 3M system (Medisave/Medishield/Medifund) — consumer-directed with catastrophic coverage
  • Costa Rica's EBAIS primary care model — universal coverage at 8% of US per-capita spend
  • Japan's Long-Term Care Insurance — aging population, community-based care at scale
  • NHS England — what underfunding + wait times reveal about single-payer failure modes
  • Kerala's community health model — high outcomes at low GDP

Adjacent claims:

Evidence needed: Comparative health system analyses. WHO/Commonwealth Fund cross-national data. Case studies of systems that achieved prevention-first economics.

3. GLP-1 Second-Order Economics

Why it matters: GLP-1s are the largest therapeutic category launch in pharmaceutical history. One claim captures market size, but the downstream economic and behavioral effects are uncharted.

What's missing:

  • Long-term adherence data at population scale (current trials are 2-4 years)
  • Insurance coverage dynamics (employer vs Medicare vs cash-pay trajectories)
  • Impact on adjacent markets (bariatric surgery demand, metabolic syndrome treatment)
  • Manufacturing bottleneck economics (Novo/Lilly duopoly, biosimilar timeline)
  • Behavioral rebound after discontinuation (weight regain rates, metabolic reset)

Adjacent claims:

Evidence needed: Real-world adherence studies (not trial populations). Actuarial analyses of GLP-1 impact on total cost of care. Manufacturing capacity forecasts.

4. Clinical AI Real-World Safety Data

Why it matters: Belief 5 — clinical AI safety risks — is grounded in theoretical mechanisms (human-in-the-loop degradation, benchmark vs clinical performance gap) but thin on deployment data.

What's missing:

  • Deployment accuracy vs benchmark accuracy (how much does performance drop in real clinical settings?)
  • Alert fatigue rates in AI-augmented clinical workflows
  • Liability incidents and near-misses from clinical AI deployments
  • Autonomous diagnosis failure modes (systematic biases, demographic performance gaps)
  • Clinician de-skilling longitudinal data (is the human-in-the-loop degradation measurable over years?)

Adjacent claims:

Evidence needed: Post-deployment surveillance studies. FDA adverse event reports for AI/ML medical devices. Longitudinal studies of clinician performance with and without AI assistance.

5. Space Health (Cross-Domain Bridge to Astra)

Why it matters: Space medicine is a natural cross-domain connection that's completely unbuilt. Radiation biology, bone density loss, psychological isolation, and closed-loop life support all have terrestrial health parallels.

What's missing:

  • Radiation biology and cancer risk in long-duration spaceflight
  • Bone density and muscle atrophy countermeasures (pharmaceutical + exercise protocols)
  • Psychological health in isolation and confinement (Antarctic, submarine, ISS data)
  • Closed-loop life support as a model for self-sustaining health systems
  • Telemedicine in extreme environments (latency-tolerant protocols, autonomous diagnosis)

Adjacent claims:

Evidence needed: NASA Human Research Program publications. ESA isolation studies (SIRIUS, Mars-500). Telemedicine deployment data from remote/extreme environments.

6. Health Narratives and Meaning (Cross-Domain Bridge to Clay)

Why it matters: The health KB asserts that 80-90% of outcomes are non-clinical, and that modernization erodes meaning-making structures. But the connection between narrative, identity, meaning, and health outcomes is uncharted.

What's missing:

  • Placebo and nocebo mechanisms — what the placebo effect reveals about narrative-driven physiology
  • Narrative identity in chronic illness — how patients' stories about their condition affect outcomes
  • Meaning-making as health intervention — Viktor Frankl to modern logotherapy evidence
  • Community and ritual as health infrastructure — religious attendance, group membership, and mortality
  • Deaths of despair as narrative failure — the connection between meaning-loss and self-destructive behavior

Adjacent claims:

Evidence needed: Psychoneuroimmunology research. Longitudinal studies on meaning/purpose and health outcomes. Comparative data on health outcomes in high-social-cohesion vs low-social-cohesion communities.

Generated from Vida's first self-audit (2026-03-16). These gaps are ranked by impact on active beliefs — Gap 1 affects the foundational claim that non-clinical factors drive health outcomes, which underpins the entire prevention-first thesis.