Medical research: cancer is hugely overfunded; here’s what to choose instead

Note: the be­low was posted to my blog; I ex­pect for­mat­ting etc will be ren­dered bet­ter there. Also some im­por­tant ap­pen­dices and foot­notes are available there, but not here. Apolo­gies to in­ter­na­tional read­ers for the UK slant on this ar­ti­cle, al­though I sus­pect that a similar story would ap­ply in other de­vel­oped coun­tries.

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If you’re go­ing to donate to med­i­cal re­search, don’t donate to can­cer—there are bet­ter choices. Cancer ac­counts for 43% of the re­search spend, but only 9% of the dis­ease bur­den, and you can see in the chart be­low that it’s an out­lier.

Hav­ing said this, it may still be a bet­ter choice than some other (non-med­i­cal-re­search) char­i­ties.




This chart seems to lead to the con­clu­sion that you should pick other ar­eas of re­search to fund, rather than can­cer, on the grounds that it’s already a crowded fund­ing area. Bet­ter ar­eas ap­pear to be re­pro­duc­tive health & child­birth and in­fec­tious dis­ease. If you want to see a table of the data from this chart, to­gether with the figures that show the gap be­tween the dis­ease bur­den and the re­search spend (this gap be­ing pro­por­tional to the dis­tance of the point from the red line on the above chart) check out the foot­note1. (re­minder—for foot­notes, see my blog)



Rea­sons why you might dis­agree with this con­clu­sion

1. Tractabil­ity—scale and ne­glect­ed­ness aren’t the only things that mat­ter
2. You may dis­agree with the DALY weights
3. The re­search spend figures are only show­ing part of the pic­ture
4. Some cat­e­gories may be be­ing re­searched, but aren’t cap­tured in these stats prop­erly
5. This chart uses global dis­ease bur­den—you may care about the lo­cal dis­ease bur­den
6. Th­ese cat­e­gories are too crude


1. Tractabil­ity—scale and ne­glect­ed­ness aren’t the only things that mat­ter
The chart above may seem to sug­gest that the scale of the prob­lem is the only fac­tor to con­sider. This is not the case. We may choose to fund some­thing be­cause we think that more progress will be made if we fund that area; in this sce­nario, we may say that this is a more tractable (or “easy”) area of re­search. In gen­eral tractabil­ity is good, be­cause fund­ing some­thing with a higher chance of suc­cess is bet­ter than fund­ing some­thing with a lower chance of suc­cess, all other things be­ing equal.

How­ever, we know that the funds *aren’t* be­ing al­lo­cated to can­cer as op­posed to other ar­eas be­cause donors have taken this into ac­count and con­sider can­cer to be more tractable.

So should we ex­pect bet­ter tractabil­ity, or bet­ter progress, from well-re­searched ar­eas (such as can­cer) or less-well-re­searched ar­eas (such as men­tal health)?

Some ex­am­ples to illus­trate what I mean:
- Cancer: Cancer Re­search UK talk about the cur­rent can­cer sur­vival rate hav­ing reached 50%, and their aim to reach 75% by 2034; my read­ing of their lan­guage is that they are op­ti­mistic that can­cer (an area which already has a track record of progress) is a good tractable area to fund.
- Men­tal Health: MQ (a men­tal health re­search re­search char­ity) seem to con­sider fund­ing un­der-funded re­search to be an op­por­tu­nity; as far as I can tell, they have made no ex­plicit claims that (for ex­am­ple) men­tal health may have lower hang­ing re­search fruit, so to speak. How­ever im­plicit in their lan­guage is the be­lief that tractabil­ity for men­tal health is at least as good as that of can­cer.

My—ad­mit­tedly cur­sory—con­ver­sa­tions with re­searchers sug­gest that there are ar­gu­ments both ways as the above ex­am­ples sug­gest. Some­times an un­der-ex­plored area can yield low-hang­ing fruits; some­times an area be­ing un­der-ex­plored means that re­searchers haven’t quite worked out the best re­search ques­tions to ask yet, which might mean that re­search in that area is lead­ing nowhere.

To my mind, both ar­gu­ments seem rea­son­able, so I’m in­clined to as­sume that we can treat tractabil­ity as roughly equal across health cat­e­gories. If any­one can give a bet­ter, and ev­i­dence-based, in­di­ca­tion of how to treat this, I would love to take this into ac­count.

2. You may dis­agree with the DALY weight­s
Deter­min­ing the dis­ease bur­den in­volves us­ing a mea­sure com­monly used by the WHO called the DALY, which counts how many years have been lost from peo­ple dy­ing to­gether with the num­ber of years spent in dis­abil­ity. DALYs gen­er­ally as­sume that be­ing dis­abled is bet­ter than be­ing dead, but how much bet­ter de­pends on the dis­abil­ity; a weight­ing fac­tor is as­signed to each type of dis­abil­ity2. How­ever get­ting these right is hard, and you may dis­agree with the WHO on this.

3. The re­search spend figures are only show­ing part of the pic­ture
It’s true that the figures fo­cus just on UK spend, and also ig­nore gov­ern­ment ex­pen­di­ture. It could be that, for ex­am­ple, that UK char­i­ta­ble can­cer re­search spend is re­ally high to make up for a lack of gov­ern­ment spend on can­cer re­search, or a lack of spend by other de­vel­oped na­tions. I sus­pect that this isn’t true, how­ever I haven’t done the dig­ging to check.

The rea­son I sus­pect that this isn’t true is (to echo an ear­lier com­ment): we know that the funds *aren’t* be­ing al­lo­cated to can­cer as op­posed to other ar­eas be­cause donors have taken this into ac­count and are mak­ing up for a lack of gov­ern­ment or in­ter­na­tional re­search spend.

4. Some cat­e­gories may be be­ing re­searched, but aren’t cap­tured in these stats prop­er­ly
For ex­am­ple, 2.7% of the global mor­bidity bur­den comes from road in­juries. It could be that re­search is hap­pen­ing on road in­juries, but (per­haps) it’s not cap­tured in the statis­tics be­cause the source of the data (the As­so­ci­a­tion of Med­i­cal Re­search Char­i­ties, or AMRC) used data that didn’t treat this as med­i­cal re­search.

Over­all, I don’t think this is likely to be a con­cern, ex­cept in “Other”, which in any case is a fairly un­helpful cat­e­gory.

5. This chart uses global dis­ease bur­den—you may care about the lo­cal dis­ease bur­den
In­ter­est­ingly, I had as­sumed that chang­ing the global dis­ease bur­den to the UK-spe­cific dis­ease bur­den would ac­count for the ap­par­ent over-al­lo­ca­tion to can­cer, how­ever it ap­pears that this only goes part of the way to­wards do­ing this—there is still a ma­te­rial over-al­lo­ca­tion to can­cer based on the UK prevalence of can­cer. I’ve cre­ated a copy of the above chart, but re­placed the global dis­ease bur­den with the UK-spe­cific dis­ease bur­den—you can find the chart be­low3. (re­minder—for foot­notes, see my blog)

6. Th­ese cat­e­gories are too crude
To a cer­tain ex­tent, this is a fair crit­i­cism—for ex­am­ple, lump­ing to­gether sev­eral differ­ent metabolic and en­docrine dis­eases leaves open some of the un­cer­tain­ties that arise from lump­ing things to­gether; e.g. maybe the pro­por­tion spent on di­a­betes re­search is (per­haps) higher than the pro­por­tion of dis­abil­ity bur­den at­tributable to di­a­betes, but we aren’t see­ing it be­cause the dis­ease bur­den for non-di­a­betes con­di­tions within the metabolic/​en­docrine cat­e­gory is also quite high. (I haven’t checked whether this is the case.) As a later piece of work, I may see whether it’s pos­si­ble break those cat­e­gories down fur­ther.

In par­tic­u­lar, “Other” is a no­tably crude and un­helpful cat­e­gory; it is likely that it in­cludes some sub-cat­e­gories which are more ne­glected than re­pro­duc­tive health or in­fec­tious dis­ease, so see­ing this break­down could be use­ful.

How­ever I don’t think it de­tracts from the con­clu­sion about can­cer—it’s still true that the UK al­lo­cates 43% of its re­search fund­ing to can­cer, whereas the only 9% of the global dis­abil­ity bur­den is for can­cer.

A minor note...
In case you’re feel­ing like you’ve seen some­thing like this be­fore… af­ter the ice bucket challenge there was an in­fo­graphic do­ing the rounds that com­pared how much money re­search char­i­ties got with how much they kill peo­ple. I would sug­gest that this chart is in fact much bet­ter than that in­fo­graphic—if you would like to know more, I’ve ex­panded on this in a foot­note.4 (re­minder—for foot­notes, see my blog)


And lastly, apolo­gies to in­ter­na­tional read­ers for the UK fo­cus of this piece. I sus­pect that its con­clu­sions would still ap­ply in most other coun­tries in the de­vel­oped world, but have not checked this.

For sources, ap­pen­dices, and foot­notes, please see http://​​think­ingaboutchar­ity.blogspot.co.uk/​​2017/​​08/​​donat­ing-to-med­i­cal-re­search-heres-why.html.