Wednesday, November 05, 2008

Research Funding: Low Hanging Fruit

A few weeks ago, Bayman posted a story from the Globe and Mail about unrealistic expectations for a cure for cancer and in the comments AC wrote
I think the expectation comes from the fact that we've basically cured many diseases that were low-hanging fruits [...] And it might or might not be worth the money; perhaps we could cure 100 smaller diseases for that price.
It turns out that focus on low-hanging fruit is also an issue within the cancer research community. The Independent reports that in spite of record levels of funding for cancer research in the UK many "unfashionable" cancers are being neglected:
Some of the deadliest cancers, such as those affecting the lung and pancreas, get the least amount of public money, while five cancers with some of the best survival rates, including breast and leukaemia, receive nearly two-thirds of the money.
This seems counterintuitive. One would think that cancers such as lung cancer - which remains the leading cause of cancer death for both men and women - would receive a higher percentage of funding dollars. But that isn't the case. This is attributed to the fact that current research focuses on areas where major discoveries are more likely or the disease is easier to study, and this is partly due to the fact that future grants can depend on past success so reaching for those higher fruits can be risky career-wise. Is this a problem? Should focus shift from areas with diminishing returns to those where there's still a lot of ground to be covered? Or should we finish off the 'low hanging fruit' before climbing the ladder? And if the former, how do we accomplish it?


Anonymous Coward said...

This is self-perpetuating too because the higher the survival rate (think breast cancer for example), the more survivors are left working as patient advocates and fundraisers.

kamel said...

Is that an argument for going after 'low hanging fruit'?

The Independent article makes the same claim - that more survivors means more advocates, but I'm not sure it makes perfect sense. Wouldn't lung cancer have just as many or more people who are touched by the disease? Not necessarily survivors but people who have lost a sibling/parent/spouse. Are survivors more likely to become or better advocates?

Breast cancer is a hard comparison to make since it's both one of the most common and most curable. What about a cancer like leukemia that has similar funding to lung cancer but affects fewer people (4500 vs 23900 new cases estimated for 2008 / 2400 vs 20200 deaths) and a better 5-year survival (50% vs 15%)? (these numbers are from the Canadian Cancer Society Cancer statistics booklet found here)

Of course there are other factors, such as the fact that leukemia is more common in children and lung cancer is associated with smoking.

So I guess that takes us back to my original question - how should we prioritize cancer research funding?

Anonymous Coward said...

I've been thinking about that very same question, because I have the impression that therapeutics which are chosen to undergo clinical trials do so more by chance than by virtue. There isn't any prioritizing going on to choose the medication with the greatest potential benefit to patients as a measure of say quality of life and number. I often see a virus being chosen over another or a dose and treatment regimen with little justification.
However free markets usually have a tendency to back winners, they are for example better at estimating odds (such as who will be elected). The only problem in relying only on businesses to prioritize therapeutics is that maximizing return on investment is not the same as maximizing benefit to patients, even if there is a significant overlap....

kamel said...

Sure a pharmaceutical company is going to maximize profits, but here we have government agencies and public money (NCI, NCRI, etc.) with arguably screwed up research priorities. Return on investment is a different equation for them. It's been a long time since I've taken economics but I would think for them the diminishing returns on highly treatable cancers would shift priority to areas where much more progress can be made, unless the problems of the field are really that much more daunting/expensive to tackle.