Sunday, June 28, 2009

Research funding or Why we have still haven't found a cure for cancer

Cancer has ben known to medicine since the time of Hippocrates. And modern medicine has known and studies causes of cancer since the mid-18th century. In 1971, Nixon announced a project to create a cure for cancer and (a la Kennedy, with regard to the moon mission) announced a definite cure in the next five years. Today, nearly 40 years and $105 billion dollars of public investment later (the private investment can be considered to be at least a significant fraction the public investment), we are no closer to finding a cure. In fact, after adjusting for age and size of the population, the cancer death rate has dropped by only 5% in the last 50 years. Compare this with nearly 60% drop in the death rates of diseases like pneumonia and influenza. Why is this the case?

Part of the reason is that cancer has multiple causes and we are not really sure about the true causal linkage between the various factors and the cancer cells misbehaving. Environmental factors cause some types, exposure to radioactivity causes other types, tobacco is a well-known factor causing mouth and lung cancer and there are viruses that cause still some other types. The common thread linking all of these causal factors and the various different types of cancers they cause is difficult to isolate. And therefore while we continue to make some improvements around the margin (getting people to live for a few additional months or years), a true cure has been elusive.

But another likely cause is the way in which various research funding agencies have made investment prioritization decisions. The funds have invariably gone to small-budget, incremental improvement type projects which are usually along previously established avenues of inquiry. The truly innovative approaches and especially the risky (from a success of the project standpoint) proposals have seldom obtained funding. The process developed to identify research subjects have been good at avoiding funding truly bad research. However, by the same token, they have continued to fund projects that are conventional and low risk and as a result, only contributing to marginal improvements. A recent article in the New York Times sheds some more light on to this topic.

My view is that this is quite a common problem (sub-optimal funds allocation) when funds are limited. This is not only true for cancer research in particular or any other form of medical research in general, but even in the financial services industry that I am part of. The funds allocation agency feels pressure not to waste the limited funds and also to make sure that the maximum amount of research projects get the benefits of the fund. Therefore the push to fund projects that are from proven areas and are set up to make incremental improvements to the areas. Also, this leads to a tendency to parcel the funds and distribute small quantities into a large number of projects, While what they should be paradoxically doing (given the shortage of funds) is to make the bold bet and fund those areas which may not be as proven but show the highest promise for overall success. Again, this happens more commonly than in the field of cancer research.

Challenging the financial budget, the status-quo way of thinking is not easy to do. There will be people who will say No and be discouraging, rarely because them have something to lose but mostly because the tendency is to play safe. People usually do not get fired for taking the safe, conventional-wisdom driven decisions. It is the risk-takers that get panned if the risks do not play out as expected.

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