Cancer "Progress" Report
Despite hundreds of billions of dollars appropriated for cancer research, as well as the efforts of thousands of the world’s best minds, progress in preventing or curing cancer has been almost non-existent. I find this unacceptable. We should be doing better. We need to be doing better. So what’s the problem? and more importantly, how can we fix it?
In an excellent New York times piece, which I strongly recommend reading in its entirety, Gina Kolata explores why advances have been so elusive in the drive to cure cancer. (Kolata also smartly avoids the “war” metaphor.)
I find particularly troubling one of the problems she identifies:
And for all the money poured into cancer research, there has never been enough for innovative studies, the kind that can fundamentally change the way scientists understand cancer or doctors treat it. Such studies are risky, less likely to work than ones that are more incremental. The result is that, with limited money, innovative projects often lose out to more reliably successful projects that aim to tweak treatments, perhaps extending life by only weeks.
Kolata hits upon a problem that plagues not just cancer research but scientific research in general. Funding is given to popular ideas that are likely to be successful. Less popular and longshot ideas are unlikely to receive funding, and if they are lucky enough to receive grant money, it’s usually a drop in the bucket compared to popular mainstream approaches. To understand why this bias towards “successful” studies is problematic, note what a Sloan-Kettering cancer specialist explained to Kolata about, what exactly constitutes a “successful” idea or research study?
For example, a study may state that a treatment offers a “significant survival advantage” or a “highly significant survival advantage.” Too often, Dr. Saltz says, the word “significant” is mistaken to mean “substantial,” and “improved survival” is often interpreted as “cure.”
Yet in this context, “significant” means “statistically significant,” a technical way of saying there is a difference between two groups of patients that is unlikely to have occurred by chance. But the difference could mean simply surviving for a few more weeks or days. [Emphasis Mine]
Billions spent on research yield expensive drugs with horrible side effects, that might give one an extra few weeks to live. Certainly, this is not always the case, but far too often it is. I find this both disappointing and sad. As Kolata explains, a different definition of success tells a different story because the death rate for cancer has barely changed since 1950:
Data from the National Center for Health Statistics show that death rates over the past 60 years — the number of deaths adjusted for the age and size of the population — plummeted for heart disease, stroke, and influenza and pneumonia. But for cancer, they barely budged.
The numbers are “plummeting” for many of the leading causes of death, but for cancer, they don’t seem to moving at all. All the money, all the awesome technology, all the hard work, and we have precious little to show for it. Does this bother anyone? Is it possible that we are doing something wrong? Perhaps we should try some new approaches?
There is a faint glimmer of hope. The director of the National Cancer Institute (NCI) has recently recognized that “the theories of Darwinian and somatic evolution can help us better understand and control cancer.” To support this and other interdisciplinary research, the NCI is committing $75 – 150M over five years. But, $15 – 20M a year is not enough. There are far too many valuable researchers lost in the long tail of science. We need more money. We need fresh ideas and different approaches. The time for change is long overdue.
Related posts:
- Physics.Cancer.GOV
- Approaching a Cure for Cancer
- The Conflict Between Complex Systems and Reductionism
- One Company, Two Approaches to Cancer
- Cancer as Evolution — 2008 Summary
4 Responses to “Cancer "Progress" Report”
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great argument. it always comes down to the incentive structure.
[...] Provenge stimulates T-Cell proliferation and theses cells lyse the cancer cells. Although the NY Times reports it is “proof of concept” that cancer vaccines can and do work it doesn’t seem to be particularly far in the research space from mainstream work with the concerns pointed out by Rafe here and Daniel here. [...]
For quite some time now, i’ve been thinking that the corporate incentive structure is UNFAIR. Not because of the absolute level of compensation. Lebron James ain’t hurting anyone and neither is Puff Daddy. What I think MIGHT be a problem are the short term incentives, like 1-year cash bonuses based in part on (unrealistic) accounting measures like EPS. Giving these cash bonuses is like handing out “call options”, which practically always encourages risky behavior (higher implied volatility). The other issue is that the board ought to be paid in stock ONLY. BUT having read this post, I’m beginning to think that the positives (growth) may actually outweight the negatives (lack of stability). The reality is that LEVERAGE is what turns mistakes into CRISIS. A mistake without leverage is curable with time.
As far as applying it healthcare R&D – that’s very tough. I don’t know if free markets provide the correct framework. In reality if you have cancer, you want to extend your life. If you don’t have cancer, you want to put that ugly reality somewhere in a dark corner of your brain and eat an apple once a day hoping that you never have to confront your mortality that way. So the way the PUBLIC AND markets see it, the real problem IS extending people’s lives that already have cancer. It seems very short sighted, but i’m a bit hesitant in declaring it so. Democracy and free market do sacrifice the minority. Of course when it comes to health, it feels so inhumane. So the only point is that the NATURAL incentive structure has a bit of a free rider problem. So we DO need the government to step in and throw out some carrots for original research. BUT it’s very rare that we can outsmart and outincentivize the market. If you’re out of school, then the laternatives to government money are much better. so i’m guessing those funds will hit school researchers. Nothing wrong with that in my opinion. those are the people that don’t have the normal incentives to begin with, so unfortunately i don’t think we can REFOCUS the corporate sector, but i also am not sure that’s such a good idea to begin with. Increasing funds for original thinking in schools – go for it. but those guys would have probably done the reseach anyways :)
@Alex You got it. We need to find better ways to incentivize risky approaches and outside the box thinking. The current system for allocating scientific research funding rewards those who follow safe, popular, mainstream ideas (which also don’t include much interdisciplinary research.) Any ideas on how we can improve the incentive structure?