Is Research for Eliminating Cancer Intentionally Stifled?

About three months ago, someone made an interesting claim to me. Citing his encounter with an unnamed doctor at an unspecified event as his source, he claimed that almost all of cancer research funding is dedicated to what he called "controlling" the disease, or treating the disease after it has occurred. He further claimed that research into the complete elimination of the possibility of people getting cancer, for which he used the term "curing", is intentionally held back by refusing to fund such projects. The reason, according to him, was that pharmaceutical companies make more money if people get sick and need to be treated, and less money if less people suffer from horrible diseases such as cancer. In other words, no research that focuses on hitting cancer at its core gets funded. Apparently, he hadn't given much thought to the fact that most medical research is funded by organizations other than for-profit pharmaceutical companies [1]. In any case, he was very insistent that I believe his claim solely on the authority of an unknown doctor whose authority I had no way of verifying. Go figure!

What I present here is based what I found at that time and shared with him and a few friends, along with small improvements. There may, of course, have been updates to some of the data sources used during these three months. But I am assuming that the big picture still remains pretty consistent. With that clarified, let us dive in.

Claim

If you want to work on a research project which has the potential to decrease the occurrence of cancer in the population (i.e. less people will "get" cancer), your work will be intentionally held back by a refusal to fund it because it affects the bottom line of pharmaceutical companies.

Questionable Assumptions

The claim assumes that for-profit pharmaceutical companies are the major source of funding for cancer research. It ignores the existence of government funding and not-for-profit organizations and hence fails to present itself as a well thought out argument.

Real world data shows that the majority of cancer research is funded by governments, academic research networks and not-for-profit organizations. In their 2019 study, Schmutz et. al. found that for-profit organizations accounted for only 17% of Cancer research funding. [1]

With that made clear, let us proceed to analyse the claim. How do we find out whether or not the claim is true?

Ways to verify or falsify the claim

This claim can be demonstrated to be false if we can find funding statistics about cancer research which meet the following criteria:

1. Identify how much money is going into which areas of research.
2. The classification into those areas of research can somehow be correlated to the two kinds of research that the person mentioned.
3. The data shows that there is significant funding for research that will help reduce the risk of people getting cancer.

Definitions

Before discussing the data, it will benefit to describe what we are looking at.

Common Scientific Outline

You will see a term "CSO" or "Common Scientific Outline" appear in the data. It refers to a classification system organized into six broad areas of scientific interest in cancer research. It classifies the general research area into these categories:

1. Biology.
Research included in this category looks at the biology of how cancer starts and progresses as well as normal biology relevant to these processes.

2. Etiology.
Research included in this category aims to identify the causes or origins of cancer - genetic, environmental, and lifestyle, and the interactions between these factors.

3. Prevention.
Research included in this category looks at identifying individual and population-based primary prevention interventions, which reduce cancer risk by reducing exposure to cancer risks and increasing protective factors.

4. Early Detection, Diagnosis, and Prognosis.
Research included in this category focuses on identifying and testing cancer markers, imaging and other methods that are helpful in detecting and/or diagnosing cancer as well as predicting the outcome or chance of recurrence or to support treatment decision making in stratified/personalized medicine.

5. Treatment.
Research included in this category focuses on identifying and testing treatments administered locally (such as radiotherapy and surgery) and systemically (treatments like chemotherapy which are administered throughout the body) as well as non-traditional (complementary/alternative) treatments (such as supplements, herbs). Research into the prevention of recurrence and treatment of metastases are also included here.

6. Cancer Control, Survivorship, and Outcomes Research.
Research included in this category includes a broad range of areas: patient care and pain management; tracking cancer cases in the population; beliefs and attitudes that affect behavior regarding cancer control; ethics; education and communication approaches for patients, family/caregivers, and health care professionals; supportive and end-of-life care; and health care delivery in terms of quality and cost effectiveness.

More details can be found at https://www.icrpartnership.org/cso

CSOs relevant to the claim:

As it can be seen after going through the CSOs and their subcategories, cancer research that will help reduce or eliminate the risk of people getting cancer falls under CSO1: Biology, CSO2: Etiology and CSO3: Prevention.
So in order to falsify the claim, we need to demonstrate that a significant portion of cancer funding goes to CSOs 1,2 and 3.

The Data

Eckhouse and Sullivan in 2006 [2] have done a detailed analysis of public funding of cancer research in the EU and compared it to the funding situation in the US. In EU they report that a cumulative 59% of the public cancer research funding goes to CSOs 1, 2 and 3. For US they report 51% for the same. In a later report from 2008 [3], they compare it to Canada which spends a cumulative 57% on these three. As can be obviously seen, 59%, 51% and 57% is quite a significant chunk of the public research funding for cancer.

Of course, there are more up to date sources too. The International Cancer Research Partnership (ICRP) maintains a database of research funded by the partnership [4]. For the financial year 2019/20, it currently shows 44% of their funded projects (by number of projects) belonging to CSO 1, 2 and 3. Readers can also go through the individual research projects and see what they are about, which countries they are being run in and which organizations are funding them.

The American Cancer Society maintains a publicly available summary of investment by area of research which is updated in May/June every year [5]. It currently shows data for the financial year 2018 during which $46,910,796 out of a total investment of $115,786,623 went to research in CSO 1, 2 and 3, which is more than 40% of the total funding. Keep in mind that this summary also includes "uncategorized" which may include projects that put the actual number a bit higher.

UK's National Cancer Research Institute (NCRI) also maintains funding statistics by CSO, including a summary [6] as well as a detailed data package in the form of a spreadsheet file [7]. For the financial year 2018/19, the data shows 45% of the funding going to CSO 1, 2 and 3.

There are also more databases available [8] which you can go through to find out what kind of cancer research is being funded.

Conclusion

While it may be tempting to think that pharmaceutical companies are influencing public funding for cancer research to maximize their profits, the evidence is overwhelmingly against the claim made that there is enough such influence to cause a noticeable adverse effect. The central claim that studies aimed at decreasing or eliminating the occurrence of cancer in general population get next to no funding is seen to be false. It is no surprise though, because even assuming the level of moral degradation that conspiracy theories base their stories around, there are significant financial and other incentives to eliminate cancer entirely if it is indeed possible [9].

References

[1] Schmutz, A., Salignat, C., Plotkina, D., Devouassoux, A., Lee, T., Arnold, M., Ervik, M., & Kelm, O. (2019). Mapping the Global Cancer Research Funding Landscape. JNCI Cancer Spectrum, 3(4). https://doi.org/10.1093/jncics/pkz069

[2] Eckhouse, S., & Sullivan, R. (2006). A Survey of Public Funding of Cancer Research in the European Union. PLoS Medicine, 3(7). https://doi.org/10.1371/journal.pmed.0030267

[3] Eckhouse, S., Lewison, G., & Sullivan, R. (2008). Trends in the global funding and activity of cancer research. Molecular Oncology, 2(1), 20–32. https://doi.org/10.1016/j.molonc.2008.03.007

[4] International Cancer Research Partnership | Search ICRP Database. (n.d.). Retrieved March 3, 2020, from https://www.icrpartnership.org/db_search

[5] Current Investment by Areas of Research | American Cancer Society. (n.d.). Retrieved March 3, 2020, from https://www.cancer.org/research/currently-funded-cancer-research/investment-by-research-areas.html

[6] Spend by Research Category and Disease Site. (n.d.). The National Cancer Research Institute. Retrieved March 3, 2020, from https://www.ncri.org.uk/ncri-cancer-research-database-old/spend-by-research-category-and-disease-site/

[7] NCRI Cancer Research Database. (n.d.). The National Cancer Research Institute. Retrieved March 3, 2020, from https://www.ncri.org.uk/ncri-cancer-research-database/

[8] Search Funding Databases | UCSF Helen Diller Family Comprehensive Cancer Center. (n.d.). Retrieved March 3, 2020, from https://cancer.ucsf.edu/research/search-funding-databases/

[9] Research Areas: Prevention. (2015, May 10). [CgvArticle]. National Cancer Institute. https://www.cancer.gov/research/areas/prevention