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Crowdsourcing contest: global research on disease

June 24th, 2012

In comments, David Barry, winner of the previous crowdsourcing contest writes

I would be interested in seeing how much global research funding goes towards different diseases. My goal here is to see if research funding into a disease is roughly proportional to the global burden of the disease, or if there are relatively under- and over-funded areas; the former might then be the best place for individuals to donate to, if they want to support medical research.

The global burdens are on the WHO’s website: http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html I don’t know where I’d find funding statistics. As a first step, I’d be happy with just US/EU government agency funding data. For instance, the National Cancer Institute has a nice table here, http://www.cancer.gov/cancertopics/factsheet/NCI/research-funding

This is a great topic, and I encourage readers to look into it. I’d offer the minor caveat that research is conditioned to some extent by the availability of researchable topics. For example, I believe (though I’m happy to be proved wrong) that the mortality rates from prostate cancer are similar to those for breast cancer, but that breast cancer research gets much more funding. As I understand it, this is mainly because there don’t appear to be as many promising avenues for research on prostate cancer.

Also, a reminder that my crowdsourcing request for a simple model-based estimate of the date at which a minority of Census respondents will identify as Christian is now open. (Minor update: The proportion claiming Christian affililation fell from 64 to 61 per cent between 2006 and 2011. Simple extrapolation gives a target date of 2031. I’m sure a model with some demography would do better than this).

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  1. FMark
    June 24th, 2012 at 19:30 | #1
  2. FMark
    June 24th, 2012 at 20:11 | #2

    And I think from my cursory look the census the total proportion of people who reported Christian as their religion went up in 2011 compared to 2006, but obviously there’s a lot of complexity to unpacked.

  3. Karen
    June 24th, 2012 at 20:18 | #3

    Mortality rates from prostate cancer are certainly similar to breast cancer within Australia. It’s complicated because many prostate cancers are so slow-growing that they will never need treatment, but doctors don’t really know yet how to decide when to treat, and of course the treatment can have significant negative consequences. I think some of the breakthroughs in breast cancer have been in working out how to tailor treatment to the individual’s case, depending on their risk factors.

    I think the reward for research dollars can be very different for different diseases, so it shouldn’t necessarily be proportional to the global burden of disease. I saw a documentary once on the attempt to develop a malaria vaccine. The message I took away was that the biggest issue was not lack of funding but rather the massive scientific difficulty of developing such a vaccine, and the small number of new ideas coming through. Of course they’re still doing good work in terms of fighting malaria, but that’s a different topic.

    One other question I’ve considered thanks to personal experience is the effectiveness of research funding. My mother had Multiple Myeloma, and despite being less common than some of the other haemotological malignancies, more drugs were becoming available. This may have been partly because there were more avenues for research, but it’s also because of the Multiple Myeloma Research Foundation, which was started by a pharmaceutical executive with an MBA from Harvard. It has a very different approach to many medical charities, and focusses partly on breaking down the barriers to drug development, based on the founder’s experience in the industry. It appears to have helped drugs be developed more quickly and for significantly less research funding. Some of the drugs it’s helped developed are now being trialled for many other cancers, including more common cancers that I expect are better funded overall.

  4. Ikonoclast
    June 24th, 2012 at 20:28 | #4

    The National Cancer Institute (USA) says;

    “An American woman’s chance of being diagnosed with breast cancer is:

    from age 30 through age 39 . . . . . . 0.43 percent (often expressed as “1 in 233″)
    from age 40 through age 49 . . . . . . 1.45 percent (often expressed as “1 in 69″)
    from age 50 through age 59 . . . . . . 2.38 percent (often expressed as “1 in 42″)
    from age 60 through age 69 . . . . . . 3.45 percent (often expressed as “1 in 29″) ”

    Of course, if women don’t get tested they can’t be diagnosed. I don’t know what the test rates are in the US.

    According to the Prostate Cancer Foundation of Australia;

    “…the chance for a diagnosis of prostate cancer:

    For a man in his 40s – 1 in 1000
    For a man in his 50s – 12 in 1000
    For a man in his 60s – 45 in 1000
    For a man in his 70s – 80 in 1000″

    Wikipedia reports; “More than 80% of men will develop prostate cancer by the age of 80. However, in the majority of cases, it will be slow-growing and harmless. ” I am not sure how this squares with the table above.

    These figures say nothing about death rates. We can note, however, that younger women clearly face a much higher risk of breast cancer than younger men face for prostate cancer. The risk turns around at late old age and very old men (over 80) face a very high risk of prostate cancer. Often though, as the cancer is slow at this age, it is something else that kills the very elderly man before the prostate cancer does. On the face of these stats, a higher spend on breast cancer screening and treatment makes sense.

  5. June 24th, 2012 at 21:32 | #5

    “…a simple model-based estimate of the date at which a minority of Census respondents will identify as Christian…”

    How, in such modelling, would you take into account the possibility of a swing back to religiosity? Let’s say we have some hugely catastrophic event/s (quite possible: wars, famines, climate-change caused weather chaos etc…) combined with a well organised capitalisation on that by organised religions, which then causes steep rises in the numbers of, eg, ‘christians’?

    The history of, and the links between, collapse/authoritarianism/religiosity seems to be fairly well documented and studied.

  6. June 24th, 2012 at 21:42 | #6

    Back to the current subject, Jonas Salk discovered/created the polio vaccine.

    His attitude to his vaccine and his work on it is admirable:

    ‘When news of the vaccine’s success was made public on April 12, 1955, Salk was hailed as a “miracle worker”, and the day “almost became a national holiday.” His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When he was asked in a televised interview who owned the patent to the vaccine, Salk replied: “There is no patent. Could you patent the sun?”‘

    http://en.wikipedia.org/wiki/Jonas_Salk

    At the risk of being decried as bolshie, wouldn’t there also be some room for consideration of the decline of our Academy as a place of research per se, into a place of ‘profitable’ ‘outcomes’?

  7. June 24th, 2012 at 22:57 | #7

    Thanks, Megan.

    Another example, all around us, which utterly shoots down in flames the ridiculous, nonsensical ideology imposed upon us in 1983 by Paul Keating. This private free-market ideology holds that no-one would make a worthwhile contribution to society unless they stood to gain materially at someone else’s expense (or else be consigned to poverty, destitution and misery if they did not) is free open-source software upon which the Internet is built. Without the free open source Apache webserver, open source Sendmail programs and all the other software that drives server computers and network hardware, it would not have been possible to build the Internet anywhere near as fast as it was built.

  8. John Quiggin
    June 25th, 2012 at 05:18 | #8

    @FMark
    Total proportion claiming to be Christian fell from 64 to 61 per cent between 2006 and 2011. So, to make the first entry in my own contest, linear extrapolation gives 2031 as the date for a Christian minority. I’m hoping someone will do something a little more sophisticated than that.

  9. David
    June 25th, 2012 at 09:28 | #9

    Well let’s open this can of worms right up and start challenging a few things. Is it a lack of funds, disproportionate funding targets, poor allocation of funds (i.e. the wrong people won the grant), or is it a bit more complex than that?

    The biggest problem here is defining what a disease is: a disease versus a cancer a disease versus a virus, or a mental disease versus a preventable disease. Knowing the health issue is also vital in in context. Cancer can be either be a natural mutation, a genetic leading towards a particular trait, and or human preference (i.e. smoking, no I will not enter the debate on addiction here). The winter flu rapidly changes and spreads between humans, pigs and birds. While let’s face it sooner or later we age and we die of something. So is a heart attack solely a condition of diet or is it the body wearing out. This in part explains why the deaths by WTO region are different.

    Let’s not even discuss the problems associated with detection in different regions (did an individual really die from that or was it the easiest thing to put down). Just how good is the underlying data set at attributing death to the right category. I saw an interesting talk a while ago and in once upon a time in China AIDS did not exist in the country according to the officials, it was killing people but it could not be reported as AIDS.

    Health expenditure by rights needs to deal with what is currently an issue, to what could be an issue in the future (i.e. lifestyle and diabetes was not really considered 30 years ago), potential flair ups (ebola, etc) and other unforseen issues and what is driven by public opinion and/or companies peddling miracle cures (anyone remember the ABC’s Hollow Men)

    While some stuff like diarrhoea is actually an easy and cheap fix with oral rehydration solutions in a first world hospital (providing it’s not something like Clostridium difficile where we need a whole argument here on how we use antibiotics, see the TB stats). But the problem is that it’s often associated with sanitary conditions, think refugee camps due to conflict or drought where lack of clean water compounds the treatment. We have a solution but can we get the product to who needs it? The question then, becomes are we looking at all the right data sets (health expenditure only?).

    While AIDS is another disease that spreads due to poor education and lack of appropriate preventative risk management equipment (i.e. condoms, needle exchange, etc).
    When we examine funding in time series we have to realise the short term or long term nature of the issue. For example, small pox was eradicated. The concept of disease burden is also a question of the greater good (or aid expenditure). Are we talking about burden being in dollar terms or human terms? The notion of how do we determine the adequate levels of funding by disease and by country are we talking about returns in quality of life or $/GNP, $/GDP per life saved or % of GDP invested versus the nominal value.

    Like all R&D it’s a balance between what is an issue now, what will become an issue in the future and rightfully or wrongfully protecting people from their own behaviour. But you need to really understand the system.

    So who should you fund? Probably those on the front line dealing with the manmade complications on a daily basis. But if you really want to fund someone in Aus, I would take a careful look at the PC report to see where the money actually goes. http://www.pc.gov.au/projects/study/not-for-profit/report

  10. fmark
    June 25th, 2012 at 09:39 | #10

    And to further clarify the original question, is it all biomedical research funding (including private pharmaceutical research, etc.), or only public funding that we are interested in?

  11. David Barry
    June 25th, 2012 at 10:57 | #11

    @David

    I deliberately put the word “might” in the statement that relatively under-funded areas “might be the best place to donate to” because of all the caveats. My approach to the problem is: first let’s see how much money is being spent where, then decide if there’s a good reason why any apparently underfunded areas aren’t attracting as much money as a simple model would suggest they should. Gathering the data first and then looking for anomalies seems to me the natural way of going about it.

    fmark, I’m interested in total funding (public + private), but public funding would be a decent start.

  12. David
    June 25th, 2012 at 12:02 | #12
  13. David Barry
    June 25th, 2012 at 12:49 | #13

    That is great, thanks!

  14. Luke Elford
    June 25th, 2012 at 18:20 | #14

    Professor Quiggin, here are my projections for the Christian share of the population for the coming census years:
    2016 57.7%
    2021 54.2%
    2026 51.1%
    2031 47.9%

    This was my method:
    1) To get projections of the Christian share for the 0-4 age group for coming census years, I used the percentage change in shares between 2006 and 2011; so for example, for 2016 the figure is 49.56/51.66*49.56 = 47.54%, and for 2021 it is 49.56/51.66*47.54 = 45.61%.

    2) To estimate how the Christian share changes as a cohort ages, I compared the 2001 and 2011 data, and assumed that the same percentage change in the Christian share would occur for each cohort as it moved passed a given age. For example, for the cohort aged 25-34 in 2001, aging to 35-44 in 2011, the Christian share fell from 62.22% to 59.23%, or 4.8%. I thus assumed that for every cohort, passing age 35 resulted in a 4.8% fall in the Christian share.

    Conceptually, dealing with these changes is a bit of a nightmare, since they reflect migration and religious conversions about which we have no extra information. But I think it makes more sense to view these changes as age-specific rather than cohort-specific. So, it wouldn’t make sense to assume that the big fall in the Christian share for the cohort that aged from 15-24 to 25-34 between the 2001 and 2011 censuses would be repeated as the cohort aged still further, but it does make sense to assume that younger cohorts would go through a similar change when they reached that age.

    A number of improvements are possible. For example, so far I’ve just assumed that the age structure of the population stays the same as it was in 2011. It should be straight forward to incorporate ABS age-specific population projections.

    The results I’ve obtained are pretty much what you’d get from simple projection of the Christian share for the whole population. But I don’t know that we can get a much more accurate estimate without lots of information about the relationships between religion and migration, birth rates and death rates, and more detailed information about religious conversions. But then we wouldn’t be looking at a “simple model” so much as a full-on research project, probably requiring the expertise of actual demographers.

  15. Luke Elford
    June 26th, 2012 at 09:48 | #15

    Some updated projections for the Christian share, fixing a small conceptual problem and using ABS projections for the age structure of the population.

    2016 57.8%
    2021 54.6%
    2026 51.6%
    2031 48.8%

    Population ageing slows the decline in the Christian share, but it is still a minority by 2031.

  16. Sam
    June 26th, 2012 at 10:38 | #16

    I wonder when christians will no longer be even in the plurality?

  17. June 27th, 2012 at 00:25 | #17

    In assessing where the best value for money would lie in donations one also needs to consider the likely future global burden of disease, not just where it is at the moment. I can remember an article in the late 80s denouncing the share of money spent on certain “glamorous” diseases compared to those that killed far more people. I was right with the author until they started talking about what a waste of money AIDS research was, since the numbers dying from AIDS was still quite small compared to some other diseases, and quite a bit was being spent on it. Errr yes, if you ignored the fact that the death rate was rising incredibly rapidly at that point, and was clearly going to rise for many years to come unless something was done. It was already quite obvious that deaths from AIDS would surpass the diseases it was being compared with in a few years time, and of course this is in fact what happened – that supposedly overfunded research was probably one of the best investments of all time.

  18. Freelander
    June 27th, 2012 at 00:40 | #18

    Sadly as one form of craziness disappears, Christianity in this case, other forms of craziness fill the vacuum created.

    Mainstream Christianity has lost favour with the knuckle dragging classes because it has mellowed from its hayday. Those good old days of burning at the stake. In short the mainstream, even with its habitual abuse of children, and other widespread clergy deviance, is no longer crazy enough to gain net recruits.

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