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GLOBAL CANCER INITIATIVES

28 CANCER CONTROL 2021

Updating the economics of the

"War on Cancer": The false

metaphor and faulty economics of

the "War against Cancer"

Smita Srinivas, India Lead and Co-Investigator, the Innovation for Cancer Care in Africa Project (ICCA), The

Open University, Milton Keynes UK and the National Centre for Biological Sciences-Tata Institute of Fundamental

Research (NCBS-TIFR) Bengaluru, India.

W

ars come and go and some unfortunately last a

long time in the imagination. The so-called "War on

Cancer" is faulty on many fronts: metaphorically,

one cannot wage a war on cancer because cancer reflects

complex biological processes whose science is still being

understood, thus any "war" is certain to be "lost"; the costs of

better prevention and early treatment combined are vital to

understanding the long-run quality of life losses to patients;

and that the "war" itself has many fronts: health concerns

including geography, gender, income, and other social divisions

and differences (1). The metaphor of war is best seen as a

simplistic approach to politics and financing, for industry, for

politicians, NGOs, and scientists (2,3). It assumed that led by

political will, laboratory science would proceed from R&D

to patients in a determined march, partnering with national

institutes of health, an active set of industrial firms, and an

array of non-profits, with beneficial effects for the economy

and rewards for firms. Similar to the "linear model" of science,

which used shorthand rhetoric to concentrate investments

during the second world war and establish the supremacy of

science, the "War on Cancer" directed investment and claimed

an inevitable role for industry (4).

One problem with the "war" metaphor is that social

priorities are not directly translated as if by a camp of military

strategists with a clear finger on the map, tracing the most

directly effective path to an outcome. Yet, while the metaphor

has been recognized as flawed, the health economics is not always contested or updated (5). Another problem is that a

"standard model" of cancer science(s) is not neatly organized

on standardized institutional fronts and acts as only one, albeit

powerful, source of knowledge and industrial transformation

(6). Other sources may be engineering firms, patient networks,

"traditional" systems of science, non-profit advocacy, or clinical

"applied" research. With multiple biological and social causes

and correlates, cancer stakeholders extend outside the labbased model.

Industrial organization and technological efforts (both

technical and organizational) is thus a fundamental feature of

cancer care response from diagnostics to treatment, palliation

to rehabilitation. If it becomes easy to identify and abrade

a tumour through better laser optics and miniaturization,

clinical skills will change. Conversely, making it easier for

researchers to study tissue samples can stimulate more

ambitious prototyping to advance the design of patientfriendly miniature optics or handheld diagnostics.

A dynamic economics for cancer and health

A dynamic economy is not accurately described as actors under

a command and control military tent; neither a linear march to

success, nor paths entirely driven by the efficient intentions

of a heartless industrial complex. Institutions are the social

norms, customs, guidelines, standards, rules, regulations, and

laws which, through specific organizations such as government

agencies, business firms, or universities, define the scope of

The "War on Cancer" is an undoubtedly a poor metaphor. Cancer is a complex biological process,

not a single target for bellicose action; science is not organized on war strategy principles; and

the winners and losers in a military war reflect neither experience nor choices of cancer patients

and scientists. A more fundamental problem exists: the economics of the so-called "War" are

faulty. The first section of this essay discusses the false War metaphor and its faulty economics. The

second describes a more dynamic economic context that draws from evolutionary and institutional

perspectives.

Index

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