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.