You can’t take the risk out of cancer research, so why are we even trying?
I'm not usually one for the quasi-motivational lifestyle quotes which now seem to pepper my Facebook timeline on a daily basis. Cute cats boldly encourage me to 'face my fears'. Galloping horses urge me to 'become who you are'. Throughout it all my stoically unsentimental heart remains unmoved.
So just why did the at-first-glance equally banal "you don't have to see the whole staircase to take the first step" (written, you guessed it, up a set of stairs) make me stop and think?
The answer is cancer research. Or any type of scientific research for that matter. Because with research the path never seems that clear.
On that first 'step', at the very beginning of a new line of inquiry, the next step often remains shrouded in fog. Maybe there won't be a staircase at all. Or maybe that research will lead, Hogwarts-style, to a destination several floors away from the one first hoped for. To fund research is surely to accept a certain amount of risk, to know that there can never be a guaranteed return on the investment.
The best you can do, in my opinion, is to support great ideas from great scientists. Give them the freedom to unleash their imagination, help them uncover new understandings of cancer and trust that the science will lead us to new clinical applications.
Let's take olaparib (also known as Lynparza), a relatively new drug which is now available for some women affected by ovarian cancer. Olaparib is the first in a brand new class of cancer drugs called PARP inhibitors, and it is the first real hope for improving ovarian cancer survival in years. It works by exploiting a defect some types of cancer have in their ability to repair DNA.
Before starting to develop olaparib scientists first needed to spend years working out how DNA can be damaged and subsequently repaired in our cells, and how these processes can go wrong in cancer. These researchers might have hoped, but they could not have foreseen their work would ultimately lead to olaparib.
Now I'm not totally impartial on this- Worldwide Cancer Research funded some of this early background work and I'm bound to feel it is important. But the point remains, without this essential early research, olaparib would not exist. Yet much of it was funded without the explicit intent to develop a drug later on. There is just no way the researchers could guarantee their work would lead to a new cancer treatment years later.
And here's my beef with the changes I see in cancer research funding: I worry that many funding bodies now seem to require increasing levels of certainty before investing. They want a mountain of preliminary data, alongside the usual research proposal and they want predictions of how the research will make a difference. They want to be reassured that the research is going somewhere useful. But where does that leave the truly innovative research, the 'suck it and see' research that brings us those important first steps?
The research that happens simply because cancer cells can do some weird and unexpected things, and we might just need to know why. I worry that this type of research is being squeezed out, albeit with the best of intentions, and that ultimately we will all be worse off for it.
When funding bodies have designated priority areas this has the potential to restrict ingenuity and invention. We must resist the need to drive the research agenda and tell scientists - the real experts - what questions they need to be answering.
The truth is that nobody has a crystal ball to predict which research will eventually turn out to be the most important. That's why Worldwide Cancer Research's funding strategy doesn't place boundaries on the questions scientists want to answer. We believe it is important to consider funding any innovative research that might reveal something new and important about cancer, even if the true impact may only become apparent years later.
Years ago we funded Professor Dario Alessi from Dundee University, whose early work on the use of the diabetes drug metformin in cancer renewed the world’s interest in the drug.
He recently told me that if we hadn't taken a chance and chosen to think outside the box, "...nothing would have happened in this area. No other bit of funding [he] has ever received has achieved quite so much." It might not be as pithy as those quotes from cats in my Facebook timeline, but to me it's a hundred times more powerful.
This article also appears on Huffington Post blogs where Dr Helen Rippon is a contributor.