It seems to me that research funding is surprisingly well calibrated with a bias for infectous diseases as opposed to what I as an amateur would call “structural failure” collecting ischemic heart disease, stroke, injury and so on.
Looking at the “overfunded” category the worst offenders are HIV and cancer. I suppose cancer research is overfunded because people donate to causes their loved ones suffered and cancer tends to kill old people with a lot of money. But I have no good explanation for the overfunding of HIV which is a completely preventable disease on the personal level by using a condom and refraining from using IV drugs. BTW, the most successful HIV reduction programs give out free needles and condoms, reducing the need for medical treatment and of course human suffering in the first place.
Looking at the “underfunded” category we have injury, ischemic heart disease, COPD, depression, stroke. Injury is something that disproportionally affects poorer people, so I use the reverse reasoning to cancer. I have no good explanation for the underfunding of the other diseases here, except for maybe depression which has a bit of a stigma to it. At best I’d guess that heart attack and stroke do not have the spectacular, drawn out suffering like cancer and HIV treatment have.
It seems to me that research funding is surprisingly well calibrated with a bias for infectous diseases as opposed to what I as an amateur would call “structural failure” collecting ischemic heart disease, stroke, injury and so on.
I too was incredibly surprised to see how close everything lies to the 1:1 line. Most overfunded only 16% over the line? Most underfunded 11% below? Holy crap, the people behind that deserve a medal.
Looking at the “overfunded” category the worst offenders are HIV and cancer. I suppose cancer research is overfunded because people donate to causes their loved ones suffered and cancer tends to kill old people with a lot of money. But I have no good explanation for the overfunding of HIV which is a completely preventable disease on the personal level by using a condom and refraining from using IV drugs.
I suspect cancer is probably at least partially up because there’s so many subfields of cancer that don’t always behave like each other. There’s breast cancer, skin cancer, pancreatic cancer… a lot of the time you need to do separate research on each, and that kind of duplication might spill over into money applied.
Could HIV funding levels being a bit over the ratio be a result of recent declines in disease burden but an unchanged allocation? Antiretrovirals have massively decreased the burden on the big overhang of those who got the disease over the decade before they were developed, at least in developed countries, and at least until resistant strains develop.
Or perhaps the desire to end an expanding disease, thus taking into account future levels of expanded burden? It’s not like advances in treating HIV are intended only for the US where the only reason it’s still expanding is that the people who are infected live on for decades while on average not ‘replacing’ thesmselves (you can see a small dip in the number of people with the disease in the nineties, as new infection rates declined but before antiretrovirals kept those with the disease alive longer). Most of the bad effect is centered in Africa where its growing much much more rapidly. And I don’t think it being preventable really enters into these calculations, as prevention has obviously not actually worked in many places. Though prevention should obviously be a big fraction of the effort against it.
As for Inury being underfunded, isn’t it also the case that ‘research’ on injury has been going on for as long as there have been people, whereas molecular biology and germ theory and the like have opened up new vistas in treating communicable diseases and many other things only in the last century or two? There’s probably a lot less expected utility in the research they can do there.
In the case of HIV there are likely a variety of different functions going on: First political organization: dealing with HIV became connected to the gay rights movement, especially when religious figures and politicians who were not happy with the gay rights movement said that gays deserved it or that it was punishment from God or otherwise mocked what was happening.
Second, HIV has a long time from diagnosis to when it becomes AIDS. This makes it a disease where the people with it can actively take part and lobby for more funding- since the primary treatments put the disease merely in check rather than curing it, the medical results make this tendency more strong rather than less strong.
Third, the massive increase in HIV cases in the 1980s made it seem like a disease that was a general threat to the population, and people are still riding that assumption.
Fourth, HIV is a disease that in principle (and sometimes in practice) can arise in a variety of different populations: the presence of people who received it from blood transfusions helped make it feel more like a disease threatening the general population (this connects in the obvious way to point three), and this combined with the presence of HIV+ babies to give a strong emotional aspect.
But I have no good explanation for the overfunding of HIV which is a completely preventable disease on the personal level by using a condom and refraining from using IV drugs.
Condom usage reduces the changes of getting infected via sex by ~90% not 99.9%.
I found the ‘injury’ entry too, but I’m not sure it is a good target for improving. ‘injury’ is broad. I know what HIV is, and I have a good idea of what researchers might do to improve it (‘develop a vaccine’; ‘discover a new drug’), but what does one do with a category like ‘injury’?
Presumably this category embraces everything from burning yourself on a stove to falling on ice to heavy machinery at work killing you; there’s not one or a few different problems there, but thousands of distinct ones which have next to no causal mechanisms in common. (And people are frustrated by cancers...!)
So research may have counterintuitively low ROI: OK, so you managed to cut stove burns by say 10% using your extremely expensive public health campaign to switch as many houses as possible from electric coils to induction heating, but stove burns were only say 5% of all accidents in the first place so your ROI works out to be terrible compared to dumping even more money into HIV or something.
As expected, car accidents and falls in the elderly account for a largest chunk of deaths. Next you have a cluster of poisoning and suicide (which I guess is classified as unintentional?). Some quick googling suggests that traffic accidents and falls are both roughly top 20 in leading causes of (global) DALY lost, although I’m out of time to check for better sources. I’d bet that poisoning is a bigger problem than currently measured in poorer countries.
Can these causes be targeted? An interaction of public policy and technology has reduced (and continues to reduce) deaths per million vehicle miles traveled. On the latter, I’ve noticed that “risk of falling” is often tracked in studies of the elderly, although I don’t know anything more about this.
An interaction of public policy and technology has reduced (and continues to reduce) deaths per million vehicle miles traveled.
Traffic accidents are hard because risk homeostasis works to negate improvements, and a lot of research has already been put into improving automobile safety, so the outside view is that we should expect continued diminishing returns. On the other hand, autonomous/self-driving cars are a new innovation which could potentially make a big difference. So that seems like a good area to target.
Next you have a cluster of poisoning and suicide (which I guess is classified as unintentional?).
Good luck trying to reduce suicide! Poisoning… I dunno. Many of those might be suicide, and the obvious tactics of child-safety locks and warning labels have been implemented for a long time. Is there any low-hanging fruit there?
I’ve noticed that “risk of falling” is often tracked in studies of the elderly, although I don’t know anything more about this.
Falling is a huge problem for elderly, and also one that seems to me like it could be easily tackled. As Joshua says, there’s architectural improvements to housing that would reduce risk of falling which are currently uncommon, and there are other tactics: exercises and vibrating platforms may be able to improve the balance of elderly, and there’s a biological aspect in weakened bones (vitamin D clinical trials sometimes show reductions in all-cause mortality, which seems to be largely due to better bones leading to fewer damaging falls, and this may be why the bisphonates also reduce all-cause mortality).
An interaction of public policy and technology has reduced (and continues to reduce) deaths per million vehicle miles traveled.
One other thing to note here is that it isn’t clear how much of the technology improvement is technological improvement in medicine. In particular, there’s an argument that murder rates have gone down because people who would have died from from some injuries are now being saved. (See e.g. this summary. ) If so, this has likely also contributed to the reduction in automobile fatalities, although I’m not aware of any studies which have specifically looked at that impact.
Though this still leaves the door open to mitigating road traffic injury, and injury more generally, through improved medical technology. There is at least one juicy bit of low-hanging fruit waiting to be taken here.
I don’t have a specific breakdown data on types of falls in the elderly but one category that is common is falls in the bathrooms. Switching to curbless showers (which have become more common in general in North America) reduces shower falls in the general population and (I’ve been told by people in the industry) reduces falls especially in the elderly. There are likely many small aspects of household design that can help here in similar ways.
Since you asked...No, suicide is not classified as unintentional. Nor is homicide! That is not a chart of unintentional injury, but of all injury, with unintentional causes highlighted by being colored, while suicide and homicide are in white.
But I have no good explanation for the overfunding of HIV which is a completely preventable disease on the personal level by using a condom and refraining from using IV drugs.
one would think so but certain demographics can’t seem to handle this
It seems to me that research funding is surprisingly well calibrated with a bias for infectous diseases as opposed to what I as an amateur would call “structural failure” collecting ischemic heart disease, stroke, injury and so on.
Looking at the “overfunded” category the worst offenders are HIV and cancer. I suppose cancer research is overfunded because people donate to causes their loved ones suffered and cancer tends to kill old people with a lot of money. But I have no good explanation for the overfunding of HIV which is a completely preventable disease on the personal level by using a condom and refraining from using IV drugs. BTW, the most successful HIV reduction programs give out free needles and condoms, reducing the need for medical treatment and of course human suffering in the first place.
Looking at the “underfunded” category we have injury, ischemic heart disease, COPD, depression, stroke. Injury is something that disproportionally affects poorer people, so I use the reverse reasoning to cancer. I have no good explanation for the underfunding of the other diseases here, except for maybe depression which has a bit of a stigma to it. At best I’d guess that heart attack and stroke do not have the spectacular, drawn out suffering like cancer and HIV treatment have.
I too was incredibly surprised to see how close everything lies to the 1:1 line. Most overfunded only 16% over the line? Most underfunded 11% below? Holy crap, the people behind that deserve a medal.
I suspect cancer is probably at least partially up because there’s so many subfields of cancer that don’t always behave like each other. There’s breast cancer, skin cancer, pancreatic cancer… a lot of the time you need to do separate research on each, and that kind of duplication might spill over into money applied.
Could HIV funding levels being a bit over the ratio be a result of recent declines in disease burden but an unchanged allocation? Antiretrovirals have massively decreased the burden on the big overhang of those who got the disease over the decade before they were developed, at least in developed countries, and at least until resistant strains develop.
Or perhaps the desire to end an expanding disease, thus taking into account future levels of expanded burden? It’s not like advances in treating HIV are intended only for the US where the only reason it’s still expanding is that the people who are infected live on for decades while on average not ‘replacing’ thesmselves (you can see a small dip in the number of people with the disease in the nineties, as new infection rates declined but before antiretrovirals kept those with the disease alive longer). Most of the bad effect is centered in Africa where its growing much much more rapidly. And I don’t think it being preventable really enters into these calculations, as prevention has obviously not actually worked in many places. Though prevention should obviously be a big fraction of the effort against it.
As for Inury being underfunded, isn’t it also the case that ‘research’ on injury has been going on for as long as there have been people, whereas molecular biology and germ theory and the like have opened up new vistas in treating communicable diseases and many other things only in the last century or two? There’s probably a lot less expected utility in the research they can do there.
In the case of HIV there are likely a variety of different functions going on: First political organization: dealing with HIV became connected to the gay rights movement, especially when religious figures and politicians who were not happy with the gay rights movement said that gays deserved it or that it was punishment from God or otherwise mocked what was happening.
Second, HIV has a long time from diagnosis to when it becomes AIDS. This makes it a disease where the people with it can actively take part and lobby for more funding- since the primary treatments put the disease merely in check rather than curing it, the medical results make this tendency more strong rather than less strong.
Third, the massive increase in HIV cases in the 1980s made it seem like a disease that was a general threat to the population, and people are still riding that assumption.
Fourth, HIV is a disease that in principle (and sometimes in practice) can arise in a variety of different populations: the presence of people who received it from blood transfusions helped make it feel more like a disease threatening the general population (this connects in the obvious way to point three), and this combined with the presence of HIV+ babies to give a strong emotional aspect.
Condom usage reduces the changes of getting infected via sex by ~90% not 99.9%.
I found the ‘injury’ entry too, but I’m not sure it is a good target for improving. ‘injury’ is broad. I know what HIV is, and I have a good idea of what researchers might do to improve it (‘develop a vaccine’; ‘discover a new drug’), but what does one do with a category like ‘injury’?
Presumably this category embraces everything from burning yourself on a stove to falling on ice to heavy machinery at work killing you; there’s not one or a few different problems there, but thousands of distinct ones which have next to no causal mechanisms in common. (And people are frustrated by cancers...!)
So research may have counterintuitively low ROI: OK, so you managed to cut stove burns by say 10% using your extremely expensive public health campaign to switch as many houses as possible from electric coils to induction heating, but stove burns were only say 5% of all accidents in the first place so your ROI works out to be terrible compared to dumping even more money into HIV or something.
The causes of injury are quite skewed. From the CDC, here is chart showing leading causes of “fatal unintentional injury”: http://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_injury_deaths_highlighting_unintentional_injury_2012-a.pdf. Note that this isn’t DALY-lost.
As expected, car accidents and falls in the elderly account for a largest chunk of deaths. Next you have a cluster of poisoning and suicide (which I guess is classified as unintentional?). Some quick googling suggests that traffic accidents and falls are both roughly top 20 in leading causes of (global) DALY lost, although I’m out of time to check for better sources. I’d bet that poisoning is a bigger problem than currently measured in poorer countries.
Can these causes be targeted? An interaction of public policy and technology has reduced (and continues to reduce) deaths per million vehicle miles traveled. On the latter, I’ve noticed that “risk of falling” is often tracked in studies of the elderly, although I don’t know anything more about this.
Traffic accidents are hard because risk homeostasis works to negate improvements, and a lot of research has already been put into improving automobile safety, so the outside view is that we should expect continued diminishing returns. On the other hand, autonomous/self-driving cars are a new innovation which could potentially make a big difference. So that seems like a good area to target.
Good luck trying to reduce suicide! Poisoning… I dunno. Many of those might be suicide, and the obvious tactics of child-safety locks and warning labels have been implemented for a long time. Is there any low-hanging fruit there?
Falling is a huge problem for elderly, and also one that seems to me like it could be easily tackled. As Joshua says, there’s architectural improvements to housing that would reduce risk of falling which are currently uncommon, and there are other tactics: exercises and vibrating platforms may be able to improve the balance of elderly, and there’s a biological aspect in weakened bones (vitamin D clinical trials sometimes show reductions in all-cause mortality, which seems to be largely due to better bones leading to fewer damaging falls, and this may be why the bisphonates also reduce all-cause mortality).
One other thing to note here is that it isn’t clear how much of the technology improvement is technological improvement in medicine. In particular, there’s an argument that murder rates have gone down because people who would have died from from some injuries are now being saved. (See e.g. this summary. ) If so, this has likely also contributed to the reduction in automobile fatalities, although I’m not aware of any studies which have specifically looked at that impact.
Though this still leaves the door open to mitigating road traffic injury, and injury more generally, through improved medical technology. There is at least one juicy bit of low-hanging fruit waiting to be taken here.
I don’t have a specific breakdown data on types of falls in the elderly but one category that is common is falls in the bathrooms. Switching to curbless showers (which have become more common in general in North America) reduces shower falls in the general population and (I’ve been told by people in the industry) reduces falls especially in the elderly. There are likely many small aspects of household design that can help here in similar ways.
Since you asked...No, suicide is not classified as unintentional. Nor is homicide! That is not a chart of unintentional injury, but of all injury, with unintentional causes highlighted by being colored, while suicide and homicide are in white.
Oops! Thanks for catching that.
one would think so but certain demographics can’t seem to handle this