Editorial

Will & Deni McIntyre/Science Photo Library

Time for a new approach to the cancer research funding gap

For the AACR Progress Report see http://cancerprogressreport. org/2014/pages/toc.aspx For more on the Executive Order from the White House see http:// www.whitehouse.gov/the-pressoffice/2014/09/18/executiveorder-combating-antibioticresistant-bacteria For The Lancet Oncology Editorial see Lancet Oncol 2010; 11: 499

Good progress has been made against cancer in the USA, driven by federally funded biomedical research, but a huge health and financial burden remains. Benefits have not been uniform for all types of cancer, nor for all patients diagnosed with a given cancer. The Patient Protection and Affordable Care Act should tackle the ongoing challenge of cancer health disparities. However, further progress is likely to be hampered by ongoing funding shortfalls, as underscored by a report published by the American Association for Cancer Research on Sept 17, 2014, calling for increased federal investments in the National Institutes of Health (NIH) and National Cancer Institute (NCI). Although 21·5 million new cancer cases are anticipated to occur by 2030, funding cuts for the NIH have amounted to US$1·6 billion and, with levels not matching biomedical inflation, a further $3·5 billion dollar shortfall in NIH funding has resulted since 2010. Despite the rising health and economic burden of cancer, in fiscally challenging times federal agencies need to focus on research areas where the potential impact is greatest and commercial support is low.

On Sept 18, US President Barack Obama called for a strategic, coordinated, and sustained effort to tackle antibiotic resistance. Antibiotics have revolutionised cancer treatment by supporting advanced surgical procedures and aggressive therapies. The development of new antibacterial drugs, in addition to vaccines, diagnostics, and other novel therapeutics, would benefit cancer care substantially. Investment in comparative research on competing treatments will ensure that resources available to clinicians are used efficiently and to maximum effect—potential savings of $700 billion per annum have been projected in an Editorial in The Lancet Oncology, against the $2·5 trillion annual US health-care spend. Furthermore, with expectations that more than 50% of US cancer deaths in 2014 will be related to preventable causes, strategies targeted at healthy living could substantially reduce cancer incidence. To achieve maximum improvements in cancer care, the NIH and NCI need to step out of their comfort zone and focus on new targets that deliver greater health-related returns for their investment. „ The Lancet

Alison Wright/Corbis

Reducing the number of disaster refugees

For the report see http://www. internal-displacement.org/ assets/publications/2014/ 201409-global-estimates.pdf

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Natural disasters are inevitable but are the population displacements they cause also unavoidable? 22 million people were made refugees by natural disasters in 2013, according to a report released last week from the Internal Displacement Monitoring Centre and the Norwegian Refugee Council. This number is three-times higher than that for displacements caused by conflicts in 2013. Displacement increases the risk of health problems such as infectious diseases from overcrowding in refugee camps or worsening of chronic diseases due to disruption of care. However, a substantial number of displacements from natural disasters should be preventable. As the report notes, increased investment in disaster risk reduction measures such as better urban planning, maintenance of flood defences, and implementation of building standards for houses to withstand small-scale hazards, could help reduce displacements after natural events. This year marks 10 years since a magnitude-9 earthquake under the Indian Ocean triggered what is believed to be the most devastating tsunami in history. In the wake

and shock of the disaster, 168 countries endorsed the UN’s new Hyogo Framework for Action 2005–15, which outlined what countries should do to become more resilient to disasters. Progress reports have noted that countries have made good advances in strengthening disaster management, but have been slower to develop early warning systems and to address underlying risk drivers such as rapid urbanisation. Some experts have also criticised the framework for its neglect of other factors that increase the impact of disasters such as poor governance. The opportunity now exists to build a stronger global disaster reduction agreement. Countries have been discussing what should follow the Hyogo framework post-2015, a process that will culminate next March at the 3rd UN World Conference on Disaster Risk Reduction in Sendai, Japan. A new climate change pact and the next, sustainable, development goals are also being debated. Consideration of how to reduce human vulnerability to disasters in these discussions could make a real difference to the world’s growing refugee crisis. „ The Lancet www.thelancet.com Vol 384 September 27, 2014

Time for a new approach to the cancer research funding gap.

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