Giving to medical research, and the case of cancer

When I was ten and the first of my grandfathers died, I wanted to give my entire piggy bank to cancer research. Millions of people have the same instinct, and that is exactly what raises the next question: when a cause already has a lot of support, what difference does your next euro make?

Romain Barbe

Founder · Mieux Donner · 13 min read

This instinct is very widely shared. The Ligue nationale contre le cancer, France's best-known cancer charity, receives a large share of its donations from people affected by the disease, either directly or through someone close to them. The Téléthon, France's annual televised fundraiser, runs on the same motivation, with huge media exposure on top. And that is precisely what complicates things: when millions of people share your instinct, the cause is less neglected. A disease can be enormous and terrifying, and already receive a great deal of money. Both are true at once.

This article doesn't argue that medical research is useless, or that these charities do a poor job. It asks a narrower question: for an individual donation, today, what does your extra euro change?

Two questions we often confuse

When we choose where to give, we are really answering two very different questions.

The second question is about marginal impact: the difference between the world with your donation and the world without it. It depends entirely on what is already funded. Two causes of identical scale can have very different marginal impacts if one receives ten billion a year and the other ten million.

You can give as a gesture, because a disease took someone you loved. That donation has value, and nobody has the right to judge it. But if your aim is to help as many people as possible and prevent as much suffering as possible, then the question changes, and so does the answer.

How much does cancer research already receive?

In France, the Institut national du cancer (the national cancer institute) says it spends around €50 million a year on research, and Inserm €20 million through its dedicated programme. It estimates that the Ligue contre le cancer and the Fondation ARC together spend around €65 million a year.[1] Globally, the pharmaceutical industry invests more than $80 billion a year in oncology research and development, with over 2,500 drug candidates in clinical development, around five times more than in any other therapeutic area.[2]

Where French generosity goes

France's major research-funding charities don't all do the same thing.

What these organisations have in common isn't only that they fund research, and in fact none of them does only that. It's that they work on diseases found in rich countries, and several of them put children at the forefront of their communications. Yet these diseases account for little of global mortality, including among children.

This is also one of the reasons we explain why our recommendations don't target beneficiaries in France.

The Institut Pasteur is a special case. Its work focuses on infectious diseases that hit low-income countries hardest, malaria and tuberculosis in particular, and its international network is based there. The argument made here applies to it much less than to the other four.

What does a euro given to research achieve?

The most robust estimate comes from GiveWell, in 2014. Holden Karnofsky compared the budget of the US National Cancer Institute with the survival gains seen for cancers in the United States. He arrived at around $2,800 per year of life gained. By comparison, distributing insecticide-treated bednets then cost around $80 per year of healthy life.[4]

Karnofsky also assumes that cancer research produces less benefit per dollar than research in many other fields, partly because cancer already attracts a lot of interest from funders.[4]

The second finding is more awkward. Twelve years on, there is still no independent estimate of the cost per life saved of a donation to medical research. None of the major French charities publishes one. The link between funding and a discovery is hard to establish, and that difficulty is real. But it doesn't cut both ways. When you give to research, you accept a level of uncertainty you don't accept when funding a bednet distribution, and you also have good reason to think the return will be lower, since the cause is already well funded.

Other studies are more optimistic. Glover and colleagues estimated the return on UK cancer research, both public and charitable: £15 billion spent between 1970 and 2009, and 5.9 million years of healthy life gained between 1991 and 2010, an internal rate of return of around 10%, close to the 9% previously estimated for cardiovascular research.[5] That is a real, positive return.

Two details from this study matter. The average lag between funding research and seeing a health benefit is estimated at fifteen years. And 51% of the years of life gained came from the fall in smoking, in other words from prevention and public policy rather than new treatments.[5]

What about care?

The same reasoning applies to care. Treating a child with cancer in a high-income country costs an average of $425,000 over three years or more, including accommodation and travel, according to figures published by one of the largest children's hospitals in the US, and $564,000 according to an independent study of 927 patients in the United States. That amount sets a floor on the cost per life saved: you can't save a child for less than their treatment costs.[6]

This isn't an argument against caring for sick children. It's an observation about what money can do: if the goal is to save as many children as possible, it goes much further elsewhere.

Not all research is equal

Coefficient Giving, formerly Open Philanthropy, puts around 30% of its scientific research and global health grants into vaccine research, more than $150 million since 2016. Its conclusion isn't that research has little impact, but that the money is allocated arbitrarily: funding varies by a factor of 10 or more between infectious diseases, often for no good reason.[7][8]

For a comparable disease burden, a dollar spent on a vaccine against group A strep or hepatitis C therefore adds to far less existing funding than a dollar spent on HIV. Coefficient Giving sets out the limits of the exercise itself: disease burden projections are uncertain, funding data is incomplete, and not all extra money is equally useful. Some fields are short of good ideas or researchers more than money.[7]

The same gap exists within cancer

This comparison doesn't require any trade-off between France and Africa. Kamath and colleagues compared the revenue of 119 US cancer charities, nearly $6 billion a year, with incidence, mortality and years of life lost by cancer type. Breast cancer, leukaemias, lymphomas and childhood cancers are well funded. Digestive, gynaecological, brain and lung cancers are poorly funded. And the seven cancers linked to stigmatised behaviour (tobacco, alcohol, injected drugs, sexual behaviour, sunbeds) are all underfunded on at least one measure.[9]

Is a rare disease a neglected disease?

A donor might reply: that's exactly why AFM-Téléthon funds what nobody else will.

Take an extreme case. If twenty children worldwide had a disease nobody funded, and €50,000 were enough to treat them, that donation would have a huge marginal impact. Very few people affected, but almost nothing spent, and a need that a modest sum could meet in full.

Now keep those twenty children, and suppose several million euros have already been committed. The problem is the same size. What has changed is what remains to be funded. Relative to the scale of the disease and what is left to do, the cause is no longer neglected, and the next euro achieves much less there.

That is the situation for most rare diseases in rich countries. They look poorly funded next to breast cancer. They are very well funded relative to the number of people they affect, and even more so compared with the diseases that kill the most people worldwide. An orphan disease in France isn't a neglected cause on a global scale.

Who should fund research?

Choosing between a group A strep vaccine and a hepatitis C vaccine takes a scientific team, direct access to researchers and the ability to follow a programme over ten or fifteen years. That's the work Coefficient Giving and the Gates Foundation do, and they do it better than an individual donor could. Global funding for research into neglected diseases reached $4.17 billion in 2023, 63% of it from governments, and 83% of the philanthropic share came from the Gates Foundation alone.[10]

There's a second, more mechanical reason. Launching a research programme has a high entry cost: you need to raise a minimum budget, often several million, before anything can start. A €100 donation doesn't fund a tenth of a clinical trial. It waits to be pooled with thousands of others, and the funder then decides where it goes.

Distributing proven treatments works differently. It isn't free of thresholds either: opening a campaign in a new region means raising a budget before you start. But it is far more incremental and needs much less coordination. Once the campaign is running, each extra euro funds one more bednet, one more dose of vitamin A, one more vaccinated child, with no scientific judgement call needed.

What is already reducing cancer, without waiting for a breakthrough

The HPV vaccine, available for twenty years

Cervical cancer kills around 300,000 women a year, the vast majority in sub-Saharan Africa. For around twenty years there has been a vaccine against human papillomavirus (HPV) that prevents it. According to the estimates GiveWell uses, vaccinating 1,000 girls prevents around 15 cancers, 12 deaths and 243 years of healthy life lost.[11]

What's missing here isn't a discovery. It's delivery.

Tobacco, the most underfunded lever against cancer

Tobacco kills more than eight million people a year, and around 75% of these deaths occur in low- and middle-income countries. Yet tobacco control in these countries receives around $76 million a year in development aid and philanthropic funding.[12] That's roughly a thousand times less than the industry spends each year on oncology research.

Coefficient Giving estimates that advocacy for higher tobacco taxes can deliver a very high social return, while stressing that this result depends heavily on the size of the country targeted and the assumed likelihood of success.[12] In Glover's study, half the years of life gained attributed to UK research already came from the fall in smoking.[5]

Alternative proteins, an avenue to approach with caution

The International Agency for Research on Cancer classifies processed meat as carcinogenic to humans, and red meat as probably carcinogenic. The WHO attributes around 34,000 cancer deaths a year worldwide to diets high in processed meat, and estimates that red meat would cause 50,000 if the link were shown to be causal.[13] Making alternative proteins competitive would automatically reduce this exposure.

So where should you give?

Two things to take away.

If you want your euro to translate into an identifiable effect, distributing proven treatments is still the most direct lever for an individual. That's where evaluators have solid data, and where each extra euro corresponds to something concrete.

If you're set on funding research, change the question. Rather than "which disease affects me?", ask "which research has nobody else to fund it?" Vaccines against group A strep or hepatitis C, and treatments for neglected tropical diseases.

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