Good question! I think we seem to be going at a steady pace, but that depends on who you ask. Ultimately, it probably depends on what your expectations are of progress; my hunch is that people have higher expectations for cancer than for other diseases, particularly since it’s received so much attention historically, and that sets us up for inevitable failure when these expectations fail to materialize – much like the ‘war on cancer’ in the latter part of the 1900’s.
Broadly speaking, one can approach this from a treatment perspective and a prevention perspective. From a treatment perspective, there is definitely progress: “Since 1971, the cancer death rate is down more than 25 percent. Between 1975 and 2016, the five-year survival rate increased 36 percent. The arsenal of anticancer therapies has expanded more than tenfold.” We’re also in a position now where immunotherapies are becoming commonplace, and the drugs are becoming highly sophisticated. I think the next big treatment frontier is figuring out how best to use the arsenal of drugs we have, i.e., can we combine therapies in such a way that our treatments become more effective. We obviously hope to keep developing breakthrough drugs, but there’s a lot of untapped potential in lower-cost solutions and re-combining cancer drugs in new ways. This would also certainly save money, but pharmaceutical companies are obviously not as interested in doing this. To sum up, I think the treatment frontier involves greater experimentation with the implementation of drugs we currently have.
I’m not as convinced that our cancer prevention progress has been as impressive, however. Obviously, we’ve gotten a lot better at identifying environmental contaminants that might increase the likelihood of developing cancer, but a lot of the lifestyle diseases (e.g., obesity) that increase the risk of cancer haven’t been solved by any means. Ultimately, preventing cancer in the first place is a lot more efficient than having to treat it later.
As the saying goes – cancer is such a heterogenous phenomenon that it might not be prudent to lump them all together. They’re so distinct that the ‘war on cancer’ is more a ‘war on many, many fronts’. We’re definitely making progress, but we shouldn’t expect a one-size-fits-all solution anytime soon.
Definitely an enormous issue! I’m not as familiar with the Long-COVID data, but the issue applies to a lot of other fields/areas.
I argue in the book that one of the most prevalent issues is linked to how researchers are incentivized to publish quickly and often. This means that studies will often tend to be under-powered (i.e., too few participants to show the ‘right’ level of statistical certainty) because it’s time-consuming to include more patients and because it’s often more expensive. The result is, as you point out, that we’re inundated with studies that don’t show much of an effect size, or at least not enough to conclude anything meaningful. Ultimately, this wastes research resources on a systems level, because one big study would have sufficed for fewer resources overall. But because it’s a publishing game, researchers aren’t incentivized to collaborate as much as we’d like from a progress perspective. In the book, I call this ‘artificial progress’, where we think we’ve learnt something new about the world (through the publishing of these studies), but ultimately we’re just misleading ourselves and need to use even more resources to clarify studies that should have been clear from the outset.
One could argue that it should ‘cost’ more for authors to submit under-powered studies to journals, since journals often accept their research despite the methodological flaws, and therefore authors aren’t penalized for this type of behavior. The journals might also prioritize interesting results over the study size being adequate – meaning that too many of these articles get published. Authors and journals ultimately both ‘win’ from this behavior.
I think this issue of sloppy research methods is probably MUCH more prevalent than we think, but I haven’t been able to find reliable sources. In the book I talk about research misconduct and fraud, where some “studies suggest that the true rate of fraud among published studies lies somewhere between 0.01% and 0.4%.” I’d suspect the rate of sloppy research methods to be many times higher than this.