The British Imperial Cancer Research Fund, Europes largest independent cancer research institute, will celebrate its centennial next year. But it may not be the ICRF for much longer. It is expected to merge with the countrys second biggest cancer charity, the Cancer Research Campaign. The new organization, assuming it comes into being, will almost certainly assume a new name.
Although the merger has not been finalized, the two organizations said in a joint statement that "a merger could bring real benefit to cancer research and to cancer patients." The rationale is that the two charities research programs complement one another. The ICRF employs about 1,000 scientists and doctors and has extensive laboratories, while the CRC is more committed to project funding in the form of grants.
But there is deep concern that a merger would favor ICRF employees at the expense of CRC grantees, who rely on short-term funding. The ICRF researchers are hired on a full-time basis, just like any other employee, but CRC grantees depend on the renewal of short-term grants for their research.
"The issues are up for discussion," said Gordon McVie, M.D., Ph.D., director general of CRC. "Were in the middle of consultation with all the people involvedvolunteers, fundraisers, and scientists. No decision will be taken until at least October."
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Between 1959 and 1979, the Charity Commission registered 340 new charities to promote medical knowledge and/or research. Yet between 1979 and 1993, there were 1267 new registrations, 290 in the cancer field alone.
The charity sectors overall contribution to research outstrips that of the government-funded Medical Research Council. "For far too long the government has relied on cancer research charities to fund the majority of research," said Paul Nurse, Ph.D., director general of the ICRF.
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Overall, the charitable sector spends between £160 million and £200 million (about US $229 million and $286 million) on cancer research, while the British government is estimated to spend between £112 million and £170 million (US $160 million and $243 million). (The large discrepancy between the two figures is accounted for by different interpretations about what constitutes expenditure on "research" as opposed to infrastructure. Either figure is roughly ten times less than that spent in the United States in absolute terms.)
But research funding is only part of the problem. Researcher Tim Allen-Mersh, M.D., noted that he is in favor of the merger and that another critical player, the National Health Service, has recently stepped up its commitments to cancer research (see News, April 4, p. 496; May 2, p. 670).
"A merger may help to stitch up the biology that will produce good therapeutic initiatives, but how do you transform this into translational researchinto phase I and II studies that move things forward from the laboratory to the patients bedside?" said Allen-Mersh, of the Chelsea and Westminster Hospital, London, and consulting surgeon to the small, independent charity, Colon Cancer Concern.
But Allen-Mersh sees Britains charity-driven culture as a reflection of strength as well as weakness. He said he is concerned that the proposed merger will create a huge monolith that will focus primarily on new therapies while ignoring many of the concerns of patients and relatives.
"Bereaved relatives donating money to research frequently want it to be spent on something that might have helped the person they have lost," he said.
Such aspirations explain the proliferation of cancer charities and Britains pioneering role in the development of the modern hospice movement, starting in 1967 with the opening of St. Christophers Hospice in London.
"Charities are one of the few effective vehicles through which the public can influence the medical research agenda," said Diana Garnham, chief executive of the Association of Medical Charities.
The great British charity tradition started with a charity law in 1601 after the dissolution of the monasteries. "The idea was to wrestle independence from the church and the state and to provide the individual with the freedom to be philanthropic or altruistic, more or less as they chose, Garnham explained. "Our charity law really does provide a very great freedom from interference from the state."
But David Taylor, B.Sc., professor of health policy, School of Pharmacy, London University, suggested that that freedom may not be what is needed. "Our strong charity culture could be seen as letting the government off the hook at the expense of cancer research. What we really need is a powerful triumviratecharity, state, and industry."
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