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Whether and to what extent research funding should be distributed in proportion to disease
burden is, in itself, an area of debate. Some have put forward that greater health gains can
potentially be achieved at no additional cost by allocating resources more fairly in proportion
to health needs.21 24 This argument is supported by studies that have found positive
correlations between disease-specific research funding and the development of new
therapies and innovations.25 26 However, more research funding may not necessarily
translate into less disease burden in all situations,27 and appropriate ways to define and
measure disease burden may differ depending on the context. Moreover, as already
discussed, funders may consider other criteria to be as or more important, such as potential
for progress and public interest.27 Nevertheless, the results of this research suggest that in
absolute terms and in relation to burden, some digestive diseases have received little in the
way of Horizon 2020 research funding.
This study found that gastroesophageal reflux disease, eosinophilic oesophagitis, dyspepsia,
gastritis and duodenitis, peptic ulcer disease, inguinal, femoral, and abdominal hernia, and
paralytic ileus and intestinal obstruction received very limited if any research funding in the
form of Horizon 2020 grants. Unsuccessful research proposals were not available to analyse,
and it is possible that the lack of funding awarded may relate to a shortage of proposals in
these areas. However, many of the diseases mentioned did not appear to be similarly underresearched
(as measured by publication output) in relation to disease burden. These findings
suggest that a lack of research activity in these disease areas is unlikely to be the sole
explanation for the scarcity of funding. It is also possible that whilst these diseases did not
appear to be under-researched, there may be a lack of pan-European research collaboration
in these disease areas, which may present a barrier to obtaining Horizon 2020 funding.
Alcohol-related liver disease appeared both under-funded and under-researched in relation
to the high level of burden associated with this disease. Other studies have observed similar
findings, with alcohol-related liver disease receiving less research attention (in terms of
publication and conference output, research funding and therapies under development) in
relation to burden compared with chronic viral hepatitis and non-alcoholic fatty liver
disease.26 Possible explanations underlying this finding relate to the social stigma associated
with substance use disorders which can reinforce victim-blaming attitudes and subsequent
under-funding of these disorders within research programmes.24 26 Likewise, the burden
associated with alcohol-related liver disease disproportionately falls on more
socioeconomically disadvantaged groups,28 who may have less say and influence over
research priority decisions.29 30 31 Several avenues for further research in relation to alcoholrelated
liver disease have been proposed, including research to improve large-scale early
White Book 2: Part 2


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