ideasIdea
A public registry of unanswered clinical questions linked to funding calls
Keep a public list of the questions doctors and patients most need answered but no trial addresses, and tie research funding to it.
Guideline panels repeatedly note evidence gaps but the gaps are buried in documents. The James Lind Alliance sets priorities with patients and clinicians but has limited oncology coverage. The proposal creates a structured, open registry of evidence gaps extracted from computable guidelines and living reviews, prioritised by burden and patient input, with funders committing to reference it in calls and trialists to register which gap a trial addresses.
Hypothesis
A gap registry referenced by funders will increase the share of newly funded oncology trials addressing prioritised gaps and reduce redundant trials on already-answered questions.
Rationale
Research waste from redundant and misdirected trials is estimated at a large share of spending; making gaps explicit and prioritised gives funders and trialists a common target.
What would test it
Extract gaps from ten living reviews; have two funders reference the registry in calls for two years; measure the proportion of funded trials mapping to prioritised gaps versus before.
Maturity
speculative
Who has to act
philanthropy
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.
- Patients lack understanding, navigation and agency · Most patients cannot understand their options, find trials, or push back, so decisions are made for them.