Cancer research is sometimes criticized for being timid. Drug companies run enormous trials looking for small improvements. Critics say they should run smaller trials and more of them.
Which side is correct depends on what’s out there waiting to be discovered, which of course we don’t know. We can only guess. Timid research is rational if you believe there are only marginal improvements that are likely to be discovered.
Sample size increases quickly as the size of the effect you’re trying to find decreases. To establish small differences in effect, you need very large trials.
If you think there are only small improvements on the status quo available to explore, you’ll explore each of the possibilities very carefully. On the other hand, if you think there’s a miracle drug in the pipeline waiting to be discovered, you’ll be willing to risk falsely rejecting small improvements along the way in order to get to the big improvement.
Suppose there are 500 drugs waiting to be tested. All of these are only 10% effective except for one that is 100% effective. You could quickly find the winner by giving each candidate to one patient. For every drug whose patient responded, repeat the process until only one drug is left. One strike and you’re out. You’re likely to find the winner in three rounds, treating fewer than 600 patients. But if all the drugs are 10% effective except one that’s 11% effective, you’d need hundreds of trials with thousands of patients each.
The best research strategy depends on what you believe is out there to be found. People who know nothing about cancer often believe we could find a cure soon if we just spend a little more money on research. Experts are more sanguine, except when they’re asking for money.