The payout for philanthrocapitalists is not personal financial returns, but seeing the evolution of benefits that save society money.
A trailblazer for this finely focussed wealth-sharing in Australia is an ambitious network – seed-funded by Billabong surf wear millionaire Gordon Merchant – that hopes to set a benchmark for philanthrocapitalism and develop a vaccine to prevent skin cancer, a disease that costs the Australian economy A$5 billion annually.
Abundant sunshine has helped to make Australia one of the world’s most relaxed and optimistic countries. But it has come at a price. Australia is now the skin cancer capital of the world. More than 1800 Australians die each year from skin cancers.
They cost the economy A$5 billion a year through treatment and lost work productivity. Two-thirds of Australians will have developed a skin cancer before they reach the age of 70.
Ian Frazer, an immunology professor at the University of Queensland, says: “In Australia, it is not a matter of whether you get skin cancer, but when you get your first one.”
Armed with alarming statistics like these, Frazer and David Wilkinson, head of the school of medicine at the University of Queensland, have embarked on what they believe is a world-first strategy to conquer one of Australia’s most intractable health problems.
They have formed the Skin Cancer Network, a body that aims to pull together experts fighting skin cancer all over the country to pool their research.
More radically, they are funding their network with a model new to Australian medicine – philanthrocapitalism. Governments have been spending more than A$250 million a year battling skin cancer, more than for any other type of cancer.
Despite years of public health warnings on the potentially deadly impact of too much sun exposure, skin cancers keep growing at a faster rate than other cancers.
The Merchant Foundation created by Gordon Merchant, founder of the Billabong surf and skate brand empire, has provided seed money for a quest that the Queensland professors eventually hope will raise up to A$50 million.
Funds of that scale will enable the network to “identify the main issues, throw a heap of money at them and deliver a king hit”, says Frazer, a former Australian of the Year. And it’s an ambitious vision.
Frazer, who helped to create Gardasil, a vaccine against cervical cancer, believes it might be possible to develop a vaccine against viruses in the skin that promote skin cancer.
“Within my lifetime, we should be able to remove the threat of skin cancer from the next generation,” says Frazer, 57.
Philanthropy from rich people, giving their money to charities and other good public causes, is hardly new. But philanthrocapitalism takes it further.
The role models are Bill Gates and Warren Buffett, two of the world’s richest men, who declared five years ago that they planned to give away most of their vast wealth to try to eradicate diseases that were killing millions of people.
To describe such approaches, two British writers, Matthew Bishop and Michael Green, coined the term for their book Philanthrocapitalism: How the Rich Can Save the World.
Bishop says philanthrocapitalists are “real game-changers” because they seek to channel their vast wealth towards strategic targets.
“They’re actually able to provide really imaginative and creative solutions to some of the biggest problems facing us.”
The University of New South Wales has become the host institution for the Pacific Friends of the Global Fund, fighting AIDS, tuberculosis and malaria.
Funded by the Bill and Melinda Gates Foundation, the Pacific Friends’ strategic partners at UNSW are the Centre for Social Impact, the Kirby Institute for Infection and Immunity in Society, and the National Centre in HIV Social Research.
The institute has also received a separate pledge of A$10 million over three years from Chuck Feeney, an Irish American philanthropist who has given a reported A$500 million mainly to help medical research in Australia.
With an eye on the institute’s progress, the pledged amounts from Feeney’s Atlantic Philanthropies are to be paid in equal, twice-yearly installments, and must be matched by the university to continue.
Since 2010, the University of New South Wales has also been home to the Lowy Cancer Research Centre, Australia’s first institution to integrate work on childhood and adult cancer research. It was founded with a substantial A$10 million grant from Frank Lowy, one of Australia’s leading businessmen and philanthropists, and his family.
The centre now includes the previously separate Children’s Cancer Institute Australia, and will allow researchers to explore links between childhood and adult cancers that could help to improve survival rates.
Les Hems, director of research at the Centre for Social Impact, says the role of philanthrocapitalism in cancer research is becoming “absolutely crucial”.
Traditional or “old” philanthropy involved gifts of money coupled with trust that it would be put to a good cause. “A key aspect of philanthrocapitalism is measuring the results of a venture at crucial points,” he says. “It involves a similar long-term aim of a financial investment.
The difference is that it looks at the evolution of a social benefit rather than a financial return. Just as ordinary investors want regular financial reports on their investments, philanthrocapitalists seek only regular reports on how the project is going.”
The centre itself is at the forefront of developing new investment models in Australia with a philanthrocapitalism approach: encouraging business foundations and rich individuals to invest their money in projects where the prime outcome is a social benefit more than a financial return.
But financial returns of a different sort – saving society money – inevitably follow if the money helps to conquer diseases.
The Skin Cancer Network had its birth in such thinking. Frazer says: “A group of us were sitting around asking what we could do to make a difference. The answer lay in a lot more money than ordinary medical grants can offer. It’s really a Gates Foundation approach to medicine, which in turn is more businesslike than a government approach of equitable funding. The government would laugh at me if I asked for A$50 million. It would say it could fund 50 (research projects) for that. Maybe so. But it won’t get the answers.”
The answers are needed for a problem that has built gradually in Australia since the 1950s with all the elements of a perfect medical storm: a largely Celtic and Anglo-Saxon population with skin types unsuited to strong sun exposure, together with the advent of beach culture, youth culture and the liberation from clothing styles, such as hats and long-sleeved garments that had helped to protect earlier generations of Australians.
Wilkinson says the skin cancer disease burden is now enormous.
“There’s fantastic research happening in Brisbane, Sydney, Melbourne and elsewhere, but it doesn’t attack the burden as a whole in a strategic way. The answer is not putting another building up, or moving people from one building to another. It’s about linking all these people up and putting a strategy in place.”
Critical factors Frazer argues such a national network, backed by the funds that only philanthrocapitalism could raise, would drive serious research and attract the world’s best people.
“Money tends to glue people together and make them feel there’s a long-term approach,” he says. The Merchant Foundation has agreed to lead a fundraising effort around Australia with a target of between A$25 million and A$50 million.
There are three critical issues around skin cancer that could be explored through such a national network. The first is the whole question of what causes skin cancers, and why some people with fair skin succumb to them, while others with similar skin types and similar exposure to the sun do not.
Most of Australia’s public education campaigns have focused on melanoma, the most aggressive form of skin cancer, which can spread fatally to other parts of the body if not caught early.
Basal skin cancer, a more common form, is more benign. Frazer says the bigger worry comes from a third form, squamous cancer, which needs much more research.a nasty one, and the cause of the biggest burden of the disease,” he says.
He would like to explore how genetics and variations in people’s immune systems may expose some people to greater risk of skin cancer after sun exposure. “We’re looking at the nature of immune response in the skin,” he says.
“If you take away the body’s defence systems, skin cancer becomes more common.”
One big hypothesis he wants to test is how some viruses (such as wart viruses) embedded in skin may pose a skin cancer risk for people with damaged immune systems. If such a link can be proved, Frazer believes a vaccine analogous to the cervical cancer (human papillomavirus) vaccine could be developed.
“The virus issue is a big unknown,” Frazer says. “Melanoma seems to be linked more to genetic predispositions. But the smoking gun evidence shows that viruses could apply to squamous and basal skin cancers. So if we can define these risk factors, we can identify which people are going to get into trouble from sun exposure more than others, and warn them from an early age.”
A second possible project could be a “skin cancer pathway”, aimed at improving diagnosis and thus cutting deaths. Wilkinson says too many patients are not being seen and treated until melanoma and squamous cancer, the two most dangerous ones, have reached late stages.
And even when lesions have been identified as suspicious, wrong biopsy techniques are too often used. He cites a report that 25% of invasive melanomas in Victoria had only partial biopsies, when national guidelines call for biopsy by excision.
More worryingly, only one-third of melanomas in Victoria were excised with correct margins, and just 6% were followed up appropriately.
“Clearly there are widespread gaps in adherence to best practice guidelines among Australia’s medical workforce,” Wilkinson says.
“Unlike other cancers, almost all skin cancers arise on the skin and are therefore visible. If all such skin cancers were correctly identified, biopsied and treated appropriately, it is strongly believed that almost no one would die.”
Finally, funds could allow the network to embark on the most comprehensive study yet of educating children, teenagers and young adults, up to the age of 35, about preventing skin cancer. Ideally, such a study would select about 10,000 people in Queensland and Tasmania (two opposite extremes of sun exposure) and observe them over 20 years.
The people would be divided into two random groups, and subjected to different education intensity levels. One would receive “regular encouragement” through Facebook, Twitter and other social media about using sunscreen, hats and sunglasses to block out sun.
The other would receive just “standard advice”. Over the 20 years, each group would be measured for skin ageing, new moles and new skin cancers. Frazer and Wilkinson are confident that philanthrocapitalism will allow the Skin Cancer Network to set a benchmark with projects of this sort. “This is an unusual approach to health issues in Australia,” says Frazer.
“We hope it will set a precedent by showing it is better to take a businesslike approach to identifying fundamental issues and finding out what should be done. Then, with Australia’s experience of skin cancers, we can go global and find out if [the issues are] the same in other countries.”
* Article courtesy of Knowledge@Australian> School of Business. http://knowledge.asb.unsw.edu.au
