Cancer research is one of those rare phenomena that is so deeply ingrained as a noble and good thing in the public imagination that to ask tough questions about its quality, effectiveness and value almost risks being a serious breach of etiquette.
But those questions are about to be asked. MPs on the Commons science and technology committee have announced a massive root and branch investigation that will examine, in effect, whether the multi-million pound cancer research industry actually works.
The committee will look at the organisation, funding and regulation of cancer research, whether the research is effective and how well it percolates into clinical practice. Its terms of reference pull few punches: they amount to a detailed, challenging critique of the existing system.
Leading the charge is poacher-turned-gamekeeper Dr Ian Gibson, Labour MP for Norwich North. Before entering Parliament in 1997 he was head of cancer studies at the University of East Anglia.
He is outspoken, and unafraid to mix it with the medical science establishment.
Dr Gibson argues that while the UK has some of the worst cancer survival rates in the western world, there is little sense of public disquiet that this may be in part due to the failings of cancer research. Confidence in the NHS or the politicians who run it may falter, but cancer charities continue to suck in vast piles of cash from an ever-generous public, and dispense it liberally into research.
Cancer charities in the UK collectively spent around£130m on cancer research in 1998-99. The Cancer Research Campaign and the Imperial Cancer Research Fund account for£51m and£55m respectively. The drugs companies spent around£500m on cancer research last year .
NHS Research and Development and the Medical Research Council provide millions more.
This huge resource is badly organised and inefficient, argues Dr Gibson. There are too many charities, each doing their own thing, often duplicating work. The financing of clinical trials is a mss. NHS Research and Development is pathetic, while scientific advances are often slow to translate into clinical practice.
The public takes it on trust that they (the charities and other research organisations) are doing a good job. I would argue that an independent force is needed to look at what they do, he says.
The current system, he asserts, is flawed by a wasteful research establishment riven by individual and corporate ambition and rivalry - this dreadful history of them running for knighthoods and MBEs - at the expense of a properly co-ordinated approach.
He wants to see the creation of a national cancer institute to bring unity of purpose to the cancer research business. This could draw together all interested parties - including patients groups - to decide a strategic programme of research priorities and share and disseminate findings.
Both CRC and ICRF declined to give detailed responses to some of the questions posed by the investigation - each organisation is preparing detailed written evidence for the committee.
Jean Mossman, director of cancer advice charity Cancer BACUP, welcomes the investigation. We need to ensure that high-priority cancer research is undertaken, and the results implemented quickly and effectively so that patients have swift access to better care. That's not always the case at the moment.
She says several problems need looking at: the painfully slow grants bureaucracy; the lack of job security for researchers, many of whom are on short-term contracts; the difficulties getting enough patients into clinical trials. The slow and fitful take-up of new drugs by the NHS, such as the ovarian cancer drug Taxenol.
Mike Fry, chief executive of specialist cancer unit the Christie Hospital trust, is unconvinced by Dr Gibsons critique of the cancer charities. It feels to me that it is better organised than the vast majority of medical research. The chances of there being wholesale duplication is a lot less.
He agrees that the research system could be streamlined - good cancer researchers have a 10-20 per cent hit rate: they spend a lot of time preparing grant proposals that come to nothing - and accepts that there are difficulties in carving out research time for clinicians overloaded with casework.
But he points out that the big charities call the shots because they provide most funding.
I see the theoretical accountability deficit but the government cannot have it both ways; either it funds cancer research to a level where it has a legitimate place at the table, or it relies on the charities, he says.
Julie Kirkbride, Conservative MP for Bromsgrove and a vice-chair of the all-party Commons group on cancer, urges caution.
There may be duplication at the margins, but any reorganisation should not create a model that is overcentralised or bureaucratic. Im always a bit wary of politicians getting involved in these things.
Dr Gibson, however, believes that too many lives, and too much publicly raised money, is at stake for the industry to be left to its own devices.
And he believes the committees investigation will trigger change. He says: This will revolutionise the way we look at cancer services in this country.