- Email: [email protected]
Widening the gap: additional concerns with crowdfunding in health care
Correspondence
Widening the gap: additional concerns with crowdfunding in health care In an editorial published in The Lancet Oncology,1 the editors note that aging populations and the consequent increase in the global burden of cancer will create new shortfalls in cancer care services worldwide. They note that in Canada, charitable giving has struggled to keep up with these shortfalls, leading to the increased use of medical crowdfunding by individuals. This observation is supported by our own research on medical crowdfunding by Canadians, where seeking funds for cancer-related care is the most common cause for using crowdfunding. In June, 2016, we collected 1808 active cancerrelated campaigns by Canadians on the crowdfunding platform GoFundMe who had raised nearly CAD$13 000 000 (£7 900 000). These findings are consistent with the large number of cancer-related campaigns noted in the editorial from the crowdfunding platform JustGiving. The editorial raises concern with abuses stemming from crowdfunding campaign posters fraudulently creating fake campaigns and those raising money for unproven inter ventions. We share these concerns and have noted other ethical issues raised by this practice.2,3 Resorting to medical crowdfunding exposes recipients to a substantial loss of privacy, where crowdfunding requires them to publicly state their medical condition and treatment, describe the nature of their financial need, post photos and videos documenting their private life and medical treatment, and post regular updates on their medical status. This information is publicly available and the campaigner must actively share it with a network of friends and strangers in order to succeed in raising funds. Moreover, www.thelancet.com/oncology Vol 18 May 2017
although a formal charity such as those discussed in the editorial is more likely to distribute resources according to need, crowdfunding is much less equitable in disbursing funds. Individuals most likely to be successful in meeting their fundraising goals are those with large social networks, a sympathetic story to tell, or contacts in the media to help promote their campaigns. Although all individuals legitimately seeking crowdfunding are in a position of vulnerability, crowdfunding tends to favour those in a relative position of privilege in their communities.4 The editorial expresses concern that the rise of medical crowdfunding shows a failure of publicly funded health systems, illustrating the need for more efficient provision of health care. We agree, but also contend that crowdfunding serves to undermine systemic reforms of this kind. Medical crowdfunding serves as a means of addressing the symptoms of systemic failures. Because it most benefits relatively privileged members of society, the concern is that those groups will choose to become reliant on using crowdfunding at the expense of advocating for systemic change. This is not a purely hypothetical concern, because our own research shows that the reasons given for encouraging crowdfunding donations largely do not include mention or critique of systemic failures.5 Thus, crowdfunding for cancer-related care is likely to benefit those people best in a position to advocate for systemic change while leaving behind those who are lacking the social position to either benefit from crowdfunding or attract attention to the failure of health systems to meet their needs.
1 2
3
4
5
Mind the gap: charity and crowdfunding in health care. Lancet Oncol 2017; 3: 269. Snyder J. Crowdfunding for medical care: ethical issues in an emerging health care funding practice. Hastings Center Report 2016; 46: 36–42. Snyder J, Mathers A, Crooks VA. Fund my treatment!: a call for ethics-focused social science research into the use of crowdfunding for medical care. Soc Sci Med 2016; 169: 27–30. Burtch G, Chan J. Reducing medical bankruptcy through crowdfunding: evidence from GiveForward. Thirty Fifth International Conference on Information Systems. 2014. https://pdfs.semanticscholar.org/c4c7/148df6 f372a853ac6f9f7f56701ce165188c.pdf (accessed April 6, 2017). Snyder J, Crooks VA, Mathers A, Chow-White P. Appealing to the crowd: ethical justifications in Canadian medical crowdfunding campaigns. J Med Ethics 2017; published online Jan 30. DOI:10.1136/medethics-2016-103933.
We declare no competing interests.
*Jeremy Snyder, Peter Chow-White, Valorie A Crooks, Annalise Mathers [email protected] Health Sciences (JS, AM), Department of Geography (VAC), and School of Communications (PC-W) Simon Fraser University, Burnaby, BC V5A1S6, Canada
e240
Widening the gap: additional concerns with crowdfunding in health care In an editorial published in The Lancet Oncology,1 the editors note that aging populations and the consequent increase in the global burden of cancer will create new shortfalls in cancer care services worldwide. They note that in Canada, charitable giving has struggled to keep up with these shortfalls, leading to the increased use of medical crowdfunding by individuals. This observation is supported by our own research on medical crowdfunding by Canadians, where seeking funds for cancer-related care is the most common cause for using crowdfunding. In June, 2016, we collected 1808 active cancerrelated campaigns by Canadians on the crowdfunding platform GoFundMe who had raised nearly CAD$13 000 000 (£7 900 000). These findings are consistent with the large number of cancer-related campaigns noted in the editorial from the crowdfunding platform JustGiving. The editorial raises concern with abuses stemming from crowdfunding campaign posters fraudulently creating fake campaigns and those raising money for unproven inter ventions. We share these concerns and have noted other ethical issues raised by this practice.2,3 Resorting to medical crowdfunding exposes recipients to a substantial loss of privacy, where crowdfunding requires them to publicly state their medical condition and treatment, describe the nature of their financial need, post photos and videos documenting their private life and medical treatment, and post regular updates on their medical status. This information is publicly available and the campaigner must actively share it with a network of friends and strangers in order to succeed in raising funds. Moreover, www.thelancet.com/oncology Vol 18 May 2017
although a formal charity such as those discussed in the editorial is more likely to distribute resources according to need, crowdfunding is much less equitable in disbursing funds. Individuals most likely to be successful in meeting their fundraising goals are those with large social networks, a sympathetic story to tell, or contacts in the media to help promote their campaigns. Although all individuals legitimately seeking crowdfunding are in a position of vulnerability, crowdfunding tends to favour those in a relative position of privilege in their communities.4 The editorial expresses concern that the rise of medical crowdfunding shows a failure of publicly funded health systems, illustrating the need for more efficient provision of health care. We agree, but also contend that crowdfunding serves to undermine systemic reforms of this kind. Medical crowdfunding serves as a means of addressing the symptoms of systemic failures. Because it most benefits relatively privileged members of society, the concern is that those groups will choose to become reliant on using crowdfunding at the expense of advocating for systemic change. This is not a purely hypothetical concern, because our own research shows that the reasons given for encouraging crowdfunding donations largely do not include mention or critique of systemic failures.5 Thus, crowdfunding for cancer-related care is likely to benefit those people best in a position to advocate for systemic change while leaving behind those who are lacking the social position to either benefit from crowdfunding or attract attention to the failure of health systems to meet their needs.
1 2
3
4
5
Mind the gap: charity and crowdfunding in health care. Lancet Oncol 2017; 3: 269. Snyder J. Crowdfunding for medical care: ethical issues in an emerging health care funding practice. Hastings Center Report 2016; 46: 36–42. Snyder J, Mathers A, Crooks VA. Fund my treatment!: a call for ethics-focused social science research into the use of crowdfunding for medical care. Soc Sci Med 2016; 169: 27–30. Burtch G, Chan J. Reducing medical bankruptcy through crowdfunding: evidence from GiveForward. Thirty Fifth International Conference on Information Systems. 2014. https://pdfs.semanticscholar.org/c4c7/148df6 f372a853ac6f9f7f56701ce165188c.pdf (accessed April 6, 2017). Snyder J, Crooks VA, Mathers A, Chow-White P. Appealing to the crowd: ethical justifications in Canadian medical crowdfunding campaigns. J Med Ethics 2017; published online Jan 30. DOI:10.1136/medethics-2016-103933.
We declare no competing interests.
*Jeremy Snyder, Peter Chow-White, Valorie A Crooks, Annalise Mathers [email protected] Health Sciences (JS, AM), Department of Geography (VAC), and School of Communications (PC-W) Simon Fraser University, Burnaby, BC V5A1S6, Canada
e240