Three Quarters.
Awareness Campaigns Work. That Is the Problem.
Movember has funded more than 1.8 billion Australian dollars of men's health work. Prostate cancer is now the best-funded cancer in America per death, ahead of every other cancer studied. The moustache worked. So did the pink ribbon. This post is about what that proves, and about everything that never got a campaign.
Every November the moustaches come back, and every November I have the same two thoughts in the same order.
The first is unqualified admiration. Movember started with a few friends in a pub and has funded more than 1.8 billion Australian dollars of work on mental health and suicide prevention, prostate cancer and testicular cancer. [1] That is an extraordinary thing to have built out of facial hair.
The second thought is less generous, and for years I could not make it precise enough to say out loud. It went something like: and meanwhile nothing. Meanwhile endometriosis. Meanwhile menopause. Meanwhile the forty years that nobody is funding.
So I went and checked, expecting to find that men's health is lavishly funded and women's health is not.
That is not what the numbers say, and the thing they do say is considerably worse.
Here is the short version, and then I will spend the rest of the post defending it. Prostate cancer and breast cancer are the two best-funded cancers in the United States. They are also the two with the most recognisable awareness campaigns on earth. The cancers that kill the most people per case, pancreatic and lung, receive a fraction of what either of them does. [2]
Awareness campaigns do not merely raise their own money. They reorder a national research budget. The moustache worked. The ribbon worked. And that is exactly why the conditions with no campaign at all are in the state they are in.
Dollars Per Death
US federal research funding per estimated cancer death, nine cancers, fiscal year 2025. Tap a bar.
Mohindroo and Thomas, JAMA Network Open 2026. Deaths are estimated from incidence and five-year survival, not observed. One fiscal year of funding. [2]
Look at the top two and the bottom two together, because the pairing is the whole argument.
The two best-funded cancers per death are the two with campaigns. Chirayu Mohindroo and Anish Thomas compared fiscal year 2025 federal funding against incidence and survival for nine cancer types. Prostate cancer received 126,992 dollars per estimated death, the highest figure in the set. Breast cancer received 69,800 dollars per estimated death, and 1.58 billion dollars in total, the largest total of any cancer studied. [2]
The two worst-funded are the ones that kill fastest. Small-cell lung cancer received 2,818 dollars per estimated death. Non-small-cell lung cancer received 1,754. Pancreatic cancer, 8,945. The authors note that the cancers with the highest mortality-to-incidence ratios received disproportionately lower federal funding, while breast and prostate, both with ratios below 0.10, received the most per death. [2]
And ovarian cancer sits in between. 419 million dollars in total, 43,275 dollars per estimated death. Less than half of what prostate receives per death, and roughly a quarter of breast cancer's total. Cervical and uterine cancers were not in the sample at all. [2]
If you wanted to argue that men's health is overfunded and women's is neglected, this table refuses to help you. Breast cancer has the largest total budget of the nine. The thing the table actually demonstrates is narrower and far more useful: funding follows attention, and attention is manufactured.
Which raises the obvious question. What happens to a disease that nobody has manufactured attention for?
Three Quarters
What happens across the whole NIH portfolio once you normalise funding to disease burden.
Mirin, Journal of Women's Health 2021. The dots are an illustration of the proportion reported, not a plot of individual diseases. [3]
Arthur Mirin took NIH funding across the disease portfolio and normalised it to burden, measured in disability-adjusted life years, then looked specifically at diseases that fall predominantly on one sex. The result, in his own words:
"In nearly three-quarters of the cases where a disease afflicts primarily one gender, the funding pattern favors males, in that either the disease affects more women and is underfunded (with respect to burden), or the disease affects more men and is overfunded." [3]
And the size of it: "the disparity between actual funding and that which is commensurate with burden is nearly twice as large for diseases that favor males versus those that favor females." A chi-square test returned a p-value of 0.015. [3]
His conclusion is one sentence long. "NIH applies a disproportionate share of its resources to diseases that affect primarily men, at the expense of those that affect primarily women." [3]
Note what this does and does not claim. It is not saying men's diseases are frivolous or that men are not suffering. It is saying that when you measure how much a disease costs a population in years of healthy life, and then ask how much research money it receives, the relationship between those two quantities is systematically different depending on who gets the disease.
Funding follows attention, and attention is manufactured. The moustache is not the problem. The problem is that this is how the money moves at all.
Now put the two findings side by side. Campaigns move money, demonstrably and enormously. And across the portfolio, the diseases that land on women are the ones running below their burden. Those are not two separate facts. The second is what the first produces in a system where nobody is obliged to allocate by need.
Six Links in the Chain
How a funding gap becomes a knowledge gap becomes a woman in a waiting room. Tap through.
Each link has its own evidence. The chain itself is my argument, not a finding. [4][5][6][7][8][9][10][11]
Endometriosis receives 0.038 percent of the NIH health budget. It affects at least one woman in nine.
That is not a rhetorical figure. Katherine Ellis, Rachael Munro and Jennifer Clarke put it in the title of their paper: endometriosis is undervalued. NIH funding for a condition affecting at least 11 percent of women worldwide, around 6.5 million in the United States and over 190 million globally, amounted to 0.038 percent of the 2022 health budget. [6]
Now ask why. It is not because endometriosis is rare, or mild, or cheap. The multicentre study across ten countries documented the diagnostic delay and the losses in quality of life and work productivity that come with it. [7] It is one of the most expensive chronic conditions a health system quietly absorbs.
It is because endometriosis does not kill you. It takes your twenties and thirties, your fertility, your capacity to work through a Tuesday, and it leaves you alive at the end, which means it never produces the kind of death count that moves a budget line or a newspaper.
And here is the part I want to be precise about, because this is where I stop being polite. The funding system responds to two things: mortality, and campaigns. Prostate cancer has a mortality-to-incidence ratio below 0.10 and the most successful men's health campaign ever built, and it receives more money per death than any other cancer in the country. [2] Endometriosis has neither. It has no deaths to count and no moustache.
So a system with exactly two levers has nothing to offer the largest category of female suffering there is: chronic, non-fatal, lifelong, and overwhelmingly borne by women. Not neglected by accident. Structurally unreachable.
The moustache did not cause this. It proved it. It demonstrated, with 1.8 billion dollars of evidence, that if you build a vehicle the money arrives. [1] Twenty-two years later there is still no equivalent vehicle for the conditions in this paragraph, and the reason is not that nobody has thought of it.
Five things to hold against me
Men's health is not fine, and I am not arguing that it is. Movember's largest arm is mental health and suicide prevention, and the gender paradox in suicide is real: women report more suicidal ideation and behaviour, while men die by suicide at substantially higher rates. [12] That the funding for it had to be raised by volunteers growing facial hair is evidence for my argument, not against it.
The cancer funding paper is one fiscal year, nine cancer types, with deaths estimated from incidence and survival rather than observed, and no breakdown of what the money was spent on. Prevention research and treatment research are not the same thing, and the study does not separate them. [2]
Normalising funding to disease burden assumes burden is the right allocation rule, and that is a genuine argument rather than an obvious truth. Scientific opportunity matters: sometimes a field is ready for a breakthrough and deserves money out of proportion to its burden. Rare diseases would be destroyed by strict burden-based allocation. DALYs themselves embed contested judgements about how to weigh disability against death. [3]
Movember's money is private philanthropy. People are entitled to give to whatever moves them, and nobody owes endometriosis their donation. My argument is about public allocation and about which conditions can generate a campaign at all, not about where any individual should send twenty euros. [1]
And the chain in the third section is my construction. Each link has evidence behind it; the claim that they compound into a single mechanism is an argument I am making, and you should treat it as one.
As a funding category it collapses into breast cancer and reproduction, both of which do comparatively well. Everything else, endometriosis, adenomyosis, PCOS, fibroids, menopause, vulvodynia, female-pattern cardiovascular disease, disappears inside a term that sounds like it is already being handled. Name the condition instead.
The reason Mirin's paper lands is that it stopped making a moral case and made an arithmetic one. Years of healthy life lost per euro of research funding is a number anyone can check, and it is far harder to dismiss than an anecdote about a waiting room. [3]
A visible, repeatable, low-cost, slightly ridiculous act, attached to a single month and a single clear ask. That is the entire mechanism, and it moved 1.8 billion dollars. [1] There is no reason it cannot be built for a condition that affects one woman in nine, and considerable evidence that nothing else works as well.
Women experience adverse drug reactions nearly twice as often as men, and most drugs in current use were approved on trials conducted in men. [8] In 2019, three years after the policy requiring researchers to consider sex as a biological variable, eight of nine biological disciplines showed no increase in the proportion of studies that actually analysed their data by sex. [5] Including both sexes and reporting on both are different things, and only one of them has improved.
I set out to write that men are getting the money and women are not, and the data would not let me.
What I found instead is more uncomfortable, because it removes the villain. There is no committee deciding that women matter less. There is a funding system with two inputs, death counts and public attention, and a category of human suffering that produces neither. Chronic, non-fatal, lifelong, female. It is not that the system rejected those conditions. It is that the system has no port they can plug into.
The moustache is proof of concept, and I mean that sincerely rather than bitterly. A few men in a pub built the second input from nothing and used it to move a national research budget. Everyone who has ever said that awareness campaigns are empty gestures should look at 126,992 dollars per death and reconsider.
So no, I do not want November to stop. I want somebody to do it again, in a different month, for the eleven percent.
Most of what I know about how female conditions get written out of the evidence base ended up in The Art of Female Health, including the chapters on diagnostic delay and on why the trials that set your dose were run in somebody else's body. nammu.academy/book
References
- Movember. About us. Organisational reporting, not peer-reviewed; figures as published by Movember. https://movember.com/about-us
- Mohindroo, C., & Thomas, A. (2026). Incidence, mortality, and federal research funding by cancer type in the US. JAMA Network Open, 9(4), e267837. https://doi.org/10.1001/jamanetworkopen.2026.7837
- Mirin, A. A. (2021). Gender disparity in the funding of diseases by the U.S. National Institutes of Health. Journal of Women's Health, 30(7), 956–963. https://doi.org/10.1089/jwh.2020.8682
- Beery, A. K., & Zucker, I. (2011). Sex bias in neuroscience and biomedical research. Neuroscience & Biobehavioral Reviews, 35(3), 565–572. https://doi.org/10.1016/j.neubiorev.2010.07.002
- Woitowich, N. C., Beery, A., & Woodruff, T. (2020). A 10-year follow-up study of sex inclusion in the biological sciences. eLife, 9, e56344. https://doi.org/10.7554/eLife.56344
- Ellis, K., Munro, D., & Clarke, J. (2022). Endometriosis is undervalued: A call to action. Frontiers in Global Women's Health, 3, 902371. https://doi.org/10.3389/fgwh.2022.902371
- Nnoaham, K. E., Hummelshoj, L., Webster, P., et al. (2011). Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertility and Sterility, 96(2), 366–373.e8. https://doi.org/10.1016/j.fertnstert.2011.05.090
- Zucker, I., & Prendergast, B. J. (2020). Sex differences in pharmacokinetics predict adverse drug reactions in women. Biology of Sex Differences, 11, 32. https://doi.org/10.1186/s13293-020-00308-5
- Liu, K. A., & DiPietro Mager, N. A. (2016). Women's involvement in clinical trials: Historical perspective and future implications. Pharmacy Practice, 14(1), 708. https://doi.org/10.18549/PharmPract.2016.01.708
- Mazure, C. M., & Jones, D. P. (2015). Twenty years and still counting: Including women as participants and studying sex and gender in biomedical research. BMC Women's Health, 15, 94. https://doi.org/10.1186/s12905-015-0251-9
- Canto, J. G., Rogers, W. J., Goldberg, R. J., et al. (2012). Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA, 307(8), 813–822. https://doi.org/10.1001/jama.2012.199
- Canetto, S. S., & Sakinofsky, I. (1998). The gender paradox in suicide. Suicide and Life-Threatening Behavior, 28(1), 1–23. https://doi.org/10.1111/j.1943-278X.1998.tb00622.x