The Netherlands has long been at the global forefront of oncology research. Yet significant gains can still be made in translating scientific knowledge into clinical practice. The debate on valorisation tends to centre on commercial pathways: startups, patents, and partnerships with the pharmaceutical industry. However, there is another category of research that is equally urgent: new insights that contribute to the sustainability of healthcare, but do not offer a commercial business model. In a recent publication in Het Financieele Dagblad, this issue is brought into sharp focus. 

From knowledge paradox to healthcare 

The gap between scientific excellence and real-world application has been recognised in the Netherlands for decades. Government reports from ten to fifteen years ago already referred to the “knowledge paradox”: strong in research, but lagging in valorisation. Today, a new urgency has emerged: the sustainability of healthcare is under increasing pressure.

Bertholt Leeftink, Managing Director at Oncode Institute, identifies the two major challenges of our time:

“We face a climate challenge, and rightly, governments are investing in innovation to enable the energy transition. The second challenge is the healthcare transition: ensuring the financial sustainability of healthcare and the availability of sufficiently qualified personnel. Both are reaching their limits, while demand for care continues to rise. Cancer is, by definition, a disease of ageing. We must leverage our leading scientific expertise to enable the healthcare transition. That is our responsibility to taxpayers and contributors.”

“We face a climate challenge, and rightly, governments are investing in innovation to enable the energy transition. The second challenge is the healthcare transition: ensuring the financial sustainability of healthcare and the availability of sufficiently qualified personnel. Both are reaching their limits, while demand for care continues to rise. Cancer is, by definition, a disease of ageing. We must leverage our leading scientific expertise to enable the healthcare transition. That is our responsibility to taxpayers and contributors.”

Society as the end user 

The solution does not lie solely in developing new, high-cost medicines. Leeftink advocates for a broader understanding of valorisation: not only translating research into marketable products, but also into smarter, more effective care. He refers to this as the societal return model—where value is not captured in a new product, but in improved treatments and better patient outcomes.

For new drug development, a clear commercial pathway exists: patents, venture capital, and pharmaceutical partnerships. But for research focused on improving treatment strategies without introducing a new drug, funding for clinical development is often lacking.

“In these cases, society is the end user, asking for better treatment, rather than a market seeking a new product,” says Leeftink. He emphasises that this is not a critique of the pharmaceutical industry. “Pharmaceutical companies are indispensable. But it is logical that industry does not invest in research aimed at reducing the dosage of existing drugs or improving patient selection.” The result is clear: this type of research often fails to progress beyond the laboratory.

Research that never reaches the clinic

Two examples illustrate the challenge.

In a specific type of colorectal cancer, biological insights suggest that short-course immunotherapy followed by surgery may be more effective than the reverse sequence. A larger clinical trial is needed to validate this hypothesis. However, there is no commercial party willing to fund such a study: confirmation would lead to reduced use of an expensive therapy and therefore lower revenues.

A second example concerns breast cancer. Research indicates that the effectiveness of chemotherapy may be influenced by the phase of the menstrual cycle. Optimising treatment timing could improve outcomes, reduce side effects, and lower costs. “The societal value is clear,” says Leeftink. “But there is no private party willing to invest, as there is no commercial return.”

Oncode Institute connects fundamental research with clinical application. When a commercial pathway exists, industry takes over. But for innovations where the endpoint is better care, rather than a marketable product, there is no clear route forward. “There is currently a vacuum,” Leeftink concludes.

A programmatic, long term approach 

The solution Leeftink proposes is not the creation of a new institute or additional funding, but a multi-year public programme focused on appropriate care.

“Mobilise our leading research community to drive innovation that contributes to the sustainability of the healthcare system.”

He stresses that this should be a national programme. “The lesson from the National Growth Fund is that we do not need to create new organisations that further fragment the landscape. Implementation should be entrusted to an existing national organisation that knows how to translate scientific excellence into clinical relevance.”

Government must be willing to take a coordinating role—not by allocating additional funds, but by deploying existing resources in a targeted, long-term manner, aligned with clear ambitions. “Bring researchers and clinicians together around this mission, programmatically and over multiple years.” Without such direction, we are not heading toward a healthcare transition, but toward a healthcare crisis.

He refers to the Wennink report: “Wennink is right—knowledge must reach the market. But knowledge must also reach society. The societal return model is just as real as the commercial one. For the healthcare transition, we need both pathways. At present, that second pathway is not sufficiently developed.”