Us is funding less medical research, despite growth in global investment


Us is funding less medical research, despite growth in global investment

Evidence published in JAMA finds that from 2004-2012 the rate of investment in medical research in the US declined. However, globally there has been a significant increase, particularly in Asia.

While the rest of the globe is investing in medical research, the US rate of investment has declined.

Dr. Hamilton Moses III, of the Alerion Institute and Alerion Advisors LLC, North Garden, VA, and Johns Hopkins School of Medicine, Baltimore, MD, and colleagues examined developments over the past 2 decades of medical research investment, as well as resulting patents, publications and new drug and device approvals.

The study indicates the scarcity of previous research comparing medical research in the US with other developed countries.

Publicly available data from 1994-2012 was compiled to examine the current anatomy and historical trends of medical research including international research funding, productivity and disease burden by source and industry type.

US funding growth rate decreased from 6.0-0.8% per year

The findings address three major trends - reduced science investment in the US, underfunding of service innovation and globalization.

Reduced science investment

Total US funding increased 6% per year between 1994-2004, the largest increase in biomedical and health services research. However, the rate of growth declined to 0.8% per year between 2004-2012, reaching $117 billion (4.5%) of total health care expenditures.

Private sources increased from 46-58% between 1994-2012. The industry reduced early-stage research, favoring medical devices, bioengineered drugs and late-stage clinical trials, particularly for cancer and rare diseases.

National Institutes of Health (NIH) allocations correlate imperfectly with disease burden, with cancer and HIV/AIDS receiving disproportionate support. Cancer and HIV/AIDS were funded well above the predicted levels based on US disability alone, with cancer accounting for 16% of total NIH funding and 25% of all medicines currently in clinical trials.

Underfunding of service innovation

Health services research, which examines access to care, the quality and cost of care, and the health and well-being of individuals, communities, and populations, accounted for between 0.2 and 0.3% of national health expenditures between 2003-2011. Health services research funding increased 4.6% per year from $3.7 billion in 2004 to $5.0 billion in 2011.

Private insurers ranked last (0.04%) on the revenue spent on research and development, with health care services 19th (0.1% of revenue), among 22 industries in their investment in innovation.

The study suggests that additional investment by insurers and health systems in delivery innovation should be considered to bring them to the median of other service industries. This could produce an annual influx of $8-15 billion, potentially quadrupling the level of effort overall.

"To achieve a new strategic vision for research, the United States will need a roadmap that sets priorities, describes needed structural and organizational changes, and creates an environment that enables innovation," Dr. Victor J. Dzau, of the Institute of Medicine, Washington, DC, and Dr. Harvey V. Fineberg, of the University of California, San Francisco, write in an accompanying editorial. They continue:

"By taking the necessary political and institutional steps to ensure commitment of adequate resources over time, adopting a comprehensive research strategy, and attaining greater coordination and efficiency, the United States can retain its leadership position in biomedical research."

Globalization

US government research funding declined from 57-50% of the global total between 2004-2012. Meanwhile, private funding from US companies declined from 50-41%. The total US (public plus private) share of global research funding declined from 57-44% during this period.

Asia, particularly China, tripled investment from $2.6-9.7 billion between 2004 and 2012, preferentially for education and personnel. The US share of life science patents declined from 57-51% between 1981 and 2011.

During the same period, the share of highly valuable patents filed by US inventors decreased from 73-59% between 1981 and 2011, while all other countries in the analysis increased their share of highly valuable patents.

The authors of the research comment:

The analysis underscores the need for the United States to find new sources to support medical research, if the clinical value of its past science investment and opportunities to improve care are to be fully realized."

"Substantial new private resources are feasible, though public funding can play a greater role. Both will require non-traditional approaches if they are to be politically and economically realistic. Given global trends, the United States will relinquish its historical innovation lead in the next decade unless such measures are undertaken," they conclude.

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Section Issues On Medicine: Medical practice