From 2004 to 2012, the rate of investment in medical research in the U.S. declined, while there has been an increase in research investment globally, particularly in Asia. For the last century, medical research, including public health advances, has been the primary source of and an essential contributor to improvement in the health and longevity of individuals and populations in developed countries. The United States has historically been where research has found the greatest support and has generated more than half the world's funding for many decades. Few previous analyses have compared medical research in the United States with other developed countries. Hamilton Moses III, M.D., of the Alerion Institute and Alerion Advisors LLC, North Garden, Va., and Johns Hopkins School of Medicine, Baltimore, and colleagues examined developments over the past two decades in the pattern of organizations that conduct and support medical research, as well as resulting patents, publications, and new drug and device approvals. Publicly available data from 1994 to 2012 were compiled showing trends in U.S. and international research funding, productivity, and disease burden by source and industry type. Patents and publications (1981-2011) were evaluated using citation rates and impact factors.
The largest increase in biomedical and health services research funding in the U.S. occurred between 1994 and 2004, when funding grew at 6 percent per year. However, from 2004 to 2012, the rate of investment growth declined to 0.8 percent annually and (in real terms) decreased in 3 of the last 5 years, reaching $117 billion (4.5 percent) of total health care expenditures. From 1994 to 2004, the medical device, biotechnology, and pharmaceutical industries had annual growth rates greater than 6 percent per year, with biotechnology demonstrating the largest increases. The share of U.S. medical research funding from private industry accounted for 46 percent in 1994 and grew to 58 percent in 2012. 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 did not correlate proportionately with disease burden. Cancer and HIV/AIDS were funded well above the predicted levels based on U.S. disability alone, with cancer accounting for 16 percent of total NIH funding and 25 percent of all medicines currently in clinical trials.
It is widely believed that the clinical research industry needs structural changes. The needed changes include better coordination across funders and research institutions, development of new funding sources, improved grant evaluation processes, changes in education and training, rationalization of capital investments, and improved operational efficiencies. 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. It will remain to be seen how the Trump administration, with the proposed NIH funding cuts will affect this dynamic situation.