JAMA: U.S. lead in medical research is at risk

Overall funding in decline as the government has scaled back support

The federal government has invested less in medical research in recent years, while the share of such investments coming from drugmakers and medical device manufacturers has significantly increased, according to an analysis published in the JAMA.

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For the study, researchers examined publicly available data from 1994 to 2012 showing trends in both the United States and abroad in:

  • Disease burden;
  • Productivity; and
  • Research funding.

The trends were sorted by industry type and source. In addition, the researchers looked at patents and publications from 1981 to 2011.

According to the analysis, U.S. investment in medical research decreased to a compound annual growth rate of 0.8% from 2004 to 2012, following a decade of annual growth at 6%. The report showed that research investments slowed from:

  • The biomedical industry;
  • The medical device industry;
  • The pharmaceutical industry; and
  • NIH.

For example, NIH financing from 1994 to 2004 had a 7.3% compounded annual growth rate, while financing from NIH slowed to a -1.8% compounded annual growth rate from 2004 to 2012. Overall, industry financing represented 58% of medical research funding in the United States in 2012, up from 46% in 1994.

Meanwhile, the report noted that the United States placed last in a regional global ranking of investment pace from 2004 to 2011. Specifically, the report showed that:

  • Asia had growth of 9.4% annually;
  • Canada had growth of 4.5% annually;
  • Europe had growth of 4.1% annually; and
  • The United States had growth of 1.5% annually.

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Overall, the report found that U.S. spending on global medical research fell by 13%. However, the United States still remains the top funder of new medical research discoveries throughout the globe, despite the dwindling pace of funding.

In addition, the study found that medical research financing in the United States increased for health service initiatives by a compounded annual rate of 4.6% between 2004 and 2011, hitting $5 billion. That amount represents 0.3% of total health spending, according to the analysis.

According to the study, investments made by health care providers and insurers in the United States for health services research fell behind median research investments made by other industries by about $8 billion to $15 billion.

Funding slowdown leads to research gaps

The study noted that the investment slowdowns have led to research gaps for certain conditions.

The 27 diseases that account for 84% of mortality in the United States receive just 48% of NIH funding. Furthermore, while certain diseases, such as HIV/AIDS and cancer, receive funding at greater rates than predicted based on disease burden, other conditions such as depression, migraines, and stroke are underfunded based on disease burden, according to the study's authors.

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Findings show need for greater investment

Institute of Medicine (IOM) President Victor Dzau and former IOM President Harvey Fineberg said the findings show the need for greater investment in research, as well as the need for new financing sources.

In an editorial also published in JAMA, they wrote, "These data reveal how rapidly the [U.S.] is at risk of losing its global scientific leadership and competitiveness." They added, "Given global trends, the [U.S.] will relinquish its historical innovation lead in the next decade unless such measures are undertaken."

Meanwhile, Dzau and Fineberg noted that industry in the United States is shifting more of its funding to late-stage clinical trials, while investing less in early-stage research initiatives. They wrote that the "shift ... reflects the increasing costs, complexity and length of clinical trials but may also reflect a de-emphasis of early discovery efforts by the U.S. pharmaceutical industry."

They added that drug and medical device research makes up 4% of U.S. health expenditures, meaning that the country "spends $116 billion on research aimed at 13% of total health care costs but only $5.0 billion aimed at the remaining 87% of costs" (Evans, Modern Healthcare, 1/13 [subscription required]; Millman, "Wonkblog," Washington Post, 1/13).

The takeaway: The U.S. remains the top funder of medical research in the world, but federal funding medical research in recent years has grown at much slower pace, creating gaps in research for certain medical conditions.

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