Medical Research Spending Doubled Over Past Decade

NEW YORK, Sept. 20-It's not rising as fast as local real estate values, but funding in the U.S. for biomedical research doubled -- when adjusted for inflation -- from $37.1 billion in 1994 to $94.3 billion in 2003.

Industry is picking up about 57% of the tab for medical investigation, with the National Institutes of Health kicking in another 28%, reported researchers in a special issue of the Journal of the American Medical Association, previewed at a press briefing here.

Overall industry spending on drug, biotechnology and medical device research increased by 102%, from $26.8 billion in 1994 to $54.1 billion in 2003.

The decade was a heady one for medical device researchers, who saw research funds from industry in that sector rise an impressive 264%. In contrast, pharmaceutical companies and biotech firms were somewhat less bountiful with their support, at 89% and 98% growth, respectively.

The increase in research spending also appears to match the public mood. Results of a survey of public attitudes and perceptions about health care and research, published in the same issue of JAMA, found that more than half of Americans want more spent on research, and two-thirds are willing to have their taxes increased (albeit slightly) to achieve this goal.

So what are we getting for all of this? According to Hamilton Moses III, M.D., of the Alerion Institute in North Garden, Va., and other health care analysts, the number of new molecular-entity approvals by the FDA has declined from an annual average of 35.5 in 1994-97, to 23.3 in 2001-2004.

In addition, health services researchers have languished in the shadows, with only 1.5% of total research crumbs being tossed their way. Translated into percentage of total health expenditures devoted to research, the U.S. over the decade that was studied spent 5.6%, but only 0.1% for health services research, the authors noted.

Still, "the doubling over a decade of total spending by U.S. public and private research sponsors in real, inflation-adjusted terms should be reassuring to those who fear that financial sponsorship for research is not paralleling scientific opportunity," Dr. Moses and colleagues wrote. "It is also reassuring that spending on health and biomedical science research by companies and government is not following reductions in research and development in other industries or reduced support for other areas of science."

At the same time however, spending on health services research, which focuses on the clinical benefits of discovery, appears to be getting short shrift, the authors suggested.

The study also revealed shifts in research priorities, with pharmaceutical companies devoting 41% to clinical trials (phases 1-3) in 2003, compared with a 28% commitment in 1994.

In addition, funding for post-approval (phase 4) trials more than doubled, from 5% at the beginning of the study period to 11% at the end.

Meanwhile, medical device companies have been going gangbusters, investing in biological research as well as investigations into materials and electronics used in devices. The device industry is also conducting more involved clinical trials. All of this activity, the authors said, "reflects the convergence of drug and device applications, as with drug-eluting implantables [e.g., stents], neural stimulation, alternative drug delivery, and in vivo therapeutic monitoring."

Dr. Moses and colleagues noted that the current emphasis on supporting clinical investigators and programs rather than bricks, mortar and equipment appears to be coming at the expense of academic medical centers, which traditionally supported their teaching and patient care missions with cross-subsidies from research.

"Changes in clinical reimbursement and other pressures on operating margins in academic medical centers limit the amount of cross-subsidy available for research," the authors wrote.

That theme was supported by a second paper in the Sept. 20 JAMA, which found that academic medical centers increasingly have to scramble for funding sources, while coping with problems such as scientific integrity (or lack of it), competition with industry for research talent, and escalating research costs.

"The present era offers more promise for progress in medical research than ever before," wrote Jordan J. Cohen, M.D. and Elisa K. Siegel of the Association of American Medical Colleges (AAMC) in Washington.

"Ironically, the present era also presents more daunting challenges for the conduct of medical research than any previous generation of investigators has likely had to face," they continued.

Among the challenges academic researchers face, the authors contended, are "high (and often unreasonable) public expectations for lifesaving discoveries," worries that financial conflicts of interest compromise integrity, maintaining academic standards while partnering with industry, higher research costs and less funding, and shifting from a system that rewards individual achievement to "one that fosters teams of collaborating investigators to pursue 'big science.'"

Fortunately for the research and academic communities, the public appears to be behind them, according to authors of a third study looking at Americans' attitudes about health care and medical research.

In a summary of 10 years worth of survey data, Mary Woolley and Stacie M. Propst, Ph.D., of Research!America, in Alexandria, Va., reported that in a 2005 poll, Americans ranked health care at the most important domestic issue, above education and jobs.

Also in 2005, 78% of those surveyed said that it was "very important" that the U.S. maintains global leadership in health-related research. More than half of Americans (55%) said they want more spent on research. What's more, two-thirds of Americans surveyed (67%) said they're willing to pay $1 more per week in taxes for additional medical research.

Almost half of those surveyed also said that research into disease prevention was more valuable than research into cures.

• Reviewed by Zalman S. Agus, MD Emeritus Professor at the University of Pennsylvania School of Medicine