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Cited by 447Health and Medical Research ImpactsPharmaceutical Economics and PolicyResearch, Science, and Academia

The Anatomy of Medical Research: US and International Comparisons

Moses, Hamilton, Matheson, David H. M., Cairns-Smith, Sarah, George, Benjamin P., Palisch, Chase, Dorsey, E. Ray·2015·JAMA
DOI 10.1001/jama.2014.15939
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Abstract

IMPORTANCE: Medical research is a prerequisite of clinical advances, while health service research supports improved delivery, access, and cost. Few previous analyses have compared the United States with other developed countries. OBJECTIVES: To quantify total public and private investment and personnel (economic inputs) and to evaluate resulting patents, publications, drug and device approvals, and value created (economic outputs). EVIDENCE REVIEW: Publicly available data from 1994 to 2012 were compiled showing trends in US 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. FINDINGS: (1) Reduced science investment: Total US funding increased 6% per year (1994-2004), but rate of growth declined to 0.8% per year (2004-2012), reaching $117 billion (4.5%) of total health care expenditures. Private sources increased from 46% (1994) to 58% (2012). Industry reduced early-stage research, favoring medical devices, bioengineered drugs, and late-stage clinical trials, particularly for cancer and rare diseases. National Insitutes of Health allocations correlate imperfectly with disease burden, with cancer and HIV/AIDS receiving disproportionate support. (2) Underfunding of service innovation: Health services research receives $5.0 billion (0.3% of total health care expenditures) or only 1/20th of science funding. Private insurers ranked last (0.04% of revenue) and health systems 19th (0.1% of revenue) among 22 industries in their investment in innovation. An increment of $8 billion to $15 billion yearly would occur if service firms were to reach median research and development funding. (3) Globalization: US government research funding declined from 57% (2004) to 50% (2012) of the global total, as did that of US companies (50% to 41%), with the total US (public plus private) share of global research funding declining from 57% to 44%. Asia, particularly China, tripled investment from $2.6 billion (2004) to $9.7 billion (2012) preferentially for education and personnel. The US share of life science patents declined from 57% (1981) to 51% (2011), as did those considered most valuable, from 73% (1981) to 59% (2011). CONCLUSIONS AND RELEVANCE: New investment is required if the clinical value of past scientific discoveries and opportunities to improve care are to be fully realized. Sources could include repatriation of foreign capital, new innovation bonds, administrative savings, patent pools, and public-private risk sharing collaborations. Given international trends, the United States will relinquish its historical international lead in the next decade unless such measures are undertaken.

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  • The pharmaceutical industry remains one of the main sponsors of health research.

    “Given these demands, many RCTs are conducted with substantial industry funding, and the pharmaceutical industry remains one of the main sponsors of health research (Flacco et al. 2015; Moses et al. 2015; Holman and Elliott 2018).”

    From Sponsorship bias in randomised controlled trials on postoperative pain after third molar extraction: A meta-research study (2026) · cites this paper as Moses et al. 2015

  • Many research projects in the USA are funded by private initiatives, unlike most other countries.

    “Also, many research projects in the USA are funded by private initiatives, unlike most other countries 29 , 30 , 31 .”

    From Global mapping of randomized controlled trials in dentistry (2024) · cites this paper as [31]

  • International trials of various pharmacotherapies have sometimes found discordant results in patients enrolled in the United States than seen in overall trial results.

    “International trials of various pharmacotherapies have sometimes found discordant results in patients enrolled in the United States than seen in overall trial results.19–32”

    From REDUCE-IT USA: Results From the 3146 Patients Randomized in the United States (2020) · cites this paper as [26]

  • The reasons for discordant US results range from low numbers of patients enrolled in the United States to potential differences in background medical management or in patient risk profiles.

    “The reasons range from low numbers of patients enrolled in the United States to potential differences in background medical management or in patient risk profiles.”

    From REDUCE-IT USA: Results From the 3146 Patients Randomized in the United States (2020) · cites this paper as [26]

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Authors
Moses, H., Matheson, D. H. M., Cairns-Smith, S., George, B. P., Palisch, C., & Dorsey, E. R.
Affiliations
  • Johns Hopkins University (US)
  • Boston Consulting Group (United States) (US)
  • Boston Consulting Group, Boston, Massachusetts
  • University of Rochester Medicine (US)
  • Stanford Medicine (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2015-01-13
Volume
313
Issue
2
Pages
174
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2014.15939
OpenAlex
W2099877908
Cited by
446
References
34
Citations by year
2026: 21 · 2025: 37 · 2024: 24 · 2023: 32 · 2022: 30 · 2021: 40 · 2020: 37 · 2019: 36 · 2018: 47 · 2017: 46 · 2016: 56 · 2015: 39 · 2014: 1
FWCI
67.06
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health and Medical Research Impacts
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
  • Social Sciences › Decision Sciences › Information Systems and Management › Research, Science, and Academia
Keywords
health research funding, research investment, health services research, research productivity, National Institutes of Health, globalization of science, health care expenditure, rare diseases, cancer research, HIV/AIDS research, citation counts, impact factor, health system innovation
MeSH terms
Clinical Trials as Topic, Efficiency, Health Expenditures, Health Services Research, Industry, National Institutes of Health (U.S.), Patents as Topic, Publishing, Research Support as Topic, United States, Private Sector, Drug Approval, Device Approval, Biomedical Research, Internationality

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