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The Anatomy of Medical Research: US and International Comparisons
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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“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
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“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]
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“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]
In the citing paper
“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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Bonkowsky, J. L., deVeber, G., Kosofsky, B. E., Augustine, E. F., Bassuk, A. G., Brooks‐Kayal, A. R., Felling, R. J., Fullerton, H. J., Glass, H. C., Grinspan, Z. M., et al. (2020) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2020.08.012 · Cited by 13
Friedrich, J., Lindauer, U., & Höllig, A. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.834003 · Cited by 14
The importance of discovery science in the development of therapies for the critically ill
on behalf of the Translational Biology Group, Juffermans, N. P., Radermacher, P., & Laffey, J. G. (2020) · Intensive Care Medicine Experimental · doi:10.1186/s40635-020-00304-4 · Cited by 12
Principles of Clinical Research
Puzzitiello, R. N., Agarwalla, A., Forsythe, B., & Leong, N. L. (2018) · Springer eBooks · doi:10.1007/978-3-319-96938-1_15 · Cited by 12
The State of Research Funding for Interventional Chronic Pain Therapies
Agarwal, S., Gharibo, C. G., & Schatman, M. E. (2023) · Journal of Pain Research · doi:10.2147/jpr.s418801 · Cited by 12
Misreporting of Results of Research in Psychiatry
Bowcut, J., Levi, L. W., Livnah, O., Ross, J. S., Knable, M. B., Davidson, M., Davis, J. M., & Weiser, M. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbab040 · Cited by 11
Shalev, L., Helfrich, C. D., Ellen, M., Avirame, K., Eitan, R., & Rose, A. J. (2023) · Israel Journal of Health Policy Research · doi:10.1186/s13584-023-00583-8 · Cited by 11
Ledley, F. D., & Cleary, E. G. (2023) · PLoS ONE · doi:10.1371/journal.pone.0288447 · Cited by 10
Making value a priority: how this paradigm shift is changing the landscape in health care
Kimberly, J. R., & Cronk, I. (2016) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13209 · Cited by 11
Miró, Ò., Santos, P. B., Graham, C. A., Cone, D. C., Ducharme, J., Brown, A. F., & Martín‐Sánchez, F. J. (2016) · Emergency Medicine Journal · doi:10.1136/emermed-2016-205893 · Cited by 11
Industry Sponsorship of Research in Otolaryngology
Rathi, V. K., Abt, N. B., Kozin, E. D., Naunheim, M. R., & Gray, S. T. (2017) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2017.0002 · Cited by 11
Trends in Country-Specific Surgical Randomized Clinical Trial Publications
Forrester, J. A., Forrester, J. D., & Wren, S. M. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.4867 · Cited by 11
Proportion, Type, and Characteristics of Physician Entrepreneurship in Massachusetts
Greenblatt, W. H. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.26938 · Cited by 10
Cheng, H. L., Garneau, H. C., Yuan, M., & McGovern, M. P. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108767 · Cited by 11
Methodological Quality of Surgical Mortality Studies Using Large Hospital Databases
Payet, C., Lifante, J., Carty, M. J., Rabilloud, M., & Duclos, A. (2016) · Annals of Surgery · doi:10.1097/sla.0000000000002119 · Cited by 10
Building the future for national trauma research
Price, M. A., Kozar, R. A., Bulger, E. M., & Jurkovich, G. J. (2020) · Trauma Surgery & Acute Care Open · doi:10.1136/tsaco-2019-000421 · Cited by 10
Jesus, T. S., Castellini, G., & Gianola, S. (2021) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3401 · Cited by 10
Tupetz, A., Barcenas, L., Phillips, A., Vissoci, J., & Gerardo, C. J. (2021) · PLoS ONE · doi:10.1371/journal.pone.0262215 · Cited by 11
“The fact that the majority of clinical trials in medicine are funded by industry did not seem to influence this belief [19, 20].”
BackgroundPagel, P. S. (2022) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2022.02.008 · Cited by 10
Public investment in biomedical research in Europe
Bouillon, R., Slørdahl, S. A., Nogueira, M. M., Steinhausen, K., Varela‐Nieto, I., Pacini, G., Röllinghoff, M., & Syka, J. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00326-8 · Cited by 10
Show Me the Money! Trends in Funding for Health Services Research
Simpson, L., Koechlein, L., Menachemi, N., & Wolfe, M. J. (2018) · Health Services Research · doi:10.1111/1475-6773.13040 · Cited by 10
Saa, C., Bunout, D., & Hirsch, S. (2019) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001322 · Cited by 10
The global tuberculosis epidemic: turning political will into concrete action
Lytras, T., & Kalkouni, O. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2018.08.73 · Cited by 10
Cleary, E. G., Jackson, M. J., Folchman-Wagner, Z., & Ledley, F. D. (2020) · medRxiv · doi:10.1101/2020.07.01.20144576 · Cited by 10
Chenfouh, I., Atassi, M., Yeznasni, A., Lekfif, A., & Abda, N. (2024) · Journal of Medical Education and Curricular Development · doi:10.1177/23821205241296985 · Cited by 9
The 12-Year Experience of the Hungarian Pancreatic Study Group
Szentesi, A., Hegyi, P., & on behalf of the Hungarian Pancreatic Study Group (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14041362 · Cited by 9
“Public and private financing did not support improvement in this field either [8,9].”
A PLAN to address the Parkinson pandemic
Dorsey, E. R., Okun, M. S., & Bloem, B. R. (2025) · Journal of Parkinson s Disease · doi:10.1177/1877718x251378115 · Cited by 11
Self-citation
Metadata
- 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)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2015-01-13
- Volume
- 313
- Issue
- 2
- Pages
- 174
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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
- 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 › Business, Management and Accounting › Management of Technology and Innovation › 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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