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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
In the citing paper
“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]
In the citing paper
“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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O’Gara, P. T., & Oetgen, W. J. (2015) · JAMA · doi:10.1001/jama.2015.1921 · Cited by 3
Contemporary Cardiovascular Device Clinical Trials (Trends and Patterns 2001 to 2012)
Vaduganathan, M., Tahhan, A. S., Greene, S. J., Kelkar, A. A., Georgiopoulou, V. V., Kalogeropoulos, A. P., Fonarow, G. C., Gheorghiade, M., & Butler, J. (2015) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2015.03.062 · Cited by 3
Our time is now – how companion animal veterinarians can transform biomedical science
Mellanby, R. J. (2015) · Journal of Small Animal Practice · doi:10.1111/jsap.12421 · Cited by 3
Pharmacological Basis of Anesthesia: How to Overcome Stagnation?
Kissin, I., & Vlassakov, K. V. (2018) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000003405 · Cited by 3
Pension and state funds dominating biomedical R&D investment: fiduciary duty and public health
Roller, S. (2019) · Globalization and Health · doi:10.1186/s12992-019-0490-x · Cited by 3
Engagement of medical specialty trainees in research: experience at a Lebanese medical school
Fayad, F., Tabesh, O. A., Lotfi, T., Haddad, F., & Nemr, E. (2020) · Eastern Mediterranean Health Journal · doi:10.26719/emhj.20.038 · Cited by 3
“The complex process of securing funding is not limited to developing countries (16) as it is also reported as a major obstacle in developed countries (17).”
BackgroundA world away and here at home: a prioritisation framework for US international patient programmes
Berkman, E. R., Clark, J. D., Diekema, D. S., & Jecker, N. S. (2021) · Journal of Medical Ethics · doi:10.1136/medethics-2020-106772 · Cited by 3
Rio, F. G., Alonso‐Arroyo, A., de-Granda-Orive, J. I., Castelló‐Cogollos, L., & Aleixandre‐Benavent, R. (2021) · Respiratory Medicine · doi:10.1016/j.rmed.2021.106486 · Cited by 3
Medical Research Disparities in Latin America
Barrera, J. V., Molano, M. D. P. B., Kumar, V., Cruz, L., Arrieta, M., & Landinez, G. P. (2023) · Digestive Disease Interventions · doi:10.1055/s-0043-1775580 · Cited by 3
Characteristics and Impact of Randomized Trials on Drugs or Devices in Cardiovascular Medicine
Spagnolo, M., Laudani, C., Greco, A., Giacoppo, D., & Capodanno, D. (2024) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-024-00670-4 · Cited by 3
“Notably, with projected values reaching US$1156.00 billion for drugs compared to US$511.20 billion for devices by 2024, the drug market outperforms the device market [4–6].”
BackgroundInfluentialRole of industry sponsorship and research outcomes of myopia control interventions
Kai, J.-Y., Chen, H., Dong, X., Li, D., Lança, C., Grzybowski, A. E., & Pan, C. (2025) · British Journal of Ophthalmology · doi:10.1136/bjo-2024-326347 · Cited by 3
“Online supplemental efigure 1–4 display the forest plots which pooled the mean differences in SE and AL changes in industry-sponsored studies and non- industry-sponsored studies, respectively.”
Kraut, R. Y., Katz, L. S., Бабенко, О., Carvallo, F. D., Alexanders, R., Chan, D. S., Campbell, S., Eurich, D. T., & Garrison, S. (2020) · Current Gerontology and Geriatrics Research · doi:10.1155/2020/6085368 · Cited by 3
Scientometric Mapping of Mucormycosis Research in Relation to the COVID-19 Pandemic
Dayal, D., Gupta, B. M., & Kappi, M. M. (2022) · International Journal of Medicine and Public Health · doi:10.5530/ijmedph.2022.2.11 · Cited by 3
Planning the Future of Neurology
Martin, J. B., & Moses, H. (2014) · JAMA Neurology · doi:10.1001/jamaneurol.2014.3448 · Cited by 3
Self-citationFitzpatrick, N. E., Maier, J., Yasko, L., Mathias, D., Qua, K., Wagner, E. B., Miller, E. P., & Reís, S. E. (2016) · Academic Medicine · doi:10.1097/acm.0000000000001335 · Cited by 3
Velden, D. L. V. D., Levit, L. A., Chang, G. J., Facktor, M. A., Goodman, K. A., Kaufman, J., Konecny, G. E., Kwan, S. W., Mooney, M., Smith, G. L., et al. (2019) · Journal of Cancer Policy · doi:10.1016/j.jcpo.2019.100188 · Cited by 3
A Step in the Right Direction for Surgeon-Scientists
Ryan, C. T., & Rosengart, T. K. (2021) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2020.12.019 · Cited by 3
Addressing Racial Disparities in NIH Funding
Comfort, N. T. (2021) · Journal of Science Policy & Governance · doi:10.38126/jspg180408 · Cited by 3
“The US has long been an established pioneer in STEM but is quickly losing its position as a global leader in www.sciencepolicyjournal.org JSPG, Vol. 18, Issue 4, September 2021 biomedical research and innovation (Dzau and Fineberg 2015; Moses et al. 2015; Sekar 2020).”
BackgroundRethinking the Career Landscape for Nicotine and Tobacco Trainees and Early Career Professionals
Kleykamp, B. A., Gipson, C. D., Maynard, O., Treur, J. L., & Oliver, J. A. (2018) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty041 · Cited by 3
On the conditions for objectivity : how to avoid bias in socially relevant research
Jukola, S. (2015) · Jyväskylä University Digital Archive (University of Jyväskylä) · Cited by 3
The Growth of Health Spending in the USA: 1776 to 2026Preprint
Getzen, T. E. (2017) · SSRN Electronic Journal · doi:10.2139/ssrn.3034031 · Cited by 3
Acknowledgment analysis: insight into biopharmaceutical company-funded papers and patents
Zhang, X., & Xie, Q. S. (2025) · Scientometrics · doi:10.1007/s11192-025-05238-w · Cited by 3
“However, limited attention has been focused on the characteristics of industry–academic collaborations (Moses et al., 2015).”
The Extremity War Injury Symposium: Emerging Combat and Readiness Research
Dickens, J. F., & Schmidt, A. (2021) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-20-01030 · Cited by 2
Gao, C., Duan, X., Peng, L., Zhao, Y., Li, P., & Mou, K. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1698503 · Cited by 3
Valladares-Garrido, M. J., Mejia, C. R., Rojas-Alvarado, A. B., Araujo-Chumacero, M. M., Córdova-Agurto, J. S., Fiestas, J., Rojas-Vilar, F. J., & Culquichicón, C. (2020) · F1000Research · doi:10.12688/f1000research.26596.1 · Cited by 2
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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