(Reuters Health) - - The U.S. is losing its lead in global medical research, and many of the projects that do get funded overlook common diseases that afflict millions of people, according to a new analysis.
Experts point to falling public and private spending on the kind of basic research that leads to new discoveries, and a lack of innovation in delivering healthcare, in a paper in the Journal of the American Medical Association that’s part of a series on the future of medicine,
“With respect to U.S. public financing there has not been the political will to make biomedical research a priority in the same way that it was in the 1970s with the war on cancer or in the 1980s with the war on AIDS,” said lead study author Dr. Hamilton Moses, of the Alerion Institute and Alerion Advisors LLC in North Garden, Virginia.
At the same time, private U.S. companies have concentrated investment in advanced clinical trials rather than on the basic research that’s needed to tackle some of the chronic conditions like diabetes that afflict the greatest number of people, Moses told Reuters Health in an interview.
Overall U.S. investment in biomedical and health services research grew just 0.8 percent a year from 2004 to 2012, down from a 6-percent annual growth rate between 1994 and 2004, Moses and his colleagues found.
Government funding in the U.S. fell to 49 percent of the world’s public research investment by 2011, down from 57 percent in 2004.
U.S. industry, which accounted for nearly half of corporate investment worldwide in 2004, slipped to 41 percent of private funding in 2011.
Asia, aided largely by China, tripled investment to $9.7 billion in 2012 from $2.6 billion in 2004.
In the U.S., public funding concentrated on cancer and rare diseases, with less than half of government investment targeting 27 common diseases – including chronic obstructive lung disease, injuries, stroke, dementia and pneumonia - that account for 84 percent of deaths in the U.S. and significant disability.
Cancer alone accounted for 16 percent of total funding from the National Institutes of Health and was the target of one in four medicines in clinical trials, the study found.
“With cardiovascular disease, the number one killer, some of the large pharmaceutical companies have really pulled back in this area,” said Dr. Kenneth Kaitin, director of the Tufts Center for the Study of Drug Development in Boston, Massachusetts.
“The industry has changed over the last few years and there has been tremendous pressure to reduce research and development costs that has resulted in a tremendous shift away from high-volume, low-cost medicines toward seeking a billion- dollar drug that treats a very, very small population,” said Kaitin, who wasn’t involved in the study.
Health services research, which looks at issues around access to care as well as quality and costs, has accounted for less than 0.33 percent of national health expenditures between 2003 and 2011, the study found.
Private insurers ranked last (0.04 percent of revenue) and health systems 19th (0.1 percent of revenue) among 22 industries in their investment in innovation in this area, the authors note.
“This is concerning in terms of trying to tackle improved quality of care and improved access to care, and in terms of bending the cost curve,” said Glen Giovannetti, a global life sciences expert at Ernst & Young in Boston.
“There’s lots and lots of research done on drug development and much less done on whether one course of treatment is better than another,” said Giovannetti, who wasn’t involved in the study.
With respect to both biotech and health services research, there is an acute need to increase research investment and to create more reliable funding mechanisms, said Dr. Victor Dzau, president of the Institute of Medicine, a division of the U.S. National Academies of Science.
Dzau, who co-wrote an editorial accompanying the study in JAMA, said the danger of disparate, unreliable funding streams is that it forces scientists to work in fits and starts, often abandoning promising basic research.
“If you think about all of the major advances in health care services, biomedical research, and diagnostics, there is no question that it’s based on innovation and relied at the start on basic research,” Dzau told Reuters Health.
“When we decided to put a man on the moon that was an aspirational goal, and we as a nation should be able to recognize that this is now an important moment in medical research,” Dzau said. “We aren’t saying give money for money’s sake. We are saying set priorities, and give researchers at least five years of stable funding to pursue specific goals.”