Public support fuels boom in U.S. medical research

Total U.S. investment in biomedical research has more than doubled in a decade, rising from $37 billion annually in 1994 to more than $94 billion by 2003, a new report shows. The statistic should please most Americans: According to a second report, almost 80 percent of people consistently support medical research as one of the nation's top spending priorities.

"Americans want to be on the cutting edge and they want to be the leader, we see that in the research as well," says Stacie Propst, director of science policy at the nonprofit advocacy group Research! America, which lobbies in support of increased investment for biomedical research.

In their review, Propst and co-researcher Mary Woolley collected data on Americans' attitudes toward health-related research, gleaned from 88 state and federal surveys conducted between 1996 and 2005.

The surveys revealed increasing pessimism among Americans as to the quality and cost of the health care they receive, with 60 percent now saying that the United States does not have the best health-care system in the world. These and other findings appear Sept. 21 in a special themed issue of The Journal of the American Medical Association devoted to trends in biomedical research.

One study found the financial health of biomedical research to be sounder than ever. The report's authors examined public-sector and private-industry records on investment from government, industry and private foundations between 1994 and 2004.

"We've seen growth and a real doubling of funding in all sectors," says lead researcher Dr. Hamilton Moses of the North Garden, Va.-based Alerion Institute. "The proportions are really unchanged over the decade, with roughly 60 percent coming from industry and the remainder coming from government and foundations."

The federal government's main health-research branch, the National Institutes of Health, supplied about 28 percent of funding by 2004, increasing its investment from $1.8 billion in 1994 to more than $2.5 billion by 2003. Overall the federal government allotted about 5.6 percent of its total 2004 health budget to biomedical research.

The recent surge in funding from both the public and private sectors has been driven by public support and commercial need, Moses says.

"Without question, medicine and biomedical science has captured the public's attention and their awareness of new treatments that are dependent on science," he says, "and that's translated into funding."

Part of this enthusiasm has stemmed from recent scientific advances, especially the completion of the human genome.

"That pushed us in the 1990s to do what became at that point technologically feasible," Moses says. "It added to the momentum."

"On the commercial side," he adds, "clearly all of the three major types of companies -- traditional pharmaceutical companies, biotechnology companies and medical-device companies -- view health and medicine as a growing market."

He says that medical-device companies, especially, are being boosted by an influx of venture capital that wasn't there before.

And yet the study did uncover one sobering statistic: Despite the doubling in research investment, the number of new drugs receiving Food and Drug Administration approval actually dropped during the past decade, from an average of 35.5 a year between 1994-1997 to only 23.3 annually by 2001-2004.

There appear to be a number of reasons for that slowdown, Moses says.

"For one thing, the clinical-trials process is much more expensive and laborious, and more has to be done now to prove the safety and efficacy of drugs," he says. "And the trials themselves are more involved. They require more attention to science, larger numbers of patients and a longer duration," all of which add to the cost of research without guaranteeing a marketable product.

Moses adds that the gap between new discoveries in basic science and their translation into a drug or device ready for use by patients has always been a long process. Starting with advances such as insulin and penicillin in the early part of the 20th century, it has taken an average of two decades for the science to be assimilated into new therapies.

According to poll numbers tabulated by Research! America, however, Americans still have faith in the promise of biomedical research. Some of the main findings:

-- 94 percent of Americans said that medical and health research is important to the U.S. economy, and 79 percent said that the federal government should support such research "even if it brings no immediate benefit."

-- 67 percent of Americans are willing to pay $1 a week more in taxes to support additional medical research, and 61 percent believe that there are "too many regulatory barriers" to research.

-- When asked what type of research was more valuable, research aimed at preventing or curing disease, 48 percent said that preventing illness should be the priority.

-- Embryonic-stem-cell research garnered support from 58 percent of Americans, with 34 percent saying that they strongly favored it.

Of the 29 percent who objected to this type of research, 57 percent cited religious reasons. Only 1 percent of those surveyed objected to the use of animals in health-related research.

Americans are much less enthusiastic about the quality of the health care they receive, however. Six out of 10 Americans polled in 2005 say that the U.S. system is no longer the best in the world, and 55 percent say that they are dissatisfied with the quality of the nation's health care. That number is up sharply from the 44 percent reported in 2000.

Still, the public's support for health-related research hasn't dimmed, Propst says.

"About 80 percent of Americans, in both state and national polls, say that they do support research funding as a priority," she says, "and that's been consistent over the past decade."

With funding levels at an all-time high, Moses says, the challenge now is to spend that money more wisely -- especially when the mechanisms driving diseases such as AIDS, Alzheimer's and cancer are so complex.

"Everyone has to do a better job," he says. "The burden on scientists is to be more discriminating, to pick questions that are important, not just interesting. We need to do a better job of saying, 'Here is where we are blocked, here's what we really just don't understand. Let's work on understanding it and devote our resources to that' -- and then move on."