Growth in overall funding for biomedical research in the US slowed down between 2003 and 2007, a new study has found.

Annual funding rose from US$75.5 billion to US$101.1 billion over the five-year period, reported University of Rochester and other researchers in their analysis published in the Journal of the American Medical Association (JAMA). Adjusted for inflation, that represented average annual growth of 3.4% between 2003 and 2007.

A previous study published by the same authors in 2005 found that biomedical research funding from all sources tripled in nominal value and doubled when adjusted for inflation between 1994 and 2003. The annual growth rate in funding over that period was 7.8%.

The slowdown in biomedical research funding during 2003-07 was despite a 25% increase in research and development investment by industry, which accounted for the largest proportion (58%) of overall research expenditure during that period, followed by the federal government with a 33% share.

Growth in research activity by medical device (59%) and biotechnology (41%) companies significantly outpaced the contribution of pharmaceutical companies (+14%), the JAMA study noted.

Meanwhile, inflation-adjusted funding by the National Institutes of Health (NIH) – by far the single largest supporter of biomedical research in the US – fell by 12% between 2003 and 2008. Total federal funding for biomedical research increased by 0.7% over that period, whereas it doubled between 1994 and 2003.

Indeed, extending the analysis to 2008 produced an even more dispiriting picture of the research funding landscape. Using incomplete data, the study authors estimated research funding by the NIH and industry in that year at US$88.8 billion, which represented a drop in funding when adjusted for inflation.

As has been noted elsewhere, the “flat-lining of federal funding for biomedical research in particular has a cascading effect on the academic research enterprise, leading to scientists spending more of their time chasing funding, influencing career choices of new graduates, discouraging higher-risk research, and curtailing the establishment of new scientific programmes and construction of research facilities”, commented the University of Rochester.

New model needed

Another key observation from the JAMA study was that the overall growth – albeit slower – in biomedical research funding between 2003 and 2007 was not accompanied by an increase in drug and device approvals by the US Food and Drug Administration.

For example, the number of new molecular entities approved by the FDA in 2001 and 2008 was 21 and 17 respectively. Similar trends have been seen in biologics and device approvals.

According to lead author Dr Ray Dorsey, a neurologist at the University of Rochester Medical Center, the decade-long decline in research productivity means the “current model is not working well if the desire is to approve new model therapies to improve health. We need to modify incentives to reward risk and increase support for companies pursuing early-stage and innovative research”.

One problem, the University of Rochester researchers suggested, is that the mainstream pharmaceutical industry is putting more of its money into late-phase clinical trials and has “largely abdicated the role of early-stage research and development to smaller companies that often serve as the bridge between academic research and the market”.

With limited resources and capital, these smaller players “face considerable risk and increasing pressures to generate promising results in short time frames from impatient markets. The model currently creates little incentive for investors to put capital into companies who are engaged in research that may be innovative, but has a higher risk of failure”.

Health services research

Dorsey also called for rethink of funding priorities, particularly with respect to health services research, which makes up a fraction of the more than US$2 trillion in annual healthcare spending in the US.

Supported by foundations and federal agencies such as the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the NIH and the Center for Medicare and Medicaid Services, health services research is aimed at improving healthcare quality and access while controlling costs, by examining the impact of financial, social, technological and organisational factors on public health.

Total spending on health services research was US$2.2 billion in 2008. In the context of the ongoing national debate about reining in healthcare costs and impending legislation that will dramatically increase the number of Americans with health insurance, this commitment is inadequate, the study authors argued.

“We spend almost US$5 for every US$100 in national health expenditures on biomedical research, but we spend less than a dime on ensuring those treatments reach the right people and the right time,” Dorsey said. “Given the massive changes in healthcare that may occur in the very near future, we need to dedicate more resources to understanding the most effective and efficient ways of delivering care.”