The US’s investment in medical research between 2004 and 2012 declined significantly. The same can’t be said for the rest of the world, as global investment in biomedical research actually increased during that same period, according to a study published today in the Journal of the American Medical Association.

The US is "at risk of losing its global scientific leadership and competitiveness."

"The United States is at risk of losing its global scientific leadership and competitiveness," write Victor Dzau and Harvey Fineberg, current and past presidents of the Institute of Medicine of the National Academies in Washington, DC, in an editorial also published today in the Journal of the American Medical Association. "One indicator after another demonstrates numerous other countries outpacing the United States in their commitment to research."

In the study, Moses and his team used publicly available data to understand patterns in global medical research investment between 1994 and 2012. They found that the rate of research investment growth increased by 6 percent per year in the US between 1994 and 2004. But between 2004 and 2012, the amount of money for research decreased by 0.8 percent a year — as the US's global contribution to biomedical research dollars dropped to 44 percent in 2012, from 57 percent in 2004. And while the US was cutting its medical research investments, Asian countries increased their global investment by 7 percent.

The decline in medical research funding in the US has largely hurt early-stage research, specially "proof-of-concept research," which demonstrates the feasibility and usefulness of a treatment after its discovery. Instead of ensuring that medical discoveries make it to later stages in medical research, funding has gone toward developing medical devices and late-stage clinical trials. This means that some discoveries never get to move ahead, because there's no money to make it happen.

"The diseases where the need is greatest... have been relatively underfunded."

The study also reveals an imbalance in the types of diseases that receive funding. The amount of money that goes toward cancer and HIV/AIDS research, for instance, is greater than the predicted burden associated with these diseases. "The diseases where the need is greatest — autism, depression, Alzheimer’s, Type 2 diabetes — are diseases that have been relatively underfunded compared to cancer and HIV/AIDS," says Hamilton Moses, a co-author of the study and the chairman of Alerion Advisors, a consulting group.

Patents and copyrights in the US are also in decline. For example, the US contributed 57 percent of the world's life science patents in 1981, and now contributes 51 percent. And of the patents considered most valuable, the US contributed 73 percent in 1981. In 2011, however, that number was 59 percent. "We view this as a cloud on the horizon," Moses says. "As Asia and other countries patent more and the quality of those patents are greater, the threat to the US supremacy is real."

The reasons for the decline in medical research aren’t straightforward. Part of it has to do with a change in the investment landscape, where industry has taken to funding projects that yield results over short periods of time. "The investor worldwide has become impatient." Moses says. "As a result, the markets have rewarded short-term performance, and that means that a marketing dollar goes further than a science dollar." But a bigger part of the reason lies in economic downturns that occurred in the early 2000s, as well as in enhanced interest in international security following 9/11. "When the US federal government runs deficits, biomedical research is de-emphasized," Moses says. And although this may seem intuitively correct, "you would hope to see that trend reversed — investment in science and tech is a very good economic investment."

"Asia knows that biomedical research is a vehicle for them to enhance their international stature."

The good news, Moses says, is that it is possible to have a huge impact by changing research priorities. For a long time, Ebola wasn’t viewed as a threat, and therefore received very little funding. But now that the world has taken notice of the disease, advancements are happening quickly. And although we still don’t have a vaccine, many trials are currently underway. "The machinery of research and development can move very effectively and you can get to new vaccines and new treatments rather quickly," he says. Thus, making changes in the way government and industry invests in medical research could potentially have a large impact on people's lives — even over short periods.

"That’s why Asia is investing; Asia knows that biomedical research is a vehicle for them to enhance their international stature and the growth of their own populations," Moses says. If the US wants to ensure that the health of its citizens is taken care of in the future, or that research in the country won’t be hindered by non-US patents, "the US needs to increase spending in biomedical research," and "investment in health services research."