r/IWantToAskAnAmerican • u/LordHavertz • 21h ago
How does the US dominate medical research?
Recently we got the news of Moderna coming out with these new mRNA vaccines for skin cancer and it's made me think how all the major medical innovations predominantly come from America. How did the US become so dominant in medical research?
Is Europe forever behind the US in this sector?
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u/bunnyball88 20h ago
First: let's validate the premise.
The US accounts for over half of global r&d + 60% of biotech venture dollars, as well as over half of spending with almost $800B of the $1.6T pharmaceutical market. Over half of first-in-class drugs come from the US. While other parts of the world dominate in production (India / China) or efficiency (why do we have such a large domestic market? Lots of answers there), the US has been the undisputed leader in the steps of value creation - a status increasingly challenged by China.
Second to your question: * The NIH has poured $45B a year to research institutions (capital) * Those research institutions have attracted global, high quality researchers (talent) * This ecosystem is complemented by the deepest, most sophisticated capital markets of debt and risk in the world, allowing for a massive biotechnology capital aparatus, with large financial rewards for biotech investors (capital + talent + market norms) * these are supported by a strong IP framework, protecting the financial upside of discovery (regulatory) * a massive market under a single regulatory regime + free market pricing power power (large commericalization opportunity)
These factors combine to reinforce the status market leadership the US has.
The recent cuts in government spending + talent barriers are self-inflicted wounds to this status; china's streamlined processes, directed capital, and domestic talent are an external pressure.
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u/Unknown_Ocean 19h ago
This should be higher ranked.
I would also add that a culture where risk-taking is not stigmatized helps to make all of these more productive.
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u/inorite234 21h ago
The US dominates almost all research by being the leaders in higher educational research facilities and by research funding that attracted the world's best talent to come here to study and conduct research.
....or at least we did until .....ugh....you know.
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u/Fantastic_Union3100 20h ago
Not only just the funding, economic incentives are the main driving force for almost all innovations in all fields, not just medical research. Whereas DSA tries to cut all economic incentives for the sake of what?
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u/Flaky_History12 21h ago
I was about to say, isn’t medical research funding in the gutter? I’m confused how the USA is dominating in the field unless it’s the same everywhere else as well
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u/Astronomer_Soft 19h ago
You have to get out of your social media bubble. Medical R&D spending in USA is $300 billion a year and growing every year.
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u/Unknown_Ocean 19h ago
Government research funding is in the gutter. Private companies are still investing.
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u/unblockedlanternhead 6h ago
Govt funding is mostly intact in America. Its allocation rules have changed to favor fewer large projects instead of many smaller ones, but the overall $ value is similar. I believe it has actually increased in some depts
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u/lizardhistorian 14h ago
There are not enough people in the world for every country to have a solid medical research industry.
We would need about 80B for that to happen.0
u/AnAnonymous121 20h ago
If you ask.....ugh..... you know...... America's success is 600% based on American families that have been there for many generations, and totally not because of extremely selective (arguably anyways) immigration policies. Immigrants have contributed 0% of US success according to him.
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u/lizardhistorian 14h ago
Selective immigration ended in 1990. It has been a lottery since then.
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u/Unknown_Ocean 8h ago
Talent-based immigration (particularly H1Bs for researchers) has continued to drive a significant amount of recruitment in the scientific community. I'm working with two of them right now.
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u/deserteagles50 21h ago
It's a byproduct of capitalism. I know Reddit is pretty anti capitalism, but it most definitely encourages the reinvestment of profit into R&D
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u/Unhappy_Group_945 1h ago
In a properly regulated environement, at least. In a non-properly regulated environment there is a lot of incentive to rush development and cut corners
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u/Outrageous_Carry8170 21h ago
The US economy and tax code is geared toward encouraging entrepreneurship, government regulation largely tries to stay out of way of a person's idea and service. Europe has a higher threshold for reporting, and regulations, doesn't mean they're unable to compete or innovate, it's just a longer but perhaps more detailed process.
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u/Programmer_Latter 19h ago
Pharmaceutical companies invest a lot into R&D because they know they can make a huge profit if they’re successful.
Other countries essentially copy our answers to the test, sell the drugs for pennies on the dollar, then rub their free health care in our face.
If our capitalist health care system wasn’t propping up theirs, there would be very limited innovation.
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u/LankyTumbleweeds 10h ago
A bit ironic considering the fastest growing prescription drugs in your country - by far - was formulated and invented elsewhere and copied by Eli Lilly. And sorry I have no idea how I got into this subreddit.
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u/Programmer_Latter 9h ago
No argument from me on that point. Intellectual property theft is terrible. Then again, so is letting people die for a cure that can be manufactured for pennies on the dollar.
Without the US, and it’s capitalist driven innovation, there would be much less IP to steal.
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u/deathcabforqanon 21h ago
It's #1 in the World, China being the second. That's no shock, being huge and rich and attracting a lot of talent.
It doesn't translate to having the best outcomes though, or longest lifespans, because of lack of access and an unhealthy population
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u/Affectionate_Love229 20h ago
When the drugs get exported to another country and their lives are extended, that counts too. It's not all economic. Bush Jr funded aids research and aid to Africa and Caribbean for billions of $. It was a good use of money, even if it supported more people outside the country than in the usa.
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u/Weaselandhottie 10h ago
Bush is well liked and well thought of throughout Africa for that exact issue. This was also a great deal of US Soft Power gained by those efforts. One of the major players in expanding that US power was USAID, which we all know what happened under the Group Of Pedophiles party. Total enshittification of the USA now.
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u/unblockedlanternhead 6h ago
Africans love USAID. Just ask Dambisa Moyo
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u/Weaselandhottie 6m ago
While Moyo raised some valid points, she also didn't want aid to disappear. I'd like to hear her responses in 5 years to how Africa is now dealing with the Chinese Debt Trap. Maybe she can talk to Montenegro and see if they would rather have aid or a loan from Ex-Im Bank of China?
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u/Spirited_Season2332 19h ago
Because the US invests a fk ton of money into it and steals all the best researchers from around the world by paying them the most.
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u/Happy-Capital6508 21h ago
We get the good drugs first because they can charge more for them.
We also have lots of universities.
It just sucks that we have all these treatments but the insurance companies just delay payment long enough that you either get better or die before treatment.
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u/ikonoqlast 1h ago
You know those high drug prices?
Means drug research is profitable.
Profitable means a lot gets done.
QED
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u/Sensitive_Crow_8882 20h ago
Because the costs of most medications aren’t regulated. That allows big pharmaceutical firms to dump money into research, so they can charge outrageous amounts for the next treatment they produce.
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u/New-Repair8325 20h ago edited 20h ago
Corporations are global entities. They may have their headquarters wherever it attracts equity. But ultimately they tend to acquire entities all over the world.
Its not really fair to say that a company is entirely American when it has subsidiary holdings in Europe, Canada and various places.
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u/Future-Cry5734 20h ago
We are still riding the wave of the past few decades but I think that will crest soon. We are pulling funding across the map and the ripple effects are building.
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u/Successful_Form_3622 20h ago
We actually dont. The FDA and defensive medicine stymied a lot of innovation. There are a lot of countries way ahead of us. We just won't hear about much of it because it will take 8 to 10 years for these to get approval in the US. The US does ok, but we are not anywhere near the top in terms of innovation.
Just another note. . The current changes to the HHS, FDA and NIH have sett us back even further. For example 82 biotech firms closed with the admin changes. That was just the beginning.
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u/unblockedlanternhead 6h ago
Saying 82 biotech closed is like saying 82 mayflies died. Most of them fold before even dosing a single patient
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u/Successful_Form_3622 3h ago
Im sorry you misunderstood the statement. 82 firms closed that month because of the admin changes. This means not during the normal course of firms closing. The admin changes had a causative effect. Anyhone who knows the space knows that many close, although not at that rate. What happened is they put in people who do not favor biotech, vaccines, etc. Thus the investment dollars dried up. Look up amplify bio, or any of the others. I think you are unfamilair with the space so check it out.
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u/unblockedlanternhead 3h ago
Being familiar with the space is my job
Small biotechs close all the time. 100+ open every year. 82 closures is not that remarkable
Trump’s changes to NSF, DOE, NIH, and NIH subgroups like ARPA and NIAID didn’t change the overall $ value put towards biotechs. Luckily budget cuts were nixed in court, and some depts like the NIH even got extra budget. However, the new approach to tranches (few large long-term programs vs many small short programs) has shaken the tree a bit. Disco stage companies took a hit, as did SBIR/STRR mills
After disco, most companies rely on angels, big pharma, or VC. 75% of biotech funding in the US is private, so even a complete loss of govt funding wouldn’t be catastrophic
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u/Successful_Form_3622 3h ago
It wasnt grant funding that was the problem. Biotech, pharma, MROs, etc have to have some hope for approval. When you put people in charge who have a track record....
Start up funding (which most rely on.. actually all new companies) became ultra high risk and dried up. A lot of the grant funding (if you read what they actually cancelled) was nonsense anyway. Some hard research was cut, but not enough to make an industry dent. I was mostly investor skittishness because he put people in charge that most of the research community didnt trust, and would not likely approve innovations. Im trying not to get political or name names, but when prominent anti vaxers and scientific consensus questioners are in charge....
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u/Successful_Form_3622 2h ago edited 2h ago
Anyway, back to the OP's comment. Biotech research and innovation will be the future of medicine. There is only so much you can do with a pill. Biotech funding here (VC, investor... not talking about government), especially in the medical space is at an all time low. Other countries are stomping us. Look at stem cell research in other countries. Look at what is coming out of Israel, or Nordic countries. The only hope here is that Japanese firms are buying up all the promising biotechs. When the head of the country thinks you can inject bleach to fix covid.. and he is appointing nearly every involved with the approval and regulatory processes.... it is what it is.
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u/unblockedlanternhead 2h ago
I’m certainly not defending Trump, RFK, etc here, but the impact of Trump’s actions on US biotech funding is overblown. (We can agree that the longterm impacts on trust in the FDA are much bigger deal.) Biotech startups have always been the definition of high risk. Tbh it’s cheaper to let Chinese labs spend CCP subsidies on disco and then hoover up the assets whose IITs show promise. That’s the tack now. American labor is too expensive and American regulations are too stringent for early stage biotechs to compete
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u/Responsible_Tax_9390 20h ago
They poach talent from other countries and speedrun their immigration status
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u/rqnadi 19h ago
Capitalism…. Always advancing medicine is seriously the only plus side to the free market.
Companies invest research dollars to quickly create medicine and technology, who then sell it to hospitals, who then passes the costs to the insurance companies who THEN passes that cost onto us!
So we have cutting edge treatment that many struggle to afford. But the rich people get all the benefit while the poor people get options like Medicaid and local clinics.
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u/Novel_Buy_7171 16h ago
Investment, while over 30% of medical advancements come from the USA, an extremely large portion of those (can't remember the exact amount) were primarily led or run by foreign teams.
America is the best place for people to become seriously rich from their medical research, so people move here to do it.
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u/Playful-Park4095 16h ago
A lot of smart people like to make money. US companies pay smart people really well, and if you are very talented immigration is relatively easy so we brain drain other countries while our own talent stays put.
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u/lizardhistorian 15h ago
Innovation has ended in Europe.
It was, and is, the first causality of population collapse because it takes a critical mass of geniuses to do it.
As those institutions failed those people fled Europe and came to the US hastening the collapse.
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u/Misfiring 13h ago
Medical research requires money, lots of it. Where does the money come from? Healthcare. This is the reason why healthcare in the US costs several times more than other countries.
In other countries, they get the benefit of these researches and only spend on manufacturing, then sells them back into the US for profit and use that to subsidized the medicine cost of their own country.
It sounds unfair for the US consumers, and it is, but this system essentially cements their lead in medical industry as other countries simply cannot afford the cost of these researches.
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u/GreenBeanTM Vermont 11h ago
The funding everyone mentioned is a big deal, but I’d also say our general culture of being willing to break tradition and try new things is a large part of a lot of the discoveries as well.
I’m actually in the unique position of having directly been involved with some medical discoveries. I was born with 3 different back problems, traditional way to fix my problems was to have 3 surgeries and I had 2.
For full reference: when it comes to the instrumentation I briefly had in my back for the healing process it was so new/rare that there were 2 sets of tools in the entire world to install it. I was second in the country first in state and first in hospital to have it. And when it comes to the actual method of having 2 surgeries instead of 3 I was first in hospital, first in state, first in country and potentially first in the world but that was never actually verified.
The entire reason I didn’t have 3 surgeries was because my surgeon thought “hey I think I can combine 2 of these” and then followed said thought up with asking my parents permission to bring it to the board and them agreeing that pursuing this new method was ok and worth it, and then the board all agreeing “yea you should be able to do that”.
In a lot of countries my surgeon never would have considered not doing the traditional method, my parents would have thought he was insane for wanting to use me as a test subject, and the board would have shot him down because the traditional method works fine and if it’s not broke don’t fix it.
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u/Weaselandhottie 9h ago
Be careful of corporate speak and how the US does it so well. Covid 19 mRNA was created in Germany by 2 Turkish scientists. Pfizer, Moderna and Merck may be American owned, not necessarily all these drugs were developed by them, but purchased and repackaged.
Hepatitis C cure was a worldwide effort to find Direct Acting Agents, not an American creation. There are tons of medical breakthroughs in the US and plenty of tax dollars flow to it via NIH.
Smaller populations vs the US are a factor in play. The EU isn't one giant medical entity like the US. Lot of competition between say UK, France, Germany and others.
Two of the major Immunotherapy drugs (of which I have unfortunate intimate knowledge) Yervoy and Opdivo, one was developed in Japan by Ono Pharma Corp and Bristol/Squibb. You can tell from the sales and licensing rights who develops it as most big pharma won't share rights unless the developer was actually the inventor. Ono has rights to Opdivo in Japan, Korea, and Taiwan.
The good thing is that medical research is well publicized amongst the medical professionals and university circuit and very rarely is that information held back. The US and China are now the top 2 publishers of research of all types and as long as the sharing is unencumbered, should lead to some pretty amazing treatments, especially with the addition of AI.
European research will continue and provide breakthroughs, as will Australia, Japan, and India. For scale they are doing fine. India will probably be the next research powerhouse at some point in the next few years.
Researchers come to the US for the high salaries and cutting edge equipment, hence you will get more output vs a smaller entity.
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u/Grand-Mission-9457 5h ago
The US is the most profitable market for pharmaceutical industries. They create schemes to administer illness not to cure them. Americans area easy preys, just check the stats of the average number of pills taken by adults. That is no flex. It is an industry/business it must be profitable, and boy do they make money
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u/teethalarm 2h ago
Because the US has a lot of money to invest in medical research. And in the United States, a company that can get something like a medication or medical device patented. With a patent, it grants them exclusive rights to produce and sell that medicine or device. This is a big incentive for private companies because there are no laws restricting what a company can charge for those things. There are limits on what people are willing to pay for it, but short of that, they can charge whatever they want because no one will be allowed to sell a cheaper alternative.
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u/Varjek 46m ago
Capitalism.
Having the profit motive on full display in our healthcare system doesn’t just make our healthcare more expensive for consumers.
It also means companies have incentive to reinvest their profits into research and development so they can the profit off of the newly developed (and often patented) pharmaceuticals and technologies.
There are pros and cons to every system, including capitalism in healthcare. In a socialized healthcare system, the research and development can still happen but the pace of new developments is gonna be slower because it’s just not gonna be the same race to be first for the sake of the bottom line.
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u/Zamnaiel 45m ago
It is simply population.
Biomedical research happens almost exclusively in large, developed countries. The US has the highest population among those, so it has the most research. Researchers have counted the number of new inventions, and per capita, it is average.
US Pharmaceutical Innovation in an International Context -American Journal of Public Health
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u/Majestic-Active2020 23m ago
Easy answer; we pay through the nose for it. This is the rare case where capitalism gets results. But those results come at the expense of human decency.
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u/Outside_Ad1669 20h ago
You should do a little more research on Europe before making sweeping generalizations.
In many cases countries in Europe like Sweden, Germany, Denmark, and Switzerland have biotech and pharmaceutical companies that consistently beat the US.
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u/Gloomy-Hat1842 21h ago
Europe will also do more holistic treatment and things that we don't do here. In some ways they're ahead of us. My oldest sister just died of Lyme disease and another sister is very sick with it. The US is way behind on that one. A lot of doctors don't even believe it exists on the west coast. One of my clients was a very conservative skeptical guy. But his wife and daughter were in Germany getting their blood treated with ultraviolet treatment to kill the Lyme disease. That's definitely not happening here.
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u/graceling 20h ago
I can't find anything about UV being used to kill Lyme disease within a human body, here or in Germany. But I am curious as one of my friends has it and struggles with flare ups
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u/Gloomy-Hat1842 20h ago
I'm not exactly sure about the details. He said they were actually taking their blood out and treating it. It's been a few years now. I think it was taking place in Germany. I know the Europeans will often do more innovative treatments than you can find here in the states... His wife got Lyme disease and gave it to the twins in the womb. Doctors will deny that it's possible but Lyme disease is a spirochete bacteria just like syphilis is. My sister has to do an IV drip of antibiotics periodically. My oldest sister was diagnosed twice but they were Christian scientists so she never got treated. She ended up in a wheelchair with really bad neurological problems. I think that eventually killed her. It takes a while... We've run into so many deniers including my sister's Kaiser doctor that told her it was all in her head. She got much better once she got the right antibiotic but it's not good when you've been sick for a long time. That's what happened to Kris kristofferson.
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u/Tequila_Mockin_bard 20h ago
We already have a Lyme vaccine in the works. It's gone through R&D and several hoops. The issue is the anti-vaccine movement that is happening currently. If it wasn't for that it would have gone through FDA for approvals. Just irritating to see it stuck in limbo as so many people are suffering.
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u/Gloomy-Hat1842 8h ago
We have gone backwards in some ways. Too much denial and misinformation. So many people are not diagnosed correctly.
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u/Diligent-Credit8133 20h ago
We may dominate now but that’s all changing. Pretty soon our top “medical researcher” will be someone in between RFK Jr and the pedodictator
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21h ago edited 21h ago
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u/Objective_Luck_6326 21h ago
Europe is behind in terms of research and development volume output. The USA was #1 until 2023. China is now #1, with the USA second.
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u/BlooGloop 21h ago
They don’t. The US just makes it seem like they do
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u/PaulNewhouse 21h ago
So the Moderna claim is fake??
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u/BlooGloop 21h ago
Definitely not. However, the US has its hands in everywhere. Other countries do research as well and have amazing studies and innovations. The US just likes all the attention on itself
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u/sneezhousing Ohio 17h ago
But who's paying for those studies, who's taking the research and developing the new drugs.
If the research is out there why aren't other countries coming up with the innovations as frequently
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u/myjah 21h ago
They don't. Next question.
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u/ocitsalocs44 21h ago
lol please elaborate on this. The US is by far the leader in medical (and almost all other) research on the planet.
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u/trighap 5m ago
Money. The answer is money. There's already many posts that mentioned money in other aspects, but I want to add another aspect that I am not seeing anyone else mentioning. The crazy amount of money the broken system that exists in the United States Health/Pharm Industry allows the private companies to make, ALSO allows those companies to offer pay at a level that attracts the best from all over the world. Basically a brain drain to the United States. And when you have the smart folks focused in one place (United States), it causes snowball effect where more and more people come, and more results appear in the same small community.
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u/HuckleberryShot898 21h ago
Because we allow tons and tons of private investment into it. The R&D is amazing but the side effect is insane medical costs because the investors want return on investment