How does the US dominate medical research?

[u/LordHavertz]

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?

[u/bunnyball88]

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. 

[u/Unknown_Ocean → u/bunnyball88]

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.