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At TEDMED, the Best and Worst of Times for American Medicine

Federal funding has dropped 22 percent in the last decade, undermining the promise of personalized medicine.

Courtesy: TEDMED

In an onstage interview in Washington, D.C., this week, National Institutes of Health Director Francis Collins painted contrasting pictures of the state of medicine in America.

Speaking at TEDMED, the health-focused offshoot of the alternately celebrated and mocked speaker series, he began by listing off the many ways in which we’re on the edge of a golden age.

The cost of full genome sequencing is on its way to $1,000, down from about $10 million in 2008. Scientists are coming to understand the idiosyncratic mix of microbes that each of us carries on us and in us. Researchers are redoubling efforts to understand how brain circuits do their thing. And oncologists are learning to treat tumors as the individual mess of mutations they are, not as generic lumps that affect everyone the same way.

Added up, it promises to push us past one-size-fits-all health care and into an era of personalized medicine. It means individuals can receive treatments that will be most effective within their unique biology or, even better, that specific susceptibilities to diseases can be addressed before symptoms appear.

And yet! It’s also in some ways the worst of times for medicine in America. Collins noted that the National Institutes of Health research funding has dropped more than 20 percent in the last decade (adjusted for inflation, using 1998 dollars).

“We have lost ground,” he said.

It means we’re losing scientific momentum to other nations, inviting the best and brightest minds to move into other industries and undercapitalizing a massive driver of the U.S. economy, he said. (A 2011 report by United for Medical Research said NIH investments generated $62 billion in economic activity and supported more than 400,000 jobs.)

NPR’s “All Things Considered” underscored the cost in a report this week, noting that 3,400 scientists lost sustaining grants between 2012 and 2013, according to an analysis of National Institutes of Health Data.

“There are far more scientists competing for grants than there is money to support them,” NPR said. “That crunch is forcing some people out of science altogether, either because they can’t get research funding at all or … because the rat race has simply become too unpleasant.”

A report from the Center for American Progress put it in starker terms.

The cumulative nature of biomedical research investment is such that every dollar invested today must be viewed through the lens of a considerably long time horizon. Many breakthroughs are the result of painstaking research that takes place over the course of years and decades.

For example, 30 years of research elapsed between the key enabling discovery for the antidepressant Prozac and its introduction to the market. And 21 years elapsed between the key enabling discovery for the ovarian cancer drug Nolvadex and its introduction to the market.

Therefore, the choice between more or less NIH funding today can mean the difference between whether or not scientists make a critical breakthrough several decades from now.

Private industry obviously can and does play a big role in advancing research, but it’s difficult to even approach the spending power of the U.S. government.

While biotech investments climbed during the last two quarters, they actually fell two percent for the full year in 2013 to $4.5 billion, according to the MoneyTree Report from PricewaterhouseCoopers, the National Venture Capital Association and Thomson Reuters. Investments in software were more than double that, reaching $11 billion last year.

Both were dwarfed by NIH spending on medical research, which now totals $30.1 billion annually. But on an inflation-adjusted basis, that funding has dropped by $5.1 billion in the last decade.

“We seem to have lost our moxie and we’ve got to get that back,” Collins said.

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