Can We Ever Spend Too Much on Biomedical Research?

The answer depends on whom you're asking.

New Nobel co-laureate in medicine Craig Mello "deplored poor funding of medical research as a waste of precious time [that] costs human lives," according to Agence France Presse. "The consequence of not acting is we are sentencing people to death when we could be helping" with new drugs and therapies, Mello said at a news conference in Worcester, Massachusetts.

Mello shares this year's Nobel Prize in medicine with Andrew Fire of Stanford University School of Medicine for their work on silencing malfunctioning genes known as RNA interference (RNAi).

I want a very long and a very healthy life. And even if I did exercise more, eat less, and party more moderately, the number of years that might be added to my life expectancy is still not all that great. As it stands, there's a 50-50 chance that I will make it another 25 years. So let's just say that I have more than a passing interest in the progress of biomedical science (and you should too).

It is a truism at every scientific conference I attend that research dollars are becoming ever scarcer. Scientists generally identify the culprits responsible for this cash shortage as the chiseling politicians who are simply too dim to understand the vital importance of scientific research. I find this view of politicians naturally attractive. So, could it be that "we" are spending too little on such research?

According to a 2005 study in the Journal of the American Medical Association: "Biomedical research funding increased from $37.1 billion in 1994 to $94.3 billion in 2003 and doubled when adjusted for inflation." Fifty-seven percent of biomedical research dollars came from industry and 28 percent from the National Institutes of Health (NIH). The JAMA study added that in 2003,"the United States spent an estimated 5.6 percent of its total health expenditures on biomedical research, more than any other country."

In July 2006, the research lobbying group, Research!America, estimated that by 2005, health care research spending had risen to more than $111 billion. Of that total, industry spent $61 billion, government paid out $37 billion, and universities, states and philanthropies shelled out $13 billion. Total U.S. research and development expenditures, according to the American Association for the Advancement of Science, rose to $312 billion in 2004, nearly two-thirds ($200 billion) of it coming from private industry. Private industry and the government in the United States together provide 35 percent of the world's total R&D funding.

Research!America groused that the percentage of health care expenditures devoted to research had fallen from a high of 5.8 percent in 2004 to 5.5 percent in 2005. The report does note that back in 1991 research funding constituted only 3.5 percent of health care spending. Research!America claims that 58 percent of Americans think that research spending should be at least 7 percent of health care expenditures. In 2005, that would have funneled an additional $30 billion or so into biomedical labs. Assuming that the extra $30 billion went solely to the NIH—essentially doubling its budget—that would likely mean that the agency could fund 40 percent of the studies submitted to it instead of the 20 percent it does now. That would make a lot of scientists happy, but 60 percent would still be left shaking their beakers for handouts.

So why are researchers constantly complaining that research moolah is harder than ever to come by? It's clearly not because the supply is growing smaller. What about the demand side? According to the National Science Foundation, in 1993 America had 463,000 working scientists and engineers with doctoral degrees; 124,000 toiled away in the life sciences and half of those labored in academia. By 2003, that number of working scientists and engineers with doctorates had grown to 593,000, of whom 146,000 were in the life sciences and again, about half inhabited academic labs. All other things being equal, since money available for biomedical research more or less quadrupled over that period while the biomedical researchers chasing after grants increased only about 18 percent, there should be a lot of happy well-funded biologists. But there is not.

The felt scarcity of research dollars probably results from two interacting developments. First, as biomedical knowledge increases exponentially the possible number of worthwhile experiments that researchers can imagine also soars. This leads to ever more proposals being submitted for funding consideration. Second, the questions being asked by researchers are now more complex, making biomedical experiments more expensive. Perhaps less benignly, overcautious regulatory requirements are eating up a lot of clinical pharmaceutical research dollars and slowing the introduction of new medicines.

So is the newly minted Nobelist Mello right? Is too little being spent on biomedical research? With regard to private biomedical research, drug, biotech and medical device companies are aiming to spend as much as it takes to maximize their profits. That is, companies are trying to gauge what we (and our insurers) are likely to spend, based on our wealth, for treatments that can be created using current and soon-to-be-produced biomedical knowledge. In the future, cancer will be cured at a reasonable cost and, the good news is that Mello's work on RNAi may be pointing the way.

Unlike in the private sector, government support for research has no natural limit other than what taxpayers are willing to bear. Cambridge University theoretical biogerontologist Aubrey de Grey is promoting the Methuselah Mouse prize which encourages researchers to find ways to double or triple the healthy lifespan of a mouse. De Grey believes that once effective anti-aging treatments have been demonstrated in a mammal that the public will break down the doors of the Capitol or Parliament to demand that politicians spend vastly more on biomedical research. Perhaps that will happen. All I know is that the proper amount of research spending is that amount that will enable me and you to live as long we'd like. Is that asking for too much?