THE LEARNING HEALTH SYSTEM SERIES

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This publication was initiated and funded by the National Academy of Medicine (NAM). It has undergone peer review according to procedures established by the NAM. Publication by the NAM signifies that it is the product of a carefully considered process and is a contribution worthy of public attention but does not constitute an endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine.

International Standard Book Number-13: 978-0-309-71666-6
International Standard Book Number-10: 0-309-71666-7
Digital Object Identifier: https://doi.org/10.17226/27588

Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: National Academy of Medicine. 2024. The State of the U.S. Biomedical and Health Research Enterprise: Strategies for Achieving a Healthier America. M. H. Laitner, A. M. Huang, and S. Takala-Harrison, editors. NAM Special Publication. Washington, DC: The National Academies Press. https://doi.org/10.17226/27588.

“Knowing is not enough; we must apply.
Willing is not enough; we must do”
—GOETHE

LEADERSHIP
INNOVATION
IMPACT

for a healthier future

ABOUT THE NATIONAL ACADEMY OF MEDICINE

The National Academy of Medicine is one of three Academies constituting the National Academies of Sciences, Engineering, and Medicine (the National Academies). The National Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, health care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

Learn more about the National Academy of Medicine at NAM.edu.

THE STATE OF THE U.S. BIOMEDICAL AND HEALTH RESEARCH ENTERPRISE

AUTHOR GROUP

E. ALBERT REECE (Chair), University of Maryland School of Medicine

JEFFREY R. BALSER (Sub-Group Chair), Vanderbilt University Medical Center

DIANE E. GRIFFIN (Sub-Group Chair), Johns Hopkins Bloomberg School of Public Health

KIRSTEN BIBBINS-DOMINGO, University of California, San Francisco; Journal of the American Medical Association

VICTOR J. DZAU, National Academy of Medicine

KAFUI DZIRASA, Duke University Medical Center

CLAIRE M. FRASER, University of Maryland School of Medicine

LINDA P. FRIED, Columbia University Mailman School of Public Health

ANN KURTH, The New York Academy of Medicine

SUDIP PARIKH, American Association for the Advancement of Science

RANDALL RUTTA, National Health Council

MARY WOOLLEY, Research!America

KEITH YAMAMOTO, University of California, San Francisco

ELIAS ZERHOUNI, Johns Hopkins University; Opko Health

HUDA Y. ZOGHBI, Baylor College of Medicine

Project Staff

AUDREY M. HUANG, University of Maryland School of Medicine

MELISSA H. LAITNER, National Academy of Medicine

SHANNON TAKALA-HARRISON, University of Maryland School of Medicine

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CONSULTATIVE EXPERTS

The author group would like to express its sincere gratitude to the following experts, who were called upon to share their views on the past, present, and future state of the U.S. biomedical research enterprise for this publication. Their insights and knowledge have informed the final form of this publication.

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REVIEWERS

This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). As an NAM Special Publication, it is the product of a carefully considered and systematic process and has the approval of the NAM Council. It is not a consensus study of the National Academies of Sciences, Engineering, and Medicine, and does not necessarily represent positions of the individual authors’ organizations.

The author group thanks the following individuals for their review of this report:

The reviewers listed above provided many constructive comments and suggestions, but they were not asked to endorse the content of the Special Publication and did not see the final draft before it was published.

Review of this publication was overseen by GILBERT S. OMENN, University of Michigan Medical School. Responsibility for the final content rests entirely with the author group and the National Academy of Medicine.

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CONTENTS

Acronyms and Abbreviations

Executive Summary

1 Introduction

2 A Strategic and Coordinated Approach to the U.S. Biomedical Research Enterprise

3 Streamlined, Coordinated, and Increasingly Impactful Funding

4 A Renewed Focus on Health Equity

5 The Need for Federal Coordination and Use of Convergence Science

6 A 21st-Century Workforce for the U.S. Biomedical Research Enterprise of the Future

7 A Renewed and Revitalized U.S. Biomedical Research Enterprise Is Possible

References

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BOXES, FIGURES, AND TABLE

BOXES

1-1 Definitions of Types of Research Included in the U.S. Biomedical Research Enterprise

2-1 National Agenda Setting Example 1: Singapore

2-2 National Agenda Setting Example 2: China

2-3 National Agenda Setting Example 3: European Union

FIGURES

1-1 Top 10 leading causes of death in the United States, by sex, 2019 and 2020

1-2 National Institutes of Health funding by institute, 1999–2021

1-3 Cancer incidence and mortality in the United States, 1999–2021

1-4 National Institutes of Health funding by year

1-5 Future state of the U.S. biomedical research enterprise

2-1 National Institutes of Health spending on basic and applied research, 2003–2022

2-2 Life expectancy at birth and age 65, by sex: United States, 2021 and 2022

2-3 Maternal mortality rate by race and Hispanic origin: United States, 2021 and 2022

2-4 Age-adjusted suicide rates by sex: United States, 2001–2021

2-5 U.S. deaths due to dementias

2-6 American confidence in scientists falls

2-7 Trust in science varies among groups

2-8 Basic science research expenditures (% gross domestic product) by country, 2000–2021

3-1 Gross expenditures on research and development by country, in terms of % gross domestic product, 2000–2021

3-2 Basic science research expenditures (% gross domestic product) by country, 2000–2021

3-3 Current state of the U.S. biomedical research enterprise

4-1 Prostate cancer: Age-adjusted rate of new cases per 10,000 men by race/ethnicity

4-2 Female breast cancer: Age-adjusted death rate per 100,000 women by race/ethnicity

4-3 Estimated HIV infections in the United States by region, 2021

6-1 Number of U.S. trainees by career stage, 1979–2019

6-2 U.S. postdoctorate recipients, by broad field, 2001 and 2021

6-3 Median annual salary of doctorate recipients with definite commitments in the United States, by position type and broad field, 2021

7-1 Current state of the U.S. biomedical research enterprise

7-2 Future state of the U.S. biomedical research enterprise

TABLE

2-1 Health Conditions Impacting Women and Men in the United States, 2022

ACRONYMS AND ABBREVIATIONS