Americans who want better treatments for their diseases should be pleased that the lame-duck Congress passed the 21st Century Cures Act, which will promote medical innovation. They should be wary, however, of the $4 billion budget boost that the law gives to the National Institutes of Health.
The assumption seems to be that the root of all medical innovation is university research, primarily funded by federal grants. This is mistaken. The private economy, not the government, actually discovers and develops most of the insights and products that advance health. The history of medical progress supports this conclusion.
Few findings in medical science significantly improved health until the late 19th and early 20th centuries. During that period came breakthroughs such as anesthesia and antisepsis, along with vaccines and antibiotics to combat infectious diseases. The discovery of vitamins and hormones made it possible to treat patients with deficiencies in either category.
In America, innovation came from physicians in universities and research institutes that were supported by philanthropy. Private industry provided chemicals used in the studies and then manufactured therapies on a mass scale.
Things changed after World War II, when Vannevar Bush, who had led the U.S. Office of Scientific Research and Development during the war, persuaded Congress to increase federal subsidies for science. The National Institutes of Health became the major backer of medical research. That changed the incentives. Universities that had previously lacked research operations suddenly developed them, and others expanded existing programs. Over time these institutions grew into what I call the government-academic biomedical complex.
Since then, improvements in health have accumulated. Life expectancy has increased. Deaths from heart attack and stroke have radically decreased, and cancer mortality has declined. New drugs and devices have ameliorated the pain and immobility of diseases like arthritis. Yet the question remains: Is the government responsible for these improvements? The answer is largely no. Washington-centric research, rather, might slow progress.
Many physicians have never lacked motivation to develop treatments for diseases. But the government-academic biomedical complex has recruited predominantly nonphysician scientists who value elegant solutions to medical puzzles—generally preferring to impress their influential peers rather than solve practical problems. Vannevar Bush believed that basic research, unrelated to specific ends, was the best approach to scientific progress. How something works became more important than whether it works. Aspirin, for example, came into use even though researchers weren’t sure exactly what made it effective. That approach would never work today. Instead of the messy work of studying sick patients, scientists now prefer experimenting with inbred mice and cultured cells. Their results accrue faster and are scientifically cleaner, but they arguably are less germane to health.