3 ms·

> and almost all major medical advances and research comes out of the US Are you're basing that on the number of clinical trials compared to other countries or

by heffer 4y ago

> and almost all major medical advances and research comes out of the US Are you're basing that on the number of clinical trials compared to other countries or regions using the data from the WHO [1]? As someone who worked for a large pharma company for almost 10 years I'd say it's easy to think that when in reality it's just easier to conduct clinical trials in the US compared to, for example, the EU. With the US market having the highest margins for pharmaceuticals and no ban on ads for prescription medicine it's also important to spend as much time in the US market while still under patent protection. A quicker way to enter the US market is by doing clinical trials in the US. The company I worked for is global (like most pharma companies) and, depending on the indication, the research is actually more likely to not have been conducted in the US. [1]: https://www.who.int/observatories/global-observatory-on-health-research-and-development/monitoring/number-of-clinical-trials-by-year-country-who-region-and-income-group-mar-2020 https://www.who.int/observatories/global-observatory-on-heal...

haldujai 4y ago
I mean isn't that still the same thing? At the end of the day it doesn't really matter where the basic science/product design/manufacturing/drug discovery/initial idea was conducted as for any of those to be clinically useful or enter practice we need high quality evidence/large studies which are mostly coming out of the US. It also doesn't matter WHY it's happening in the US, but I've elaborated on a few reasons below as it's not just profit related. I made my statement on the basis of research productivity[0] (of course there will be some bias in this) and personal experience as a physician. I'm less aware of pharmaceuticals as that's not my area of expertise (radiology) but medical devices, emerging imaging technology and oncology and clinical research are certainly dominated by U.S. researchers/institutions. There are of course areas where other countries are equally strong/stronger due to niche powerhouses or disease prevalence (e.g. cardiovascular surgery in Germany, hepatobiliary disease in Japan) but even then the US is still a near peer and if you throw a dart at a list of guidelines you'll practically always find an American institution driving it or playing a large part. A particularly striking and easy to assess example is in oncology where AJCC/NCCN basically set the standard, 5 of the top 10 cancer centres are US[1] (and the delta between the top 2 and the rest is very large) and the standardized imaging guidelines (e.g. BI-RADS for breast cancer which is now adopted worldwide) come out of America. Consequently these institutions get a lot of $$$ from donors and international patients (e.g. Sheikh Zayed buildings at Hopkins and MD Anderson). As another example we can look at 7T MRI installations (effectively pointless for clinical use at this time), there are approximately the same number of units installed in the US as the entirety of Europe[2] although most/the best magnets are made by Siemens. Now for a technology like this to enter routine clinical practice someone has to show that it's actually better to justify the cost and these studies are mostly coming out of the US as it's easier to collaborate, conduct clinical research with large enough sample sizes, and there's (effectively) unlimited $ to waste on experimental ideas that may/may not pan out. Once that research is done (which is more important than the industry funded pilots) and is shown to be better, other countries can just adopt it without taking on the risk of funding a new procedure/surgery/treatment regimen that takes away $ from someone else in a zero-sum public system. It's not that other countries don't have smart people or discover things it's just incredibly hard and/or pointless from a resource perspective to compete with the US who also culturally value 'being the best' (both vs. the rest of the world and vs. each other) and afford their clinicians generous/mandatory protected time to divert from clinical duties to scholarly activities (definitely true for Canada, UK and Germany where I have interacted with the most physicians). [0]https://www.scimagojr.com/countryrank.php?area=2700 https://www.scimagojr.com/countryrank.php?area=2700 [1]https://www.newsweek.com/worlds-best-specialized-hospitals-2021/oncology https://www.newsweek.com/worlds-best-specialized-hospitals-2... [2]https://www.google.com/maps/d/u/0/viewer?mid=1dXG84OZIAOxjsqh3x2tGzWL1bNU&ll=33.76862681470264%2C-44.37421905714891&z=4 https://www.google.com/maps/d/u/0/viewer?mid=1dXG84OZIAOxjsq...

by heffer 4y ago

haldujai 4y ago

I mean isn't that still the same thing? At the end of the day it doesn't really matter where the basic science/product design/manufacturing/drug discovery/initial idea was conducted as for any of those to be clinically useful or enter practice we need high quality evidence/large studies which are mostly coming out of the US. It also doesn't matter WHY it's happening in the US, but I've elaborated on a few reasons below as it's not just profit related. I made my statement on the basis of research productivity[0] (of course there will be some bias in this) and personal experience as a physician. I'm less aware of pharmaceuticals as that's not my area of expertise (radiology) but medical devices, emerging imaging technology and oncology and clinical research are certainly dominated by U.S. researchers/institutions. There are of course areas where other countries are equally strong/stronger due to niche powerhouses or disease prevalence (e.g. cardiovascular surgery in Germany, hepatobiliary disease in Japan) but even then the US is still a near peer and if you throw a dart at a list of guidelines you'll practically always find an American institution driving it or playing a large part. A particularly striking and easy to assess example is in oncology where AJCC/NCCN basically set the standard, 5 of the top 10 cancer centres are US[1] (and the delta between the top 2 and the rest is very large) and the standardized imaging guidelines (e.g. BI-RADS for breast cancer which is now adopted worldwide) come out of America. Consequently these institutions get a lot of $$$ from donors and international patients (e.g. Sheikh Zayed buildings at Hopkins and MD Anderson). As another example we can look at 7T MRI installations (effectively pointless for clinical use at this time), there are approximately the same number of units installed in the US as the entirety of Europe[2] although most/the best magnets are made by Siemens. Now for a technology like this to enter routine clinical practice someone has to show that it's actually better to justify the cost and these studies are mostly coming out of the US as it's easier to collaborate, conduct clinical research with large enough sample sizes, and there's (effectively) unlimited $ to waste on experimental ideas that may/may not pan out. Once that research is done (which is more important than the industry funded pilots) and is shown to be better, other countries can just adopt it without taking on the risk of funding a new procedure/surgery/treatment regimen that takes away $ from someone else in a zero-sum public system. It's not that other countries don't have smart people or discover things it's just incredibly hard and/or pointless from a resource perspective to compete with the US who also culturally value 'being the best' (both vs. the rest of the world and vs. each other) and afford their clinicians generous/mandatory protected time to divert from clinical duties to scholarly activities (definitely true for Canada, UK and Germany where I have interacted with the most physicians). [0]https://www.scimagojr.com/countryrank.php?area=2700 https://www.scimagojr.com/countryrank.php?area=2700 [1]https://www.newsweek.com/worlds-best-specialized-hospitals-2021/oncology https://www.newsweek.com/worlds-best-specialized-hospitals-2... [2]https://www.google.com/maps/d/u/0/viewer?mid=1dXG84OZIAOxjsqh3x2tGzWL1bNU&ll=33.76862681470264%2C-44.37421905714891&z=4 https://www.google.com/maps/d/u/0/viewer?mid=1dXG84OZIAOxjsq...