For decades, the United States has led the world in medical research and discoveries. Much of that research has been sponsored by the U.S. National Institutes of Health. But the U.S. has been losing ground to other nations that are investing in their own medical research institutions. Recently, there has been political pressure to reduce NIH funding and to prohibit funding of research that includes politically sensitive subjects. Such de-investment in research and censoring of NIH research grants will accelerate America’s de-throning as the world’s leader in medical research.
The best way to determine what countries are producing cutting edge medical discoveries is to look at where papers in prestigious medical journals originate from. The New England Journal of Medicine is widely considered to be the most prestigious medical journal in the world. Each year, the New England Journal of Medicine receives 16,000 manuscripts for consideration but only accepts about 200 original research papers per year for publication – it is highly, highly selective. For a paper to be accepted, it must provide important new information about diseases and disease treatment. It must then go through a very rigorous peer review process where experts in medicine, science, and statistics analyze the methods, results, conclusions, originality, and value of each study. In the end, only the highest quality research papers get published from the best of the best researchers in the world. In each weekly issue, the New England Journal of Medicine contains 3 – 5 original research articles.
I looked at issues of the New England Journal of Medicine published over the past twenty years. Specifically, I reviewed all issues published in the years 2004, 2009, 2014, 2019, and 2024. In other words, I sampled the issues published every five years. For each issue, I determined the country of origin for each original research article. By focusing on the original articles, I ignored editorials, review papers, letters to the editor, and cases of the week since they are not original research and do not reflect where in the world active top-tier research is occurring.
Over the 5-years (2004, 2009, 2014, 2019, and 2024), there were a total of 1,041 original research articles published. The table above lists the countries of origin for these research articles. Only countries with at least 2 articles published in these 5 years were included in the table. The countries publishing the most articles were the United States, the United Kingdom, France, Canada, Germany, the Netherlands, and China. However, over the 20-year time period from 2004 to 2024, there has been an important change in the country of origin of these research articles as shown in the graph below.
Historically, the United States has dominated New England Journal of Medicine articles. In 2004, 53% of the research for published articles originated in the United States (dark blue line above). The United Kingdom has historically had the second most research articles, followed by France, Canada, The Netherlands, and Germany. In the past, China did not produce much high quality research that made it through the rigors of the New England Journal of Medicine’s review process – in 2004, only one article from China was published in the Journal, accounting for just 0.5% of all published articles.
But over the past 20 years, things have changed. The United States no longer accounts for the majority of published articles – in 2024, only 41% of articles originated from the U.S. The most notable change has been the gradual increase in articles originating from China from 0.5% of articles in 2004 increasing to 7.1% of articles in 2024.
The decline in the United States’ superiority in major published research articles does not necessarily mean that the U.S. medical researchers are no longer producing as much high-quality research as they did in the past – it could alternatively mean that the rest of the world is now producing better medical research than in the past. Research originating in China is a clear example of this. In China, the majority of research funding comes from the Chinese government through the National Natural Science Foundation of China, which is administered by the Ministry of Science and Technology. The Chinese government has made a deliberate decision to prioritize medical research.
The United States is now in danger of falling behind in medical research. Much of the medical research that pharmaceutical companies and medical technology companies do not sponsor falls to the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). This includes basic science research, epidemiology research, and research that is unlikely to result in new, profitable products. Moreover, the NIH and CDC sponsor research in areas that corporations cannot (or will not) fund due to the potential for conflict of interest or the potential that a profitable product could lose its marketability. The main recipients of NIH and CDC funding are researchers at U.S. universities who depend on grant funding to pay their salaries, run their laboratories, and pay their research staff.
Without NIH funding, universities would no longer be able to pay researchers and their staff with the result that these individuals would pursue career changes and seek employment elsewhere. It takes years for an academic medical researcher to become trained and skilled enough to perform high-quality research. The average age of researchers getting their first RO1 grant from the NIH is 46-years-old for physicians (MD) and 43-years-old for PhDs. The implication is that it takes 20-25 years of research experience after college to produce a successful researcher. When a nation stops funding medical and scientific research and that nation’s researchers are forced to make career changes, it can take up to a quarter of a century for that country’s research output to recover after resumption of funding. Think of it as analogous to burning down an orchard and then regrowing it from seeds – it takes many years before the orchard produces fruit again.
The Chinese government realizes this and sees state-supported funding of medical and scientific research as an investment. They are playing the long game and realize that research funding today can result in China becoming the dominant producer of high-quality medical and scientific research in the future.
The recent political calls to defund the NIH and CDC will accelerate the decline in U.S.-produced high-quality medical research. Even if NIH and CDC funding is halted only temporarily for one or two years, the repercussions in reduced U.S. research manpower will last for one or two decades. The United States has long prided itself as the world’s leader in cutting edge medical research. Defunding the NIH and CDC will send the world the message that we are ceding that leadership to China.
February 6, 2025
