I am looking for metrics as to which countries — that is which medical systems — have contributed the most to medical innovation. That can range from pharmaceuticals to pacemakers to well…please let me know what you know. Thanks in advance for the help.
Addendum: Speaking of medical innovation, here is a new piece on neuroeconomics, from The New Yorker.
Here is one place to start:
http://inventors.about.com/library/inventors/blmedical.htm
I take it the general argument goes that the U.S. medical system produces
more innovation because the return on innovation in our health care market
is higher? But presumably if a pharmaceutical or pacemaker is developed
in Germany or India it can/will still be sold & profited on in the U.S. if
it is truly an advance. So do we credit the domestic system of the country
that produced the innovation or the system of the country where the
innovation earned its greatest returns?
This opinion piece in today’s National Post (Canada):
http://www.canada.com/nationalpost/financialpost/story.html?id=510e166d-2b73-4a7e-a9e3-506e2d4bdbfb
claims that “Americans have played a role in 80% of the most important medical advances of the past 30 years.”
No source, and lots of qualifiers.
I researched recent innovations ranked highest by U.S. physicians in 2001. Four of the top five innovations were developed in the U.S.
MRI
Paul Lauterbur (US) and Peter Mansfield (UK) shared the Nobel prize for the research. American Raymond Damadian used their research to develop and build the first commercial MRI scanner.
ACE inhibitors
Captopril was the first one, developed by three scientists working for Squibb in NJ.
Balloon angioplasty
Andreas R. Gruentzig, a German surgeon, first performed angioplasties in Zurich in 1977. His presentation to the American Heart Association the same year led to quick adoption of the technique.
Statins
Used to lower cholesterol, these drugs were first developed by Merck in the U.S. But the initial research was done by Akira Endo and Masao Kuroda in Tokyo.
Coronary artery bypass graft
Argentine René Favaloro performed the first bypass at the Cleveland Clinic.
Here’s a link to the physicians’ rankings:
http://tinyurl.com/qmkcn
I suspect we’d find that most of the other top innovations were developed by American companies or in American hospitals.
I’m very interested to hear what you come up with for your paper. I hope that I can’t guess what it says already.
There are two cultural aspects to the Japanese that skew their apparent lower performance as medical innovators.
1. Healthier lifestyle
2. While they honor old people they do not go in for the end-of-life Heroics we do. I think an American spends 1/3 or 1/2 of their lifetime total medical expenditure during his/her last year of life.
The Swiss are major players in pharmaceuticals, but they make the major part of their money in the US, of course. And how would one assign credit to a new drug from a Swiss company, a key idea for which came from an Indian-born medicinal chemist working in their US research labs?
I second the comments of those above on how such things are going to complicate the answer to your question. I continue to think that the US does very well in medical innovation, but putting a believable number on it won’t be easy.
# of medical journals
# of medical journal articles
# of new medical compounds (especially drugs)
Total numbers of experiments are probably more important than breakthroughs since failures are at least as important as successes. For example, islet cell therapy: the idea was first floated and attempted in the US, but after many failed attempts (and, in the process, lessons learned), success was had in Canada. Newton’s “standing on the shoulders of giants” is alive and well in medical research.
Also, R&D spending as a surrogate. Using only the figures in the IEEE’s last “Top 100 R&D spenders” survey, American medical companies accounted for 57% of the total medical R&D spending (of course, that’s only limited to big R&D spenders, not all medical product developers).
Also, I came across a reference last year to a study on this topic done by Robert Goldberg at the Manhattan Inst., but I haven’t read it and can’t vouch for it.
A quick interjection from a physician outside of the US.
It is interesting that PPIs got a rating when the big advance in ulcer therapy was the discovery of Helicobacter Pylori, the bacteria that causes ulcers. Tagamet made an awful lot of money but seven days of antibiotics cures the things rather than stopping the symptoms. Discovered in Adelaide. The problem with H.Pylori is it actually cut drug company profits so economically it is difficult to measure.
SSRIs are also interesting. They are actually slightly less effective than the tricyclics they replaced. The advantage was less dry mouth and less toxicity in overdose. The big win was the push, popularised by “Listening to Prozac”, to turn depression into a common experience. In the 1970s the rate of depression was 1-3:100 000. It is now 1:10. This is an epidemic created for profit, the medicalisation of unhappiness and concurrent devaluation of a mental illness.
My only real point is that focusing on the devices and drugs measures the value of medical advance to those that sell to us rather than the value to the practice and science of medicine. Not saying the huge pots of NIH money don’t help that either but the profitability of drugs and devices is not, in itself, a measure of advance. MRI was invented in Scotland, only commercialised in the US. Most of us would credit the former.
Having said that, trying to quantify this must be a vile way to spend a week and I sympathise.
Saul Mullen: “MRI was invented in Scotland, only commercialised in the US. Most of us would credit the former. ”
There is no question that British physicist Peter Mansfield deserves partial credit for development of MRI. But not everyone credits him, or Scotland, with the invention of MRI. Many instead credit American Raymond Damadian.
“The initial concept for the medical application of NMR, as it was then called, originated with the discovery by Raymond Damadian in 1971 that certain mouse tumours displayed elevated relaxation times compared with normal tissues in vitro.† MRI From Picture To Proton, McRobbie, Moore, Graves and Prince, (Cambridge University Press, 2003).
“In 1970, Raymond Damadian, M.D., made the seminal discovery that started MRI, namely that there is a marked difference in T1 and T2 relaxation times between normal and abnormal tissues of the same type, as well as between different types of normal tissues.†(Science, 1971)
“Raymond V. Damadian, inventor of the Magnetic Resonance (MR) scanning machine . Experimenting on rats, Damadian discovered dramatic differences in the quality and duration of NMR signals emitted by cancerous versus healthy tissues that confirmed his idea of the MR body scanner. His 1971 paper, “Tumor Detection by Magnetic Resonance,” was met with skepticism from the scientific community, but Damadian forged ahead, filing the first of his patents for an MRI scanner the next year.† From the website of the Lemelson-MIT program, the foundation administered by MIT’s School of Engineering that recognizes significant invention.
According to Wikipedia: “In recording the history of MRI, Mattson and Simon (1996) credit Damadian with describing the concept of whole-body NMR scanning, as well as discovering the NMR tissue relaxation differences that made this feasible.† James Mattson and Merrill Simon. The Pioneers of NMR and Magnetic Resonance in Medicine: The Story of MRI,
Wikipedia also notes: “Damadian also won a large patent case against GE and other manufactures for infringing his MRI patents.†
Comments on this entry are closed.