Why is science not advancing faster? So many publications, so few flying cars or cancer cures.

The key question here is “advancing where?”. Where exactly do we want science to go and what do we want it to do when it gets there?

Let’s look where R&D money is being spent. Willingness to pay seems like a pretty good indicator of our true – as opposed to stated – desires.

The first thing to note is that most R&D in the US (and the world, but let’s stick with the US) is funded by industry. Industry accounts for 2/3rds of the spend, the Federal government for about another third. My crude attempt at categorizing US R&D from both sectors looks like this:

From An interactive look at federal R&D budgets over time and in context and Businesses Spent $341 Billion on R&D Performed in the United States in 2014

Three items – Computers/IT, biomedical and defense – comprise 2/3rds of all R&D spending. If you feel like science is stagnating because you don’t have a flying car, because there is no Theory of Everything, because space travel (let alone time travel) is mostly a fantasy, because we don’t understand how the brain works, because we don’t have fusion reactors, because we don’t understand environmental causes of disease – well, maybe it’s because we aren’t funding research in those areas. Funding is no guarantee that we will get those things, but lack of funding guarantees we won’t.

I don’t think there is much cause for complaint about the pace of computer and IT innovation. The pace of military innovation is wholly situational – as long as we are ahead of our enemies, we are doing fine.

But there is ample cause for complaint when it comes to bang-for-buck in biomedical research spending. It’s not just that it costs more and more to develop each new drug. It’s that those drugs (and new procedures) don’t really do a lot to make our lives better or longer.

Here are age-adjusted death rates in the US for cardiovascular diseases, the #1 killer worldwide:

Data from Trends in Cardiovascular Mortality and Public Health Goals

And here are US cancer deaths (the #2 killer) per new cancer diagnosis:

Data from https://gis.cdc.gov/grasp/USCS/D…

Not surprisingly, gains in US life expectancy are also stalling out:

The fact that those gains aren’t stalling out in comparable countries tells us a couple of things:

1. Scientific productivity does not automatically translate into better and longer lives.
2. We will get a better return on investment by increasing access to existingdrugs and procedures, rather than inventing new ones.
3. Sociology trumps technology.

We already know this. For instance, the best predictor of drug efficacy is not its performance in clinical trials. Rather it is whether the patient actually takes the drug as prescribed [1] [2] [3] [4] [5] .

We also know that it is far better to prevent disease than to attempt to cure it. And we know that preventive interventions are far more effective than medicines [6] [7] . Yet we spend far more money researching cures than preventions.

So I would argue that we are getting precisely what we want from biomedical research: a steady stream of expensive drugs with overly inflated claims that absolve us from taking responsibility for our own health.

If that’s not scientific advancement, then what is?

Footnotes

[1] Medication Adherence: WHO Cares?

[2] Engaging Patients to Optimize Medication Adherence – NEJM Catalyst

[3] Medication Adherence

[4] Adherence and health care costs

[5] http://www.who.int/chp/knowledge…

[6] Deployment of Preventive Interventions — Time for a Paradigm Shift | NEJM

[7] Deaths Preventable in the U.S. by Improvements in Use of Clinical Preventive Services